Managing your growth in unmanageable time. AARON BURKY DIRECTOR, TRANSITIONAL OPERATIONS CONIFER HEALTH SOLUTIONS

Agenda Topics From then until now… growth year over year Fluctuation in payer practices Using Key Tools or KPI’s to manage The hit of a conversion…. What to expect or not expect? Best Practices in a ever changing world Brief Case Study What does the future hold and how can we manage it

From then until now…..  Managed Medicaid Penetration  National  % 23.1MM recipients  % 42.3MM recipients  Texas  % 2.7MM recipients  Steady growth even without ACA funding Medicaid expansion  2014 and now it looks like this..  ACA funding Medicaid expansion in 26 states, with 4 still considering (20 not considering at this time)  Federal Government involvement allows states to offer Medicaid coverage up to 138% of FPL  Expected to add 4-7MM recipients in expansion states in 2014 alone  Non-expansion states still expanding to Medicaid Managed Care  Value of budget predictibility  TX—Over 10% of population expected to be a recipient of Medicaid Managed Care

Payer changes  Payer patient plan options  HMO/PPO/Health Exchange  Ability to switch plans as much as monthly in some cases  Additional enrollment documents and processing  Texas—enroll with TMHP first, then with MCO  Payer provider reimbursement changes per plan  Importance of monitoring appropriate reimbursement  Government payer—Compliance impact  Understanding of higher number of payers  Understanding deductibles and POS policies for different payers  Have to operationalize these differences to be effective  What can we expect and how can we differentiate which plan is chosen?  Patient advocates—be proactive

Key Performance Indicator Suggestion  Understand patient mix  Track and trend all elements of the life cycle of the claim  Contracting  Use analytics in negotiations—understand entire organizational performance to KPIs  What are the causes of not obtaining optimal reimbursement?  Pre-billing  Patient Access, coding, billing edits  Post-billing  Cycle times at payer, denials, underpayments  Post-payment  Effective methods of post payment audit and review  Hold payers accountable to contract terms

The hit of a conversion…. What to expect or not expect?  What can you expect?  Dictionary Challenges  Billing edit variances  Cash flow sustainability  DNFB new user training.  Vendor movement reduction  Not just benefit of DSH/Non- profit/Safety-net hospitals, 1/3 drop in 1 st qtr 2014 of uninsured at investor owned systems  Patient Mix changes  Higher relative ER volumes—survey by American College of ER physicians shows no overall change in ER volumes, but 35% increase in Medicaid ER

Best Practices  Trending and Tracking  Clinical nurse  Managed Care/Contracts involvement  Network with other providers  Know your laws/statutes  EMTALA—higher ER volumes  Patient Advocacy  Find Medicaid patients a PCP so they don’t have to use the ER  “Safety-net” hospitals that treat a disproportionate share of poor and uninsured benefit  Take advantage of drop in uninsured and capitalize  Use to offset Medicare cuts

Case Study  453 Bed Acute Care Facility in KY  $310MM annual NPSR  KY is an expansion state with an already high Managed Medicaid penetration rate of 90%  Disputes  1 st quarter 2012  650 visits/month Managed Medicaid  286 denials/month  1 st quarter 2014  900 visits/month Managed Medicaid  820 denials/month  How to resolve:  Track and trend  Consistent billing edit review— engage vendor partners and leverage their experience  Legal involvement  Specific laws related to ER visits  Held payer accountable  Work items in bulk

What does the future hold? 2014  Large increase of Managed Medicaid  Uncertainty in effectiveness of system  Vitally important contract negotiations Beyond  ACA picks up the tab for expansion for 3 years  What happens next?  Are we back to current state or is that long enough to correct  Continued importance of KPIs, Contracts and Payer performance monitoring

Thank you AARON BURKY CONIFER HEALTH SOLUTIONS