NASCHIP 10-21-05 final - Jane ONeill

Welcome!

National Association of State Comprehensive Health Insurance Plans

October 21, 2005Panama City, Florida

• WellPoint/Anthem 2004 merger forms largest U.S. health benefits company

• Blue Cross and Blue Cross Blue Shield subsidiaries in 13 states

• Specialty companies and affiliates in other states: behavioral health, dental, life, pharmacy, vision, workers compensation, PPO, TPA, disease management

• 28 million medical lives

• 35,000 associates nationwide

WellPoint, Inc.

Clinical / Medical ManagementClinical Business Plan Intervention ProgramsTherapy Management Disease ManagementPatients-At-Risk

FormularyManagementTreatment GuidelinesP&T CommitteesManufacturer DiscountsPreferred Rx ProgramsPrior Auth Center

ReViewPoint®

Online Reporting @ ReportsRx.com

Claims ProcessingClaims KeyingOnline DUR

Network ManagementNational NetworkCustomized Local NetworksMAC Programs

ConsultativeServicesIncentive ProgramsBenefit DesignsInterventionsAccount ManagementSales SupportBusiness StrategiesPharmacy Care Pharmacy Care

ManagementManagementPrecisionRxIntegrated Mail Service PharmacySpecialty Pharmacy

Web Toolswww.wellpointrx.comwww.myrxbenefits.comwww.healthenvelope.comwww.precisionrx.comDynamicCME

Full Spectrum of Services

Provider Education - What works?

• Overall• Concise educational materials• Evidence-based and unbiased • Highlight and repeat essential messages• Specific recommendations or patient profiles for intervention• Positive reinforcement• Multi-faceted approach*• Aligned with financial incentives**

• Web-based• Short and concise courses• Level of interactivity• Quality of content• Ease of use

*

Impact of Inappropriate Prescribing

• Over and Under Utilization• Pharmacotherapy

• Increased Cost• Pharmacy• Medical

• Increased Resources • Diminished Treatment Outcomes

• Increase Side Effects• Reduced Drug Effectiveness

Patients @ Risk Drugs of Abuse

• Program Goals• Communicate possible excessive use situations to

prescribers• Identify abuse situations • Decrease utilization and potential abuse situations

• Rx’s per member• 41% decrease

• MD’s per member• 24% decrease

• Pharmacies per member • 25% decrease

ITOPITOPSMSM ProgramsPrograms

• Interactive problem-based learning roundtables with CME accreditation

• Target physicians using pharmacy claims• Utilize national or community expert in disease state to

share best practices• Discuss difficult clinical cases with participating physicians• Physician receive patient specific data relevant to their

practice• Outcomes focused

• Improve quality and clinical outcomes• Optimize the use of appropriate therapies• Promote formulary compliance• Reduce costs

IMPROVED TREATMENT OUTCOMES through PHARMACOTHERAPY

ITOPSM Program Results• ‘Statin Formulary Compliance

• Target: High prescribers of NF ‘statins• Results:• New Start: +5.8% vs -2.4% (control)• Continuing: +4.5% vs -1.2% (control)

• Hypertension – Combination Therapy• Target: Physicians with patients who are candidates

for combination therapy• Results: 2.3% ↑ (absolute) in use of combination

therapy

Post-MI TM Program Example

Post-MI TM Program Results

• Appropriate therapies• 46% added beta-

blocker• 32% added ‘Statin• 18% added antiplatelet• 11% added ACEI/ARB

• Medication Adherence• 25% refilled within 2

weeks• 35% refilled within 4

weeks• 42% refilled within 6

weeks• 45% refilled within 8

weeks

• Target Population: 802 physicians (848 patients)• Follow-up: Patients with 6-month follow-up data

Health EnvelopeHealth Envelope®®/MyRxBenefits/MyRxBenefits

• An innovative health management and member self-service platform that offers:

• Health Information• Disease Management• Case Management• Compliance Programs• Consumer Directed Pharmacy

• Integrated medical and pharmacy claims database

• Personalized messaging system• Supports NCQA standards including new

Quality Plus• Interventions designed to help improve

HEDIS scores • URAC accredited• Revenue generating• Owned and operated by WellPoint PBM

Health Envelope®/MyRxBenefitsHealth Envelope®/MyRxBenefits

•• Consumer Driven ApplicationConsumer Driven Application

• Generic and Mail Pricing

• Generic and Brand Formulary Options

• Drug monographs and pill imaging

• Accumulators and OOP tracking

• Benefit and Eligibility

• Claims History

• Downloadable Forms

• 18 Month EOB (2006)

• Member specific formulary-look (2006)

• OTC alternatives and coupons (2006)

• Co-branding (forms, logos, etc.)

MyRxBenefits

Claims History

Tax Summary

Formulary Search Tool

MyRxOptions

• Personalized messaging and targeted health education

• Health status survey, blood glucose, medication, food and activity logs, goal setting and performance feedback

• Retrospective personalized graphs and reports

• Refill and preventive health screening reminders

HealthEnvelope® – Diabetes DSM

HealthEnvelope® Drug Information

• Drug Alerts (FDA Recalls, New Drugs, New Indications, Voluntary Withdrawals)

• Drug Search (monograph and pill image)

• Drug Information FAQ (i.e. Formulary, Generics, etc.)

• Refill Reminders

• Retail to mail interventions

• Generic switch interventions

• Detailed treatment options section for all health topics

• Medication Adherence Tool

• Generic Finder

• RxEducator

• Drug Interaction Checker (2006)

Half Tab Program

• Voluntary tablet splitting program• Selected products- Statins and SSRI’s• Notified all members and providers • Tablet splitter avaliable

• Benefits• Member copay reduced• Plan paid ingredient cost reduced

• Retail to Mail Conversion Programs• Targeted to members’ individual needs• Communication of benefits and

advantages of mail service• Delivered via the most effective medium for

your members (i.e., email, phone, or mail)• Specifically targeted patients based on

client specifications (medication, benefits, savings, etc.)

Retail-to-Mail Conversion Programs

Summary- Pool/ WellPoint Projects

• Drugs of Abuse• 6 quarters- 277 pts, 597 MD’s, 401 pharmacies

• ITOP- Diabetes 50 MD’s invited• Point of Reference

• Osteoarthritis- 1500 members, 1200 MD’s• GERD -2400 members, 1700 MD’s• Hyperlipidemia – 500 members , 500 MD’s• Diabetes- 2500 members, 1000 MD’s

• Health Envelope/ My Rx Benefits- all members• Half Tab- 7500 members, 1700 MD’s• Retail to Mail- 1500 members• Formulary Change Notification- 4800 members& MD’s

Thank you !

jane.o’[email protected]