March 13, 2013

CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®′ Registered trademark of CareFirst of Maryland, Inc.

PROPRIETARY AND CONFIDENTIAL

March 13, 2013

CareFirst - Making a Difference CareFirst Commitment

Making a Difference in our Communities City

Julie Wagner Grants Program Manager


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The CareFirst Organization…

The largest insurer in the Mid-Atlantic region, serving 3.4 million members Employs about 5,000 associates and contractors in Maryland, Washington, D.C.,

Northern Virginia, West Virginia and North Carolina Has the largest provider network in the region, with more than 80 percent of the

region’s health care providers participating in one or more networks Launched the nation’s largest Patient-Centered Medical Home (PCMH) program of

its kind Since 2008, through our CareFirst Commitment program, we’ve contributed more

than $340 million to community programs designed to increase health care access, affordability, safety and quality throughout Maryland and the National Capital Area


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Corporate Memberships

Community Sponsorships

Targeted Health Giving Through Others

Programmatic Initiatives

Subsidies and Enhanced Access Programs

Catalytic Giving

Our community giving program is strategic and carefully guided by an overarching goal of dedicating resources to initiatives that catalyze change and create systemic efficiencies in the health care delivery system.

In priority order, our giving is focused on: Subsidies to enhance health care

access Catalytic giving to improve the health

system Targeted giving to organizations that

seek to improve health, and Community sponsorships and

memberships

Strategic Giving…


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Catalytic Funding…CareFirst funds innovative community initiatives and programs throughout our service area: • to improve the region’s health care delivery systems, • identify and seek to promote change on broader health

initiatives, and ultimately,• to affect the long-term health of our community.

More specifically, we’ve focused our efforts on five key areas to address these objectives:

– Improving Maternal and Child Health; – Battling the Obesity Epidemic; – Empowering the Region’s Safety Net Clinics; – Addressing the Region’s Shortage of Nurses; and – Expanding CareFirst’s Patient-Centered Medical

Home Concept – Improving Maternal and Child Health


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Supporting the Community…Corporate Memberships & Sponsorships

Associate Volunteerism• American Heart Association Internal Fundraising• United Way Campaign• Volunteerism

We sponsor over 344 events, region-wide, with nonprofit partners per year, throughout our entire region. These events support the operating budgets of nonprofit organizations and provide CareFirst well over 150,000 direct impressions and countless others through the media.

- Promote participation using the latest tools and technology - Incentives such as matching funds and recognition


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Grant Funding…

Grant Applications

• Review applications in 3 grant cycles

• Special RFP Issued

• Awards & Reporting


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Case Study…

Safety Net Health Centers (SNHC) Patient-Centered Medical Homes (PCMH) Initiative


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SNCH PCMH RFP Process…

2011July Guidelines for Grant Applications

CEO Information Sessions August Grant SubmissionsSept Evaluation TeamsOct RecommendationsNov Final AwardsDec MOU Development


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Populations Targeted by SNHC PCMH Projects…

• Behavioral Health Issues• Chronically Ill• HIV+• Homeless Individuals• Diverse Communities • Low Income Patients• Underserved Populations• Uninsured Patients


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SNHC PCMH Grantees…CareFirst Safety Net Health Centers Patient-Centered Medical Homes Initiative Grantees

Organization Grant Service Area Grant Award Grant Period

Arlington Free Clinic Arlington, VA $350,000 3 yearsBaltimore Medical Systems, Inc. Baltimore City, MD $498,905 2 yearsCalvert Healthcare Solutions, Inc. Calvert County (MD) $287,762 2 yearsChase Brexton Health Services, Inc. Baltimore City $250,000 2 yearsChoptank Community Health System Caroline, Dorchester,

Talbot Counties (MD)$400,000 2 years

Community Clinic, Inc. Montgomery and Prince George’s Counties (MD)

$1,585,521 3 years

Health Care for the Homeless, Inc. Baltimore City, MD $750,000 3 yearsMary’s Center for Maternal and Child Care

Washington, DC and Montgomery County (MD)

$596,665 3 years

Primary Care Coalition of Montgomery County

Montgomery County (MD) $599,514 3 years

Spanish Catholic Centers of Catholic Charities

Washington, DC $300,000 3 years

Total Health Care Baltimore City, MD $1,994,876 3 yearsUnity Health Care Washington, DC

$913,801

3 years


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Regions Serviced by SNHC PCMH Projects…

* Figures represents number of projects servicing that area.


PCMH Measurements Key: Black – Organization Defined Goals Blue – CareFirst Goal AdditionsProject Metrics…

Organization Grant Award Project Description PCMH Measurement Target Population Number

Targeted

Arlington Free Clinic $350,000 Complete transition to patient-centered medical home. Care for patients with multiple chronic health conditions.

Quality, Health Outcomes, Utilization,

ER Diversion, Hospitalizations, Cost

Per Patient, Cost Savings

Chronically Ill, Low Income,

Underserved, Uninsured

1,600

Baltimore Medical Systems, Inc.

$498,905 Address unmet health needs of adults with behavioral health issues and chronic health conditions.


ER Diversion, Hospitalization, Cost Per

Patient, Cost Savings

Behavioral Health Issues, Chronically

Ill, Low Income, Underserved,

Uninsured

750

Calvert Healthcare Solutions, Inc.

$287,762 Coordinate care for chronically ill adults who are between 117% and 200% of the poverty level.



Per Patient, Cost Savings

Behavioral Health Issues, Chronically

Ill, Low Income, Underserved,

Uninsured

276

Chase Brexton Health Services, Inc.

$250,000 Empanel to care teams, chronically ill patients who are non-adherent or at risk of non-adherence to recommended health services.

Health Outcomes, Utilization, Cost Per


Chronically Ill, HIV+, Low Income,


200

Choptank Community Health System

$400,000 Enroll in a yearlong diabetes management program all uninsured patients with elevated HbA1c.

Health Outcomes, ER Diversion, Utilization, Hospitalizations, Cost

Per Patients, Cost Savings

Chronically ill, Low Income,


250


Project Metrics…

Community Clinic, Inc. $1,585,521 Target people with diabetes, hypertension, asthma, and HIV/AIDS for participation in the patient-centered medical home.


ER Diversion, Hospitalization, Cost Per


Chronically ill, HIV+, Low Income, Underserved,

Uninsured

2,566

Health Care for the Homeless, Inc.

$750,000 Develop a patient-centered medical home model tailored for the unique medical and social health issues of homeless people.

Quality, Health Outcomes, Utilization

Behavioral Health, Chronically Ill,

Homeless, Low Income,


750

Mary’s Center for Maternal and Child Care

$596,665 Using staff and technology, enhance care coordination given to individuals with asthma, hypertension, and diabetes.

Quality, Health Outcomes, Utilization, Cost Per Patient, Cost

Savings

Chronically Ill, Immigrants, Low

Income, Underserved,

Uninsured

2,973

Primary Care Coalition of Montgomery County

$599,514 Transform two safety net health centers into patient centered medical homes and enhance support and care for people with multiple chronic illnesses.


Cost Per Patient

Multiple Chronic Illnesses, Low


Uninsured

500

Organization Grant Award Project Description PCMH Measurement Target Population Number Targeted


Project Metrics…

Spanish Catholic Centers of Catholic Charities *

$300,000 This project has been closed due to leadership changes, challenges with project design and staff recruitment. ****

Total Health Care * $1,114,000 Transform one safety net health center into patient centered medical homes and enhance support and care for people with multiple chronic illnesses to reduce inappropriate use of emergency departments.



Savings



Uninsured

1,200

Unity Health Care $913,801 Reduce misuse of the emergency department among patients with multiple chronic health conditions.



Savings



Uninsured

19,000

Organization Grant Award Project Description PCMH Measurement Target Population Number Targeted


Grant Project PerformanceQuality

Health OutcomesUtilization

Emergency Dept. DiversionHospitalizationsCost Per Patient

Cost Savings

CareFirstSupport

Offering of Quality Technical

Assistance

Offering of Relevant, Quality

Training

Grantee Engagement

Timely Submission of Reports

Participation in Collaborative Meetings

Participation in Care Coordination Meetings

Participation in Trainings & Utilization of

Technical Assistance

Promoting Project Success…


Successes and Challenges…

Successes Challenges

Increased Preventive Services Implementation Delays

Early Adoption by Staff Cost Saving Data Measures

Hispanic Outreach Delays from Ancillary Organizations

Hiring Staff Recruitment

Care Plans in EMR System Patient Recruitment

Partnership Communication, Protocols & Guidelines

Communication with Grantee Partners

Value Added

Closer Relationships with our non-profit partners

Better understanding of non-profit challenges (e.g. Medicaid etc…)

Shared learning


2013…

Monitoring & EvaluationTechnical Support

February• 27 Creating a PCMH Culture (in-person)• 27 Recruiting and Retaining PCMH Participants (in-person)

March • 13 PCMH Program Monitoring and Evaluation (webinar)• 20 Measuring Patients’ Perceived Health Status (webinar)• 26 Health Literacy/Plain Language – Part I (webinar)

April• 10 Integrating Data Integrity Into the PCMH Clinic Culture (webinar)• 16 Considerations for Integrating Care Plans With Information Systems (webinar)

• May• 21 Health Literacy/Plain Language – Part II (in-person)


Questions…

Contact:Julie [email protected]

Documents

March 13, 2013