Leading Age PEAK Session 3/18/2015 David Hassenpflug, VP, Medical Facilities of America Will Saunders, CEO, AllyAlign Health

Case Study of the Virginia Duals Program

The Opportunity and Solution 3 Va Duals Initiative The Solution  Va drives integration of duals into managed care:  May of 2012: Va application filed with CMS  May 2013: Va signs MOU with CMS  April of 2014: Initial enrollment begins  Two requirements:  State wide  Mandated MCO utilization  Three MCOs selected:  Humana  Anthem  Virginia Premier  MFA/AllyAlign co-found a network of forward thinking LTC providers  The MFA/AllyAlign perspective was to engage with the MCOs and proactively offer solutions  MCOs realize an aligned partnership with quality LTC providers is the best way to drive material savings  Network incented to:  Decrease SNF days  Decrease readmission rates  Impact cost of care for custodial residents  Providers win:  Preferred relationships to increase volume  Share in savings pool to reward quality and efficiency

VLTCC State Wide Coverage

State Wide Contracts Executed 9 Network model live with Anthem (~ 1,500 members) and VPHP (~700 members) Scope of Work – Phase I Comprehensive assessments and Plan of Care for institutional members Outcome: Compliance value to MCOs Insight into data for population Working relationship with MCO personnel Scope of work – Phase II Gain share for demonstrated savings in post acute and institutional populations Outcome: Reward for investments in improving total cost of care for institutional members Process to assess members skilled needs and share savings resulting from improvements in LoS and RTA.

Network Model MCO Post- Acute Pool Residential Pool *FFS Services Post- Acute FFS NF Capitation VLTCC 50% Par Providers Post-Acute FFS Residential Cap Post-Acute Incentive Residential Incentive NFist/PCPs Post-Acute FFS (Prof. Fees) NFist Cap Post-Acute Incentive Residential Incentive Owned by MFA, AllyAlign and other LTC Providers *FFS Services: Include services for non-network members like initial HRAs, HCC coding 10

Competencies and Requirements 11 IT/IP Requirements – Care coordination platform Ability to integrate MCOs assessment instrument and automate the Plan of Care Interface with MCOs systems (claims, critical data for Star measures: HEDIS measures/required date elements) Track total cost of care of patient Drive clinical alerts to providers Provider network partners with dashboards and tools to demonstrate performance measures Track outcomes – Assessment instrument and platform to support skilled referrals Engage with payer on state wide basis Provider engagement – Supply NPs/RNs on full time basis – Engage attending physicians/Medical Directors of facilities

Enrollment Status 13

Insights and Lessons Learned Programs have an extended implementation period Long Term Care is the key challenge to address in managing the cost and quality of care for Dual Eligibles – Opt out rates are high MCOs now appreciate that SNF/NFs play a unique and critical role MCOs will seek increasingly seek solutions to manage LTC – MCOs have traditionally developed solutions for Nursing Home Eligible members – In the absence of proactive solutions MCOs will implement solutions that have potential to create significant administrative burden LTC providers must organize and deliver value to MCOs Most MCOs are willing to partner and share savings with quality LTC providers

Insight Into Future Trends and Dynamics