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Anthem BCBS Kentucky

Discover the remarkable improvements made by Anthem BlueCross BlueShield Kentucky in 2018, including advancements in HEDIS measures, member satisfaction, claims processing, and more.

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Anthem BCBS Kentucky

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  1. Anthem BCBS Kentucky July 2019 By reading this document you agree that the information contained herein is confidential and proprietary to Anthem and shall not be distributed to a third party without the prior written consent of Anthem.

  2. Anthem BlueCross and BlueShield Kentucky

  3. Quality Outcomes2018 Improvements in 115 of 148 HEDIS Measures (includes sub-measures) • CAHPS • Child - Remarkable improvement in 8 of 9 scores • Adult - 5 of 9 scores at 75th percentile or greater

  4. Notable Statistics • Claims • In calendar year 2018, we processed 99.4% of claims within 30 days, exceeding the requirement of 90%. • Our average turnaround time was 6.1 days. • 2019 trends continue with 99.2% claims paid within 30 days at an average of 4.17 days to process claims. • Member/Provider Call Statistics • 6.8s Average Speed of Answer (Member) • 3.8s Average Speed of Answer (Provider)

  5. Notable Statistics • Emergency Room Utilization • 743 Visits/1000 Members for SFY19 representing a -4.2% reduction from SFY18 • Member Cost • 2019 Claims PMPM $458.60 • 96.6% Medical Cost Ratio

  6. Network Adequacy

  7. New and Innovative ProgramsWhole Person Health • Anthem recognizes that clinical care is only one in a series of factors that impact a members health outcomes. • Social and economic factors and physical environment have a greater impact on a member’s length and quality of life. • Access to food, jobs, childcare, transportation and housing have a huge impact on a member’s ability to be self reliant.

  8. New & Innovative ProgramsComplex Care Management Complex Care Management Promoting and Supporting Highly-coordinated, Specialized Care Focus 100 Profiles our highest risk Members and includes a team review of the Care Management engagement and progress toward each person’s goals HOPE Program The High Outreach to Promote Engagement (HOPE) program addresses our highest utilizers of health care services. Currently a telephone-based outreach program in the Commonwealth, HOPE engages Members with high utilization or avoidable health care visits in motivational interviews and person-centered planning to reduce occurrences. During the first two months of 2019, HOPE outreach saved $1,283 per participating Member per month, for an overall savings of $215,583 (22.35%) in Kentucky.

  9. New & Innovative ProgramsMember Empowerment Program Member Empowerment Program Initially developed to support the Kentucky HEALTH program, the Member Empowerment program was designed to assist Members seeking employment and education. Building on our initial investments, we have redesigned the Member Empowerment program to address additional SDOH and provide broadened access to community-based resources. The Empowerment program provides: • Person-centered, strengths-based needs assessments and individualized, actionable goal plans • Access to innovative value added benefits that address the specific needs of Kentucky Medicaid Members • Tangible opportunities for Member economic mobility and improved health outcomes • Connections to existing community-based economic and social support services in the Members’ area • Support to overcome common barriers that may prevent Members from achieving self-sufficiency

  10. New & Innovative ProgramsSubstance Use Programs Substance Use Programs

  11. Questions? By reading this document you agree that the information contained herein is confidential and proprietary to Anthem and shall not be distributed to a third party without the prior written consent of Anthem.

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