The Landscape of Health Care

the Landscape of Health Care

UPMC HEALTH PLAN 2006 ANNUAL REPORT

One Chatham Center 112 Washington Place Pittsburgh, PA 15219 www.upmchealthplan.com winds of change Windsof Change

The world of health care is one of constant movement and transition. UPMC Health Plan harnesses this energy to offer the best value to our customers, while never losing focus on our top priority: the well-being of our members. We are creating beneﬁ t solutions and continuously ﬁ nding new and better ways to improve our members’ health and the health of our local communities.

Our extensive network offers members the ﬁ nest health care from world-renowned medical experts, the latest medical breakthroughs, and the most innovative and effective health promotion programs in the region.

Our quality, satisfaction, and cost outcomes bring value to each of our stakeholders, including the employers we serve, our members, physicians, and the community.

We draw from the best to deliver the best, maximizing value and protecting the most precious resources of our community: the men, women, and children of Western Pennsylvania.

President’s Letter 2

Common Ground: Network 4

Conﬂ uence of Care: Product Portfolio 12

Reaching New Heights: Service 30

Building Bridges: Community Partnerships 34

Financial and Corporate Information 38

1 President’s Letter President’s Letter

In the pages that follow, we explore the distinc- tive topography of Western Pennsylvania, At UPMC Health Plan, we understand that innovation, along as captured by with service excellence, creates the bedrock for health care Pittsburgh photogra- pher Richard Kelly. solutions that employers, members, and communities value. Our hills and rivers, as By providing competitive pricing, a comprehensive and much as our people, help deﬁ ne our region. robust network, quality programs, and unmatched service, Here, water rushes we enable our members to receive the best health care along Slippery Rock from the region’s premier physicians, as well as exceptional Creek in McConnells Mill State Park in health promotion and wellness programs. Lawrence County. A favorite destination The past year was an exciting one for the Health Plan. for paddlers and rock climbers, the park We continued to leverage our close provider, academic, and includes the 2,500-acre Slippery Rock Gorge. industry relationships to create new programs for our members. We developed additional ways to give members tools to Staying improve their health status, including easy online access to personal health information, telephone coaching, and health improvement programs.

The MyHealth program continues to support employers committed to helping their employees achieve better health.

We established new approaches to improve cost and quality transparency, as well as new services such as UPMC Work Partners, which includes workers’ compensation and Diane P. Holder, President short-term disability programs. UPMC Health Plan UPMC Insurance Services Division As other health insurers consolidate nationwide, UPMC Health Plan is committed to remaining a local resource for our members. Our major focus continues to be on Western Pennsylvania, and we are proud of our efforts and results in the region. On the pages that follow, you will read about how the Health Plan and the companies of the UPMC Insurance Services Division are successfully changing the terrain of today’s health care landscape by providing products and services with our customers’ best interests in mind.

As the Health Plan celebrates its 10-year anniversary, I would like to take this opportunity to thank our employer partners, our members, our physicians and hospitals, and our employees for another successful year.

I am pleased to present you with this overview of our accomplishments in the past year and our vision for the future.

2 Changing the Landscape of Health Care Photo by Richard Kelly 3 Network Network

CommonGroundm A shared vision of excellence

At UPMC Health Plan, we think about our provider network Just steps from the University of Pittsburgh’s one member at a time. We make sure our doctors and research and medical facilities, Schenley Park offers trails and solitude hospitals are close to where people live and work, and we in the heart of the city. make sure every medical specialty is covered. Our extensive pharmacy network makes it easier for members to obtain the medications they need.

But our idea of common ground goes beyond geography. We ﬁ nd shared concerns with our customers, understanding that breadth and depth of resources matter to employers. Our shared mission with the University of Pittsburgh Medical Center (UPMC) and other providers strengthens our commitment to our members and brings greater efﬁ ciencies to our business processes.

4 Changing the Landscape of Health Care Photo by Richard Kelly 5 Network Network

Daniel Brooks, MD, is the chief operating ofﬁ cer Melissa McNeil, MD, of Sewickley Valley Hospital and chief medical is chief of the Section ® ofﬁ cer for The Medical Center of Beaver, both part of Women’s Health of To provide seamless service to our members who of Heritage Valley Health System. Heritage Valley the Division of General live or work outside of our Western Pennsylvania works collaboratively with UPMC Health Plan on Internal Medicine area, we partner with PHCS, a national provider a number of projects that involve the community at the University of network. PHCS has a network of nearly 450,000 in areas such as diabetes testing, mammography Pittsburgh. Dr. McNeil physicians and 4,000 facilities across the country. screening, and other preventive services. pioneered the integra- tion of comprehensive women’s health services as part of the

practice of internal ™ medicine. MMO serves our Ohio members through its more than 190 hospitals and 20,000 physicians. A Comprehensive Hospital Network 92% of the hospitals in the Western Pennsylvania region are part of the ® UPMC Health Plan network, which includes more than 80 hospitals. Whether our members travel within the U.S. or in foreign lands, they continue to have easy access to care through our travel assistance partner, Assist America. This beneﬁ t enables members to A Comprehensive Provider Network The physicians in our network are carefully selected locate doctors and hospitals and access emergency based on solid credentialing criteria. Every medical care. Assist America personnel can help replace 200 = Obstetrician-Gynecologists specialty is represented—there are no gaps. prescriptions, provide emergency medical Physicians 382 evacuation, and arrange transportation for family Pediatricians members to join sick or injured relatives. 444 Primary Care Physicians Specialists 2,069 4,547

A provider network without gaps Collaborating to improve care Hospitals in the UPMC Health Plan Commercial Network UPMC Health Plan has the depth and In partnership with our network providers, Allegheny County Butler County Fulton County Potter County breadth to serve every member well. we continue to ensure that members Children’s Hospital of Pittsburgh Butler Memorial Hospital Fulton County Medical Center Charles Cole Memorial Hospital Eye & Ear Institute UPMC Passavant Cranberry Our network of over 80 hospitals and get the right care, in the right amount, Jefferson Regional Medical Center Greene County Somerset County Kindred Hospital of Pittsburgh Cambria County Southwest Regional Medical Center Meyersdale Medical Center more than 7,500 physicians makes at the right time. Lifecare Hospital of Pittsburgh Memorial Medical Center Somerset Hospital up one of the most comprehensive Magee-Womens Hospital of UPMC –Lee Campus Huntingdon County Windber Medical Center In 2006 we began a program in which Mercy Hospital –Main Campus J.C. Blair Memorial Hospital teams of providers in the region. The care management professionals visit Ohio Valley General Hospital Miners Medical Center Tioga County Health Plan’s network includes 92% of Sewickley Valley Hospital Indiana County Soldiers and Sailors Memorial Hospital high-volume physician practices. These St. Clair Memorial Hospital Clarion County Indiana Regional Medical Center the hospitals in Western Pennsylvania. The Children’s Institute Clarion Hospital Venango County care managers, all of whom are regis- The Children’s Home of Pittsburgh Jefferson County UPMC Northwest For members who live or work outside tered nurses and certiﬁ ed educators, UPMC Braddock Clearfield County Brookville Hospital UPMC Cancer Centers Clearfield Hospital Punxsutawney Area Hospital Warren County of Western Pennsylvania, we offer help members manage chronic condi- UPMC McKeesport Dubois Regional Medical Center Warren General Hospital UPMC Montefiore Lawrence County the national PHCS network of 4,000 tions. The focus is on early intervention UPMC Passavant Crawford County Ellwood City Hospital Washington County facilities and 450,000 physicians; Ohio and making sure members get the care UPMC Presbyterian Meadville Medical Center Jameson Health System Monongahela Valley Hospital UPMC Shadyside Titusville Area Hospital –North Campus The Washington Hospital residents who are members have they need—resulting in better health UPMC Sports Medicine –South Campus access to the MMO network of 190 and lower long-term costs. UPMC St. Margaret Elk County Westmoreland County UPMC South Side Elk Regional Health Center McKean County Frick Hospital Excela Health hospitals and 20,000 physicians. Western Psychiatric Institute and Clinic –St. Marys Health Center Campus Bradford Regional Medical Center Latrobe Area Hospital Excela Health Expanded in 2006 was our Hospital Members traveling 100 miles or more –Ridgway Health Center Campus Kane Community Hospital Mercy Jeannette Hospital Care Coordination program. Our care Armstrong County Westmoreland Regional Hospital from home have access to the services Armstrong County Memorial Hospital Erie County Mercer County Excela Health coordinators work with hospital person- Hamot Medical Center Grove City Medical Center of Assist America. Assist America staff nel at several network hospitals to make Beaver County Millcreek Community Hospital UPMC Horizon Outside Pennsylvania can help members locate hospitals The Medical Center of Beaver Saint Vincent Health Center –Greenville Campus Weirton Medical Center (West Virginia) sure our members get the proper level Aliquippa Community Hospital –Shenango Campus Wheeling Hospital (West Virginia) and physicians, replace prescriptions, Fayette County Memorial Hospital and Medical Center of care in the most appropriate setting. Bedford County Highlands Hospital Mifflin County of Cumberland (Maryland) and access other emergency travel UPMC Bedford Memorial The Uniontown Hospital Lewistown Hospital Sacred Heart Hospital (Maryland) services anywhere in the world. Blair County Altoona Hospital Nason Hospital Tyrone Hospital

6 Changing the Landscape of Health Care 7 Network More than 3,000 Armstrong County elementary Network school students and their families are taking steps toward better health, thanks to an initiative funded in part by UPMC Health Plan. The community-based program aims to reverse the troubling rise in childhood obesity rates.

“Our goal is to promote wellness and healthy lifestyles across the entire community, not just among those who are overweight,” says pediatri- cian Kiran Bhat, MD, of Children’s Community In an independent survey, Pediatrics–Armstrong. Dr. Bhat and Patricia Shiring 88% of physicians reported (right), executive director of the ACMH Hospital Foundation, along with the Armstrong County that they were satisfi ed School District, are part of the grassroots effort to reverse the rise of childhood obesity rates in with UPMC Health Plan, Armstrong County. The program includes physical compared to a score of 80% activities, as well as menu and cooking advice from nutritionists. for all other health plans.

“ When the entire UPMC Health Plan’s “Excellent” accreditation community is healthier, from NCQA is based on a set of standardized everyone benefi ts.” performance measures Dr. Kiran Bhat Care Org designed to ensure d C an e iiz that purchasers and g a consumers have the a tt n o information to reliably a nn compare health care

M Photo by Richard Kelly plans.

Improving community health Achieving high-quality outcomes Emphasis on performance UPMC Health Plan partners with the for our members We continue to expand our pay-for- physicians and hospitals of UPMC as Our close working partnerships with the performance programs, collaborating EX XCELLENT well as other leading community hospi- physicians and hospitals in our network with physicians and hospitals to tals and physicians to build strong, enable us to provide consistently high- implement performance measures healthy communities. Working alongside quality service and continue to improve that are manageable and meaningful. UPMC physicians and other community clinical outcomes and the health of By measuring network physician doctors, we speak the same language the community. In 2006, the National practices against clinical, quality, and and help translate best practices Committee for Quality Assurance administrative standards, the Health and the latest fi ndings into improved (NCQA), a nonprofi t organization that Plan helps physicians help their patients. medical outcomes for our members. evaluates managed care organizations, performed the second full audit of our High physician satisfaction scores An example is the Health Plan’s products and services. Once again, we Each year, physicians rate UPMC Health collaboration in an Armstrong County received an “Excellent” accreditation Plan and all other health plans in which community-based program to reverse from NCQA, the highest honor a they participate on performance and the troubling rise in childhood obesity managed care company can earn, for service measures. Results obtained rates. The Health Plan is contributing our commercial HMO and point-of- through an independent survey indicate both funding and the services of its service plans, our Medicaid plan, and that 88% of physicians who responded weight management experts to support our Medicare Advantage plan. reported that they were “very satisfi ed” this effort to improve the health of more or “somewhat satisfi ed” with UPMC than 3,000 elementary school students We recognize that collaboration with Health Plan, compared to an average and their families. Children’s Community our network physicians and support satisfaction score of 80% for all other Pediatrics–Armstrong, ACMH Hospital of the doctor-patient relationship are health plans. Foundation, and the Armstrong County essential in our efforts to continue School District are partnering with to provide members with the highest the Health Plan to lead this initiative. quality of health care.

8 Changing the Landscape of Health Care 9 Network Network

A Choice of Pharmacies We save our members Wherever You Go money by encouraging the use of generic drugs. Our national pharmacy network includes Our drug formulary nearly 30,000 independent pharma- features effective, high- cies and notable retail chains, including quality generics at affordable copayments. Eckerd, Giant Eagle, Kmart, Rite Aid, Sam’s In 2006, the generic Club, Target, Walgreen’s, and Wal-Mart. substitution rate for the Health Plan’s drug Our list of covered drugs, called a formu- coverage claims was lary, is developed by our Pharmacy and nearly 59%. Therapeutics Committee along with Health Plan physicians and pharmacists, community physicians, nurses, pharmacists, and University of Pittsburgh Medical Center physicians. The result is a high-quality, cost-effective formulary that includes both generic and brand name drugs. Our clinical pharmacists work closely with care managers and network physicians to maximize The number of the value of prescription beneﬁ ts. Appropriate drug national retail chain utilization, compliance, and drug safety are key and independent elements of our medication management programs. pharmacies in the Health Plan’s network is close to

300,000 Robust pharmacy services Helping members use UPMC Health Plan places emphasis medications safely on integrating all aspects of health care, To promote safe, appropriate, and cost- including pharmacy services. We offer effective drug therapy for our members, innovative solutions to lower pharmacy Health Plan pharmacists conduct on- costs while maintaining the highest level going reviews of claims data. They look of care and service. Our in-house clinical for potential problems such as duplica- pharmacists work closely with our care tion of drugs and drug interactions managers and with physicians and net- and collaborate with fellow pharma- work pharmacists to maximize the value cists, care managers, and physicians of our members’ prescription benefi ts. to determine appropriate solutions Interactive tools enable members to use to any problems that are uncovered. a cost estimator to get personalized Easy, convenient, and accessible Integrating pharmacy and medical data information, based on their benefi t level, Our comprehensive pharmacy services helps us to obtain the best outcomes before they go to the drug store. include access to a large network of for our members. retail chains and independent pharma- The site also provides an individual cies. These pharmacies are conveniently Helping members save money list of all prescriptions fi lled in the last located in Western Pennsylvania and The combined strength of UPMC Health six months for each covered family across the country, with some locations Plan and Express Scripts, our pharmacy member. The lists can be used for accessible 7 days a week, 24 hours benefi ts manager, gives members the family tax and accounting purposes. a day. Through our mail order service, advantage of an enhanced network and Members can use the Health Plan’s members’ maintenance and specialty improved integrated services. website to order prescriptions, check medications can be delivered to their copayment levels, review the home or doctor’s offi ce. drug formulary, locate a pharmacy, and access benefi t information.

10 Changing the Landscape of Health Care 11 Product Portfolio Product Portfolio

Barges greet the morning at The Point in downtown Pittsburgh, where the Allegheny and the Monongahela meet to form the Ohio River. ConflCare uence of GoodGo health is good business

UPMC Health Plan brings together a comprehensive array of products, programs, and services to form a continuum of care that embraces all members. This integrated product portfolio enables us to help our members and the people in the communities we serve to lead healthier lives.

We offer a wide choice of beneﬁ t plans, from HMOs and PPOs to consumer-directed plans. We also support our members in making healthy lifestyle choices by offering a variety of telephone and workplace health promotion programs and health management services. And we service our clients personally, sharing timely data and making cost-saving recommendations.

12 Changing the Landscape of Health Care Photo by Richard Kelly 13 Product Portfolio Product Portfolio

UPMC Insurance Services Division Offerings

UPMC Health Plan Commercial HMO EAPOS PPO EPO Consumer Products Advantage®

Member’s care is Member is encouraged Member can go to Member can receive High-deductible plan UPMC Health Plan offers a wide choice of beneﬁ t coordinated by a PCP to have a PCP, but provider of choice in care from any network coupled with tax-advantaged plans. We service our clients personally, and our can self-direct care or out of network provider funding source service team for each account includes members of our clinical, health promotion, pharmacy, and UPMC ﬁ nance staff. This approach enables us to share Work Partners Health EAP Workers’ Short-Term timely data with our clients and make recommen- Promotion Solutions Compensation Disability dations that help them get the most for their health insurance dollar. UPMC for You Educational and wellness Counseling and Clinical and administrative Claim management (Medical programs encouraging consultation services disability management service and return-to-work Assistance) healthy lifestyles for employees services program

UPMC for Life (Medicare) UPMC HMO HMO PPO PPO Prescription PFFS Health Plan with Rx with Rx Drug Plan Plan for people Government UPMC for Life eligible for both Medicare Advantage Medicare Advantage Medicare Advantage Medicare Advantage Medicare Part D Medicare Advantage Programs Specialty Plan Medical Assistance $0 monthly premium HMO plan with prescription PPO plan PPO plan with prescription prescription drug Private Fee for (SNP) and Medicare HMO plan drug coverage drug coverage coverage Service plan Plan for UPMC for Kids™ uninsured children (CHIP) not eligible for Medical Assistance

Community Care UPMC Insurance Services Division offers Behavioral Commercial Medicare Medical Health Assistance a full range of commercial and government health beneﬁ t products to serve the needs Behavioral health coverage Behavioral health coverage Behavioral health coverage of Western Pennsylvania’s diverse for UPMC Health Plan for UPMC for Life for PA HealthChoices population. commercial members Medicare members Medical Assistance members

A plan for everyone All members have access to our exten- For members who live or work outside Commercial Products As part of the UPMC Insurance Services sive network of outstanding physicians of Western Pennsylvania, we offer The rising cost of health care creates Division, the Health Plan continuously and medical professionals and to the national PHCS network of 4,000 a struggle for employers who want seeks to expand its product offerings to the facilities and services of UPMC and facilities and 450,000 physicians; to provide employees with high-quality include all segments of the community. excellent community hospitals. Ohio residents who are members have coverage while controlling expenses. access to the MMO network of 190 Our integrated suite of programs is This network includes more than 80 UPMC Health Plan is harnessing the hospitals and 20,000 physicians. designed to improve members’ health, hospitals and 7,500 physicians to power of innovation to offer superior Members who are traveling 100 miles control costs, and maintain competitive serve our members in the Western health care solutions. or more from home have access to rates. In 2006, UPMC Work Partners Pennsylvania area. It also includes the worldwide assistance services of UPMC Health Plan offers a wide array was incorporated into the Division, 30,000 independent and retail chain Assist America. Assist America staff of benefi t plans. Employers large enabling the Health Plan to offer full- pharmacies across the country. can help members locate hospitals and and small can offer their employees service health promotion, employee Our close collaboration with our network physicians, replace prescriptions, and plans ranging from HMOs and PPOs assistance, workers’ compensation, and hospitals and physicians enables us to access other emergency travel services. to high-deductible consumer-directed short-term disability programs. These offer the fi nest health care, the latest plans that include health savings programs are fully integrated under medical break-throughs, and the most accounts (HSAs) or health reimburse- the Insurance Services Division umbrella, effective health management programs ment accounts (HRAs). We offer providing a seamless health benefi ts in ways that no other insurer in the employers the opportunity to work experience for employer groups. region can match. closely with our senior staff to customize their plan designs to match their business requirements and the needs of their employees.

14 Changing the Landscape of Health Care 15 Product Portfolio Product Portfolio

The Health Plan’s The Health Plan’s new award-winning tobacco MyHealth Record is an cessation campaign online tool designed to materials promote the help members be more MyHealth Ready to engaged in their health Quit Line. Members care. The MyHealth who need help to stop Record provides a secure smoking can call this and private website number any time. to store and manage a member’s personal health care information. The goal is to provide an educational way for members to manage chronic illnesses, participate in wellness programs, and improve their overall health.

RECORD

Commercial Products, continued nutrition, and the physiology of exercise. Keeping track of personal Coaches help members who want to quit medical history Helping employers make Our new MyHealth Record is an online a healthy workplace tobacco, manage weight, or increase tool designed to help members keep UPMC Health Plan collaborates with physical activity. Our Health Coach Line health information current, stay on top leading experts at the University of and our Ready to Quit Line for tobacco of annual screenings, and work with Pittsburgh Medical Center (UPMC) to cessation support are available 24/7. their physicians to maintain an accurate develop evidence-based assessments Assessing health status history. and programs that address the needs Our online health risk assessment tool, of members at every level of health. known as the MyHealth Questionnaire, Here’s how it works: Every claim allows members to build a personal submitted in a member’s name for tests, In 2006, we expanded the MyHealth health profi le and receive immediate procedures, offi ce visits, prescriptions, program, which includes online tools • Reminders for managing chronic feedback about their health status. The and other covered benefi ts is automati- and resources, discounts on physical medical conditions questionnaire is available to all com- cally incorporated into their MyHealth fi tness activities, medical screenings, • Record. Members can fi ll in the rest of Health resources linked to results of worksite seminars and exercise mercial members as part of enrollment diagnostic testing their health history, entering information programs, and telephone coaching. in the Health Plan. at any time, from anywhere, 24/7. They The MyHealth Record is secure and Health coaching, online, and The Health Plan also offers onsite can note family history, new symptoms, confi dential and is held to the same onsite support for healthy living screenings by medical professionals, who over-the-counter medications, and other security standards as customer In 2006, features were added to measure body mass index, levels of health-related information that may information in the banking and fi nance MyHealth OnLine to support members carbon monoxide, cholesterol, and blood not be captured in our claims database. industries. Members are the only ones in making informed decisions about glucose. Professional health coaches who can retrieve or edit their record, Additional benefi ts for members include: their health. meet one-on-one with participants which is accessed through the • Continuously recorded results of tests after testing to discuss their results and Health OnLine portal of the Health Also in 2006, we expanded our staff and lab work My offer them strategies for lifestyle Plan’s website at upmchealthplan.com. of professional health coaches who are improvements. • Personal and family health history trained in health education, counseling,

16 Changing the Landscape of Health Care 17 Product Portfolio Product Portfolio

UPMC Health Plan nurse care managers combine their special expertise with information-system support to make the most of their time on the The Health Plan offers phone with members. worksite health screen- They measure success in ings that measure decreased emergency- employees’ cholesterol, room visits and hospital blood pressure, glucose, admissions—as well body mass index, and as in the one-on-one carbon monoxide levels. celebration of a member’s Participants receive a improved scores on printout of the results on the spot and have a cholesterol test or a the opportunity to healthy lifestyle goal discuss them with a that’s been met. health coach.

If the screening results indicate that an employee would beneﬁ t from one of our care management programs, the health coach encourages him or her to participate.

Health Management Identifying gaps in care explains the signs, symptoms, and Technology helps chronically ill In 2006, UPMC Health Plan’s clinical potential hazards associated with members remain at home UPMC Health Plan is also breaking specialists and IT team worked together specifi c chronic conditions, as well as The Health Plan is collaborating with new ground to help members prevent to develop new software-based systems the medications used in treatment. providers in deploying a new technology debilitating medical conditions and to support our care managers. If an to help members with congestive control the costs—in both human terms For specifi c surgeries, the program essential test or protocol—such as an heart failure (CHF) learn to manage their and health care dollars—that these provides an overview, explains what the annual dilated retinal eye exam for own health and remain independent. diseases impose. patient needs to know, describes the a member with diabetes—is missing The Health Plan is able to provide tele- procedure, lists recovery expectations, The Health Plan offers condition-specifi c from the system’s step-by-step reporting health stations in the homes of members and offers alternatives to surgery. programs for members with a variety of of the member’s doctor visits and with CHF who are served by home conditions, including diabetes, asthma, tests, the care manager can easily Our consumer-oriented tools include health nurses. These stations monitor and cardiac diseases. In 2006, we identify the gap and assist the member quality and cost comparison tools. the members’ vital signs and routinely expanded our low-back-pain program in accessing the needed care. The Cost of Care Estimator allows report them to the members’ physicians to include collaboration with physical members to determine estimated costs and the Health Plan’s care managers. Online tools help members make therapy and chiropractic practices as health care decisions for hundreds of common conditions, By monitoring vital signs at the same part of the growing holistic approach The Health Plan offers members with procedures, and tests, as well as routine time every day, members learn to to treatment of chronic low back pain. chronic conditions access to online and specialized health care visits. recognize changes in weight, blood In our health management programs, information and tools to help them Members can fi nd additional information pressure, or blood oxygen levels. They care managers have regular contact manage their illness. online with the Web-based hospital learn ways to improve their symptoms SM or seek appropriate medical care. with members. They encourage the The Health Plan’s Emmi program, intro- comparison tool, Hospital Advisor . most effective use of medications and duced in 2006, uses an online This increased transparency of informa- testing in line with current guidelines. audio “tour guide” to answer the most tion can help members choose hospitals common questions about chronic based on quality and safety measures. illnesses and about hundreds of necessary and elective surgeries. The guide

18 Changing the Landscape of Health Care 19 Product Portfolio Product Portfolio

Health Plan Loses More Than a Ton “ Taylor’s Souper Models” Health care workers at UPMC McKeesport hospital Aaron Huet, Jessica participated in the UPMC Health We’ve Got Your UPMC Health Plan employees lost 3000+ My Todd, Greg Rayman, Back pilot. This program uses BodyMap® diagnos- pounds—an astonishing 1½ tons of Rob Triffanoff, and Matt tics and exercise instruction to help workers whose weight—during the 12-week MyHealth Mauclair, the winners jobs put them at risk for back injuries. Steeler of UPMC Health Plan’s “McKeesport Mike” Logan (shown in background) Weight Race. The event attracted more MyHealth Weight Race, lent his support to the initiative. than 500 participants, who were encour- lost a greater percentage aged to reach sensible weight loss of goal weight than any of the other 99 teams. With support from UPMC Health Plan, Pietragallo Bosick & Gordon initiated goals by forming teams and engaging a wellness program in 2006. Shown in the photo are the ﬁ rm’s Wellness in healthy lifestyle activities. Each team Committee members, who enthusiastically helped implement the program and encouraged co-workers to participate. of ﬁ ve was paired with a senior-level manager who lent his or her name to the Estimated Lost Work Hours Research shows that poor control of certain team and a health coach who provided chronic medical conditions leads to lost productivity extra motivation and support. Understanding and Addressing By 2012, disability costs and excessive absenteeism among workers— Health Risks for workers ages 45 to additional costs that few employers can afford. Through MyHealth, we offer worksite 64 are expected to rise Group Health Absence/ 37%. UPMC Health programs like the Weight Race to help Insurance Paid Time Off Plan uses comprehen- Estimated employers promote a healthy work • Claims Data Workers’ Lost Hours sive data to determine Condition per Week environment and to support employees • Prescriptions Compensation member health risks in reaching their personal health goals. • Health Risk Short-Term and develop programs Diabetes 11.4 Assessment Disability that address these risks.

• Such programs can Biometric Family & Medical Leave/ High Cholesterol 6.1 Screenings Paid Leave of Absence help employers direct their limited health care dollars toward helping Body Mass Index over 30 (obesity) 5.8 their workforce become Data Integrated Gathering Health Care healthier. Hypertension 5.1 and Analysis Programs Smoking 4.2

Source: Journal of Occupational and Environmental Medicine

UPMC Work Partners Recent literature shows a correlation Partners for good health between some health conditions, such In 2006, the law ﬁ rm Pietragallo Bosick In 2006, UPMC Work Partners was as depression, and higher rates of job- & Gordon launched a wellness program incorporated into UPMC’s Insurance related injuries. Other studies link high to support employees in adopting Services Division. This addition enables blood pressure, high glucose, and high healthier lifestyles. UPMC Health Plan the Health Plan to offer employer groups LDL with devastating consequences helped initiate the program by facilitating full-service health promotion through such as kidney failure, blindness, stroke, an onsite health screening and a weight- the MyHealth program, employee and heart attack. loss competition. In 2007, the ﬁ rm added assistance through EAP Solutions, and stress management, weight manage- workers’ compensation programs. Understanding what health risks are ment, and nutrition components to the present in their workforce can help UPMC Work Partners, one of the area’s program. The Health Plan will implement employers direct their limited health care largest and most capable providers of a screening at the end of the program dollars toward helping their workforce disability-related services, provides both to measure success. In addition to become healthier. occupational and non-occupational lunchtime education sessions presented disability programs. Employees actively engaged in our by the Health Plan’s health promotion health promotion and care management staff, Pietragallo, Bosick & Gordon pro- Targeting limited health dollars programs can begin to lose weight, vides fresh fruit for employees, healthier For employers, the cost of poor health quit tobacco, or dramatically improve choices in the vending machines, means more than just paying for their cholesterol and blood sugar levels. discounts at local bike shops, and medical procedures. It also results in Studies show these types of health walking clubs. lost productivity and absenteeism. improvements help create healthier employees who work more productively and stay on the job longer.

20 Changing the Landscape of Health Care 21 Product Portfolio Product Portfolio

Support in Making Positive Changes Community Care Behavioral Whether a member’s goal is to exercise Health Service Area The Pennsylvania Department of Public Welfare more, eat healthier, improve sleep selected Community Care to manage behavioral patterns, or kick an unhealthy habit, health services for Medicaid members in 23 EAP Solutions offers free, conﬁ dential north-central counties, effective January 1, 2007, and in three eastern counties, effective July 1. coaching and support. EAP can help with: As of July 1, Community Care will be working in

• 35 of the state’s 67 counties. Considering lifestyle changes Implemented before 2007 January 1, 2007, implementation • Choosing a positive, healthier direction in life July 1, 2007, implementation

• Setting and keeping a pace that works for the member to achieve personal goals

• Overcoming backslides

• Having patience and perseverance to reach the ﬁ nish line The Community Care EAP Solutions is quality management committed to improving team and clinical care the health and well- managers collaborate being of employees who closely to improve seek services as well as services and increase organizations that strive member satisfaction. to create a healthy work- Community Care’s place. EAP Solutions focus on quality out- serves employers, health comes and excellent care and educational clinical care distinguish organizations, and it as a leader in the national and regional managed behavioral trade union groups. health ﬁ eld.

EAP Solutions Community Care Behavioral Health The Health Plan and Community Care work together to provide exceptional EAP Solutions, a service of UPMC Work Community Care Behavioral Health, access and service to members who Partners, provides employers with a part of the UPMC Insurance Services require care for depression, bipolar comprehensive program that enhances Division, offers accessible, high-quality, disorder, anxiety, addiction, and other workplace productivity, health, and well- cost-effective care in partnership behavioral health conditions. We collabo- ness. Working in a confi dential manner, with local providers. Community Care rate on clinical practice guidelines, EAP Solutions helps employees and manages behavioral health benefi ts screening and outreach programs, and their families address personal and for UPMC Health Plan’s commercial member education. professional concerns. EAP Solutions and Medicare members. Community provides 24/7 access to counselors Care also contracts directly with the The two companies also work together skilled in services ranging from personal state and with county governments seamlessly to coordinate care; to coaching and counseling to manage- to manage behavioral health benefi ts promote safer, more effective use of ment consultation and training, crisis under Pennsylvania’s Medical medications; and to provide health intervention, and workplace wellness. Assistance HealthChoices program. management for members with multiple illnesses or complex medical conditions. A Work/Life Balance referral program Community Care is active in 35 of helps employees and family members Pennsylvania’s 67 counties. The company address fi nancial and legal concerns, serves nearly one million members elder care, child care, adoption, college whose health coverage is sponsored by planning, and even pet care. Medicaid, Medicare, and UPMC Health Plan commercial plans.

22 Changing the Landscape of Health Care 23 Product Portfolio UPMC for Life members have their own personally Product Portfolio assigned telephone representative, or Health Care Concierge. Concierges are available to help members understand their health care coverage, answer any questions they may have about their medical, dental, UPMC for Life and UPMC for Life vision, and pharmacy benefi ts, and help them fi nd Specialty Plan Service Area providers. Concierges also notify members of special events related to their benefi ts or health and telephone members if they have not heard from them in a while.

In 2006, we added Clearfi eld, Crawford, and Greene counties to our Medicare and Special Needs Plan service area. UPMC UPMC for Life Membership Growth for Life members have 70,000 access to 58 hospitals in the Western 60,828 Pennsylvania region, 60,000 ™ including all UPMC Silver&Fit , a healthy facilities. aging program offered 50,000 48,569 at no cost to all UPMC for Life members, includes membership 40,000 at a local participating fi tness club or an at- home fi tness program 29,620 Richer, more competitive benefi ts and innovative, 30,000 and online health high-quality initiatives such as the Health Care information and tools. Concierge program contributed to the more than 22,131 30% increase in our Medicare membership. The 20,000 UPMC for Life UPMC for Life Specialty Plan was added in 2006 14,994 to serve people who are eligible for both Medicare UPMC for Life 8,717 and Medical Assistance. 10,000 Specialty Plan

2002 2003 2004 2005 2006 2007

Serving Medicare Benefi ciaries Education for providers and Through our care management Support for healthy living members programs, we also provide one-on-one Our Silver&Fit™ program offers our UPMC for Life offers a variety of prod- In 2006, the Health Plan continued to support for members who have Medicare members a wide range of ucts and services that fi t the needs implement a comprehensive educational diabetes, asthma, heart disease, and health-promotion activities at no of older adults—from no-cost plans to campaign to help both our members other chronic conditions. Participants additional charge, including access to prescription drug benefi ts to person- and our physicians understand the can speak with our nurse health online information, membership at alized customer care. Medicare prescription drug options. managers over the phone and receive local fi tness centers, and an at-home Our comprehensive suite of Medicare We offer hundreds of seminars for support in following their doctor’s exercise program. offerings includes plans with and Medicare benefi ciaries at convenient plan of care and encouragement in UPMC for Life Specialty Plan without prescription drug coverage. Our locations throughout the area. making health lifestyle changes. They The Health Plan introduced a no-cost Medicare products are available to also receive educational materials Service with a personal touch Special Needs Plan in 2006 for people individuals and to employer groups that about their condition and reminders UPMC for Life members who have who are eligible for both Medicare and wish to offer retirement benefi ts. to get important tests. questions about their Medicare Medical Assistance. This plan combines In response to the federal government’s benefi ts can call their personal Health Our Living at Home program helps the coverage and protection of both implementation of the Medicare Mod- Care Concierge any time. As part of older members remain in their homes programs. ernization Act, we introduced a Part D our unique and innovative concierge and identifi es community resources These members also receive Health Prescription Drug Plan (PDP) in 2006. program, each member receives that can provide support. Care Concierge services and are Our PDP provides affordable coverage periodic calls from a special customer enrolled in our Active&Fit™ program, for both generic and brand name drugs. representative—a concierge—assigned specifi cally to that member. Members which includes membership in a We recently began offering employers are encouraged to call their personal participating fi tness center, an at-home in Pennsylvania, Ohio, and West Virginia concierges with concerns about their exercise program, and access to a Private Fee for Service Medicare plan health care benefi ts. an educational website and a toll-free for their retirees. member services hotline.

24 Changing the Landscape of Health Care 25 Product Portfolio UPMC for You Service Area Product Portfolio

UPMC for You serves UPMC for Kids provides members in 14 coun- comprehensive coverage ties, with the high- for children who would est concentration of not otherwise have health members in Allegheny insurance. Members County. Because we of this program are also are part of UPMC, our eligible for Healthy Medical Assistance Living Rewards for Kids, members have access a program that provides to some of the ﬁ nest discounts on health doctors and hospitals and ﬁ tness products in the region. and services.

UPMC for Kids Service Area In December 2006, UPMC for You Our Children’s Health Insurance Program, members reached called UPMC for Kids, is available in 27 counties. a total of CHIP provides medical coverage for all children in the state, regardless 90,910 of income. Community Programs UPMC for a New Beginning UPMC for Kids Children’s Health Our MyHealth Advice Line is available to Because a healthy community begins Insurance Program parents 24/7. The Advice Line is staffed UPMC for You with healthy babies, we focus special by trained nurses who can answer One of our most important goals is to Coverage for every child attention on mothers-to-be. Designed health-related questions and assess the serve all members of the community— As a result of the 2006 Cover All Kids specifi cally for UPMC for You members, seriousness of a child’s condition. young and old, healthy and sick, affl uent expansion of the Children’s Health our maternity program, called UPMC and poor, urban and rural. Through Insurance Program (CHIP), every child Services that support healthy kids for a New Beginning, provides education UPMC for You, our Medical Assistance in Pennsylvania is eligible for health Children in our UPMC for Kids program and coordination of care throughout program, we reach out to the disadvan- insurance coverage. are also eligible for our care manage- pregnancy. Our team identifi es women taged residents of Western Pennsylvania. ment services for a range of medical at risk for complications and helps Regardless of family income, children conditions, including asthma and UPMC for You offers a comprehensive them to arrange clinical care with their under age 19 can qualify for CHIP if they diabetes. Our special services also benefi t program for people who are obstetricians. are not eligible for Medical Assistance include nutrition counseling for over- eligible for Medicaid. Our goal is to get and are not covered by employer- As part of this program, a maternity weight children and smoking people the right care at the right time. sponsored health insurance. CHIP is a health manager encourages the member cessation programs and products. Programs focused on pediatric obesity, state and federally funded program. to follow her doctor’s plan of care and smoking cessation, and other preven- UPMC for Kids members have access connects her with support services if The Health Plan’s CHIP program is tive services are available. to our MyHealth OnLine educational needed. After the baby is born, a mater- called UPMC for Kids™. Our CHIP materials and tools for maintaining and We work closely with our UPMC for You nity care manager follows up to ensure product offers a wide range of benefi ts, improving health, and Healthy Living members and our physician network that mother and child are receiving the including preventive care and sick visits, Rewards for Kids, a program that pro- to help members get the health services necessary clinical services. behavioral health care, emergency vides discounts on health and fi tness- they need, including childhood and and hospital care, prescriptions, and In 2006, more than 635 women oriented retail products and services. adolescent immunizations, breast cancer dental and vision care. received the free infant car seats that we screenings, prenatal and postpartum offer as part of our maternity program. care, and comprehensive diabetes and asthma care.

26 Changing the Landscape of Health Care 27 Product Portfolio Product Portfolio

The power of a doula relationship lies in sharing: sharing birth experiences, sharing wisdom, “ It would and—in the case of the UPMC Health Plan doula pilot program—sharing a neighborhood. Mothers- have been very to-be and doulas are matched, in part, based on where they live. hard if she Doula Courtney Sage coached member Charla Johnson through the birth of her daughter, wasn’t there.” Khiyah, in early 2006. Charla lives in Swissvale, while Courtney lives in Pittsburgh’s East End. Charla Johnson Like many parents-to-be, Charla wanted to provide her baby with the best care possible— a concern Courtney was able to address with advice and coaching.

Photo by Richard Kelly

Outreach to mothers-to-be Working under the direction of physicians A healthy eating program for children UPMC for You is one of the ﬁ rst health specializing in obstetrics, the program In an effort to prevent diabetes and insurers in the nation to provide recruits and trains women from the related health problems, the Health Plan coverage for doulas, women who offer local community to serve as doulas. offers personalized help to UPMC for non-medical, emotional, and informa- As members of the community, the You members with overweight children. tional support to mothers before, during, doulas understand and are often helpful Called HEALTH for Families, our program and after childbirth. The Health Plan’s in resolving the issues these women includes shopping trips with personal doula pilot program, a collaboration face. They can work with mothers-to-be nutritionists and weekly telephone calls of UPMC Health Plan, Magee-Womens to help reduce risk factors associated to help families learn about nutrition, Hospital, and East Liberty Family with premature birth as well as low- healthy eating, and meal preparation. Health Care Center, is designed for our birth-weight rates. These factors include One of the primary goals of the program UPMC for You members in the timeliness of prenatal care, smoking, is to support parents in helping their UPMC Braddock hospital service area. nutrition, and stress. children to choose the healthiest foods One of the goals of this community Through this program UPMC Health Plan to eat from each of the food groups in outreach program is to reduce the hopes to strengthen the health of the the Food Pyramid. The program features low-birth-weight rate for its members community by reducing disparities in the Go Slow Whoa eating plan, which who live in the Braddock community care and improving clinical and ﬁ nancial uses color to encourage families to by helping women access early, outcomes associated with high-risk choose foods that are high in nutrition high-quality prenatal care. In 2003, pregnancies. and low in fat and calories. The eating more than 11 percent of all babies plan is available as a printed book and born in Pittsburgh were considered as an interactive online tool. A screen to be low-birth-weight babies (less from the online version of Go Slow Whoa than 5.5 pounds). However, for some is shown at right. communities, such as Braddock, the rates may be higher.

28 Changing the Landscape of Health Care 29 Service Service

Johnstown boasts the world’s steepest vehicular incline. Built in 1891, it carries both people and cars high above the city. ReachingHeights New ExceedingEx customer expectations

When UPMC Health Plan members have a question or a concern related to their beneﬁ ts or care, they need to talk to someone who can help them navigate the health care landscape. We deliver that—and so much more. We consistently surpass industry benchmarks for how quickly and accurately we answer calls.

In all areas of service, demands and expectations continue to rise. Questions are more complex, speed is no longer a luxury but a necessity, and accuracy is critically important. At UPMC Health Plan we not only meet those expectations, we ﬁ nd a way to use every interaction to guide our members toward better health.

30 Changing the Landscape of Health Care Photo by Richard Kelly 31 Service Service

More than 50,000 members participate in our Health Care Concierge Tyrone Bennett goes to work every day recalling the program words of his grandmother: Treat other people the Customer Service and Claims way you want to be treated. That philosophy serves Payment Measures him well in his role as Health Care Concierge for UPMC for Life members. His job is to guide UPMC members, one at a time, through the often complex Health Plan Industry Measure Actual Standard world of Medicare. Tyrone and his fellow Our high-touch concierges are on call to fi eld members’ questions. Average speed 18 seconds 30 seconds customer service helps of answer “When I talk to a member, I imagine how I would guide our members % of calls answered 83% 80% want someone to talk to my aunt or my cousin,” to better health. Our in 30 seconds or less he says. “Medicare can be confusing, and I like phone representa- helping my members fi gure things out.” tives are dedicated to First-call resolution 95% 80% “fi rst-call resolution” of And some calls are just plain fun. In between his inquiries and requests Claim payment 5 days 14 days regular outgoing calls to check on members and turnaround from members. any possible concerns, Tyrone dials members to Photo by Richard Kelly Claims requiring <1% 5% offer birthday wishes each year. an adjustment

Superior customer experience could be as simple as reminding them Technology to simplify health care More than 95 percent of the time, to take their medication. Our goal is In 2006, we undertook a compre- members are able to resolve issues with always the same: providing a superior hensive redesign of our website that a single phone call. Electronic data customer experience that leads simplifi es navigation and enhances interchange with our providers means our members toward better health. features. The new website attracted that nearly every claim in 2006 was more users than ever before: Concierge at your service automated—allowing us to pay claims • More than 65,000 registered users Our highly regarded Health Care in just fi ve days, compared to the accessed our member portal. Concierge service is free to all UPMC standard 14-day turnaround expected • Our network providers posted more than for Life members. Dedicated concierges within the industry. 20,000 online messages. help members navigate the often • Our employer groups processed But fast and accurate resolution of confusing world of Medicare and make nearly 23,000 transactions, including incoming calls is only part of our success. important decisions about medical, enrollments and member updates. Equally important are the outgoing dental, vision, and pharmacy coverage. New features offer more ways to calls we make to members. Through our In addition to being available any time manage health and make informed concierge and health management a member calls, the concierge calls to choices. They include: programs, we reach out to members to “check in” with the member regularly. • help them stay healthy or manage health A Health Promotion Tool Kit that helps employers get workers involved in conditions better. Sometimes that means wellness activities. encouraging them to take part in one • An online interactive tool called Emmi of our programs, or helping them fi nd a that provides information on doctor closer to home. At other times it chronic conditions and specifi c surgeries.

32 Changing the Landscape of Health Care 33 Community Partnerships Community Partnerships

BuildinguildingBridges Partnerships to improve health

UPMC Health Plan reaches out to the communities we serve. Early U.S. history lives in the Washington We want to help all our neighbors lead healthier lives, Crossing Bridge, which commemorates George Washington’s so we work with community leaders to create programs for perilous crossing of the Allegheny River in people of all ages. the 1750’s. Along the balustrades are metal reliefs of the state Sometimes the path to better health is learning how to seals of the 13 original colonies, as well prepare nutritious after-school snacks. Sometimes it’s a group as Allegheny County. walk-about during the lunch hour, or a festival celebrating outdoor activity. Whatever it is, a community improves its health one step at a time—and UPMC Health Plan leads the way.

34 Changing the Landscape of Health Care Photo by Richard Kelly 35 Community Partnerships Community Partnerships

1 3 5

The number of community 2 4 6 organizations UPMC Health Plan sponsored or contributed to in 2006 300was nearly UPMC Health Plan 1 America On the Move 3 Working Hearts 5 Venture Outdoors in the community Through our sponsorship of “America Heart disease is the leading cause The Health Plan is the title sponsor We invest in our communities On the Move” in Pittsburgh—part of of death among women and men of the annual Venture Outdoors through strategic partnerships a national initiative to promote active in the United States. UPMC Health Festival. This free event provides the that promote the health and well- living and healthy eating across Plan’s partnership with the Jewish opportunity for individuals and being of all people in Western the country—we encourage team Healthcare Foundation’s Working families to discover the diversity and Pennsylvania. Through our efforts, participation in large public walking Hearts initiative encouraged people richness of the recreational activities community leaders join together events, engaging participants in a to improve their heart health available in Western Pennsylvania. to discuss issues facing this shared effort to move more, eat less, through better nutrition, more The climbing wall shown in the photo region, including hunger, fi tness, and embrace healthier lifestyles. physical activity, screenings, and is one of many outdoor activities and family health. In the photo, UPMC staff participate stress management. The photo featured at the event. in the “America On the Move” kick- shows Health Plan staff preparing We collaborate with local and 6 Community Sponsorships off event in downtown Pittsburgh. for the event. national organizations, focusing The photo shows Steeler Charlie on initiatives that involve the 2 Healthy Living Lecture Series 4 Greater Pittsburgh Community Batch, who helped kick off the Health active participation of Health In partnership with the Pittsburgh Parks Food Bank Plan’s 2006 United Way campaign. Plan employees while improving Conservancy, the Health Plan presented UPMC Health Plan has strategically The Health Plan helps support many the health and well-being of a series of lectures that highlighted partnered with the Food Bank to other local community organizations, community members. some of today’s most important health provide resources and support for including: issues, including alternative medicine, the Campaign to End Hunger in • Bethlehem Haven fi tness and strength, asthma and our region. The photo shows Health • Boy Scouts of America Plan staff members volunteering allergies, and healthy shopping and • Genesis of Pittsburgh their time to sort and pack food for cooking with organic foods. The photo • Manchester Bidwell Corporation members of the community in need. shows a fi tness demonstration led by • March of Dimes one of our health coaches. • Rainbow Kitchen

36 Changing the Landscape of Health Care 37 Financial and Corporate Information Financial and Corporate Information

Behavioral Health $348 Commercial 18% 2006 Insurance Services Revenue $619 UPMC Insurance Services UPMC Insurance Services Distribution by Product 33% Combined Statement Combined Balance Sheet (in millions of dollars) of Revenue and Expenses Highlights For the year ended December 31 (in millions) For the year ended December 31 (in millions) While revenue for all product lines increased in 2006, Medicare the share of revenue attributable to Medicare sales $524 2006 2005 Assets 2006 2005 28% jumped from 15% in 2005 to 28% in 2006. Medical Enrollment Revenue $1,896 $1,600 Cash and Investments $358 $317 Assistance $405 Operating Expenses $1,834 $1,543 Current Receivables $120 $102 21% Operating Margin $62 $57 Other Assets $11 $8 Operating Margin % 3.3% 3.5% Total Assets $489 $427 Investment Income $15 $9 Interest Expense $6 $5 Liabilities and Equity Income Taxes $22 $20 Health Claims Reserves $157 $147 Net Income $49 $41 Other Current Liabilities $92 $74 Financial highlights: exceptional Surplus Notes $111 $128 Common Shareholder Equity $129 $78 operating performance Total Liabilities and Equity $489 $427 UPMC for Kids (CHIP) 1,497

UPMC Insurance Services UPMC for Life UPMC for Life Specialty Plan Community Care UPMC EAP Solutions With the addition of three Division Membership (Medicare) (SNP) 14,320 Behavioral Health Work Partners 131,377 new product lines in 42,351 484,295 66,682 2006—UPMC for Kids, 15,000 = UPMC Health Plan UPMC for You UPMC for Life Specialty Members (Commercial) 310,219 (Medical Assistance) Plan, and UPMC 91,709 Work Partners—UPMC Insurance Services Division membership surpassed 1 million.

UPMC Insurance Services Division A highly disciplined focus on product The University of Pittsburgh Medical fi nancial highlights refl ect the combined line management as well as the Center (UPMC) is strongly committed operating results and fi nancial posi- application of innovative technology to best-in-class governance and tion among the University of Pittsburgh solutions to achieve optimal clinical organizational transparency standards. Medical Center (UPMC) health insurance outcomes for our members while In 2006, UPMC, including the UPMC subsidiaries. effectively managing member care costs Insurance Services Division, became accounts for the Division’s exceptional the fi rst—and only—nonprofi t health Calendar year 2006 represented another operating performance. Once again, enterprise to fully adopt Sarbanes-Oxley, strong year of growth, with Division UPMC Health Plan’s administrative including the stringent requirements revenue increasing by $296 million costs were less than 8% of premium of section 404, for which an unqualifi ed (18.5%) to nearly $1.9 billion. Division revenue in 2006, an industry best opinion from UPMC’s external auditors operating margins were $62 million practice performance. This illustrates was received. (3.3 % of revenue) in 2006, compared our commitment to cost containment to $57 million (3.5%) in 2005. The Division, along with UPMC, has as well as effi ciency. also adopted industry-leading public The Health Plan also received SAS70 fi nancial disclosure practices for both certifi cation from its independent quarterly (unaudited) and annual auditor for its claims-processing internal (audited) results, allowing our community controls environment, providing addi- stakeholders to review our progress tional independent quality assurance for and fi scal health. The reporting can be our self-insured customers. found at www.upmc.com. Serving more than

38 Changing the Landscape of Health Care 1 million members Financial and Corporate Information Financial and Corporate Information

Insurance Services Division:

UPMC and its Insurance responsive community partners Services Division promote the health and well-being of the people of Western Pennsylvania by spon- soring and participating in a variety of community activities and events.

Division Overview The Division comprises a variety of health UPMC Insurance Services Division • EAP Solutions—A division of a nonprofi t As a world-class integrated health maintenance organizations, preferred companies include: entity offering employee assistance programs. care delivery system, the University provider organizations, and health-related • UPMC Health Plan, Inc.— of Pittsburgh Medical Center (UPMC) technology and benefi t management A Pennsylvania nonprofi t HMO offering • UPMC Work Partners—A for-profi t brings together a seamless end- companies offering a variety of commer- commercial, Medicare, Special Needs, subsidiary of UPMC offering a full range to-end continuum of care to meet cial and governmental health insurance and CHIP products. of workers’ compensation and short- term disability benefi t services, as the full spectrum of patients’ health and health-related products. • UPMC Health Benefi ts, Inc.— well as health and wellness services to care needs. UPMC clinical services A PPO offering Medicare Select and UPMC Health Plan offers commercial Western Pennsylvania employers. and facilities include academic, Supplemental products. and Medicare HMO products while • Community Care Behavioral Health community, and specialty hospitals, • UPMC Health Network, Inc.— also providing administrative, personnel, Organization—A tax-exempt PPO affi liated physician practices, out- A PPO offering Medicare and and fi nancial services required by most offering both commercial and govern- patient rehabilitation services, cancer commercial PPO products. entities in the Division. The nonprofi t mental behavioral health products. centers, senior living facilities, and • UPMC for You, Inc.—A Pennsylvania UPMC for You, Inc., offers benefi ts to • imaging services, among others. nonprofi t HMO offering a Medicaid Askesis Development Group, Inc.— Medical Assistance benefi ciaries. product. An entity engaged in the development As part of this integrated system, and sale of behavioral health technology Community Care Behavioral Health • UPMC’s Insurance Services Division UPMC Benefi ts Management Services— products. provides behavioral health programs for An entity that offers administrative provides a diverse array of health members of UPMC Health Plan, as services to self-insured employers. and well-being services related well as separately contracted services • to health benefi ts, health promotion UPMC IS technology Services, LLC— deliver-ed under Pennsylvania’s An entity offering ASP hosting and other and care management, employee HealthChoices Medical Assistance technology services. assistance and behavioral health, program. and workers’ compensation to the employers and the communities UPMC Work Partners provides health of Western Pennsylvania. and wellness, employee assistance, and workers’ compensation and disability programs and services.

40 Changing the Landscape of Health Care 41 Financial and Corporate Information Financial and Corporate Information

Quality Improvement Quality Improvement Committee is We believe that to improve the quality largely made up of practicing phy- and efﬁ ciency of health care delivery in sicians who create and support the our community, all stakeholders need Health Plan’s clinical policies. The to be involved in the decision-making committee is a forum enabling these process. This applies with particular physician leaders to establish signiﬁ cance to the physicians who care collaborative clinical programming for our members. UPMC Health Plan’s with our provider community.

Quality Improvement James Schuster, MD Tony Stile, MD Pharmacy and Cynthia Rosenberg, MD Committee Therapeutics Lalith Kumar Solai, MD Lisa Strouss, PharmD Paul Rowland, MD Daniel Brooks, MD Colleen Culley, PharmD Dennis Stull, MD Anne Toland, PhD James Schuster, MD Richard Cartwright, MD Michael Culyba, MD Jalit Tuchinda, MD Credentialing Steven Simon, RPh Division leadership: Kenneth Ciesielka, MD Anne Docimo, MD Ted Vana, MD Eileen Baade, MD Anthony Spinola, MD Michael Culyba, MD Eileen Engel, MD Michael White, MD Michael Culyba, MD Scott B. Stephens, RPh Nicholas DeGregorio, MD Roger Haskett, MD expert governance Jay Ziegler, MD Nicholas DeGregorio, MD Audrey Zelkovic, MD John Fisch, MD Margaret Hrinya, RPh Behavioral Health/ Marc Finder, MD William Fera, MD Physical Health Michael Jacobs, PharmD Renata Hoca, MD Jay Harper, MD Bernard Bernacki, DO Juliet Jegasothy, MD John Maher, MD Juliet Jegasothy, MD Frank Ghinassi, PhD Michael Lamb, MD Christopher Olbrich, MD Kevin Kearns, MD S. Ramalingam, MD Joon Sup Lee, MD S. Ramalingam, MD Ken Nash, MD Manuel Reich, MD Jorge Lindenbaum, MD Jay Ziegler, MD S. Ramalingam, MD Eric Rodriguez, MD Chronis Manolis, RPh Cynthia Rosenberg, MD James Schuster, MD Michael McGonigal, MD David Paterson, MD

Insurance Services Sharon Czyzewski Sharon Hicks Michael Taylor UPMC Insurance Ad Hoc G. Nicholas Beckwith, III Scott Lammie, CPA Gregory Peaslee Leadership Group Vice President President and Chief Executive Director Services Division Loren H. Roth, MD, Chairman and Chief Chief Financial Offi cer Chief Human Resources Human Resources Executive Offi cer Marketing and Committee MPH Executive Offi cer UPMC Health Plan Offi cer Diane Holder 2006–2007 Askesis Development Communications Sr. Vice President Arch Street Sr. Vice President University of Pittsburgh President Anne Docimo, MD, Group Community Director Quality Care Management, LLC Insurance Services Medical Center UPMC Health Plan and MBA Daniel Vukmer, Esq. Vice President David M. Roderick, Chief Medical Offi cer Division Insurance Services Chief Medical Offi cer Vice President and James Boyle, MD William Pietragallo II Internet Strategy Chairperson University of Pittsburgh Division General Counsel James W. Boyle, MD, Mark J. Laskow Managing Partner James Gavin UPMC Health Plan Medical Center Vice President University Director Associates LLC Chief Executive Offi cer Pietragallo, Bosick & Scott Lammie, CPA President Mary Beth Jenkins Product Development Robert G. Lovett, Esq. UPMC Health Plan Greycourt Gordon Chief Financial Offi cer Community Care Eric Bruce Chief Operating Offi cer Board UPMC Health Plan Behavioral Health David Weir Hospital Directors President Robert G. Lovett, Esq. Arthur Ramicone UPMC Health Plan and Board Chair Sr. Vice President Organization President UPMC Shadyside Trilogic Corporation Lovett Bookman Vice Chancellor for UPMC Work Partners George Huber Insurance Services UPMC Work Partners Mark J. Laskow Harmon Marks, LLP Budget and Controller Gordon Gebbens Sr. Vice President Edward Donnelly, MD Division John Lovelace University of Pittsburgh Vice President UPMC McKeesport Corporate Relations and PrimeCare Medical Norman Mitry President Catherine Batteer Finance and Division D. James Heatherington Regional Programming Associates UPMC President and Chief Loren Roth, MD, MPH UPMC for You, Inc. Vice President Controller University of Pittsburgh Executive Offi cer Sr. Vice President Vice President Children’s Hospital of Peter Eisenbrandt Medicare Medical Center Heritage Valley Health Quality Care William Gedman Children’s Health Pittsburgh of UPMC Sr. Vice President System Chief Medical Offi cer Anthony Benevento Vice President Insurance and Howard W. Hanna III Richard Ash, MD Bank Broker Division University of Pittsburgh Vice President Quality Audit, Fraud Medicare Special Children’s Community Federated Investors Joseph Molinero Magee-Womens Medical Center Sales and Marketing and Abuse Needs Plan Pediatrics President Hospital of UPMC Diane Holder Teamsters Local Union Telford Thomas Michael Culyba, MD Chronis Manolis, RPh William Pietragallo II President No. 211 President and Chief Vice President Vice President Vice Chairperson UPMC Health Plan and Executive Offi cer Medical Affairs Pharmacy Insurance Services Deb Moon The Washington Division Vice President of Richard Citrin, PhD, Edward McCallister Hospital Finance and Chief MBA Chief Information William Kottner, MD Financial Offi cer Thomas Timcho Vice President Offi cer Internal Medicine & Carnegie Mellon President and Chief EAP Solutions Geriatrics of Pamela Peele, PhD University Executive Offi cer University of Pittsburgh Washington Vice President Medical Center Jefferson Regional Health Economics upmc.com Medical Center

UPMC Health Plan upmchealthplan.com

42 Changing the Landscape of Health Care 43 Financial and Corporate Information

Mission UPMC Health Plan employees are committed to improving the health of our members by offering innovative products, cost-effective solutions, and service excellence through our unique partnerships with our health system, our members, the community providers, and our purchasers.

Values First in operation in 1873—and built even Partnership higher 13 years later— We believe positive partnerships and this lighthouse now teamwork improve results. stands 73 feet above the shores of Lake Erie Respect on Presque Isle. We treat others as we want to be treated. Integrity We do what is right. Innovation We create products and services for current and future success. Development We invest in our staff members’ continued growth and satisfaction. Excellence We strive for “best-in-class” practices and outcomes. Service We view exceptional service to all customers as a critical differentiator.

44 Changing the Landscape of Health Care Photo by Richard Kelly Design: ThoughtForm Inc.