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PHYSICIANS HEALTHCARE PLAN OF NEW JERSEY
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<PAGE>
DRAFT
WELCOME
[GRAPHIC APPEARS HERE]
PHPNJ
HMO Blue
<PAGE>
INTRODUCTION TO HMO BLUE
o BCBSNJ is the Leading Health Insurer in the State of New Jersey
o Strong Capital Base
o Significant HMO Enrollment
o Diversified Product Line
o Marketing Resources
o Strong Contracting Experience and Market Clout
o Reaching Out to Physicians for Input and Participation
Slide 1
<PAGE>
HMO BLUE'S NEW LEADERSHIP
o Christy Bell, President and COO
o Donna Celestini, Executive Vice President
o Dr. Lawrence Baker, Chief Medical Officer
Slide 2
<PAGE>
HMO BLUE MISSION STATEMENT
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Improve the health status of
members by providing access to
quality care and quality service
in a cost effective manner
- --------------------------------------------------------------------------------
Slide 3
<PAGE>
HMO BLUE VISION STATEMENT
To be the Managed Care Organization of Choice
To be the Choice of:
Members
Providers
Payers
Employees
Slide 4
<PAGE>
HOW WILL WE ACHIEVE
OUR VISION?
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By listening and responding to
our customers, by providing
quality service, and through
strong provider "partnerships"
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Slide 5
<PAGE>
OUR GOAL
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Physician directed,
market driven healthcare
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Slide 6
<PAGE>
GROWTH OF MANAGED CARE
BCBSNJ
[Graph appears here--see values below]
1994 1997
---- ----
PPO 239,972 311,657
POS 76,300 254,607
HMO 121,558 255,372
TOTAL 437,830 821,636
Slide 7
<PAGE>
TOTAL MANAGED CARE ENROLLMENT
IN NEW JERSEY AS OF 2nd QTR. 1997
[Pie Chart appears here--See values below]
CIGNA 3.0%
PruCare* 4.1%
Ameri Health 4.2%
Aetna 4.4%
First Option 7.7%
HIP 7.8%
Other 8.5%
Oxford 9.8%
HMO Blue 21.8%
US Healthcare 28.7%
Total Enrollment 2,523,483
*Estimated
Slide 8
<PAGE>
MEDICAID HMO ENROLLMENT
AS OF AUGUST 1997
[Pie Chart appears here--See values below]
Liberty 3.7%
First Option 5.4%
Other 5.9%
AmeriHealth 6.1%
HIP 6.3%
Mgd Hlth Svc 8.4%
AmPreferred 9.7%
Oxford 12.3%
US Healthcare 16.1%
MHPNJ 26.1%
Total Medicaid Enrollment 383,193
Slide 9
<PAGE>
MEDICARE HMO ENROLLMENT
AS OF AUGUST 1997
[Pie Chart appears here--See values below]
Other 0.8%
AmeriHealth 7.1%
Aetna 8.4%
HIP 8.4%
First Option 8.9%
HMO Blue 10.3%
Oxford 14.5%
US Healthcare 41.6%
Total Medicare Enrollment 133,681
Slide 10
<PAGE>
THE NEW DIRECTION
o Physician "Partnerships"
o Hassle-free Managed Care
o World Class Customer Service
o State of the Art Utilization
Management
o Disease Management
o Improving Health Status of our
Members
Slide 11
<PAGE>
DEPARTMENT OF
MEDICAL AFFAIRS
o Enhanced Medical Leadership
o "Doc to Doc" Communications
o Regional Presence
o Re-engineered Utilization
Management
Slide 12
<PAGE>
PHYSICIAN-RELATED INITIATIVES
o Provider Relations Enhancements
o Fee for Service vs. Capitation
Changes
o Increase in Billables under
Capitated Arrangements
o Provider Data
o Provider Risk Sharing
o Enhanced Physician Incentive
Programs
Slide 13
<PAGE>
PHPNJ PARTICIPATION
o Medigroup, Inc. Board of Directors
(HMO Blue)
o Professional Advisory Committee
(BCBSNJ)
o Medical Policy Committee (BCBSNJ)
o HMO Blue Subcommittees
-- Quality Improvement
-- Clinical Issues
-- Credentialing
o IME Panels
Slide 14
<PAGE>
MANAGED CARE SUBCOMMITTEE
ORGANIZATIONAL STRUCTURE
----------------------
| MEDIGROUP, INC. |
| BOARD OF DIRECTORS |
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|
|
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| MEDIGROUP OF |
| NEW JERSEY, INC. |
| BOARD OF DIRECTORS |
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|
|
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| QUALITY COMMITTEE |
| OF THE MEDIGROUP OF|
| NEW JERSEY, INC. |
| BOARD |
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|
|
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| QUALITY IMPROVEMENT|
| COMMITTEE |
----------------------
|
--------------------- | -----------------------
| CREDENTIALS | | | CLINICAL ISSUES |
| SUBCOMMITTEE |-------| SUBCOMMITTEE |
--------------------- | -----------------------
|
|
--------------------- | -----------------------
| DELEGATE OVERSIGHT| | | SERVICES QUALITY |
| SUBCOMMITTEE |-------| SUBCOMMITTEE |
--------------------- | -----------------------
|
|
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| RISK MANAGEMENT | | | UTILIZATION MGMT. |
| SUBCOMMITTEE |-------| SUBCOMMITTEE |
--------------------- | -----------------------
|
|
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| APPEALS | |
| COMMITTEE |----
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Slide 15
<PAGE>
PHPNJ PRESENTATION SCRIPT OUTLINE
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SLIDE 1
- -------
o PHPNJ representative will present reasons for considering BCBSNJ/HMO Blue,
a major health insurer in New Jersey, as an entity to align with. The
reasons are bulleted on the slide.
SLIDE 2
- -------
o PHPNJ representative will introduce HMO Blue Leadership:
Christy Bell o Senior Vice President, Health Industry Services, BCBSNJ
o President, HMO Blue - responsible for Provider
Contracting, Public Relations, Medical Management and
HMO Subsidiaries
o Twenty-five years managed care experience - previously
serving as Executive Director of Humana Medical Plan in
South Florida and as Executive Director for Fallon
Community Health Plan in Massachusetts.
Donna Celestini o Vice President of Managed Care, BCBSNJ
o Executive Vice President, HMO Blue
o Twenty plus years BCBSNJ experience in Financial,
Contracting, and Underwriting functions. Five years
experience in HMO Blue, with accountability for
Administration, Special Programs, Integrated Delivery,
Finance and Operations.
Dr. Lawrence Baker o Chief Medical Officer, HMO Blue
o Twenty years managed care experience - previously
serving as Chief Medical Officer and Senior Vice
President for Merck-Medco Managed Care and as Senior
Vice President for Medical Affairs at Tufts Associated
Health Plans in Massachusetts.
<PAGE>
Page 2
SLIDES 3, 4, 5, and 6
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o HMO Blue Representatives will review HMO Blue's Mission, Vision and Goals
o Describe How we Get Input from Members and Providers
-- Committees, surveys, forums, telephone and written communications
o Describe How we Achieve our Goals
-- TQM principles
-- Provider "partnerships"
o Describe What "Physician Directed, Market Driven Healthcare" Means
-- We have to provide what our customers want in a way that allows
physicians to provide healthcare services without unnecessary
interventions
SLIDES 7, 8, 9 and 10
- ---------------------
o HMO Blue Representatives will describe BCBSNJ's managed care growth and
marketshare
SLIDE 11
- --------
o HMO Blue Representatives will describe current HMO Blue initiatives
o Physician "Partnerships"
-- Innovative changes in incentive programs and risk-sharing opportunities
-- More provider input into development of policies and procedures
o Hassle-Free Managed Care
-- Direct access to OB/GYN's
-- Improved referral process
-- Specialists as PCP's for chronic cases
-- 24 hour medical director availability
-- Reduced pre-authorization requirements
-- 24 hour nurse line
-- Expanded network
<PAGE>
Page 3
o World Class Customer Service
-- Extended telephone service hours
-- Efficient claims processing
-- Streamlined processing of emergency room claims
-- Provider directory on-line
-- Service quality initiatives
o State of the Art Utilization Management
-- Regional presence
-- Collaborative medical management
o Disease Management
-- Current status
o Improving Health Status of our Members
-- HEDIS results
-- New programs
SLIDE 12
- --------
o HMO Blue Representative will review Department of Medical Affairs
o Enhanced Medical Leadership
-- Regional medical directors
-- Current staff of medical directors
o "Doc to Doc" Communication
-- Availability of medical leadership to participating providers
o Regional Presence
-- Plans for expansion
o Re-engineered Utilization Management
-- Hospital relationships
-- Streamlined procedures
-- Changes in contracting
-- One face to providers
-- On-site concurrent review nurses
<PAGE>
Page 4
SLIDE 13
- --------
o HMO Blue Representative will describe Physician-Related Initiatives.
o Provider Relations Enhancements
-- Regional presence
-- More reps in field
o Fee for Service vs. Capitation Changes
-- Fee for service up to panel sizes of 250
o Increase in Billables under Capitated Arrangements
-- HMO Blue will allow physicians under capitation to bill for services
that traditionally have been covered under capitation
o Provider Data
-- HMO Blue will provide individual provider reports that will show their
results vs. their peers
o Provider Risk Sharing
-- HMO Blue will describe plans for risk sharing arrangements with
provider groups
o Enhanced Provider Incentive Programs
-- HMO Blue will describe the changes planned for 1998 in its current
physician incentive programs
SLIDE 14
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o HMO Blue Representative will describe the PHPNJ participation on
BCBSNJ/HMO Blue committees and panels which are responsible for
development of programs, policies and procedures
SLIDE 15
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o HMO Blue Representative will describe HMO Blue's committees structure and
committee responsibility
