Among the steps we are taking to reduce the overuse of health care services are the following:

• Expanding the reach and impact of programs that address the overuse of procedures, such as knee arthroscopies, back surgeries, and joint replacements.
• Enhancing our drug formulary and step-therapy programs to reduce the overuse of brand-name drugs, and increase the use of clinically equivalent generic medications.
• Sharing information about practice pattern variation to help physicians identify and address specific areas of overuse within their practices.
• Implementing a number of network, member education and outreach, and 24-hour clinical access programs to reduce the number of emergency room visits for non-emergency care. We have nearly 500,000 emergency room visits in our HMO and PPO membership every year. From our analysis, we believe that more than half of those visits are for conditions that could have been treated more appropriately in a primary care setting.

Among the steps we are taking to minimize the underuse of health care services that can jeopardize a member's health status include the following:

• Enhancing our disease and care management programs to help our members better manage chronic illnesses, improve their health, and navigate the health care system.
• Removing barriers to care increases the likelihood that diseases are diagnosed early when it is more effective and less costly to treat. We are eliminating copayments for certain screening procedures, such as mammograms and colonoscopies.
• Promoting healthy habits to reduce the onset of disease (e.g. diabetes, hypertension, high cholesterol) that are induced or exacerbated by lifestyle. For example, our prevention and wellness programs, which include a health assessment, provide actionable information and programs to change behavior and encourage the adoption of healthy habits.

To reduce the misuse of health care services and help members get care in the most effective setting, we are:

• Exploring ways to encourage members to get clinically equivalent services in the most appropriate location. For example, hospital-based labs can cost significantly more than lab work done in clinics or office settings, with no measurable difference in quality or health outcomes.
• Providing members with quick access to convenient, high-quality urgent care services as an alternative to expensive emergency room visits.