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

National Emergency Management Summit 2007

Bob RehmVice President, Public Health & Clinical

StrategiesAmerica’s Health Insurance Plans

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)

CEO Readiness Task Force-2006

Defining 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.

Hurricane Katrina – Industry Response

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.

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.

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

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.

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

Pandemic Preparedness for Businesses

Presentation to:

National Emergency Management Summit

March 6, 2007

Wayne Rawlins M.D, MBA

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

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

Aetna’s Pandemic Readiness Testing Efforts

Initial Testing

2Q2006

“Table Top”Exercises

3Q2006

Full-scaleSimulation

4Q2006

Testing Integrated

into Key Management Processes

Single site response

Selected components of broader plan

Enterprise-wide response

Stages 3, 4 and 5

National, multi-site, multi-function

Stages 2 through 6

Prepared for National Emergency Management Summit-March 2007

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

Business Continuity Programs

And Pandemic Preparations

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.

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.

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.

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.

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.

Pandemic Preparedness

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.

Our Pandemic Preparedness Programs

Focus primarily on the following (Continued):

National Emergency Management Summit

March 2007

When Disaster Strikes, How Prepared Are You?

Ed Devaney, MPA, MPH, FACHE

Hurricane Charley Makes Landfall On Friday The 13th

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

Port St. Lucie

Vero Beach

Key West

Ft. Lauderdale

Melbourne

TitusvilleCape Canaveral

Holmes

TALLAHASSEETALLAHASSEE

St. Petersburg

Pensacola

Panama City

Jacksonville

Orlando

Gainesville

Naples

Fort Myers

Sarasota

Bradenton

VenicePort Charlotte

Clearwater

Ft. Walton Beach

Daytona BeachOcala

New Port Richey

Spring Hill

LakelandTampa

Kissimmee

SebringWauchula

St.Augustine

Apalachicola

Cape Coral

Arcadia

Lake Mary

Lake City

Perry

Key Largo

Miami

Jupiter

Homestead

Stuart

Sebastian

Okeechobee

Immokalee

West Palm Beach

Ft. Lauderdale

Hurricane Charley 2004Hurricane

Jeanne 2004

Hurricane Frances

2004

Hurricane Wilma 2005

Hurricane Katrina 2005

Hurricane Ivan 2004

Hurricane Dennis 2005

The Florida Experience

Hurricane Ivan 2004

All hurricanes were categories 3, 4 or 5

Ivan

Charley

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

Planning & Coordination

Response/Activation

Monitoring Recovery

Disaster Response Planning and Execution

Assign leadership team

Develop and test plans

Adopt policies Review readiness Scenario plan

Monitor state, federal, local

Communicate internally and externally

Prepare employees, other stakeholders

Activate response team

Implement action plans

Monitor state, federal, local

Communication Employee &

Community support

Return as directed

Communicate internally and externally

Employee & Community support

Conduct lessons learned

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

Vendors

Monitoring, Communication, Integration

Members

Physicians/Providers

Sales Agents and Brokers

Employees

EOC/Business Continuity

Contingency/ Disaster

Response Team

U. S. Department of Health & Human Services

Office of Preparedness & Emergency Operations

Department of Homeland Security

Florida State Emergency Contingency Team

Office of Insurance Regulation

Local Agencies

FEMA

BCBSF

National Weather Consultation Service

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

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

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

Take Home Messages