Strategies for Dealing with Narrow Network Products Richard Miller HFMA Academic Medical Center CFO Council Monday June 27, 2016

Narrow Networks: NY Hospital Participation in Health Exchange Plans *Participation Status Based on Plan Provider Directory Search, June 2016

Navigating the Turbulent “Narrow Network” Seas Source: Deloitte University Press, Deloitte Review Issue 15

Narrow Networks: “To Par or Not to Par” – That is the Question! Considerations: Patient Access Plan Membership Price Benefit Design Utilization Network Design

Provider Sponsored Health Plan: CareConnect Part of the force driving our perspective on providing high quality, low cost health care stems from the creation of our health plan, CareConnect. Benefits in Changing Market Direct necessary services into narrow network of Northwell Health providers and partners Provide new revenue/margin opportunity (“Piece of the Premium”) Develop organizational capabilities and competencies in care coordination, utilization management, and value-based care Provide an exceptional experience to our customers 9/19/2018

Measuring The Shift In Utilization – Initial Study Analysis Results Northwell performed analysis of shift in utilization patterns for CareConnect members with a utilization look-back vs. prior 3 years. Results Indicated: Unmatched

Lessons Learned Exchange products in NY Market have “narrower" provider networks, which may impact both price and utilization. Providers must weigh multiple considerations including Patient Access, Pricing, and Utilization impacts from participation in Narrow Networks. Payers must consider geographic coverage, competitive pricing, and provider quality in order to build a “sellable” network for their products Determination of Provider Participation status in narrow network products has been confusing and frustrating for patients.