Connections for Increasing Revenue Payer – Provider Connect Kelly Gregg, FHFMA, Chief Financial Officer, Diagnostic Clinic, Largo, Florida Donna Maddox, Product Director, Integrated Care, GE Healthcare IT

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Diagnostic Clinic Multi-specialty medical practice with over 100 providers on staff Serving over 400,000 patients 5 northwest Florida locations – Largo, Countryside, Palm Harbor, and St. Petersburg (2) On-site laboratory and imaging services including x-ray, PET, MRI, and CT scan Optical shop, audiology, podiatry, interventional spine care and physical therapy Walgreen’s pharmacy on-site H. Charles Cambell, M.D., FACS President and CEO Kelly Gregg, FHFMA, Chief Financial Officer James F. Rivenbark, III, M.D.  Chief Medical and Operations Officer

Medicare Advantage Members Services and processes to maximize outcomes both Clinical and Financial Advantage Care Center Care Coordination – Transition Services Value Based Revenue & Quality Management Department Diagnostic Clinic is engaged in multiple risk and shared savings programs. We have to be nimble and responsive – patients and payers make choices that impact our bottom line.

Medicare Advantage Private plan option accounts for over 30% of all Medicare enrollment. 1 Payments CMS adjusts payments to MA plans based risk adjustment factor (RAF) which measures beneficiaries’ estimated relative costs based on demographics and health characteristics Quality Bonus Payments based on Star rating system Payers have information that can provide insight for improving clinical quality and financial outcomes for providers Physicians are the owners of the clinical care quality and clinical documentation that are used to set premium levels for payers in capitated risk 1 ASPE Issue Brief, April 2014

Discovery

It’s Complicated and Important Extract data from multiple systems Transfer to paper check lists and spreadsheets Update check lists and spreadsheets Data entry into multiple systems

Florida Blue Owned by GuideWell Mutual Holding Company 850,000 + enrollees, 42 % market share HMO, PPO, and regional PPO Medicare Advantage plans

Data Exchange Payer Data Medicare Advantage members attributed to the provider organization Patient Care Summary Gaps in Care codified Diagnosis Diagnosis codes by member that have not been submitted in claims in the current calendar year (for HCC) Member suspected diagnosis Members expected and not completed quality codes ( Gaps in Care ) ADT data from BayCare Provider Data Service-based claims (already happens today) Member Gap in Care resolutions (eg. service rendered, not medically relevant, etc.) Member HCC resolutions (eg. diagnosis code, no longer medically relevant) Members Quality Code resolutions Member CCDAs (can include lab data)

Integrate Critical Information in Provider Workflow ICD 9 association with HCC, visible in all work flow Problem list ( diagnosis) reconciliation Quality indicators codified including resolution Coder support for quality reporting Transition of care management Patient and provider population metrics displayed in dashboard

Proof of Concept Demonstration Proprietary and confidential. Proof of Concept – Not a current offering or product. Concept shown represents ongoing product research and development efforts. These research and development efforts are not products and may never become products. Not for sale.

Questions

Thank you for joining us For further information: Donna Maddox donna Thank you for joining us For further information: Donna Maddox donna.maddox@ge.com