Care Management Engagement Analytics Yvette Neri-Hernandez, BCBS AZ - PowerPoint PPT Presentation

Care Management Engagement Analytics Yvette Neri-Hernandez, BCBS AZ and Mary Henderson and Penny Monical, BHI

Our Speakers Today Yvette Neri-Hernandez Mary Henderson Penny Monical Manager, Analytics Senior Vice President, Product Manager, Strategy and Data Science, Product Strategy and Innovation, BHI BlueCross BlueShield and Innovation of Arizona 2

Agenda • Health Plan Introduction • Analytics and Data Science Team • Care Management Program • whYzen Integration • whYzen Demo Proprietary & Confidential Proprietary & Confidential | 3

Health Plan Introduction BlueCross BlueShield of Arizona • Not-for-profit • Independent licensee of BCBSA Flagstaff • 1.5 million covered Lives • More than 1,500 employees Phoenix Chandler Tucson Proprietary & Confidential Proprietary & Confidential | 4

Health Plan Introduction Segmentation of Business BlueCard 37.2% CHS/Network Rental 13.1% 7.2% Federal Employee Program 7.6% Small Group 6.7% Medicare Advantage/ Medicare Supplemental 23.5% 4.7% Large Individual < 65 Group Local, Blue-Administered Proprietary & Confidential | 5 Proprietary & Confidential

Our Analytics and Data Science Customers External Audiences Internal Plan Constituents • Consumers/Members • Finance • Providers • Operations • Employers • Customer Service • Benefits Consultants • Provider Relations • Third Party • Sales and Marketing Administrators • Clinical Affairs Note: Bold italicized text indicates Current whYzen use cases at BCBS AZ. Proprietary & Confidential | 6 Proprietary & Confidential

Analytics That Inform Better Decisions Clinical/Quality Provider Performance • Population Health • Provider Reimbursement Program Evaluations • Clinical Algorithms • Fee Impacts and Implementation • Medical Management • Hospital Negotiations System Performance Analytics • HEDIS/QRS Measurement • PCMH Programs and Analytic Strategy • Value-Based Care Reports Arrangements Proprietary & Confidential | 7 Proprietary & Confidential

Care Management Analytics for Our Care Management Programs Healthy Low Risk At-Risk Chronic Complex Case Disease Management Proprietary & Confidential Proprietary & Confidential | 8

Care Management Program Identify Members Evaluate and Improve Screen Measure Outcomes Outreach Establish Goals Proprietary & Confidential Proprietary & Confidential | 9

Care Management Program Identify Current Identification Triggers Members • Inpatient notifications/precertifications Evaluate and – Behavioral health admissions Improve – Pediatric admissions – Multiple and readmissions Screen • High cost claimants Measure • Frequent Emergency Department utilizers Outcomes • Pending claims • Health Information Exchange (HIE) data Outreach Establish Goals Proprietary & Confidential | 10 Proprietary & Confidential

Care Management Program Identify Measuring Program Outcomes Members • Develop population cohorts Evaluate and – Engaged vs. non-engaged Improve – Levels of engagement • Review and measure program goals Screen – Reduced admissions and readmissions Measure – Reduced ED visits Outcomes – Closed care gaps – Improved medication and adherence Outreach – Increased PCP visits Establish Goals Proprietary & Confidential | 11 Proprietary & Confidential

whYzen Integration of AZ’s Care Management Data whYzen Utilization Wellness Management Disease Case Management Management Proprietary & Confidential Proprietary & Confidential | 12

whYzen Integration in Action DM_ DNC_ Member_ID YrMo cm_prg cm_status DM_prg DNC_Dt status Status xxxxxxx67-01 2019/09 TOC Case No Mbr Response xxxxxxx73-01 2019/09 Screening Reviewed xxxxxxx95-01 2019/09 Asthma Disenrolled xxxxxxx55-01 2019/09 TOC Case No Mbr Response xxxxxxx59-01 2019/09 Complex CM Goals Met/Issues Addressed CHF Education xxxxxxx27-04 2019/09 TOC Case No Mbr Response xxxxxxx00-01 2019/09 TOC Case Goals Met/Issues Addressed xxxxxxx83-01 2019/09 COPD Education xxxxxxx44-01 2019/09 TOC Case No Valid Demographic Info xxxxxxx79-04 2019/09 TOC Case Goals Met/Issues Addressed xxxxxxx49-03 2019/09 TOC Case No Mbr Response Diabetes Education Y 10/7/2019 Proprietary & Confidential | 13 Proprietary & Confidential

whYzen Analytics • Executive Dashboards • Guided Analytics • Interactive Analytics • Risk-Adjusted Plan Benchmarks • Automated Narratives • Published (Static) Reports • Report Scheduler • Data Extracts • Mobile Enabled 14

whYzen at Work 15

Thank you