Presentation of AMI’s Integrated Chronic Pain Program (ICPP) to CTC-RI’s Clinical Strategy and Cost Committee Richard Sarnat, M.D. – President Linda Eldridge, MBA – Vice President Client Services November 18, 2016

IMDIS® IMDIS® - Reliable standardized actionable data. Integrated Medical Data Information System IMDIS® - Reliable standardized actionable data. Two Unique Platforms Integrated Chronic Pain Physical Medicine – Chiropractic/PT/OT Management HIPAA Compliant Nearly 2,000,000 patient records

“Not seeing the Forest through the Trees” Scientific Reductionism C.J. recently enrolled with AMI. Currently enrolled in a disease management program for asthma. Her pain and fatigue levels were “seven” while depression was a “six.” When asked, she reported she was being treated by her physicians for fibromyalgia, back and neck pain and headaches and migraines. 18 month timeframe identified 230 claims   The highest number of paid claims by diagnosis was for abdominal pain, with an additional 7 professional claims for sprains and strains. The health plan had overlooked the patients low unit-cost professional claims related to pain and had focused only on the higher unit-cost institutional claims related to ER utilization and asthma.

The Chronic Pain Patient – the antithesis of the single variable. 15 – 20 pharmaceuticals, including opiates. 5+ co-morbidities High % of substance abuse High % of behavioral health issues High % of psycho-social barriers

Requested data fields to produce usable information and results AMI Does All the Work Requested data fields to produce usable information and results Claims Claim/Bill Type Claim number Patient ID Begin date End date Provider ID* Diagnosis codes Paid amounts Claim Status*Lines Claim line End Date Procedure code Procedure modifiers* Revenue Codes* Claim Line Status* RX Patient ID Provider Date of service NDC Quantity Paid Amounts Claim Status* Lookup tables One table for each of the elements flagged above with “*” Lookup value Description of value

Your Paid Claims Data In AMI Proprietary Algorithms Information Out

Opportunity Analysis 56,984 members 11,395 non-cancer and non-pediatric individuals Four chronic pain conditions: Chronic Fatigue, Neck and Back Pain, Osteo-related Pain and Headache. Member Gender 1 - Fatigue, Aches 2 - Back, Neck 3 - Osteoarthritis 4 - Headaches 5 - None Grand Total Female Total 1796 4556 638 1526 27059 35575 Male Total 537 1713 298 331 18530 21409 2333 6269 936 1857 45589 56984

Average (PMPM) cost for Non-Chronic Pain patients of $160 Average (PMPM) cost for Non-Chronic Pain patients of $160.68 versus the average PMPM costs for chronic pain patients by severity. No Chronic Pain/ Chronic Pain Category # Patients % of Total Chronic Pain Average PMPM by Severity Ratio of Chronic Pain $ to Non-Chronic Pain $ No Chronic Pain 45,589  N/A  $160.68 N/A Mild Chronic Pain 7,955 69.80% $420.10 2.6:1 Moderate Chronic Pain 3,070 26.90% $705.43 4.4:1 Severe Chronic Pain 370 3.20% $1,489.67 9.3:1

Where the Money Goes Colors match to draw eyes 69.8 link to 54%

AMI Process Workflow Data Mine Severity Rate Organize Communication Distribute Marketing Material Enrollment Calls Answer Questions Eligibility Demographics Psycho-social History Barriers to Care Medical History Baseline Metrics Acceptance Level of CAM Goals CAM Modality/ Frequency CAM Provider Community Resources Assess BH Needs Forward Care Plan Educational Materials Initial CAM Encounter Provider Encounter Form Nurse Review/Encounter Nurse Follow Up/Patient Health Plan Coordination Adjust Care Plan 6 Month Reassessment Clinical Reassessment Cost Reassessment Satisfaction Survey Pat ID: 1. Data Mine Severity Rate Organize Communication Engagement Process: Distribute Marketing Materials Enrollment Calls Answer Questions Patient Evaluation Eligibility Demographics Physco-Social History Barriers to Care Medical History Baseline Metrics Acceptance Level of CAM Care Planning Goals CAM Modality/Frequency CAM Provider Community Resources Assess BH Needs Forward Care Plan Care Management Educational Materials 2. Initial CAM encounter 3. Provider Encounter Form 4. Nurse Review/Encounter 5. Nurse Follow Up/Patient 6. Health plan coordination 7. Adjust Care plan 8. 6 Months Reassessment Outcomes Measurement Clinical Reassessment Cost Reassessment Satisfaction Survey

Baseline Metrics CLINICAL SF-12 mental SF-12 physical CAGE – substance abuse PHQ9 – depression/BH issues

Baseline Metrics COST PMPM – granular utilization Pharmaceuticals Emergency Room Inpatient Care

¹ER Reduction – Reduction in number of ER visits ²Rx/Opioid Reduction –Reduction in number of prescriptions PMPM

AMI’S Integrative Chronic Pain Program Significant improvement of quality of life Measurable and meaningful cost savings QUESTIONS?