Health Plan Strategies in Responding to Disasters, Terrorism, and Pandemic

1. National Emergency Management Summit 2007 Bob Rehm Vice President, Public Health & Clinical Strategies America’s Health Insurance Plans Health Plan Strategies in Responding to Disasters, Terrorism, and Pandemic

2. AHIP Readiness Project • The AHIP Board of Directors met in November, 2005 to review actions post-Katrina and Rita. • CEO Readiness Task Force considered “lessons learned” and AHIP Board approved the Task Force recommendations in February 2006 • CEO Readiness Task Force Goals: • Define a disaster – not all are created equal • Special nature of pandemic influenza • Identify health insurance plan “best practices” based on prior events • Define strategies for future events (AHIP, Health Insurance Plans, and State & Federal Regulatory Community)

3. CEO Readiness Task Force-2006Defining a “Disaster Event” • A disaster is an event that has significant impact on the ability of individuals to obtain health care services – including the following: • Disruption of crucial community resources. • Significant interference with key business functions. • Evacuation or relocation of large numbers of people. • Inability of employers or consumers to pay for health care services. • Medical events that overwhelm health care providers (pandemics). • Industry and regulatory actions must be appropriately tailored.

4. Hurricane Katrina – Industry Response

5. CEO Readiness Task Force-2006“Lessons Learned and Best Practices” • Getting ready for – and responding to – a disaster requires planning, coordination, and communication from both the industry and the regulatory community. • Recommended actions for industry: • Develop a contingency plan and establish accountability within the organization. • Include business partners, customers, and key stakeholders in the planning process. • Prepare for disruptions in communication networks and health care delivery systems. • Keep everyone – employees, customers, providers, and public officials in the loop before and after a disaster strikes. • Be flexible enough to adapt to changing circumstances.

6. Pandemic - Federal Activity • November 2005 – White House releases National Strategy for Pandemic Influenza, HHS releases Pandemic Influenza Plan, www.pandemicflu.gov website launched • December 2005 – The Public Readiness and Emergency Preparedness Act enacted with broad liability protections related to pandemic countermeasures and funding for pandemic candidate vaccine research and production. HHS Secretary Leavitt releases pandemic planning checklist for business and industry. • May 2006 – White House releases the Implementation Plan for the National Strategy for Pandemic Influenza. CBO releases revision to 12/05 Report, A Potential Influenza Pandemic: An Update on Possible Macroeconomic Effects and Policy Issues • September 2006 – DHS releases Pandemic Influenza Preparedness, Response and Recovery Guide for Critical Infrastructure and Key Resources • December 2006 – Institute of Medicine releases Letter Report on Modeling Community Containment for Pandemic Influenza. Senate passes Pandemic and All-Hazards Preparedness Act (S 3678) and President Bush signs into law.

7. Pandemic - State Activity • Dec. 2005 – 1st State/HHS Pandemic Summit held in Minnesota • Jan. 2006 – $100M released to States for Pandemic Planning • May 2006 – All 50 states and DC have submitted plans to the CDC • June 1, 2006 – 49 states and DC have held State/HHS Pandemic Summits • Ongoing – Legislative and regulatory activity focused on all-hazards planning (including pandemic), “pre-event” measures, and recovery activities • Disaster reporting framework • Drug supply (access to expanded refills) • Altered standards of care • Coordination between State Insurance Commissioners & Industry

8. AHIP & Industry Activities – HEALTH INSURER PANDEMIC PLANNING CHECKLIST • KEY SECTIONS: • 1.1 Plan for the impact of a pandemic on your business • 1.2 Plan for the impact of a pandemic on your employees and establish policies to be implemented during a pandemic • 1.3 Communicate, educate and provide resources for employees and enrollees • 1.4 Modify Business Practices and Policies to be implemented during a pandemic • 1.5 Coordinate with external organizations and help your community • Checklist under clearance review by OMB.

9. AHIP & Industry Activities –Supporting member’s business continuity planning efforts • AHIP Convening 2007 Pandemic Simulation Exercise • Private and public sector health care leaders by invitation • 2 day scenario-based exercise facilitated by national pandemic planning expert • Partnership with the CDC • Leading to development of guidance, tools and improved coordination • Industry Collaboration - DHS Healthcare Sector Coordinating Council (HSCC) • Critical Infrastructure Protection • AHIP & BCBSA (Co-Chairs) and 11 health insurance plans • Physical assets, supplies, communications, and the healthcare workforce • Protecting continuity of care during mass disasters • Industry Outreach - Conference Sessions on Pandemic Preparedness • Policy Conference 2006 –Pandemic Flu: Are We Ready? • AHIP Institute 2006 – Workshop: Preparing for the Real Pandemic • Communications Conference 2006 – Crisis Management: Avian Flu • Medical Leadership 2006 – Pandemic and Our Public Health Infrastructure • Executive Leadership Summit 2007 – Public Health Preparedness and Our Domestic and Global Security

10. Pandemic Preparedness for Businesses Presentation to: National Emergency Management Summit March 6, 2007 Wayne Rawlins M.D, MBA

11. Aetna’s Pandemic Preparations • Preparation began in 4Q05 • Building on a strong foundation of Business Continuity Plans and Crisis/Event Response experience • Executive level oversight and enterprise team formally established in 2Q06 • Significant preparation complete with ongoing readiness efforts integrated into day-to-day operations

12. Aetna’s Areas of Focus for Pandemic Readiness • Developed “alternate operating models” to be implemented for each stage of a pandemic • Implemented a workplace infection control program • Evaluating the pandemic readiness of our critical vendors and business partners • Determining where and when policies may need to be modified in the event of a pandemic • Communicating to key constituents about infection control measures that organizations and individuals can take and Aetna’s pandemic readiness • Monitoring international (e.g., WHO) and domestic (e.g., CDC) agency reports • Working with other leading organizations where appropriate to improve outcomes

13. Aetna’s Pandemic Readiness Testing Efforts National, multi-site, multi-function Stages 2 through 6 4Q2006 Full-scale Simulation Enterprise-wide response Stages 3, 4 and 5 Testing Integrated into Key Management Processes Single site response Selected components of broader plan Initial Testing “Table Top”Exercises 2Q2006 3Q2006

14. Prepared for National Emergency Management Summit-March 2007Health Plan Strategies in Responding to Disasters, Terrorism, and Pandemics Business Continuity Programs And Pandemic Preparations

15. Business Continuity Program • Tufts Health Plan’s Corporate Continuity Program (CCP) is responsible for the following: • Increasing organizational resilience to disruption, interruption, or loss via preventive measures. • Planning and managing corporate response to and recovery from adverse events.

16. Business Continuity Program • Primary Objectives: • Provide organizational resilience during an adverse • event which optimizes the following: • The ability of our members to obtain ongoing critical medical and pharmaceutical care, as it relates to the healthcare services we provide. • The ability of our providers to continue to provide critical medical care, as it relates to the healthcare services we provide. • Successful management of critical operational impacts, which could otherwise impair our long-term ability to survive.

17. Business Continuity Program • Tufts Health Plan currently has: • A strong, comprehensive program which incorporates planning for both short term and long term recovery of all business processes identified as critical to organizational recovery. • Our present program also contains strong change management, quality improvement, and prevention components.

18. Pandemic Preparedness • Preparation began in 4Q05. • Executive sponsor, and pandemic preparedness team formally established in 2Q06. • Significant preparation efforts have been completed. • Overall organizational pandemic preparedness plan expected to be completed in May 2007. • Simulation training for all recovery teams will then begin.

19. Pandemic Preparedness • Our Pandemic Preparedness Programs • Focus primarily on the following: • Performing Pandemic Surveillance – • To ensure our recovery teams are informed and ready. • Developing Clinical policies that support our members/ providers. • Developing HR policies and Security procedures that support our employees and our business. • Including supporting community and business social distancing and infection control measures. • Promoting Ongoing Education and Awareness. • Including employee personal/family preparedness.

20. Pandemic Preparedness Our Pandemic Preparedness Programs • Focus primarily on the following (Continued): • Developing Effective Operational Control Procedures. • Planning to help to ensure the continuity of the business. • Working with government/industry groups. • To help ensure uniformity of approach. • Developing emergency response triggers. • To determine what to do, and when to do it.

21. Hurricane Charley Makes Landfall On Friday The 13th National Emergency Management Summit March 2007 When Disaster Strikes, How Prepared Are You? Ed Devaney, MPA, MPH, FACHE

22. Background • Disasters come in many forms, with varying degrees of warning and devastation • Companies doing business in Florida know that hurricanes and tropical storms are going to be a factor in business continuity • The pace and magnitude of the tropical storm environment increased dramatically in recent years and is expected to continue • In 2004, Florida was directly impacted by 4 hurricanes and one tropical storm in a six-week period resulting in 75 deaths and $13.6 billion in damages • In 2005, there were 27 named storms with 14 hurricanes resulting in an estimated 3,000 deaths and $150 billion in damages. The gulf coast states experienced the harshest damage, and Florida was impacted by most of them directly or indirectly. • As a result of our experience, BCBSF has increased both its readiness and its ability to deal with weather-related and other potential disasters

23. The Florida Experience Hurricane Charley 2004 Holmes Hurricane Jeanne 2004 Pensacola Ft. Walton Beach Jacksonville TALLAHASSEE Lake City Panama City St.Augustine Perry Gainesville Apalachicola Daytona Beach Hurricane Dennis 2005 Ocala Hurricane Frances 2004 Lake Mary Titusville Spring Hill Orlando Cape Canaveral New Port Richey Kissimmee Melbourne Lakeland Clearwater Tampa All hurricanes were categories 3, 4 or 5 Sebastian St. Petersburg Vero Beach Bradenton Wauchula Port St. Lucie Sebring Arcadia Okeechobee Hurricane Ivan 2004 Sarasota Stuart Venice Jupiter Port Charlotte Hurricane Wilma 2005 West Palm Beach Cape Coral Ft. Lauderdale Ft. Lauderdale Fort Myers Immokalee Naples Miami Homestead Hurricane Katrina 2005 Hurricane Ivan 2004 Key Largo Key West

24. Ivan

25. Charley

26. Goal of Business Continuity and Disaster Response • Minimize the impact to the company, our members and other key stakeholders when an adverse disruption does occur • We do that through established accountabilities to: • Make thorough preparations • Ensure timely, ongoing assessments in all phases • Lead an integrated and swift decision-making team • Facilitate and monitor response implementation • Provide clear communication internally and externally • Aid recovery for both internal and external stakeholders • Apply lessons learned and facilitate continuous improvement

27. Disaster Response Planning and Execution Planning & Coordination Response/ Activation Monitoring Recovery • Monitor state, federal, local • Communicate internally and externally • Prepare employees, other stakeholders • Return as directed • Communicate internally and externally • Employee & Community support • Conduct lessons learned • Assign leadership team • Develop and test plans • Adopt policies • Review readiness • Scenario plan • Activate response team • Implement action plans • Monitor state, federal, local • Communication • Employee & Community support

28. Company Planning and Coordination • Leadership assigned with enterprise accountability • Development of business continuity plans • Response team empowered to make decisions • Pre-impact decisions and preparations • Assessment of critical staff, vendor readiness • Scenario testing, policy change potential • Communication protocols for targeted groups

29. Monitoring, Communication, Integration FEMA Florida State Emergency Contingency Team Office of Insurance Regulation Local Agencies U. S. Department of Health & Human Services Office of Preparedness & Emergency Operations Department of Homeland Security BCBSF Contingency/ Disaster Response Team EOC/ Business Continuity Vendors Members Physicians/Providers Sales Agents and Brokers Employees National Weather Consultation Service

30. Response, Activation and Recovery • Use all available resources to determine impact • Understand magnitude of disruption and estimated recovery time for stakeholder groups • Expedite key business decisions in the best interest of our members and staff before, during and after • Recovery support for employees and community • Communicate, Communicate, Communicate – internally and externally before, during and after

31. Effective Pandemic Response • Pandemic planning is expanded, specific outgrowth of Business Continuity planning • Pandemic Plan is a living document, updated periodically, and coordinated with other Blues plans • Benchmark with other industries, participate in collaborative public/private strategy • Communicate and coordinate with: • State and local emergency agencies • Public health partners • Private sector stakeholders • Exercise plans to identify gaps, make corrections and promote effective implementation

32. Take Home Messages • Do what’s right for your key stakeholders • Plan, plan and prepare • Know your goal: response and recovery • Have an integrated team respond and execute • Monitor and evaluate • Apply lessons learned from each experience • Do what’s right for your key stakeholders