The question is, we are trying to restructure the way we approach Healthcare Delivery. Where does this impact on quality and cost and accessibility, and even sometimes the published outcomes that come from some of these vendors are a little tainted by their own desire, you know, they are forprofit, quite frankly. Give me a list of nonprofit vendors who are there to improve Healthcare Delivery to low cost, and maybe i will be a little less suspicious. Understood. We could certainly come back and talk about our own independent actuarially where it is validated, or where another Consulting Firm is paid to evaluate this from an independent standpoint. I will share with you the average health plan in the u. S. It is 15. The highest in the nation happens to be kaiser. And these solutions that we are talking about our up above 75 and higher. It is a dramatically different experience. Were talking about cohorts, so of course, they will be experiencing this differently. Thank you so much. I look forward to coming back and exiting this conversation. I will turn this back it will guide the carriers. He will come up next. Thank you. We will have blue shield come up hello. I am with blue shield of california and i am the account management for the city and county of san francisco. Today, well talk a little bit about our Management Programs which we have revamped and relaunched as of january 1st, 2019. We took the programs and all of the other programs that were sideload, and integrated them into one Holistic Care approach. So previously, you were in disease management, then you might have had utilization management over here, and Behavioral Health management and pain management. Now we have integrated all of that to make it seamless for the member. We have two types of Care Management dependent upon which program you are in, so for access plus, we have shield support. It is a comprehensive all acuity Management Program that features member focused, clinical support from nurses, social workers, Health Coaches and Behavioral Health clinicians. It is designed to engage the one to two of the population who are at risk or who have the potential to be at risk. We do have a performance guarantee around that. We focus on Care Management, care coordination, and ensuring that the member has a holistic, all person focus for support. So, identification. Hyo do we identify the members and understand who needs the help the most . It is a data driven criteria based on authorization, medical and pharmacy claims, and then wellbeing assessments and direct referrals. Members can self refer to show support if they would like, but we do have a comprehensive outreach program. So we look at their predictive risk and all of the things that go into that. Risk progression trend, and then we look at all of those identifiers in order to outreach to those individuals who are either already who have a chronic condition, or are at risk. And for the trio members, we have shield concierge. Shield concierge is a more Inclusive Program for trio. It is a white glove service. We have specialized and specially trained Member Service [please stand by] mentality. Its all on us, not the member to get the care they need, or talk to somebody about their Current Health care crisis or that of a family member. So identification for shield concierge some of the what is the word im looking for if you have cancer, catastrophic injuries, diabetes, lgbtq health, opioid use, pain management, all of those things are triggers for us to outreach to a member. And then on july 1st of this year, we also launched an enhanced program that is a digital experience for members. It is individualized based on their health care needs. I didnt put that information on here, but thought i would offer it up. And that is designed to treat the whole member and give them an individualized health and wellness pass. Its based on, if i log into the program or access it from my phone, and i put in my scores and my Blood Pressure and things like that, it will help and then any other identifying factors for a health care condition, it will create an individualized health care and wellness path for that member and give them access to several different applications that are housed on our app, so they can be successful in their wellness journey. Thats it. Any questions . I guess in both populations you identify a pretty low percent. And so im assuming there is some you have quite a laundry list. Its identical for both groups. The percentage differs a little bit, but are they stratified, so if you have cancer you move to the top of the list . You know, anticipating a certain percentage in that youre going to support in this. Certain things like Behavioral Health, unless youve already killed yourself, may not be at the top. Right. No. We look if we look at the medical and pharmacy claims and all of those indicators, we are going to do outreach. We try to have we have reps trained to identify needs. We do outreach on how to best identify those in the population that need our help and they can selfrefer. At the found it is applicable to 1 to 2 . Those individuals that really need that care support. However, its available to everyone. So you know, we dont you know, i have to check and see if they make i dont believe they make a list and, you know, say okay these people first. I believe what it is, they get the indicators in and either a lot of times theyre referrals from nurses, physicians. Our utilization management teams. Since theyre all housed in one area, its easier for the member to get answers to their questions, to be directed to the right course of care, given care options. So but they do use the indicators that i mentioned to outreach to those members. And i can get you that information to see if they strat phi it. I guess the question is, we have an allclaims database. My suspicion is if we look at blue shield members both in trio and not, if you add up all the people with Behavioral Health issues, cancer, diabetes, opioid use and all that, its greater than 1. 5, 2. 5 , so there has got to be some to come up with this you know guess. This is a list of the conditions that rise to the top. And you know, its well understood the top 5 are 50 of the cost. Many of these persons have multiple chronic conditions so there is various ways to cut the data. Were just giving you a sample listing of the conditions that do rise to the top. And eventually, everybody with those conditions gets some type of care coordination, but to get with the program, you start with the highest risk. Commissioner follansbee so there is stratification. Thats what im trying to get at. How this is being implemented. Because i suspect that we have more than 1 of our blue members are diabetic. They cant be targeting all diabetics. Right, but diabetics with depression got to be multiconditions, thats what im trying to get at. How this list is being weighted. And how we perform our outreach based on that . I can get back to you with our detail around that. Thats an important indicator for our program is how we look at these people and how we outreach and decide who goes first when it comes to outreach. So any member is eligible to this, they dont have to have these particular problems . Maybe have one problem, but they dont have to have three or four . Right, if theyre in access, plus or trio they can go into shield support and shield concierge. How long has been this going on . We launched it 12019. It was new this year. We re desidesigned the whole pr. We have an all inclusive care program. So instead of disease management on one side, cure management on the other, this is wholistic approach and integrated for the member. So they can just pick up the phone and say im interested in the program . Absolutely. And are you providing any kind of report . You said you had performance guarantees, so im assuming there is reporting . Yep. We provide reporting on the success of the program, how many members are engaged and we have a guarantee around how many individuals we engage and keep on the program. We have reporting on it. President breslin so you will be reporting on that annually . Yes, absolutely. After the end of the year, we certainly will. Im wondering if you provide any sort of any cultural sensitivity training to your representatives, because i can just imagine that people of different cultures may have Different Levels of comfort. Yes, we absolutely do. Thats a large piece of our training. Not only do we train our reps to ask the probing questions, but theyre trained to be culturally compassionate and have access to language lines and other means to communicate with individuals. Any other questions . Thank you so much for your time. Good afternoon. Im with Kaiser Permanente. I would like to outline our integrated care coordination, walking you through our navigation and advocacy support resources and examples how this comes together. At Kaiser Permanente we take a teambased approach to care coordination where were able to provide the right care at the right time. This helps to reduce unnecessary treatment and Better Population Health outcomes. Clinical care is coordinated with the member at the center of our teambased care model. Every doctor, nurse or other Health Professionals have a total picture of the Members Health through our single Electronic Health record allowing for realtime information about the member to be seen. This leads to more coordinated approach. When a member is diagnosed, their primary care physician works with a care team and member to create a tailored treatment plan. The care teams help the member to navigate from one appointment to the next across the locations and specialties to deliver seamless and effective care. Kaiser permanente members are well supported should they need help navigating through the system. Member services is the primary hub for help with any type of support from benefit questions to finding a doctor, helping with care navigation, assistance with getting a Second Opinion, claim support, interpreting or paying bills, or with filing a grievance. They are member advocates and members may choose to either call or meet with them in person. We make it easy for our members to navigate their care by providing them with a variety of tools and resources. Through our website, members can, for example, email their doctor, make appointments online, find a class, look up the cost of services with our cost estimator tools, which can also help with plan selection during open enrollment, or order prescriptions online. They also have apps. We have apps for their mobile devices, allowing similar access to functions on the go. In addition, members have access 247 to clinical support through our appointment and advice nurse line where they can have access to either a nurse or doctor if needed. Other examples of clinical support are having embedded Mental Health clinicians at our medical facilities for emotional support, proactive outreach by our Clinical Care team for members with chronic conditions and help for primary care physicians connecting members to specialists or helping with Second Opinions. These are just a few examples how we can help members navigate their care. Lets look at the next couple of slides here where we provide examples of how our integrated care model works. The first example here to better illustrate our approach to care, im going to walk you through the example of sidney who has been diagnosed with high Blood Pressure. She scheduled a routine checkup with her primary care physician. At the visit, the intake nurse updates sidneys Electronic Medical record with her basic Health Information, height, weight, Blood Pressure, smoking, alcohol and exercise habits. Her results reveal high Blood Pressure so her doctor schedules a followup appointment to monitor her situation more closely. At her followup visit, sidney gets a tailored plan to includes regular Blood Pressure screenings, a new prescription, Healthy Eating classes at our medical centre, and recommendations to use the website. So sidney goes and registers online and starts using the online features to save time and monitor her health. She can now email her Doctors Office with nonurgent medical questions, schedule appointments, view lab results and more. Automatic emr prompt informs sidneys care team shes due for her next Blood Pressure screening. The care team sends phone and mail reminders and sidney receives them and makes her next appointment. After weeks of monitoring sidneys Blood Pressure lowers. During the visit, the doctor updates her prescription and electronically sends it to a pharmacy. She stops by the pharmacy to get her refill prescription filled and then sidney has been exercise class at the Kaiser Permanente facility near her home the next day. Two months later, she orders refill through kp. Org to have them delivered to her home. With the support of the care team, her hypertension is under control, she successfully reduces Blood Pressure, lost 20 pounds and built a sustainable healthy lifestyle. Our second example here to understand how our disease Management Program works, were going to follow this example of carla. Shes a 50yearold kaiser member, bothered by foot pain. She visits her primary care doctor for exam. Based on the visit, her medical history and lab results, carlas diagnose is type 2 diabetes. Kaiser Electronic Medical record system called help connect enrolls carla into our diabetes Management Program. She doesnt have to opt in. She is automatically enrolled into the program. Carla and her doctor make a care plan that includes depression and vision screening, new prescriptions and Healthy Eating classes at local Medical Center and then she learns how to test her blood sugar at home. After a few weeks, carlas daily testing shows a spike in her blood sugar. Once she is registered on kp. Org, she can email her doctor who sends her prescription to the pharmacy. Carla stops by the pharmacy to fill her prescription after a yoga class at our center and also uses her kaiser app to order refills and sent to her home at no additional charge. The new prescription works and carlas blood sugar levels are stable. A month later, she has an eye appointment, although its not relative to her diabetes vision, an automatic prompt in the system lets the receptionist know that carla is due for a mammogram. So he schedules her. Now that carlas diabetes is under control, her foot pain is gone, up to date on preventative care, and feeling more engaged at work. This teambased coordination approach to care helps members navigate to have a more seamless experience and optimal outcomes. Any questions . Commissioner follansbee we heard from the previous presentation white glove coordination. Having been a kaiser doc for 16 years, i dont see this is any different from what i was involved with over my 16 years at kaiser. The programs get better, the prompts get better, but i dont see actually any proactive interventions here, where people are automatically getting followup. They may get into a diabetes program, but the followup, the white glove, the sort of the personalized, this is the situation where it looks like a member may actually want more Personalized Care with someone they can call to help coordinate all this. And i dont hear this, other than emailing your doctor, that there is any way for a member to get Personalized Care. Right. So youre right, there is not one single point of contact for the individual. If anything i would say, there is kind of a multipronged approach or the team approach, so either working through your physician to kind of help get the coordinated Care Experience where they would refer you onto specialists. Or if youre not getting what you need, reaching out to Member Services and having them sort of help with that care coordination or any sort of problem solving. I just wanted to add a little bit there. Kate from Kaiser Permanente. There actually is a lot of proactive outreach where were tracking with Care Management and the major disease states and making sure were ensuring these members get in for their checkups. So while there is examples, it sounds like there is a lot that you can do on your phone and you can reach out to the physician and that is absolutely true, were monitoring that as well. Its actually a tremendous amount of outreach that is going on. And a couple of things, doctor, i think about for example, mental Health Professionals for example being embedded in or primary care departments as well. Its taking this so it goes beyond just what theyre in for, for that particular visit. Were really trying to treat the whole person. And this gets into, you know, a number of things we talked about, social determinates of health and all those things. So i actually believe that were extremely proactive from each of the care teams in making