Differentiate Using the Power of BHI September 14, 2010 BCBS IM Symposium, Niagara Falls, NY Don Brumfield, Executive Director, BHI Linda Schwank, Director,

Differentiate Using the Power of BHI

September 14, 2010September 14, 2010

BCBS IM Symposium, Niagara Falls, NYBCBS IM Symposium, Niagara Falls, NY

Don Brumfield, Executive Director, BHI Don Brumfield, Executive Director, BHI

Linda Schwank, Director, Enterprise Analytics, HCSCLinda Schwank, Director, Enterprise Analytics, HCSC

Gretchen Vermeulen, Account Manager, BHIGretchen Vermeulen, Account Manager, BHI

© 2010 BHI® All Rights Reserved. No reproduction without permission.2

Blue Health Intelligence

The nation’s largest health information data warehouse, bringing together the claims experience of 54 million BCBS members nationwide - HIPAA compliant to protect member privacy

Broadest, deepest pool of claims information ever created

More than twice the size of next largest data warehouse - with proportionate advantage in accuracy

Foundation of the Blues’ approach to evidence-based healthcare to help deliver higher quality care, improve health and manage costs

BHI will deliver data-driven solutions to multiple stakeholders

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BHI data warehouse is representative of the commercial group population

BHI benchmarks available for MSAs, mapped to U.S. zip codesBHI benchmarks available for MSAs, mapped to U.S. zip codes

Unmatched Breadth & Depth

Includes claims from over 14 million National Account members

© 2010 BHI® All Rights Reserved. No reproduction without permission.4

• Individual and group commercial products

• Pharmacy Only Products

• Consumer Direct Products

• All networks (e.g. BlueCard, local, custom)

• The working aged, individuals over 65 for which the Plan provides primary or secondary Commercial coverage

• Retirees with Commercial group coverage, for which the Plan provides primary or secondary Commercial coverage

• Group health insurance programs for uninsured workers and their families (small businesses, sole proprietors, and individuals)

• All Plan Exclusive Products - unique products that do not fall into standard industry models. They may be experimental in nature

The BHI data contains both medical and pharmacy claims, as well as:

Fully Integrated Data Set

© 2010 BHI® All Rights Reserved. No reproduction without permission.

Functionally Driven Workgroups

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Account Executiveand Sales Leadership

Workgroup

Medical and NetworkManagement Workgroup

Analytic WorkgroupActuarial and

Underwriting Workgroup

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BHI current capabilities span three areas:

BHI Tools

© 2010 BHI® All Rights Reserved. No reproduction without permission.

ADaM Ad Hoc Report Templates

ADaM Enterprise Reports

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BHI Account Analytic Blueprint

BHI Portal provides three (3) tools to identify Account opportunities

JumpstartIndustry Account Comparison

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Data Source

• BHI Benchmarks• Plan-specific Comparative

Statistical Extracts

• BHI claim- and member-level data

Tool / Data Advantages

• Fastest run-time• Pre-calculated benchmark

results• Completion factors applied to

benchmarks and comparative extracts

• Detailed drill down capabilities to very specific diagnosis, procedure, geography, and provider level

• Customized comparisons (e.g. Physician Specialty, Place of Service, Group vs. individual, ASO/FI, MSA, etc.)

Analytic Value

• High-level benchmark comparisons for aggregated data

• Account or SIC to Benchmarks

• Targeted, customized drill -down analyses

• Ad hoc plus report templates• Account versus All-Plan

• Pre-defined drill path analyses

• Additional time and inclusion criteria

• Pre-calculated ADaM metrics

• Next fastest run-time• Additional level of detail

compared to Jumpstart includes diagnosis groups, procedure, and revenue codes

© 2010 BHI® All Rights Reserved. No reproduction without permission.8

Industry Account Comparison Jumpstart

Released July 27Select the following Jumpstart folder to access the reports:

Public Folder > Industry Account Comparison Reports

• Industry Account Comparison (Multi-product options)• Industry Account Comparison (PPO)• Industry Account Comparison (Single Data Page)• Industry Benchmark Report

© 2010 BHI® All Rights Reserved. No reproduction without permission.

BHI Cost Analyzer

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Scope of AnalysisScope of Analysis• Identifies top performing accounts

on a risk-adjusted basis across BHI dataset

• Identifies key drivers of top performance

• Performs comparisons of account data with best-in-class cost performers

• Provides actionable strategies to help accounts improve cost performance by:

– Prioritize cost management initiatives

– Evaluate their own performance against comparable top performers

HCSC FINDS INCREASINGVALUE IN BHI

Linda Schwank, Director, Enterprise Analytics, Linda Schwank, Director, Enterprise Analytics, HCSCHCSC

© 2010 BHI® All Rights Reserved. No reproduction without permission.

HCSC Early Adoption: 2009

© 2010 BHI® All Rights Reserved. No reproduction without permission.

HCSC Today

With ADaM, HCSC has been able to greatly expand the use of BHI both internally and externally.

• Providing a large multi-national communications client with aggregated information sufficient to eliminate the client’s reliance on third party benchmarking.

• Evaluating potential savings opportunity across the System related to more stringent enforcement of payment policy guidelines.

• Drilling into the four digit SIC code, determining that HCSC employee and dependent utilization was on par with the industry’s in our geographical domains.

• Evaluating a vendor’s savings opportunity estimation for chiropractic and physical therapy management services.