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PROPRIETARY AND CONFIDENTIAL CareFirst BlueCross BlueShield is the business name of CareFirst of Maryland, Inc., and is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ® Registered trademark of CareFirst of Maryland, Inc. Innovation at Work: CareFirst’s Transformation from Passive Payer to Population Health Manager
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PROPRIETARY AND CONFIDENTIAL 2 The Problem: Rising Health Care Costs
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PROPRIETARY AND CONFIDENTIAL 3 Part of the Solution: Discounts
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PROPRIETARY AND CONFIDENTIAL 4 Challenges with Health Care Delivery
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PROPRIETARY AND CONFIDENTIAL 5 Establishing the Solution
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PROPRIETARY AND CONFIDENTIAL 6 How Our PCMH Program is Different
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PROPRIETARY AND CONFIDENTIAL 7 Decisions of PCP: When and Where to Refer Source: CareFirst Health Care Analytics, Data as of September 2010
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PROPRIETARY AND CONFIDENTIAL 8 PCMH Panels
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PROPRIETARY AND CONFIDENTIAL 9 Better Care at Lower Costs
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PROPRIETARY AND CONFIDENTIAL 10 Putting it all Together
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PROPRIETARY AND CONFIDENTIAL 11 Hospital Coordination
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PROPRIETARY AND CONFIDENTIAL 12 Complex Specialty Care
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PROPRIETARY AND CONFIDENTIAL 13 Chronic Care Coordination Field force of more than 200 National and Regional Care Coordinators
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PROPRIETARY AND CONFIDENTIAL 14 Enhanced Pharmacy Coordination
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PROPRIETARY AND CONFIDENTIAL 15 Additional Support Programs
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PROPRIETARY AND CONFIDENTIAL 16 Wellness: A Solution for All
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PROPRIETARY AND CONFIDENTIAL 17 Engagement
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PROPRIETARY AND CONFIDENTIAL 18 Transparency and Data-Driven Decisions
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PROPRIETARY AND CONFIDENTIAL 19 Searchlight Reporting® Drill Down
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PROPRIETARY AND CONFIDENTIAL 20 The Benefits of Integration Dental cleanings reduced diabetes-related medical costs up to 19% 1 68% of people with mental disorders have physical health disorders 4 24% of total health care spending is through the pharmacy benefit 2 75% of health care expenses go to treat diseases that are preventable 3 1 Managed Dental Care. Diabetic cost cutting linked to consistent oral care. February 2009. 2 CareFirst Health Care Analytics 3 Centers for Disease Control and Prevention 4 Druss BG, Walker ER. Mental disorders and medical comorbidity. Robert Wood Johnson Foundation. Research Synthesis Report No. 21. February 2011.Benefits of Integration of Behavioral Health.
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PROPRIETARY AND CONFIDENTIAL 21 Summary
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