Public Speakers Chairman Lerner asked the Secretary to call upon the registered public speakers. The Secretary responded that there were none present.

Transcription

1 Minutes of the meeting of the Managed Care Committee of the Board of Directors of the Cook County Health and Hospitals System held Thursday, July 23, 2015 at the hour of 10:30 A.M. at 1900 W. Polk Street, in the Second Floor Conference Room, Chicago, Illinois. I. Attendance/Call to Order Chairman Lerner called the meeting to order. Present: Chairman Wayne M. Lerner, DPH, LFACHE and Directors Emilie N. Junge and Carmen Velasquez (3) Absent: None (0) Board Chairman M. Hill Hammock (ex-officio) and Director Ada Mary Gugenheim Additional attendees and/or presenters were: Douglas Elwell Deputy CEO of Strategy and Finance Steven Glass Executive Director of Managed Care Randolph Johnston Associate General Counsel Cheryl Lulias MHN ACO, LLC Elizabeth Reidy General Counsel Deborah Santana Secretary to the Board John Jay Shannon, MD Chief Executive Officer II. Public Speakers Chairman Lerner asked the Secretary to call upon the registered public speakers. The Secretary responded that there were none present. \ III. Report on CountyCare Health Plan (Attachment #1) A. Metrics Steven Glass, Executive Director of Managed Care, provided an overview of the Report on the CountyCare Health Plan. The Committee reviewed and discussed the information. Chairman Lerner inquired regarding budget estimates for next year. Mr. Glass stated that he plans to provide the information next month. During the review of slide 10, Board Chairman Hammock noted that, when thinking about the budget for the coming year, it looks like CountyCare loses about 1,000 members per month for reasons other than redetermination; to stay even, in terms of membership, there needs to be 12,000 new members per year, independent of redeterminations. Mr. Glass concurred. He stated that what is not known is the proportion of people who are newly covered by Medicaid every month; he indicated that he would take a look at that. Page 1 of 42

2 Minutes of the Meeting of the Managed Care Committee Thursday, July 23, 2015 Page 2 III. Report on CountyCare Health Plan (continued) During the discussion of the information on slide 11, regarding Health Plan Comparisons, Chairman Lerner inquired whether any updates were available on consolidations of health plans or regarding any new entrants into the market. Mr. Glass stated that Advocate Accountable Care has declared that they will become a Managed Care Community Network (MCCN) effective January 1, 2016; this means they will have the same status as CountyCare, and would be a competitor. They will be a health plan in contract with the State of Illinois through its Medicaid office, and not under the purview of the Department of Insurance. Mr. Glass stated that all of the Accountable Care Entities (ACEs) and Coordinated Care Entities (CCEs) have been told that they must have a plan in place and filed with the State by September 1 st, to be effective January 1 st. They either have to link up with a Managed Care Organization (MCO) and their membership becomes the membership of the MCO, or decide what are they going to do as a business. The Advocate and North Shore Health System merger means that 90,000 members with Advocate and 40,000 members with North Shore will combine into one health plan with 130,000 members. Presence has declared that they also will pursue their own health plan and become an MCCN. It has been announced that MyCare Chicago is partnering with Molina Health Plan; Molina Health Plan is under contract with the State of Illinois, but not in this region, so Molina is a new entrant into the market effective January 1 st. Chairman Lerner stated that, if the Committee wants to have a broader discussion about strategic competition, it would seem to be appropriate to do that during the last quarter of the year. Mr. Glass concurred; he stated that this could be done at the September meeting, as the Committee is scheduled to do a deep dive that month. Dr. John Jay Shannon, Chief Executive Officer, inquired regarding information presented on slide 13; he asked whether there is a way to know of the 847,115 total enrollees in Cook County, which are Affordable Care Act (ACA) adults? Mr. Glass responded that the State does not break that information out in their general reporting; however, this is information that can be requested. With regard to slide 21, Mr. Glass stated that there are a lot of people going to a lot of Emergency Departments (EDs) all over the place, and there is a concentration in primary care, which is good. Chairman Lerner noted that, the next logical question for future discussion is - at what point do we talk about whether we remain a broad-based network versus a narrow-based network? During the discussion of the information on Care Coordination, Mr. Glass introduced Cheryl Lulias, President and Chief Executive Officer of MHN ACO, LLC, who provided additional information on the model of care; additionally, she reviewed the history and governance of MHN ACO, LLC. She noted that it is a provider-owned and provider-driven collaboration; its members are listed in the presentation. Chairman Lerner noted that he and Director Velasquez were two of the founding members of MHN. With regard to the information on driving effective care management presented in slide 33, Chairman Lerner stated that it would be helpful if this can integrated into the information provided to the Board. One cannot think about a mass of population, one has to think about cohorts of population and what distinguishes each cohort of the population. This is one simple template that really distinguishes medical complexity and provides a great example of the kinds of factoring that has to be done when thinking about the population. Page 2 of 42

3 Minutes of the Meeting of the Managed Care Committee Thursday, July 23, 2015 Page 3 III. Report on CountyCare Health Plan (continued) Dr. Shannon provided comments in a broader context, as it relates to the System overall and to CCHHS as a provider of care. With regard to the MHN model described that is being performed as standard operating practice for MHN ACO members, he wants to make sure that the Committee is aware that the hospitals and ambulatory services are not part of the ACO, but as Mr. Glass was outlining in the model during the presentation, for what the practice would be for the members of the CountyCare Health Plan, the administration looks at that as being the model for the care of the people who are in the medical homes of CCHHS going forward - whether they are CountyCare members, whether they are uninsured, or anything else. The challenge for CCHHS is going to be how to get that same level of analysis, risk assessment and support services for those individuals who are entrusted to its care. Chairman Lerner stated that when the full Board starts to do its strategic planning, it will have to spend some time on that subject, because it is complex. Mr. Glass provided a few updates on State-related matters. He stated that, even though there is no State budget, CountyCare is contractually obligated to continue to pay claims, until such time the State misses two (2) consecutive months of payments to CountyCare. He noted that the State is current in their payments through the end of June. Mr. Glass noted that a court decision was recently made regarding payment of Medicaid claims. The judge directed that payments should be made for the rates in effect as of June 30 th ; however, CountyCare s contracted amendment with the State states that CountyCare s payments should return back to the April rates effective July 1 st, so now there is a conflict between what CountyCare s contract says and what the judge ordered. Also with regard to the State and Medicaid payments, Mr. Glass stated that the Sargent Shriver National Center on Poverty and Law recently filed an emergency motion in federal district court to enforce a consent decree specifically related to access to specialty services for pediatrics. There was a ruling this morning; U.S. District Judge Joan Lefkow ordered that Illinois should pay hospitals in Cook County for Medicaid payments, even in the absence of a State budget. The details of what that means are not yet clear; it is not known whether that will be interpreted as requiring that the State must pay the health plans. Chairman Lerner concluded by stating that the Committee will be doing a deep dive in September, to talk about the strategic comparison of CountyCare s overall plan and the other plans in the market. At some point, the Committee will have to discuss the issue of broad vs. narrow networks; additionally, the Committee will need to review the remaining managed care contracts, which is one of its responsibilities. IV. Action Items A. Minutes of the Managed Care Committee Meeting, June 18, 2015 Director Junge, seconded by Director Velasquez, moved to accept the minutes of the meeting of the Managed Care Committee of June 18, THE MOTION CARRIED UNANIMOUSLY. B. Any items listed under Section V Page 3 of 42

4 Minutes of the Meeting of the Managed Care Committee Thursday, July 23, 2015 Page 4 V. Adjourn As the agenda was exhausted, Chairman Lerner declared that the meeting was ADJOURNED. Respectfully submitted, Managed Care Committee of the Board of Directors of the Cook County Health and Hospitals System XXXXXXXXXXXXXXXXXXXXXXXXXX Wayne M. Lerner, DPH, LFACHE, Chairman Attest: XXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary Page 4 of 42

5 Cook County Health and Hospitals System Minutes of the Managed Care Committee Meeting July 23, 2015 ATTACHMENT #1 Page 5 of 42

6 CountyCare Report Prepared for: CCHHS BOD Managed Care Committee Steven Glass, Executive Director, Managed Care July 23, 2015 Page 6 of 42

7 Report Format Metrics Membership Risk Management Care Management Operations Programmatic Market Share Analysis Care Coordination State Update 2 Page 7 of 42

8 Membership Data as of: 7/2/2015 Source: Daily Membership (834) File Change From Prior Month FYTD'15 Budget or Goal % to Budget/ Goal Key Measures Apr'15 May'15 Jun'15 Jul'15 Trend Monthly Membership 179, , , , % 156, % ACA 92,270 90,491 85,246 82, % 76, % FHP 84,324 90,140 88,508 87, % 74, % SPD 2,799 2,784 2,816 2, % 4, % Home/Community Waiver (incl DD) % LTC % -- FYTD Member Months 643, ,905 1,003,475 1,176,348 1,158, % ACA 415, , , , , % FHP 217, , , , , % SPD 10,580 13,364 16,180 19,046 33, % Gender = 56% Female; 44% Male Average age = Female: 32 y/o; Male: 30 y/o Key: >= Goal Within 1% of Goal Within 5% of Goal < 5% of Goal 3 Page 8 of 42

9 Membership Adds & Deletes Data as of: 7/2/2015 Source: Daily Membership (834) File Feb'15 Mar'15 Apr'15 May'15 Jun'15 Jul'15 Month Begin Membership 92, , , , , ,155 ACA Adults 1,191 5,900 4, (5,147) (3,005) FHP 30,447 19,544 23,314 2,357 (2,030) (842) SPD Total Net Change 31,730 25,508 28,076 3,241 (7,146) (3,792) Month End Membership 124, , , , , ,363 4 Page 9 of 42

10 Members by Medicaid Category 5 Page 10 of 42

11 Membership Trend to Budget 6 Page 11 of 42

12 ACA Membership Trend to Budget 7 Page 12 of 42

13 FHP Membership Trend to Budget 8 Page 13 of 42

14 SPD Membership Trend to Budget 9 Page 14 of 42

15 Medicaid Cancellations 10 Page 15 of 42

16 Health Plan Comparison Source: IL HFS, Greater Chicago Region FHP/ACA Adults, Greater Chicago Region Mar'15 Apr'15 May'15 Jun'15 # Change % Change Health Plan Sponsoring Organization(s) # # # # % Total Month Prior Month Prior Family Health Network Mt. Sinai, Norweigan, Resurrection, St. Anthony, St Bernard 195, , , , % 7, % Blue Cross Blue Shield Health Care Services Corp. 142, , , , % 4, % CountyCare Cook County/CCHHS 149, , , , % (7,248) -4.1% Harmony Health Plan WellCare 119, , , , % (516) -0.4% IlliniCare Health Plan Centene, Inc. 120, , , , % % Meridian Health Plan 101, , , , % (395) -0.3% Aetna Better Health Inc. 94, , , , % 1, % Advocate Accountable Care (ACE) Advocate Physician Partners 83,117 87,162 89,662 89, % (120) -0.1% SmartPlan Choice (ACE) Presence Health Partners, Independent Phys Alliance of IL 72,331 72,291 70,146 68, % (1,733) -2.5% MyCare Chicago (ACE) Lurie, Mercy, Norweigan, Swedish/Asian Human Svcs, Erie, Heartland HC, Mercy, Near North, PCC/C4 47,266 55,496 60,386 58, % (1,393) -2.3% HealthCura (ACE) Access Community Health Network 20,380 32,365 41,263 41, % % Community Care Partners (ACE) NorthShore, Vista, Lake County Health Dept, Erie 38,854 38,982 40,184 40, % % UI Health Plus (ACE) UI Health 23,707 27,650 35,424 36, % % Better Health Network (ACE) St Bernard's, Loretto, South Shore, Roseland/Aunt Martha's, Beloved 21,292 29,632 34,486 34, % % Loyola Family Care (ACE) Loyola Univ Health System 23,780 23,501 26,283 26, % % Next Level (CCE serving ACA only) 9,222 9,177 13,369 13, % % Illinois Partnership for Health (ACE) Blessing Health System, Cadence, Decatur Memorial, KishHealth, Memorial Health, OSF, Riverside Medical 3,610 3,674 3,574 3, % (53) -1.5% Ctr, Rockford Health System, Carle Fdn Lurie Children's Health Partners (CSN CCE) Lurie Childrens Hospital 1,688 1,678 1,708 1, % % LaRabida Coordinated Care Network La Rabida Childrens Hospital (CSN CCE) % % Total 1,269,601 1,393,646 1,475,925 1,481,018 5, % 11 Page 16 of 42

17 Health Plan Comparison Source: IL HFS, Chicago Region (includes suburban Cook & Collar Counties) ICP Greater Chicago Region (SPD population) Health Plan Sponsoring Organization(s) Mar'15 Apr'15 May'15 Jun'15 # # # # % Total # Change Month Prior % Change Month Prior Aetna Better Health Inc. 28,852 28,640 28,514 28, % (273) -1.0% IlliniCare Health Plan Inc. Centene Inc. 27,372 27,178 26,999 26, % (369) -1.4% Community Care Alliance of Illinois Family Health Network 7,841 7,740 7,611 7, % (84) -1.1% Blue Cross/Blue Shield of Illinois Health Care Services Corp 6,201 6,288 6,460 6, % % Humana Health Plan 4,588 4,524 4,528 4, % % Meridian Health Plan 4,447 4,457 4,514 4, % % Cigna HealthSpring of Illinois 4,390 4,410 4,443 4, % - 0.0% Next Level (CCE) 3,423 3,353 3,305 3, % (71) -2.1% CountyCare Cook County/CCHHS 2,648 2,704 2,759 2, % % EntireCare (CCE) Healthcare Consoritum of IL (St Bernard, Chicago Family, St James, MFS, South Shore, Roseland, HRDI, Metro 2,548 2,468 2,418 2, % (79) -3.3% South) Together4Health (CCE) Heartland Health Outreach 2,273 2,175 2,099 2, % (83) -4.0% Be Well (CCE) MADO Healthcare 1,384 1,368 1,396 1, % (7) -0.5% Total 95,967 95,305 95,046 94,381 (665) -0.7% 12 Page 17 of 42

18 Health Plan Comparison Cook County Enrollees Only FHP & ICP Enrollment Cook County only as of June 1, 2015 MCO Name FHP ICP Total % Grand County Care 171,661 2, , % Family Health Network/CCAI 139,266 7, , % Blue Cross/Blue Shield of Illinois 114,743 6, , % Harmony Health Plan 112, , % IlliniCare Health Plan 90,909 20, , % Aetna Better Health 71,198 21,361 92, % Meridian Health Plan 76,623 4,222 80, % Humana Health Plan 4,228 4, % Health Spring of Illinois 4,122 4, % Grand Total 776,744 70, , Page 18 of 42

19 Risk Management >= Goal Within 1% of Goal Key: Within 5% of Goal < 5% of Goal Change From Prior Month FYTD'15 Budget or Goal % to Budget/ Goal Key Measures Apr'15 May'15 Jun'15 Trend Risk Management ACA Adult Membership 3/2014 Baseline % y/o 16.2% 15.9% 15.0% 0.3% % -1.7% % y/o 16.0% 16.1% 15.2% 0.4% % 0.9% % y/o 13.4% 13.3% 13.0% 0.4% % -0.1% % y/o 25.8% 25.0% 25.2% 1.1% % -1.3% % 55+ y/o 28.6% 27.7% 31.6% -2.3% 27.0% 2.3% Pharmacy # Scripts filled 177, , ,667 (11,161) % Utilizing Members 29% 28% 28% 0.0% -- # Scripts/Utilizer (0.12) -- % Generic dispensing 83% 82% 82% -0.8% -- % Brand Single Source 16% 17% 19% 1.5% % Formulary 98% 98% 97% -0.7% -- 98% 0.0% % CCHHS HIV pt CCHHS pharmacy 36.7% 35.5% Data Not Yet 80% -44.5% % Maintenance Rx on Extended Supply (>84 days) 18.0% 24.0% Available 85% -61.0% Reinsurance # Claims filed % 14 Page 19 of 42

20 Key: >= Goal Within 1% of Goal Within 5% of Goal < 5% of Goal 15 Care Management Key Measures Apr'15 May'15 Jun'15 Change From Prior Month Trend FYTD'15 Budget or Goal % to Budget/ Goal Care Management PCMH Assignment % Members Assigned to PCMH 96.7% 96.3% 96.0% -0.2% % Members Unassigned 3.3% 3.7% 4.0% 0.2% -- # Assigned CCHHS/ACHN 36,268 36,559 32,934-3,625 % Total CCHHS/ACHN 20.2% 19.9% 18.7% -1.3% # Assigned MHN ACO 79,542 82,416 79,142-3,274 % Total MHN ACO 44.3% 44.9% 44.8% -0.1% -- Member Risk Stratification Total Outreached Members YTD 73,402 75,684 77,494 1,810 Health Risk Assessments/Screenings YTD 26,829 32,571 37,515 4,944 YTD % High Risk Members 2.5% 2.4% 3.0% 0.6% % 0.5% Referral Management # Authorizations: Inpatient 1,677 2,132 2, # Authorizations: Outpatient 2,901 3,397 3,361 (36) ACA Utilization Management (rolling 12 month) Nov'14 Baseline Admits/1,000 member months % Bed Days/1,000 member months % ALOS % ED Visits/1,000 member months , % % 30-day Readmissions 21% 21% 22% 1% 20% 9.1% FY'15 Q1* FYTD'15 Q2* ACA CCHHS Utilization (since 7/1/2014) (N=308,765) (N=319,221) FY'14 Q4 Benchmark Emergency Room 17.1% 12.5% -4.6% 17.2% -4.7% Hospital Inpatient 9.8% 8.3% -1.6% 10.9% -2.6% Hospital Outpatient 27.8% 36.0% 8.2% 28.8% 7.2% Other Medical 0.7% 1.1% 0.3% % 0.0% Primary Care 36.6% 34.3% -2.4% 39.8% -5.6% Specialist 10.7% 4.8% -5.9% 6.8% -2.1% Page 20 of 42 Total 18.0% 16.0% -2.0% 19.1% -3.2%

21 Operations Key Measures Apr'15 May'15 Jun'15 Change From Prior Month Trend FYTD'15 Budget or Goal % to Budget/ Goal Operations Call Center Goal Goal Met Call Volume 29,374 26,520 26,030 (490) Abandonment rate 1.4% 1.6% 1.1% -0.5% <4% Y Hold time 0:00:27 0:00:44 0:00:52 < :01:00 Y Average speed to answer 0:00:14 0:00:16 0:00:10 < :00:45 Y Claims Processing # Days Goal Met # Claims Paid 63, , ,357 (30,751) # Claims Recv'd 120, , ,831 20,127 FY'15 Q1 FYTD'15 Q2 Avg # Days Received-to-Processed 4 5 < 8 Y Avg # Days Received-to-Paid/Pend < 35 N Key: Yes No 16 Page 21 of 42

22 Market Share Analysis Goal: Understand provider utilization of CountyCare members by analyzing Paid claims. Paid claims includes $0 payments; Inclusive of Medical and BH claims Grouped claims by quarter: CY 14 Q4/CY 15 Q1/ CY 15 Q2 Seven categories: All, ED, Hospital Inpatient, Hospital Outpatient, Other Medical, Primary Care, Specialty Focus on Top 15 per category Separate reports for ACA and FHP 17 Page 22 of 42

23 Analysis Limitations Claims lag; Data current as of 7/2 Categorical definitions 18 Page 23 of 42

24 Proportional Occurrence of Top 15 Providers Across All Categories: ACA 19 Page 24 of 42

25 Proportional Occurrence of Top 15 Providers Across All Categories: FHP 20 Page 25 of 42

26 Key Findings Top 15 providers account for relatively small portion of overall paid claims, with greater concentration in primary care-related services. CY'14 Q4 Top 15 Total % ACA FHP All Claims 52.4% 30.9% ED 22.2% 39.3% Hosp IP 52.9% 73.3% Hosp OP 87.3% 90.6% Other Medical 71.1% 75.0% Primary Care 85.5% 54.5% Specialty 85.5% 54.5% CY'15 Q2 Top 15 Total % ACA FHP All Claims 51.0% 39.6% ED 23.1% 46.6% Hosp IP 59.8% 79.5% Hosp OP 89.0% 86.5% Other Medical 70.9% 86.2% Primary Care 84.2% 88.6% Specialty 84.2% 55.9% 21 Key: < 60% Page 26 of 42

27 Key Findings Top 5 providers in 2+ quarters is concentrated in a very small number of providers. Top 5 ACA Providers in 2+ Quarters Primary Care Hospital Inpatient CCHHS Advocate ACCESS CCHHS Erie Family Mt. Sinai Hospital Lawndale Christian UIC PCC Top 5 FHP Providers in 2+ Quarters Primary Care Hospital Inpatient CCHHS Advocate ACCESS Mt. Sinai Hospital Erie Family Northwestern Lawndale Christian Rush Rush Peds 22 Page 27 of 42

28 Key Findings CCHHS is the dominant provider of care for ACA Adults in virtually all categories. CY'14 Q4 CY'15 Q2 All ED Hosp IP Hosp OP Primary Care Specialty Care CCHHS 19.3% 15.3% 11.9% 34.9% 40.8% 6.4% #2 6.6% 6.0% 6.3% 18.6% 14.7% 13.0% #3 4.7% 3.3% 3.8% 6.5% 3.7% 7.0% #4 4.5% 3.2% 3.7% 5.4% 3.2% 6.5% CCHHS 16.5% 13.6% 10.1% 48.1% 33.1% 1.5% #2 5.4% 5.6% 17.8% 6.9% 17.7% 11.1% #3 4.6% 4.3% 3.8% 5.8% 4.6% 8.4% #4 4.1% 2.8% 3.1% 5.1% 4.1% 6.9% Note: Data limitations related to categorization may skew some groupings. 23 Page 28 of 42

29 What s Next Compare utilization to contracted network for areas of narrowing Analyze network on cost and quality, not just utilization Continued implementation of CCHHS provider-led initiatives 24 Page 29 of 42

30 Provider-led Care Coordination True Value of ACA requires health insurance and health practice reforms State Approach = ACEs & CCEs Shift in State focus for provider-led/providersponsored approach ACEs and CCEs in partnership with a MCO or dissolved by 12/31/2015 Advocate, Presence, Loyola likely to pursue MCCN 25 Page 30 of 42

31 CountyCare s ACO Partnership MHN ACO Model of Care implementation within member medical homes and partnering hospitals 1-year anniversary of MHN ACO contract Contract effective 7/1/2014 Readiness review completed 12/1/2014 Cheryl Lulias, President & CEO 26 Page 31 of 42

32 CountyCare Presentation Medical Home Network Provider Council Meeting Friday, June 14, :00 PM 4:30 PM Alivio Medical Center Morgan Site Morgan Conference Room 966 West 21st Street Chicago, IL Bruce Miller & Larry Goodman, MD Co-chairs Prepared for the CCHHS BOD Managed Care Committee Page 32 of 42 27

33 MHN ACO: A High Value Community Provider Partnership MHN ACO Providers MHN ACO Geography MHN ACO 48.5% Membership MHN ACO MEDICAL HOMES No. of SITES Alivio Medical Center 6 Aunt Martha s Youth Service Center 14 Chicago Family Health Center 5 Erie Family Health Center 12 Esperanza Health Centers 3 Friend Family Health Center 6 La Rabida Children s Hospital 1 Lawndale Christian Health Center 4 PCC Community Wellness 7 PrimeCare 5 Rush University Medical Group 11 Sinai Medical Group 12 MHN ACO HOSPITALS No. of SITES Holy Cross Hospital 1 La Rabida Children s Hospital 1 Developing MHN ACO ~80K CountyCare lives Rush University Medical Center 1 Mt. Sinai Hospital 1 Schwab Rehabilitation Hospital 1 TOTAL Medical Homes 86 TOTAL PCPs ~360 TOTAL Specialists ~1,200 TOTAL Hospitals 5 Page 33 of 42 28

34 Centralized vs. Practice Level Care Management At risk entity Cook County Hospitals and Health System (CCHHS) CountyCare CountyCare/TPA: CountyCare/TPA Care Management and Coordination; IT Infrastructure* MHN ACO CountyCare/TPA Complex Care 1 Care 1 Care 1 Care 1 Care 1 Care 1 Care 1 Care 1 Care 1 Care Complex Care 1 Care 1 Care 1 Care 1 Care 1 Care 1 Care *Note: Excludes Waiver, SPD & Select CSNs Practices working within a shared MHN ACO care model to improve quality and utilization Practices working within a centralized care model to improve quality and utilization Page 34 of 42 29

35 MHN Model of Care: Integrated Delivery Across the Continuum Page 35 of 42

36 MHNConnect Care Management at the Practice Level Drives ongoing risk management, facilitates bidirectional communication & supports timely care management outreach and tracking Page 36 of 42 Medical Home Network All Rights Reserved Proprietary & Confidential 31

37 MHN: Improving Care & Patient Engagement In first 12 months (as of June 30, 2015), 71.4% OF MHN ACO members have complete HRAs (health risk assessments) MHN ACO vs CountyCare network average: 34% reduction in bed days/1000* 13.9% reduction in ED visits/1000* 35% reduction in readmission rates* * Based on July CountyCare reported utilization stats 7/1/14-5/19/15 Page 37 of 42 32

38 MHN: Driving Effective Care Management MHN ACO judges effective care management by its ability to lower patient risk Medical Complexity Behavioral Health Complexity Social Complexity Criteria High Risk Frequent ED Use Avoidable Hospitalization Chronic PQI (potentially avoidable hospitalization) Gaps in Care Criteria High Risk Hospitalization or ED Use for SMI or SA High PHQ9 Untreated SA Criteria High Risk Barriers to therapeutic compliance Level of Risk Low Risk Low Risk Low Risk Page 38 of 42 Medical Home Network All Rights Reserved Proprietary & Confidential 33

39 Thank You! Raylon Lewis Jr. Lawndale Christian Patient To learn more, please visit Page 39 of 42 34

40 CountyCare Case Management Model: Vision 35 Page 40 of 42

41 Model Implementation Health plan support functions Claims-based risk stratification Risk-bearing provider agreements Broader care coordination support to network providers Foundation partnerships 36 Page 41 of 42

42 No FY 16 budget State Update Contractually required to pay claims until State misses two consecutive monthly capitation payments State current through June 15 Required to process claims through August, then dates of service < July 1 thereafter Conflicting information on payment for dates of service > July 1 37 Page 42 of 42