©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association An Independent Licensee of the Blue Cross and Blue Shield Association ©2014 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

©2016 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association.

Confidential and proprietary Blue Cross of Idaho.

ConnectedCare 2017:

How Changes to Blue Cross’ Individual and Family Plans will impact Alliance Providers and

Members

Presented by Saint Alphonsus Health Alliance

& Blue Cross of Idaho

Sept. 14, 2016

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 2

Presentation Outline

Today, we will cover:

• Partnership Expansion between SAHA and Blue Cross

• Product Details

• Marketing Materials

• Website Overview

• PCP Assignment Process

• Continuity of Care

• Referrals

• Out-of-Network

• Question and Answer Period

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 3

Expansion of partnership between SAHA and Blue Cross

The Saint Alphonsus Health Alliance (SAHA) and Blue Cross of Idaho (BCI) have redesigned benefits and networks for 2017

• Discontinuation of Individual and Family QHPs that use the Blue Cross PPO network

• Metal level plans sold through the Health Insurance Exchange and directly through Blue Cross

• Expansion of the Saint Alphonsus ConnectedCare Plan

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

Product Details

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 5

2017 QHP network overview

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 6

SAHA 2017 individual QHPs

• 6 Basic Plans

• 2 Bronze

• 2 Silver

• 1 Gold

• 1 Catastrophic

• Basic Benefits

• In-Network Individual Deductibles between $1,200 and $7,150

• Out-of-Network Individual Deductible $50,000

• ER visits subject to deductible

• 7-tier Rx benefit splits covered prescriptions into preferred and non-preferred in each level

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 7

SAHA 2017 individual ACA plans

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 8

In the Treasure Valley

Hospitals: • Saint Alphonsus Regional Medical Center • Southwest Idaho Advanced Care Hospital • Saint Alphonsus Medical Center, Nampa, ID • Saint Alphonsus Medical Center, Ontario, OR • West Valley Medical Center • Valor Health • Cascade Medical Center • Weiser Medical Center • Memorial Hospital

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

Marketing Materials

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 10

Sales materials

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 11

New ID card design

New ID card designs reinforce the network, need for referrals and PCP, and underscore the out-of-network aspects of the plans

Sample Card; Logo Design Not Finalized

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 12

We are developing detailed communication plans for all affected audiences

Brokers

• Weekly broker blasts

• Fall broker training

• Hosted webinars

• Monthly Q&A briefs

• Comprehensive product training at Online Learning Center

Public Relations

• Op-eds and guest columns

• Press releases

• Editorial board meetings; Interviews

Providers

• Provider website educational materials

• Hosted webinars with Q&A with Provider Services; Monthly Q&A briefs

• Online Learning Center training module

Members and Shoppers

• Complete members and shoppers website update

• Questions on member portal; Monthly Q&A briefs

• Renewal packet

• Member handbook and ID card

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 13

Media/Public awareness of plans

• Blue Cross of Idaho CEO Charlene Maher recently conducted an exclusive one-on-one interview with The Associated Press, focusing on the benefits of coordinated care and the QHP healthcare networks

• Media coverage is anticipated around the following dates:

• Anonymous shopping for plans (with rates) begins Oct. 1

• Open enrollment period runs Nov. 1 through Jan. 31

• Coverage begins Jan. 1

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

Website Overview

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 15

New Blue Cross Provider Directory

• Brand-new provider directory from leading industry vendor, Vitals

• ID card provider code integrated with network search fields

• SAHA has its own vanity URL: bcidaho.com/saintalphonsus

• In final product testing; tool available October 1

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 16

Saint Alphonsus Health Alliance Provider Directory

SAHA URL: saintalphonsushealthalliance.org

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

PCP Assignment Process

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 18

Here is how it works

• Blue Cross of Idaho will actively engage with SAHA Network enrollees to prompt them to choose a Primary Care Provider (PCP)

• Phone calls

• Emails

• Direct mail

• Co-branded mail from Blue Cross and SAHA

• We’ll partner with PCPs during January 2017 to try and reach out to those who haven’t selected a PCP.

• PCPs need to keep Blue Cross informed of their patient loads and notify us immediately by email notification to the SAHA Provider Relations rep when their panel is closed

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

Continuity of Care

©2015 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 20

Members in midst of treatment/care

• Blue Cross will work to identify new individual QHP members to the SAHA CCO plan to determine who is in the midst of an ongoing course of treatment.

• SAHA patients who are in this situation will be evaluated by Blue Cross’ Healthcare Operations team on a case-by-case basis.

• Members may request via phone call or letter, the continued access to request is reviewed by Blue Cross Healthcare Operations. If approved the member will be sent the application for continued access to care to be completed by the member and provider.

• Members will ultimately need to switch to an in-network specialist, if available.

Referrals

PCPs and Specialists

Responsibilities

• As a member of a Clinically Integrated Network

(CIN) communication between providers is

essential

• Utilize in-network providers when referring care

• PCPs to provide relevant medical information to

Specialists

• Specialist to coordinate with PCPs regarding

diagnosis and recommended treatment plan

Referral Specifics

• Referrals are required for all non-PCP care.

• SAHA providers need to use the SAHA referral center for

all referrals including those for out-of-area providers.

• Specialists will need to verify in the BCI online referral

entry system that the referral has been approved.

Referral Specifics

New Requirements for 2017

• Specialists will need to enter the referring PCP into Box 17

and NPI in Box 17b, or the respective field in an electronic

submission of the submitted claim form.

• Out-of-Area services and providers will require a referral from

the PCP.

• Providers will undergo a periodic audit by SAHA and Blue

Cross to ensure they are actively supporting the coordinated

care approach.

SAHA Referral Center

• For questions about ConnectedCare referrals, please

contact the SAHA Referral Center:

Phone: 208-367-DOCS(3627)

Fax: 208-367-5850

Email: BO-ResourceCenter@trinity-health.org

• ConnectedCare Referral form can be located on the

Saint Alphonsus Health Alliance website at http://www.saintalphonsushealthalliance.org/managers/alliance-

payor-information.html

Required Referrals

Visits or services by specialists/non-primary care providers; non-

primary care specialties include, but are not limited to:

• Allergy/Immunology

• Audiology

• Behavioral health

• Cardiology

• Cardiac/Cardiothoracic surgery

• Colorectal surgery

• Dermatology

• Endocrinology

• ENT/Otolaryngology

• Gastroenterology

• General surgery

• Hand surgery

• Infectious disease

• Nephrology

• Neurology

• Neurosurgery

• Oncology/Hematology

• Oral surgery

• Orthopedics

• Pain management

• Plastic surgery

• Podiatry

• Psychiatry/Psychology

• Pulmonology

• Rheumatology

• Urology

• Vascular surgery

No Referrals Needed

• Home health, home IV, hospice

• Independent lab tests

• Optometry

• Pathology

• PT/OT/ST

• Radiology/Imaging services

(mammograms, x-rays, ultrasounds,

MRIs, CT scans, PET scans)

*NOTE - professional or interventional

radiology services may be subject to

referrals as specialists

• Registered dieticians

• Visits or services by primary care

providers or generalists; primary care

specialties include the following:

• Family practice

• General practice

• Internal medicine

• OB/GYN

• Pediatricians

• Anesthesia

• Chiropractic

• DME suppliers

• Emergency or urgent care services

Out-of-area services

• The ConnectedCare plans do provide coverage for

covered family members who live outside of the service

area

– Additional information will be provided before January 2017

Out-of-area services

• The PCP must submit out-of-area referrals to the SAHA

Referral Center.

• Specialists will need to request referrals via the

member’s PCP.

• Members will notify Blue Cross of a dependent in this

situation and BCI will provide system flags so claims

process correctly.

Out of Network

Out of Network

• For services that cannot be provided within SAHA, PCPs

should submit Gap Authorizations through the SAHA Referral

Center.

• Gap Authorizations will be reviewed by the BCI Healthcare

Operations team.

• Additional documentation may be requested if necessary to

determine appropriateness of a Gap Authorization.

• Servicing provider will need to verify the Gap Authorization

was approved through the BCI online referral entry system

(JIVA).

An Independent Licensee of the Blue Cross and Blue Shield Association ©2014 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association

©2016 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association.

Confidential and proprietary Blue Cross of Idaho.

Presented by Saint Alphonsus Health Alliance

& Blue Cross of Idaho

Sept. 14, 2016