Alliance Complete Care Model Evolving our managed care organization towards more integrated and effective “whole person care”

Preparing for a Special Needs Plan: Using Population Health Investing in and utilizing analytics Integrated care Social Determinants of Health Holistic person centered care Interdisciplinary care teams Improved outcomes

What is Population Health The health outcomes of a group of individuals, including the distribution of such outcomes within the group An approach to health that aims to improve the health of an entire human population Population Health Management Coordination of care delivery across a population to improve clinical and financial outcomes through disease management, case management and demand/access management [1] Kindig D, Stoddart G. What is Population Health? American Journal of Public Health, 2003,93.

80% of Health Outcome Determinants Are Not Clinical 2017 © Copyright ZeOmega. All rights reserved. 11 Socioeconomic Physical Environment Personal Behaviors Clinical Care Source: Robert Wood Johnson Foundation, Health Affairs, 2014 Whole Patient Care Programs

Alliance Complete Care Population Health Advanced Analytics and Reporting Tools Improved Consumer Health Outcomes Social Determinants Interdisciplinary Team Consumer Engagement Interventions and Supports Risk Stratification Automating Business Processes Care Management Software Automated Workflow Text Analysis Fraud and Abuse Analysis

Alliance Data Analytics Model MicroStrategy Enterprise Reporting Behavioral Health Claims Pharmacy Data Institutional and Professional Claims Social Determinants ILI Housing Criminal Justice Data Geospatial Data John Hopkins Clinical Groupers Care Management Provider Data Consumer Demographics Consumer Eligibility Financial Data Teradata Aster Advanced Analytics Future NC-HIE and ADT Data Alliance Enterprise Data Warehouse

Alliance Complete Care Population Health Advanced Analytics and Reporting Tools Improved Consumer Health Outcomes Social Determinants Interdisciplinary Team Consumer Engagement Interventions and Supports Risk Stratification

Social Determinants of Health Housing Transportation Economic/employment security Language/literacy Food security Education

Consumer Engagement & Self-Management Appointment reminders Regular phone connection Wellness tools Behavior change Technology to track changes

Population Health and Risk Stratification How do we identify patients that have high behavioral health needs? Cost? Risk? Utilization? Need? Acuity? Diagnostic complexity? Disease burden? Community tenure?

Community Days and Utilization

Community Tenure 30% of people served account for 91% of expenditures Top 20% of people served account for nearly 100% of out-of-community placements

High Intensity Youth TFC Predictive Analytics Identified 75 youth at high risk for out-of-home placement Identifying health needs, e.g. asthma 25 were unknown to case management Create specific interventions to effect different outcomes Tiered Case Management and High Fidelity Wraparound Social determinants Consumer/family engagement Connection to primary care

Expected Outcomes Increased stable/supporting family system Increased educational opportunities Increased involvement in pro-social activities Decreased legal involvement Improved health Decreased out-of-home placement Improved community tenure Decreased cost of care

Complex IDD/TBI Interventions and Supports Engagement/Self-Management Reorganize care coordination to care team, multi-disciplinary approach to better address whole person care, inclusive of health Take long-term services and supports approach to care Engagement/Self-Management Identify technologies that support individuals to live independently

Complex IDD/TBI Social Determinants of Health Create financial sustainability of benefits and resources including financial planning and managing resources in benefit plan, including a savings resource that could address unmet needs for those on the Registry of Unmet Needs Create incentives to transition members from ICF to community housing settings

Expected Outcomes Higher quality of life in least restrictive, most socially inclusive environment of choice Increase whole person health services and supports facilitated by cross disciplinary care management Development of financial resources, plans, and support to pay for long-term needs Decrease cost of care

Alliance Complete Care Advanced Analytics and Reporting Tools Improved Consumer Health Outcomes Interdisciplinary Team Automating Business Processes Care Management Software Automated Workflow Text Analysis Fraud and Abuse Analysis

Analytics to Enhance Business Processes Text Analytics/Call Center/Patient Notes Review Screening for unauthorized PHI release/unallowable words Develop scale to evaluate call notes for threatening key words Ensure severity level in call note is consistent with risk assessment Ensure call disposition/resolution matches the call urgency

Analytics to Enhance Business Processes Fraud and abuse analytics Provider excluded/double billing Improbable billing day Improbable patient Billing for deceased patients Clinical use cases Care Management software

Care Management Solution Provides a clinical workflow to support standard case management and medication management Trigger key events for patient care Aggregates all relevant patient Information which can be made available to individual, Care Managers, providers, pharmacists Provider and member portals for improved experience and outcomes

Care Management Solution Track outcome measures Facilitate complex care analytics including gaps in care Results: 66% reduction in avoidable admissions 61% reduction in average length of stay 50% increase in adult preventative care 40% increase in administrative efficiency 25% reduction in FTEs

Multi-Disciplinary Teams Community Relations Peer Support Pharmacy Complete Care UM Medical Provider/ Service Expertise Evaluation

Summary Next progression of how we offer whole person care Foundation is data and analytics to improve care, health outcomes, and business effectiveness Creation of multi-disciplinary teams to manage care Position Alliance for Special Needs Plan