Using Health Plan Data as Part of the Arsenal to Combat

Bioterrorism and EnhanceEpidemic Detection

Dawn Wood, MD, MPH

Vice President, Corporate Medical Director

Blue Cross of California State Sponsored Business

Fred Buckwold, MD, FACPFred Buckwold, MD, FACP

Medical DirectorMedical Director

UniCareUniCare

WellPointWellPointBlue Cross and Blue Shield Companies: Blue Cross and Blue Shield Companies: serving serving

members in Colorado, Connecticut, Indiana, members in Colorado, Connecticut, Indiana, Kentucky, Maine, Nevada, New Hampshire, Ohio Kentucky, Maine, Nevada, New Hampshire, Ohio and Virginia; Blue Cross and Blue Shield plans and Virginia; Blue Cross and Blue Shield plans serving members in Georgia, Missouri and serving members in Georgia, Missouri and Wisconsin; Blue Cross of California; and, Empire Wisconsin; Blue Cross of California; and, Empire Blue Cross Blue Shield.Blue Cross Blue Shield.

UniCare: UniCare: nationwide full-service health plan, nationwide full-service health plan, marketed primarily where the company does not marketed primarily where the company does not have a licensed Blue plan.have a licensed Blue plan.

State Sponsored Business: State Sponsored Business: Medicaid contracts in Medicaid contracts in 14 states and Puerto Rico.14 states and Puerto Rico.

Health Plan Health Plan MembershipMembership**

WellPointWellPoint 34.2 million34.2 millionUnitedUnited 19.5 million19.5 millionAetnaAetna 15.4 million15.4 millionHumanaHumana 11.3 million11.3 millionCIGNACIGNA 9.3 million 9.3 millionKaiserKaiser 8.6 million 8.6 millionHealthNetHealthNet 6.6 million 6.6 millionCoventryCoventry 2.5 million 2.5 million

TotalTotal 107.4 million 107.4 million

*Data on membership enrollment compiled by MCOL from *Data on membership enrollment compiled by MCOL from company financial reports and web sites as of year end 2006company financial reports and web sites as of year end 2006

Preparedness & ResponsePreparedness & Response

SurveillanceSurveillance– National and international monitoring systems National and international monitoring systems – Earliest possible warningsEarliest possible warnings

DetectionDetection– Identification of critical events against backgroundIdentification of critical events against background

ResponseResponse– Support and leadership for immediate, short- and Support and leadership for immediate, short- and

longer-term local and national effortslonger-term local and national efforts– Communication, sharing resources, mobilizing Communication, sharing resources, mobilizing

supplies and appropriately trained healthcare supplies and appropriately trained healthcare personnelpersonnel

ContainmentContainment– Limit spread and mitigate adverse impactsLimit spread and mitigate adverse impacts– Use knowledge gained to bolster preventive effortsUse knowledge gained to bolster preventive efforts

Importance of Epidemic SurveillanceImportance of Epidemic Surveillance

SARS SARS Avian influenza (H5N1)Avian influenza (H5N1) E-coli O157:H7 outbreak (recently E-coli O157:H7 outbreak (recently

found in spinach) found in spinach) Terrorism – Anthrax casesTerrorism – Anthrax cases

Epidemics need to be found earlyEpidemics need to be found early

Current Status for Epidemic SurveillanceCurrent Status for Epidemic Surveillance A national communication system for A national communication system for

private and public partners is provided private and public partners is provided through the Centers for Disease Control’s through the Centers for Disease Control’s (CDC) Health Alert Network (HAN)(CDC) Health Alert Network (HAN)• Posts alerts, advisories, updatesPosts alerts, advisories, updates• Reporting protocolsReporting protocols• First responder instructionsFirst responder instructions

National Electronic Disease Surveillance National Electronic Disease Surveillance System (NEDSS) developed to promote System (NEDSS) developed to promote enhanced data sharingenhanced data sharing• National, state, territorial collaborationNational, state, territorial collaboration• Standards development (IT architecture)Standards development (IT architecture)

Is there a role for health Is there a role for health plans?plans?

Health Plan Surveillance DataHealth Plan Surveillance DataHealth plans regularly monitor and trend Health plans regularly monitor and trend

paid claims and capitated encounterspaid claims and capitated encountersElectronic claims submission decreases Electronic claims submission decreases

claims lagclaims lagMultiple data sources available from Multiple data sources available from

health planshealth plans• Near real-time data for:Near real-time data for:

Hospital admissions (authorizations Hospital admissions (authorizations or notifications required)or notifications required)

PharmacyPharmacy

Health Plan Surveillance DataHealth Plan Surveillance Data Diverse sources for health plan data:Diverse sources for health plan data:

• ER, hospitals, pharmacies, doctor’s officeER, hospitals, pharmacies, doctor’s office

Each data source can provide additional Each data source can provide additional information regarding disease status of a information regarding disease status of a populationpopulation

Health plans have multiple data sources and Health plans have multiple data sources and can aggregate the data to increase disease can aggregate the data to increase disease detection sensitivity and specificitydetection sensitivity and specificity

Example of Health Plan Surveillance DataExample of Health Plan Surveillance DataPharmacy claims for Cipro Pharmacy claims for Cipro

• October 2001 increase coincided with media October 2001 increase coincided with media Anthrax coverageAnthrax coverage

Example of Health Plan Surveillance DataExample of Health Plan Surveillance Data Daily Pneumonia claimsDaily Pneumonia claims

Disaster Support and ResponseDisaster Support and Response Health plan data can be used to provide a basic Health plan data can be used to provide a basic

“Virtual Electronic Medical Record”“Virtual Electronic Medical Record” Sources of data:Sources of data:

• Claims - outpatient and inpatient servicesClaims - outpatient and inpatient services• PharmacyPharmacy• Case managementCase management

Data redundancyData redundancy Disaster managementDisaster management

• Nurse advice lineNurse advice line• Provider contact and referral informationProvider contact and referral information• Outreach Outreach

Addressing Provider CapacityAddressing Provider Capacity Epidemics and bioterrorist events can Epidemics and bioterrorist events can

potentially overwhelm community healthcare potentially overwhelm community healthcare resourcesresources

Health plans maintain provider databases and Health plans maintain provider databases and healthcare provider communication pathways healthcare provider communication pathways within diverse communitieswithin diverse communities

Health plans can partner with Public HealthHealth plans can partner with Public Health• To assess and share information onTo assess and share information on

Hospital bed capacityHospital bed capacity Primary care & specialty physician capacityPrimary care & specialty physician capacity Pharmacy capacity Pharmacy capacity

• To plan mobilization of healthcare resourcesTo plan mobilization of healthcare resources

Post-Marketing SurveillancePost-Marketing SurveillanceHealth plan data is a source for trend information Health plan data is a source for trend information on on

• Side effects and adverse reactions leading to Side effects and adverse reactions leading to Diagnosed conditionsDiagnosed conditions Use of pharmaceutical agentsUse of pharmaceutical agents Emergency, hospital, and outpatient servicesEmergency, hospital, and outpatient services

Health plan data can Health plan data can • Support routine surveillance Support routine surveillance • Help create methods to minimize risk Help create methods to minimize risk

Breast cancer – estrogen linkBreast cancer – estrogen link Pain medications – cardiac damage linkPain medications – cardiac damage link

In conclusionIn conclusion Health Plans are not in the Public Health Health Plans are not in the Public Health

BusinessBusiness• Most are public for-profit companiesMost are public for-profit companies

Health Plans have data that could be useful Health Plans have data that could be useful for epidemic/disease detectionfor epidemic/disease detection

Health Plans can play a supportive role Health Plans can play a supportive role during outbreaks/disastersduring outbreaks/disasters

Health Plans have data that could be useful Health Plans have data that could be useful for public health and other medical analysisfor public health and other medical analysis