A Case for Quality The Value of Medicaid Managed Care May 10, 2011 Working to Improve Health Every Day May 10, 2011

Virginia-based; Not-for-Profit Health Plan Virginia-based; Not-for-Profit Health Plan  Service of Sentara Healthcare  25-year history  Statewide presence Diversified Membership Diversified Membership  Commercial – 277,000  Medicaid – 153,000  Medicare – 14,000 Strong Provider Network Strong Provider Network  14,000 Physicians  69 Hospitals Performance Excellence Performance Excellence  Fiscally sound; A+ rating Excellent accreditation by NCQA for 11 th consecutive year Excellent accreditation by NCQA for 11 th consecutive year Optima Health Plans Serving 440,000 Virginia Members

Optima Family Care Medicaid Managed Care Plan 147,000 Members 147,000 Members High Touch for Members High Touch for Members – Reach 72% valid new households in 90 days; touch 20% of new members Retain 85% of Newborns Retain 85% of Newborns Clinical Outreach Clinical Outreach – Automated health assessments – Outreach to frequent ER users Invest $250,000 Value Yearly with Community Partners Invest $250,000 Value Yearly with Community Partners – Girls basketball league – CHCS grant with CHIP of VA & DMAS – Commitment to Community

Virginia Medicaid and CHIP Health Plans Provide Better Access to Well Child Visits 2007 Compared to FFS 4 58% 46% Source: “Virginia Medicaid Managed Care Performance Report, ”, Virginia Department of Medical Assistance Services. December 2008.

Virginia Medicaid Health Plans Outperform FFS and PCCM in Lowering the Rate of Low-Weight Births Source: Improving Birth Outcomes Through Adequate Prenatal Care Study, Commonwealth of Virginia Department of Medical Services, December

Managing Medicaid Partners in Pregnancy Program OB HEDIS Outcomes & 2009 Prenatal Care 88.2% 84.6% Postpartum 67.5% 68.2%Actions Redesigned High Risk OB Model with Community Outreach Partner Redesigned High Risk OB Model with Community Outreach Partner NICU Dollars Saved NICU Dollars Saved – Saved > $300 PMPM / intervention baby Birth Weight Improvement Birth Weight Improvement – From 07-09, # Infants >2500 grams grew 10% High Patient Satisfaction High Patient Satisfaction

Managing Medicaid Overuse of Emergency Services The Problem # ER visits per month increasing. Over 6 months # ER visits per month increasing. Over 6 months 22,500 went to ER 3-10 times & of that, 6,100 did not have corresponding PCP visit Actions Targeted home education visits for the frequent flyers without PCP claims. At 3-mos: Targeted home education visits for the frequent flyers without PCP claims. At 3-mos: – visits / month – 53% did not return ER (17% more than group not visited) – 36% went to their PCP (5% higher than group not visited) – Cost avoidance of $252,000 Called every member after every ER visit. At 3 mos: Called every member after every ER visit. At 3 mos: – 3,300 calls / month – 25% listened to call & left message 40% of time At 6-mos, PCP appointment compliance increased to 48% At 6-mos, PCP appointment compliance increased to 48%

Transformation of Care Initiatives To Control Health Care Costs Patient-centered Medical Homes Patient-centered Medical Homes Chronic Care Management Chronic Care Management Advanced Care Planning Advanced Care Planning Accountable Care Organizations Accountable Care Organizations Knowledge Management Knowledge Management