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Member Centric Decision Management

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Presentation on theme: "Member Centric Decision Management"— Presentation transcript:

1 Member Centric Decision Management
Identification/Stratification and Consumer Segmentation BlueCross Blue Shield Tennessee Wednesday, September 26, 2012 General Session 3

2 Sherri Zink VP, Medical Informatics BCBST Phone:

3 Profile of Medical Informatics Team
PhD and Masters level analysts 100+ publications between team members Experienced Technical professionals in the field of healthcare with backgrounds in finance, actuarial, statistics, nursing and information systems External market and competitive experience including BCBST, UHC, OptumHealth, Ingenix and CIGNA Tenured leadership team with an average of 15+ years in the healthcare industry Unique skill sets and experience leveraging Health Information Exchange , EMR, and Clinical Data SaTScan™

4 Member Centric Decision Management (MCDM)
Vision: To reach the RIGHT person, the RIGHT way, at the RIGHT time, with the RIGHT message. MCDM is: Consumer Segmentation Continuous Monitoring of Population Health Personalized Approach to Consumer and Provider Outreach

5 Painting the Consumer Profile Picture

6 Clinical, Financial, & Lifestyle
INTEGRATED DATA Clinical, Financial, & Lifestyle Anchored around the consumer Supports Total Population Health Management Reporting Links consumer engagement to economic performance Showcases consumer behavior Empowers informed decision making

7 Consumer Advisory Monitoring System (CAMS)
Offers a total population health monitoring system with the goal of understanding consumers holistically Maximizes consumer outreach opportunities through customized solutions Enables our business to meet people where they are and to capitalize on those teachable moments Empowers the BCBST brand experience Improves targeted marketing for retail sales Identification Stratification Consumer Segmentation Prioritization & Optimization Preferences Outreach Engagement

8 Enabling a Personalized Approach to Consumer Engagement and Health Management
The MCDM Process Profiling the Consumer Identification Stratification Analytics Demographics Utilization Care Patterns Diagnostic Profile Risk Profile Approach to Health Maintenance Segmentation Analytics Empty Nester American Melting Pot Unmatched Utilizer Married with Family Stable Spender Moderate Mover Targeted Outreach Contact Preference

9 Flexing the Outreach Delivery Model to Meet the Unique Needs of Each Individual
Low Cost, High Opportunity High Cost, High Opportunity Low Cost, Low Opportunity High Cost, Low Opportunity Jill, Age 36 BMI < 20 Potential High Risk Pregnancy Young Married Engage with a Case Manager and Send High Risk Pregnancy Mgmt Tips Janice, Age 54 Diabetes Frequent Usage of the ER Non-Compliant with Meds BMI > 35 No Established PCP Relationship Married with Family Engage with a DM Nurse Jim, Age 60 Coronary Artery Disease Post Heart Attack Discharge Care Plan in Place Compliant with All Meds BMI < 25 Empty Nester Engage with a Letter or Joe, Age 20 Smoker BMI < 20 Young Single Engage with a Life Style Coach; recommend an on-line Health Module; send regular SMS messages to track progress

10 The Importance of Segmentation Knowing Only Half the Story
Clinical Profile Janice, Age 54 Diabetes Frequent Usage of the ER Non-Compliant with Meds BMI > 35 No Established PCP Jackie, Age 54 Diabetes Frequent Usage of the ER Non-Compliant with Meds BMI > 35 No Established PCP

11 Knowing the Whole Story
Leveraging Segmentation Knowing the whole story Knowing the Whole Story Clinical Profile Janice, Age 54 Diabetes Frequent Usage of the ER Non-Compliant with Meds BMI > 35 No Established PCP Jackie, Age 54 Diabetes Frequent Usage of the ER Non-Compliant with Meds BMI > 35 No Established PCP Lifestyle Segment Janice, Age 54 Struggling Society Segment Economically challenged Unemployed No access to computers Transient Jackie, Age 54 Suburban Style segment Established residence Family-centric living Internet savvy Employed

12 MDCM: Empowering Integrated Health Management

13 Preference-Sensitive Conditions Seamlessly integrated
BCBST Continuum of Support Leveraging MCDM Capabilities to Strategically Position our Clinical Product Portfolio for Existing and Prospective Clients 24/7 Acute Conditions Preference-Sensitive Conditions Cancer Uterine Prostate Back Major joints Low Back Pain Healthy Lifestyles Wellness Prevention Risk mgmt Chronic Conditions Diabetes COPD CAD CHF Asthma Hypertension Complex care Major trauma Cancer Transplants Injuries Colds Rashes Emergency Assessment Seamlessly integrated The new programs will be situated primarily in the center of the total health management continuum. The three center columns are representative of the Healthy Focus model we are now implementing. The outer bars, with a more intense blue color, are those services generally provided by BCBST within our Case Management, Lifestyle Coaching, and other programs. You can see that a more fully integrated and comprehensive program continues toward a long time stated goal – the right support for the right members at the right time. The next few slides further explore the offerings in the three center columns. Members receive the right support at the right time

14 MCDM: Empowering Pre-Sale Analytics

15 MCDM: Empowering Exchange Analytics and Consumer Marketing
Identifying At Risk Populations Due to Health Care Reform Target members for retention Target members at risk for leaving BCBST Monitoring movement to the Exchange and Medicaid Target members at risk for potential access to care issues Persona Categorization Persona categories by Federal Poverty Level (FPL) Welcome Empty Nesters Not so Golden Years Making Ends Meet Distribution of Population

16 Concluding Thoughts Why is this important to our Business?
Empowers total population health management Brings BCBST to parity with key competitors Commissions a pre-sale analytics process that will highlight up-sale opportunities with existing BCBST clients and new sale opportunities with prospective clients Consolidates reporting and outcomes evaluation Positions a real-time predictive capability for alerts to consumers and providers Advances BCBST toward becoming a total health solutions company Prepares our business for retail opportunities in the individual market or exchange environment Streamlines dependence on vendors

17 How to Make Micro-segmentation Work
Creating and Monitoring Your Segmentation Categories

18 Micro-segmentation Mosaic Lifestyle Groups
A – Power Elite: Enjoying all that life has to offer B – Flourishing Families: Living very comfortable, active lifestyles C – Booming with Confidence: Prosperous, established couples D – Suburban Style: Middle-aged, ethnically-mixed suburban families E – Thriving Boomers: Upper-middle-class African-American couples F – Promising Families: Young couples living child-centered lifestyles G – Young City Solos: Younger singles living active and energetic lifestyles H – Middle Class Melting Pot: Mid-scale, middle-aged and established couples I – Family Union: Somewhat diverse families supported by solid blue-collar jobs J – Autumn Years: Ethnically-diverse and mature couples living gratified lifestyle K – Significant Singles: Middle-aged singles leading active city styles of living L – Blue Sky Boomers: Lower- and middle-class baby boomer-aged households M – Families in Motion: Working-class families with diverse household dynamics N – Pastoral Pride: Eclectic mix of widowed and divorced individuals and couples O – Singles and Starters: Young singles starting out in diverse urban communities P – Cultural Connections: Diverse families in urban apartments and residences Q – Golden Year Guardians: Retirees in settled residences and communities R – Aspirational Fusion: Multi-cultural singles striving to make a better life S – Struggling Societies: Economically challenged looking to make ends meet Affluence High Low

19 Micro segmentation Lifestyle Clusters
Money to Burn Tend to be more affluent. Like to know how a product can elevate their status and are more willing to take risks with their purchases. Stable Spenders Young to middle-aged individuals that tend to be driven by how to get the most “bang for their buck.” However, they are very aware of how specific brands can reflect their lifestyle and tend to gravitate towards popular logos. American Melting Pot Contains members from a wide array of income levels and ethnicities. They take pride in local and American made products and like to see a reflection of family when making purchases. Middle-of-the-Road Mixers Middle-class, diverse households and have spending habits that are just as varied. These individuals highly regard how products affect their family when making purchasing decisions. Single Savers Mostly singles living in urban areas that tend to gravitate towards discounts when spending their hard-earned money. They aren’t as concerned with the newest products, but tend to focus on those that are tried and true. Unassigned

20 Micro segmentation Clinical Clusters
Mystery Members Majority have no claims information and missing MEDai information Barely Bothers Members in this cluster tend to do the bare minimum when it comes to maintaining their health. This is indicated by their infrequent interactions with the health plan and their low compliance rate and motivation. Moderate Movers These members value convenience when it comes to making healthcare decisions. When they do seek care from a PCP they don’t always have to see the same one. Their forecasted change is cost remains stable due to their inclination for maintaining their health. Inclined Increasers While extremely motivated and compliant, these members still seek a high amount of care. They are more chronic than the average cluster and are expected to far exceed their current year cost in the next year. Unmatched Utilizers These members are unmatched in cost and utilization. They are likely deemed highly motivated and compliant due to the increased frequency in opportunities for care. New Members Members with less than 30 days enrollment Unassigned

21 Lifestyle by Clinical Cluster Analysis
Distribution of Lifestyle Clusters for VSHP, Commercial, and Company X Populations Affluence Government Low

22 MCDM Outreach Campaign Plan

23 Results of a 2012 Diabetes Call Campaign
Top 5 VSHP segments Dx: Not very reachable Not very impactible Recommendation: Improve ability to contact members via phone, and consider different outreach modality, particularly for N & S (more rural segments)

24 Campaign Evaluation Effectiveness and Mode of Delivery Analysis
Multiple campaigns were conducted each month as part of the MCDM process with the aim of increasing member compliance with certain evidence-based guidelines We analyze the effectiveness of these campaigns, both quality and cost This information is examined by each lifestyle segment to see how our unique customers respond differently to outreach efforts The results of this evaluation is fed back into the process to make the analytical process “smarter” Call campaign outcome Breast Cancer Screening Call 2011 Diabetes Care Call 2011 Cervical Cancer Screening Call 2012 Eye Exam HbA1c Testing LDL-C Screening Nephropathy Screening # of members called 56,861 65,000 89,670 % of members reached 76% 67% 68% Conversion Rate for Reached members 11% 6% 21% 23% 12% 3.2% Conversion Rate for Not-Reached members 8% 5% 18% 19% 9% 2.5% Additional Conversion Rate relative to no intervention 3% 2% 4% 1% # of compliant members gained relative to no intervention 1,253 653 1,611 1,655 1,219 409 Table: all campaigns listed here were effective as the call-reached members had a higher Conversion Rate compared to Not-Reached members; the number of compliant members gained by the campaign was listed in the last row of the Table. Figure – MAM 2011 campaign: it showed the Conversion Rate for each intervention method in relation to member’s motivation index. In general, the Call+Mailer method was not better than the Call only or Mailer only method. The Call method produced a better outcome than the Mailer in terms of the higher Conversion Rate. Suggestion - since the Call cost less than Mailer and produced a better outcome, we can use it whenever is possible to save our intervention cost, e.g. $1.00 per mailer, $0.08 per call, if we use the Call instead of Mailer, we can properly save $45,356 on intervention for this MAM campaign (assuming no member on the no-call list).

25 ISM Governance Structure
Purpose: oversee the Identification/Stratification/Microsegmentation process to set the communication strategy and to drive standardization for the enterprise. Scope Promote and monitor enterprise wide standardization/centralization of communication Develop and approve annual member communication plan Oversee the Identification/Stratification process by approving rules for the analytics engine Drive standardization around the ID/Strat process Determine prioritization of communications Review evaluations/results and make recommendations to improve the process Approve modifications to the process based on results/strategy Oversight of the Contact Preference process Membership: VP Medical Informatics (Chair), CMO’s, VP Performance Measurement, VP Strategic Marketing, VP Pharmacy, VP Product Development Onlife, Director Quality, Director Operations, Director Product Strategy, Director Brand Strategy & Director Clinical Programs Connecting Organizational Processes Breaking Down Departmental Silos

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