REDESIGNING CARE FOR THOSE WHO NEED IT MOST…

Since 1993, CareMore and its founder, CareMore Medical Group, Inc., have been successful in delivering quality care to the Medicare population. CareMore’s only line of business is Medicare Advantage HMO, and its plans are uniquely designed for the frail elderly. We place a strong emphasis on early detection and identification of chronic conditions and co-morbidities and implement preventive and maintenance health care services that help to keep beneficiaries healthy, detect diseases at an early stage, and work to avoid preventable illnesses. CareMore joined the Anthem family of plans in  California  Plans in Los Angeles, Orange, Riverside, San Bernardino, Santa Clara and Stanislaus Counties  Offer Standard HMO plans, CSNPs, DSNPs and ISNPs  Nevada  Plans in Clark County  Offer Standard HMO plans, CSNPs and ISNPs  Arizona  Plans in Maricopa and Pima Counties  Offer Standard HMO plans, CSNPs and ISNPs  Virginia  Plans in Richmond, VA  Offer Standard HMO plans, CSNPs and ISNPs A Brief History

OUR MISSION Providing innovative and focused healthcare approaches to the complex process of aging.

WHY OUR MISSION We are here to: serve our members by prolonging active and independent life serve caregivers and family by providing support, education, and access to services protect precious financial resources of seniors and the Medicare Program through innovative methods of managing chronic disease, frailty, and end of life

CAREMORE Our Members 44% diabetics 40% hypertensive 16% COPD, ESRD, asthma, kidney disease 66% Have co-morbidities 50% at or below $30k annual income 45% Hispanic A Chronic Care Special Needs Plan

Healthcare Cost and Quality Problems are Concentrated…. Not Widespread HealthyStableSickSickest mostly 1 + Chronic Illnessmostly 3 + Chronic Illness Progressive Illness 2010 Medicare Spending Projection = $522 B 46 Million Beneficiaries Spending Per Beneficiary = $11, Million Beneficiaries - Spending $1,130 each - Total Spending = 5% ($26 B) 16.1 Million Beneficiaries - Spending $6,150 each - Total Spending = 20% ($104 B) 7 Million Beneficiaries - Spending $55,000 each - Total Spending = 75% ($391 B) Average Spending CHF, DM 85% of Beneficiaries = 25% Spending15% of Beneficiaries = 75% Spending ESRD, CANCER

The CareMore Model

Chronic Diseases are Generally Managed Poorly Patients receive appropriate care only half of the time (EA McGlynn et al) Diabetic complications could be cut 90% with best care and involved patients (Center for Disease Control and Prevention), yet Diabetes related admissions have risen from 3.5 to 6.5 million since 1993 (Dept. HHS) Low income diabetics are 80% more likely to be hospitalized (Dept. HHS) Second heart attacks can be reduced 40% (J.R. Jowers) More doctors involved in care decreases information exchange and leads to unnecessary hospitalizations (Wennberg/Dartmouth) But... Patients with serious conditions see 11 different doctors CareMore addresses these problems directly

CareMore System Functions in Parallel with Community Physicians Non-Frail Population Primary Care Physicians Extensivists Member Services Continuous Frailty Assessment Tools Provider Relations CareMore Care Centers CareMore Extensivist CareMore Care Centers Home Based Services Specialists Case Managers Primary Care Physicians Close monitoring of non-frail members to proactively identify at-risk members and aggressive management of chronic conditions to prolong the onset of frailty Intensive management of frail and chronically ill members, identified through predictive models, data scans, PCP referrals or member self-identification Frail & Chronically Ill Population

The Essentials of CareMore’s Model

CareMore Solution – New Model of Care

Conduct pre-operative exams Manage patient hospitalization decision Take control of entire inpatient stay, including specialist consultation, diagnostics, PCP communication, family communication Create and manage discharge plan Retain lead physician role during Skilled Nursing stay Follow patients on an out-patient basis until acute episode or frailty resolves Manage high-risk outpatient events, such as fall prevention programs, dementia evaluations, transplant evaluations, bariatric surgery evaluations Create transition to palliative care and end-of-life teams as appropriate Acute Episodes  Take “ownership” of patient at point of admission  Prepare patient and family for discharge  Dispatch all services necessary to avoid readmission Long Term Management  “Own” patient for remainder of life  Dispatch home-based services  Facilitate CCC and other necessary visits  Facilitate transportation and other social services Chronic Care  Conduct annual health risk assessments and create care plans  Micro-manage chronic conditions and lead interdisciplinary teams specific to a patient’s needs  Provide all wound care (diabetic, ulcerative, post-surgical)  Staff all home wireless monitoring systems  Available for 24/7 telephonic patient consultation Frailty and Palliative Care  Primary care provider and case manager for home-bound patients  Assume primary clinical role for palliative care patients Institutional/Custodial/Assisted Living Residents  Make weekly visits  Become first point of contact for facilities and family for ALL care needs ExtensivistsNurse PractitionersCase Managers CareMore’s Model Allows for Efficient Allocation of Clinical Resources

CAREMORE Care Center Community Focus Located in the heart of the neighborhood Social Environment Designed for seniors Resource for family and caregivers Frequent classes and activities Clinical Disease Management Foot Center Healthy Start Pre- Op Fall Prevention Wellness programs A Newly Defined Medical and Social Home

Healthy Start – Initial Evaluation Complete medical evaluation for all new members Goals  Early identification of chronic diseases; referral to chronic disease management programs  One complete H&P  Immediate referral to specialist if needed Results  80% of members have appt within 30 days  42% referred to prevention or support program  23% referred to a chronic care program  18% diagnosed with depression (previously unknown)  3% diagnosed with Diabetes for the first time Healthy Start – Initial Evaluation Complete medical evaluation for all new members Goals  High touch evaluation for high acuity patients  Ensures at least one complete evaluation per year: “second pair of eyes” when PCP/member engagement low Results  70% of SNP members undergo in-person annual assessment  100% Update to Care Plan and Medication Plan Johns Hopkins Predictive Modeling Software Healthy Journey –Ongoing Evaluation Complete medical evaluation for all new members Goals  High touch evaluation for high acuity patients  Ensures at least one complete evaluation per year: “second pair of eyes” when PCP/member engagement low Results  70% of SNP members undergo in-person annual assessment  100% Update to Care Plan and Medication Plan Ascender Predictive Modeling Tool identifies targets based on claims data  Monthly run of claims, Rx, lab data, age correlated to identify 5% most at-risk members  72% plugged into appropriate chronic care of frailty program CARS Identifies sick patients through software CareMore’s Model Allows for Predictive Modeling and Early Intervention

OUTCOMES  Diabetes Program o Members with A1c>9 on initial visit reduced to average of 7.08 when in program o 65% less amputations than Medicare FFS average (8.7 Medicare vs 2.96 Caremore) o Delayed Progression of Chronic Kidney Disease – Medicare average of 6 years vs Caremore 24 years based on our predictive modeling o ESRD program members have 37% less admissions and 64% fewer hospital days than Medicare average  Based on 2013 CareMore data and the most recent Medicare information

OUTCOMES  Chronic Heart Failure Program members o 28% Fewer admissions than Medicare average o 45% fewer hospital days than Medicare average o 47% fewer readmissions than Medicare average o 97% in program record daily weight through a wireless scale  Based on 2013 CareMore data and the most recent Medicare information

OUTCOMES Chronic Lung Disease Program  48% fewer re-admissions than non-Program members  52% fewer admissions than Medicare average  Members with COPD on Oxygen o 33% fewer admissions than non-Program members o 47% fewer hospital days than non-Program members o 47% fewer readmissions than Medicare average o 97% in program record daily weight through a wireless scale  Based on 2013 CareMore data and the most recent Medicare information

Payers & Providers

Drivers of Payer viability: Membership/Growth Patient Satisfaction HCC Documentation & Coding HEDIS measures Specialist utilization ER Visits In Patient Utilization Physician group Impact Identify patients who benefit from Health Plan products and services Short wait times; same day appointments; Timely communication-lab/test results; 5 STAR service Comprehensive patient visit; documentation to the highest level of specificity Comprehensive patient visit collecting HEDIS measures or referring for HEDIS-related visits Reduced referrals to specialists where appropriate; utilization of preferred/aligned specialist providers Short patient wait-times while in office; same day appointments, scheduled follow up visits, utilization of CareMore care center All of the above Alignment of Incentives

Primary Care Physicians  Quality Bonuses o HEDIS o Patient Satisfaction  HCC documentation bonuses o Patient assessment forms o Coding accuracy  Shared savings o Membership panel viewed as stand alone financial statement for Medical Group or POD PARTNERING

Specialists  Bonuses for HEDIS capture  Retinopathy screenings  Shared savings on admission/re-admission reduction  Cardiology  COPD  Nephrology  Episodic care management/Bundled payment  Cardiology  Orthopedics PARTNERING

Hospitals  Quality and Patient Satisfaction bonuses  Shared savings on admission/re-admission reduction  Episodic care management/Bundled payment  Cardiology  Orthopedics PARTNERING

IMPACT OF PATIENT SATISFACTION  GROWTH  MEDICARE STARS  MEMBER COMPLAINTS  MEMBERS LEAVING THE PLAN  HCC CAPTURE  COMPLIANCE WITH CLINICAL PROGRAMS

Getting Care Quickly: Setting appropriate and realistic expectations Offering adequate and informative explanations Acknowledging patient’s presence in the waiting room Courteous and respectful staff Getting Needed Care: Submitting prior authorizations in a timely manner Ensuring pharmacy receives prescriptions in a timely manner Collaboration between PCPs and Specialists Coordination of Care: Using health plan resources for sharing clinical information Set appropriate and realistic expectations regarding test results Offering adequate and informative explanations Member perception of all of these is KEY! IMPROVING PATIENT SATISFACTION

HOW DO WE START?  Open the dialogue with payers  Understand the quality and financial issues  Get the data  Find partners with same goals