MY CARE ALABAMA July 21, 2016 Presented by: Presley Rebman, Executive Director

Navigating the RCO Transformation

Who is My Care Alabama? GMS Shoals Hospital Muscle Shoals, AL Eliza Coffee Memorial Hospital Florence, AL My Care Alabama formed in 2014 to serve Medicaid recipients in North Alabama. HBS is a wholly-owned subsidiary of Blue Cross Blue Shield of Alabama. RCHP provides hospital and healthcare services to non- urban communities across the country.

Skilled and Experienced Administrative Partners Blue Cross and Blue Shield of Alabama – 80 years of service in Alabama – Current ALLKids (CHIP) administrator – Proven experience supporting 3 million members – Existing connectivity to most providers in Alabama – Ongoing integration with HP on ADPH immunization and Medicaid eligibility Shared Health – Subsidiary of Blue Cross and Blue Shield of Tennessee – 21 years experience in Medicaid managed care – 2013 and 2014 Best Overall Medicaid MCO in TN – 2014 Highest Annual Quality Survey Score Reduced emergency room visits for critically ill members by 12% Increased well-child visits by 27% for children ages 0-15 months and 46% for children ages 3-6 years

Offices in Florence, Huntsville, and Birmingham Currently serving 17,500 Medicaid recipients through Health Home care coordination Who is My Care Alabama?

Governing Board Members Alabama Optometric Association Alabama Pharmacy Association Martha Morrow, OD Frances Cohenour, Pharm D Shoals Chamber of CommerceMASA Charles Stewart, Manager, Southwire’s 12 For Life Program Christopher Coccia, D.O., Cullman Family Practice Grant R. Allen, MD, FAAP FQHC Citizen’s Advisory Committee Dr. Joel Powell, MD Donna Jacobs, Chair Jacqueline Milton, Co-Chair

The RCO Model A Provider-based, risk-bearing entity Incorporated as a non-profit in Alabama A service provider to Medicaid recipients only Responsible for full claims administration The RCO must be

The RCO Model Improve quality of care and overall recipient health Improve access to health care providers Control overall Medicaid expenses Minimize disruption to current access to care The RCO Model should

Regions Established Source: Alabama Medicaid Agency budget presentation, 6/22/16

Covered Services Medicaid covered services to be provided by RCOs include, but are not limited to: – Hospital inpatient and outpatient care – Emergency Room – Primary and Specialty care – FQHCs/RHCs – Lab/Radiology – Mental/Behavioral Health – Eye Care – Maternity RCOs may add services or benefits but will not receive additional capitation payments. Source: Alabama Medicaid Agency budget presentation, 6/22/16

Carved Out Services Source: Alabama Medicaid Agency budget presentation, 6/22/16 Services currently carved out of the RCOs include: – Pharmacy – Long term care – Dental services – Substance abuse services These services will continued to be covered by the Medicaid Agency

The RCO Responsibilities Customer Service Care Management Coordinate Community Resources Provider Contracting Process and Pay Claims Assume Financial Risk Education

AMA Responsibilities Member and Provider Enrollment Determine Eligibility Set Minimum Benefit Levels Set Minimum Fee Schedules

 Provide innovative approaches that remove barriers to healthcare  Increase quality and reduce costs while improving the health of our recipients  Deliver a holistic, community-centric solution to our recipients Our Vision

How are RCOs different? Source: Alabama Medicaid Agency budget presentation, 6/22/16

How are RCOs different? Source: Alabama Medicaid Agency budget presentation, 6/22/16

Who is covered by RCOs? 66% of all Medicaid recipients will be part of an RCO Source: Alabama Medicaid Agency budget presentation, 6/22/16 RCO eligibility aid categories Currently Carved-out: Plan First Dually eligible Others, such as foster care Currently Carved-out: Plan First Dually eligible Others, such as foster care

Our Approach Recipient Healthcare Providers Friends/ Family Faith Community Services Transportation Housing Food Services Education Our primary focus is the Medicaid recipient. By taking a holistic approach, we believe that recipients can experience an improved quality of life. Every entity in this wheel is required to make a difference in our Recipients’ lives.

The Bottom Line

Implementation Status Over 3,000 providers currently contracted Completed data exchange testing with HP and enrollment broker Over 50% of staff hired and in place Projected implementation budget of $10 M Prepared and ready to service our members