Blues Perspective of the Future

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Blues Perspectiveof the Future
ACLA Annual MeetingWashington, D.C. April 20,
2007
Scott P. SerotaPresident CEO
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Key Healthcare Issues
Industry faces major challenges from DC to Main
Street
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Agenda
The Uninsured
Health IT
Empowering Consumers
The Blues
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The Blues Covering America
Blue Plans cover every community coast-to-coast

• Growing number of Fortune 500 National Accounts

• 39 Blue Cross and Blue Shield Plans

BCBSA

• Blues contract with 90 of U.S. hospitals, 80 of
  doctors

• Largest processor of Medicare claims in nation

• 4.7-M member FEP Program largest private health
  insurance product in world

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The Blues Record Enrollment
Blues national enrollment reached an all-time
high in 2006
Customers (in millions)
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The Blues Global Markets
Blues are extending the Brand into international
markets

• BlueCard Worldwide offers U.S. customers access
  to medical assistance worldwide
• 7,000 physicians in 200 countries
• 850 hospitals in 84 countries
• BlueWorldwide Expat provides specialized
  insurance product for expatriates
• 100 accounts
• 700 lives
• Brands licensed to companies in 50 countries in
  Europe, Central America and South America
• 5.5 million international subscribers
• Independent Canadian Association of Blue Cross
  Plans is Associate Member of BCBSA

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Agenda
The Uninsured
Health IT
Empowering Consumers
The Blues
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A New Healthcare Model for the Future
A true consumer-centric healthcare system for the
future will realign incentives and accountability
for all key stakeholders
Current Model
Future Model
Provider
Consumer
Employer
Payer
Government
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Future Model Focuses on Consumers
Future healthcare system will be centered on
consumers
Future Model
Growing role of the individual consumer
Increasing focus on evidence-based care
Empowering consumers with transparent quality and
financial information
Need for patient privacy and security is paramount
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Building the Future Blue Health Intelligence
With more than 75M lives, BHI leads in data scope
and depth

• Shaping new care delivery model
• Partner with providers on outcomes and care
  patterns
• Robust information for consumer decision-making
• Support policy development
• State-of-the-art informatics
• Precise data
• More statistically valid measures
• Benchmark data across geographies

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Building the Future Blue Healthcare Bank
Blue Healthcare Bank supports Blue Plan CDHPs and
HSAs

• Support growing number of Blue Plan CDHPs and
  HSAs
• Easy-to-use, seamless and fully integrated
  consumer service
• Simplify healthcare spending
• Full line of financial services
• Chartered to serve all 50 states

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Building the Future Blue Distinction
Engaging consumers to enable more informed
healthcare decisions
Collaborating with providers to improve quality
outcomes and affordability
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Partnership with IHI Saving Patient Lives
Blue Cross and Blue Shield companies contributed
5 million to national campaign to save patient
lives and improve safety
Blue Companies Contribute 5 million
Institute for Healthcare Improvement
Saving Lives and Improving Patient Safety
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Agenda
The Uninsured
Health IT
Empowering Consumers
The Blues
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Blues are committed to Interoperability
Blues are working with key stakeholders across
the industry to make interoperability a true
reality for future generations
Patients
Health Plans
Rx
Patients electronic medical record in every
provider office
Community Health Agencies
Pharmacy
Other Providers
Labs
Hospitals
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Paving the Way for the Adoption of PHRs
Blues are collaborating on payer-based framework
for PHRs
Collaboration
Deliverables

• BCBSA and AHIP collaborating
• 13 BCBS Plans already have PHRs and 12 more Blue
  Plans have PHRs in development
• All 39 Blue Plans working to adopt PHRs by 2008

• Standard Data Areas (eg) Patient info, visits
  and Rx
• Implementation Guide
• Operating Rules
• Plan-to-Plan standards for transferring PHR
  information

Common Goal A seamless and interoperable system
to serve all consumers, providers and other key
stakeholders nationwide
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ICD-9 v ICD-10 Diagnosis Codes Sports Injury
Caused by Striking or Being Struck
1 ICD-9 Code
24 ICD-10 Codes

• W21.00 Struck by hit or thrown ball, unspecified
  type
• W21.01 Struck by football
• W21.02 Struck by soccer ball
• W21.03 Struck by baseball
• W21.04 Struck by golf ball
• W21.05 Struck by basketball
• W21.06 Struck by volleyball
• W21.07 Struck by softball
• W21.09 Struck by other hit or thrown ball
• W21.31 Struck by shoe cleats Stepped on by shoe
  cleats
• W21.32 Struck by skate blades Skated over by
  skate blades
• W21.39 Struck by other sports foot wear

W21.4 Striking against diving boardW21.11 Struck
by baseball bat W21.12 Struck by tennis racquet
W21.13 Struck by golf club W21.19 Struck by
other bat, racquet or club W21.210 Struck by ice
hockey stick W21.211 Struck by field hockey
stick W21.220 Struck by ice hockey puck W21.221
Struck by field hockey puck W21.81 Striking
against or struck by football helmet W21.89
Striking against or struck by other sports
equipment W21.9 Striking against or struck by
unspecified sports equipment
Striking against or struck accidentally in sports
without subsequent fall (E917.0) Includes kicked
or stepped on during game (football) (rugby),
struck by hit or thrown ball, struck by hockey
stick or puck
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Agenda
The Uninsured
Health IT
Empowering Consumers
The Blues
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BCBSA Proposal Extending health coverage to
individuals and families across America
Incomes under 50,000/year
Eligible for current public programs
Incomes above 50,000/year
Tax credits for small firms with low-wage
workers Tax credits for individuals/families if
premiums exceed 5 of income Tax credits for
unemployed Expand SCHIP to cover all individuals
below poverty (100 federal funding) Federal
grants for innovative state programs and
high-risk pools
Increase federal funding for state outreach Use
Medicaid/SCHIP funds to enroll individuals in
employer coverage (100 federal funding)
National education initiative on the importance
of being insured Other options would benefit
this group, such as tax credits for families
with high premiums relative to income and the
unemployed
Impact 30 million Americans would join the ranks
of the insured
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Blues Perspectiveof the Future
ACLA Annual MeetingWashington, D.C. April 20,
2007
Scott P. SerotaPresident CEO