Florida Blue Jacksonville, Florida

VICE PRESIDENT, INFORMATICS AND

HEALTH CARE ECONOMICS

Position Description

December 2013

Prepared by:

Michael Meyer Ryan Hubbs

Katie Haddock

Meyer Consulting www.meyerconsultinginc.com 5900 North Granite Reef Road

Suite 100 Scottsdale, AZ 85250

347.284.0160 / 602.733.6335 flbluevp@meyerconsultinginc.com

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Table of Contents

Page

I. Florida Blue Overview • History • Organizational Summary • Mission, Vision, and Values • Products and Services

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II. Community Description

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III. Position Summary 6

IV. Duties and Responsibilities 7

V. Goals and Objectives 9

VI. Candidate Qualifications 10

VII. Procedure for Candidacy 11

VIII. Appendix 1: Organizational Chart 12

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I. Florida Blue Overview History

In 1944, the Florida Hospital Service Corporation, the forerunner of Blue Cross of Florida, began operations in Jacksonville with a staff of four. The company was founded in response to the need to ensure the people of Florida had access to the highest quality medical care when needed. In 1946, the Florida Medical Services Corporation was formed, eventually becoming Blue Shield of Florida. The two companies consolidated in 1980 to form Blue Cross and Blue Shield of Florida, Inc. The company’s founding values have continued to guide its direction as it has grown into the largest health plan in the state of Florida. Under the leadership of Pat Geraghty, who became Chairman and CEO of Florida Blue in 2011, Florida Blue has directed its efforts to developing and implementing innovative, consumer-friendly solutions to the complex challenges posed by today’s rapidly changing healthcare landscape, while building on the organization’s commitment to ensuring quality, accessible care for Floridians. On April 2, 2012 the company’s new name in the market became Florida Blue – reflecting the dynamics of becoming an entrepreneurially-oriented health solutions company and better conveying the company’s commitment to positively impact Floridian’s health using a more consumer-friendly approach. As Florida Blue, the company’s focus is on the person — understanding them, how they live and what they really need in terms of their health and well-being. Florida Blue’s vision — to be a leading innovator enabling healthy communities—is both the inspirational and aspirational description of its future state. By broadening its scope and continuing to evolve, it will have more flexibility to make a greater impact on as many people as possible.

Organizational Summary

Florida Blue is the state’s largest and oldest health insurance provider. Organized as a not-for-profit, Florida Blue employs nearly 7,500 people and has revenues of approximately $8.9 billion. The company recently filed a request with the state to organize as a policy-owned, not-for-profit mutual insurance holding company (MIHC). The structure will provide Florida Blue important flexibility in today’s rapidly changing health care environment and will better enable the company to achieve its strategic objective of transforming into a health solutions company. “The unprecedented change that the health insurance and health care delivery industries are undergoing creates unique opportunities for Florida Blue to extend our leadership position to provide comprehensive health care solutions for our customers and the communities we serve,” said Patrick J. Geraghty, chief executive officer,

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Florida Blue. “We believe the MIHC structure will help us better fulfill our mission over the long term, deliver sustained value to our customers and compete in a rapidly changing environment.” Florida Blue serves more than 4.3 million health care members in its primary health insurance business, representing a 30% share of the overall Florida health insurance market. Florida Blue held a commercial membership retention rate of 92 percent for year-end 2012. The organization and its family of subsidiaries serve over 15.8 million people in 16 states with a portfolio of individual and commercial health care products, Medicare and Medicaid products, health savings and related accounts, and ancillary products such as life, disability, dental, workers’ compensation, long-term care, vision and wellness programs. Major subsidiaries include First Coast Service Options Inc. and Novitas Solutions (Medicare administration), and Navigy, Inc. (national provider portal company). In 2012, Florida Blue achieved its 24th consecutive year of positive financial performance. The company reported financial results for 2012 with consolidated net income of $217 million. Florida Blue is rated A+ by Standard & Poor’s and was just upgraded from A to A+ by A.M. Best, reflecting Florida Blue’s strong market presence, disciplined growth strategy, brand and current capitalization. These ratings are among the highest ratings in the country for health care companies. The National Committee on Quality Assurance (NCQA) has given Commendable status for both Florida Blue’s Medicare HMO plan and commercial HMO plan Health Options, Inc. (Updated 6-7-13). Florida Blue earned the CEO Cancer Gold Standard™ accreditation on Feb. 1, 2012. Florida Blue is a not-for-profit, policyholder-owned, tax-paying mutual company. Headquartered in Jacksonville, Fla., it is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. Our Mission, Vision, Values

Products and Services

Florida Blue offers a broad choice of affordable, health-related products and services through the parent company, its family of subsidiaries and joint ventures. This flexible portfolio of health care products includes traditional health care insurance (BlueOptions), Preferred Provider Organization (PPO) products, Health Maintenance

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Organization (HMO) products (Health Options, Inc. and Florida Health Care Plan), commercial Medicare products, health savings and related accounts, multiple option products, limited benefit products and ancillary products such as life, disability, dental, workers’ compensation, long-term care, vision and wellness programs. In 2012, Florida Blue applied to enter the Medicaid managed care service market in Florida through a joint venture called Florida True Health. Florida Blue is significantly expanding both its Medicare and Medicaid business. The Company has undertaken a number of leading edge programs including:

• The nation’s third-largest patient centered medical home (PCMH), with 2400 participating physicians;

• Development and launch of eight Accountable Care Organizations (ACOs), with four additional ACOs under development;

• Innovative payment arrangements with leading providers including the Mayo Clinic, the Cleveland Clinic, and the Moffit Cancer Center;

• In 2006, Blue Cross Blue Shield of Florida opened the first of its Florida Blue retail stores in Jacksonville and Pembroke Pines. The original stores were designed to provide easier access to health care for the people of Florida. Florida Blue currently has 11 Florida Blue retail centers in operation – Jacksonville, Winter Park, Palm Beach, Fort Lauderdale, Miami, Tallahassee, Tampa, Winter Haven, Sarasota, Fort Myers and Pensacola. The Pensacola and Winter Haven centers also have primary care clinics exclusively for Blue Cross and Blue Shield members.

For additional information on Florida Blue, visit its website at http://www.bcbsfl.com

II. Community Description

Jacksonville, with a population of 800,000, is one of Florida's major industrial, commercial and cultural centers. Jacksonville is located in the First Coast region of Northeast Florida and is centered on the banks of the St. Johns River, about 25 miles south of the Georgia border and about 340 miles north of Miami. The area's economy is balanced among distribution, financial services, biomedical technology, consumer goods, information services, manufacturing, insurance and other industries.

The city offers sun-soaked conditions year-round and plentiful recreational opportunities such as water sports, fishing, golfing, hiking, biking and horseback riding. Jacksonville operates the largest urban park system in the United States, providing more than 80,000 acres of parks and facilities throughout the city. Jacksonville offers a vivid cultural life including numerous theatres and entertainment

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venues; events such as The Jacksonville Jazz Festival, the second-largest jazz festival in the nation; attractions such as zoos and museums; many sports teams such as the NFL Jacksonville Jaguars as well as being home to the PGA. Jacksonville is home to many colleges and universities like Jacksonville University and the University of North Florida.

The county is home to four of the nation's best high schools: Stanton College Preparatory School (5th); Paxon School for Advanced Studies (6th); Mandarin High School (151st); and Douglas Anderson School of the Arts (158th) according to Newsweek Magazine in 2008. There are a number of private secular and non-secular schools.

More information about Jacksonville and the state of Florida can be found at these websites:

www.visitjacksonville.com www.jacksonville.com www.visitflorida.com

III. Position Summary Title: Vice President, Informatics and Health Care Economics Reports to: Senior Vice President, Business Operations, Joyce Kramzer The Vice President, Informatics and Health Care Economics (IHCE) is a newly-created position at Florida Blue. This role leads a newly-combined division comprising Provider and Network Analytics, Health Care Economics, Employer Group Reporting, Fraud/Abuse Analytics, and Business Information Management. Florida Blue has created this new structure to address the challenge of effectively capturing and utilizing increasingly complex and interconnected healthcare data to drive efficiencies, outcomes, and to better serve and engage members. This is a transformational position for Florida Blue, aligned with the company’s ongoing commitment to proactively and innovatively meet challenges and leverage opportunities posed by changing market forces, regulatory environments, consumer needs, and developments in medical care. Leading a combined team of nearly 200 FTEs, this new leader will develop and lead an organizational strategy for capturing, analyzing, and leveraging data across the company to drive operational and network efficiencies, healthcare quality, and financial performance. The initial scope will be the integration of Provider and Network

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Analytics, Business Information Management, Employer Group Reporting, Fraud/Abuse Analytics, and Health Care Economics. The Business Information Management area was formed by the division of what was previously the Information Management division at Florida Blue into two teams – IT Data Management (ITDM; will continue to report up through the Chief Information Officer) and Business Information Management (BIM). This structure is based upon the initial phases of implementation of a corporate strategy called Strategic Information Environment (SIE). The SIE strategy represents a migration to a platform that enables enterprise-wide master data management (MDM) which gives a 360º view of members, current and prospective clients, physicians, current and future product lines. BIM is comprised of business intelligence, analytics and data governance, and shares the responsibility for strategic decisions surrounding analytical information storage, structure and extraction. The Provider and Network Analytics and Health Care Economics teams were formerly dispersed throughout the organization based on the function they supported. This position is innovative and visionary in nature. The core responsibility will be to assume the strategic and operational lead for the analytics for Florida Blue. This includes working closely with various functions in the company to establish strong data governance processes; working with IT to drive towards an enterprise-wide master data management framework to support the organization’s analytic capabilities; as well as setting the strategic direction for the organization’s analytic and reporting capabilities. This role will also be accountable for developing the roadmap for the selection and management of potential vendors and partners within this space, including possible investment opportunities.

IV. Duties and Responsibilities The Vice President, Informatics and Health Care Economics will oversee and lead a combined team comprised of Business Information Management (~90 FTEs), Health Care Analytics and Economics (94 FTEs), and Employer Group Reporting (7 FTEs). This is a transformational role which will be responsible for developing, leading and managing a world-class informatics and analytics function within Florida Blue. Specific functional responsibilities will include:

Providing analytic power to drive Florida Blue’s medical cost management program and medical cost trend analysis;

Working closely with network management to provide analytic-driven contracting guidance;

Developing capabilities and driving processes to provide Florida Blue with enhanced clinical analytics that enable the organization to implement more advanced and productive provider relationships and provider contracts;

Conducting population health management analysis, including patient identification and stratification, care program analysis, identifying and meeting care gaps, et al;

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Providing analytic support for Florida Blue’s performance metrics, including HEDIS, Stars, and quality;

Providing informatics and analytic support needed to drive value-based and risk-sharing contracting efforts;

Providing informatics and analytic support for Florida Blue’s ongoing Accountable Care Organization and Patient Centered Medical Home initiatives;

Providing informatics and analytic capabilities to drive provider profiling, performance reporting, and provider contract modeling in close collaboration with the Network Management division;

Assisting Finance in setting pools, incurred but not reported (IBNR);

Aggregating competitive intelligence on networks, discounts, coordination of benefits data and consultant network benchmarking information;

Leading the implementation of the Strategic Information Environment (SIE) strategy as the overall enterprise business sponsor;

Chairing Data Governance processes and framework, collaborating with various business functions to achieve agreement of consistent data definition;

Collaborating with ITDM to design data marts, data stores supporting business functions;

Collaborating with IT in the design of enterprise data architecture to support the analytic requirements of the enterprise;

Providing analysis and outcomes of the financial, clinical, and engagement results of Florida Blue programs;

Supporting the employer group sales and account consulting functions by providing analytics surrounding population health, provider utilization, compliance, benefits results and other key medical / pharmaceutical spends;

Supporting analytics delivered by the employer group reporting portal tool, MyBlueInsight;

Meeting with employer groups, both current clients and prospective, to serve as subject matter experts on analytics and informatics, Florida Blue’s capacities in these areas, and to assist in developing strategies for benefit optimization and enhanced employee health;

Working collaboratively with the SIU/fraud division to ensure accurate compliance data is available and effectively utilized.

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V. Goals and Objectives Within the next 12 to 18 months, the successful Vice President, Informatics and Health Care Economics will have:

Developed and gained buy-in for a consolidated enterprise Strategic Information Environment (SIE) strategy (including roadmap for implementation) for capturing, analyzing, and leveraging information to provide a competitive advantage for Florida Blue’s current and future business;

Established him/herself as a credible and respected leader with senior management and staff within the Informatics and Health Care Economics division;

Successfully integrated and structured the Business Information Management, Provider and Network Analytics, Healthcare Economics, and Employer Group Reporting teams into a coordinated, “non-siloed”, and effective division;

Have set and driven toward goal metrics in MLR, quality scores, provider engagement, financial targets, and other areas that affect the operations of Florida Blue;

Developed the IHCE team by hiring top talent, mentoring, and effective staff alignment;

Developed strong, collaborative working relationships across the organization and established him or herself as a trustworthy colleague within the Florida Blue executive team;

Developed / displayed a strong understanding of the Florida health care market, including medical cost by MSA and developments in the Florida provider community;

Leveraged Florida health care market knowledge and information to enable consumer segmentation and closing of care gaps;

Developed a close, synergistic relationship with Network Management, enabling: Increased understanding of contract performance and drivers of cost; advanced provider profiling; the ability to identify higher-performing providers; and providing analytic support in step with contract negotiations, including value-based reimbursement;

Evaluated vendor relationships; determined and initiated vendor engagement or internal development with respect to existing and needed capabilities;

Provided enterprise-wide consistency in analytics;

Displayed the ability and commitment needed to make Florida Blue a leader in the use of informatics and health care analytics for the long-term.

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VI. Candidate Qualifications The Vice President, IHCE will be an accomplished, strategic leader with a passion for utilizing data and analytics to enhance outcomes, who can conceptualize and implement a consolidated organizational strategy for leveraging analytics and information management to provide a long-term competitive advantage for Florida Blue. He/she will display the ability to be a champion and influencer for health care analytics through their leadership experience in a health plan, consulting firm / vendor, or large provider organization. The successful candidate will be a proactive leader who has led or substantially participated in developing and implementing organizational strategy for analytics and information management within a maturing company. The VP will have a deep knowledge of analytics, business information management, and health care economics, and of the importance and use of these functions in driving health plan performance. He/she will display the ability to represent Florida Blue as a thought leader in IHCE to external constituencies. He/she will have a robust, “360º” understanding of health care and of the various factors and relationships that drive health plan performance. This includes the demonstrated ability to utilize IHCE functions to enhance provider engagement / contracting, medical cost management, and to better serve and engage consumers. In addition, the successful candidate will understand trends in health care and how to utilize information to effectively enable and support Florida Blue’s aggressive approach to implementing Accountable Care Organizations, Patient Centered Medical Homes, and value-based / risk-sharing pricing models. The successful candidate will be effective in a highly-matrixed environment, with the ability to manage and affect change in a large, diverse organization. He/she will have cultural competence and the ability to work effectively with a diverse range of stakeholders, as well as the demonstrated capability to effectively recruit top talent. In addition, the VP, ICHE will possess excellent communication and reporting techniques and the capability to effectively present technical issues and metrics to diverse stakeholders including health plans, employer groups, brokers, consultants, senior management and other staff. Specific requirements include:

Bachelor of Science degree, preferably in Statistics, Finance, Actuarial Science, Mathematics, Economics, or other quantitative discipline. Graduate degree in these areas strongly preferred;

A minimum seven years of experience as a medical economics or analytics lead with a strong knowledge of medical informatics;

Strong understanding of mechanics of data structures, provider pricing methodologies and risk/gain-share payment models is a plus;

Strong written and verbal communication skills;

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Leader and visionary with the ability to translate and explain complex models and health care analytics to senior management, segment leaders, and potential and existing clients;

Experience managing an analytic unit; experience managing an information management division a plus;

Understanding of provider performance standards and techniques (cost and quality);

Experience with value based/risk sharing contracts and reconciliations;

VII. Procedure for Candidacy

Meyer Consulting has been exclusively retained by Florida Blue to conduct this search. Referrals, requests for information, and expressions of interest can be sent via email to Florida Blue’s search consultants, Ryan Hubbs and Katie Haddock, at flbluevp@meyerconsultinginc.com. We can be reached via phone at 347.284.0160 (Hubbs) and 602.733.6335 (Haddock). All communication will be treated with full professional confidentiality.

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Appendix 1: Organizational Chart Chairman and CEO, Pat Geraghty

Vice President, Informatics and Health Care Analytics

SVP, Business Operations, Joyce Kramzer

Senior Director, Business

Information Management

Senior Director, Provider Profiling

Senior Director, Contracting

Analytics

Senior Director, Health Care Economics