The Value of a National Enrollment Database Eric A. Flowers, MBA July 8, 2013 v1.0

 A Familiar Concept  Benefits of National Database  Historical Concerns and Problems  What is Different Today?  ACA has created opportunities  ADAP – the Logical Starting Point  Ultimate Benefits  Conclusions Agenda Strictly Confidential – Need to Know Page 2

A Familiar Concept States sharing a common enrollment platform As part of actual Client Enrollment Process As a periodic data transfer Check for other third party coverage Check for enrollment in any other ADAP program Aggregation of demographic information that is searchable utilizing real time data Capacity to incorporate drug utilization and cost data Creates a rich data warehouse available to all states that participate Strictly Confidential – Need to Know Page 3

A Familiar Concept Strictly Confidential – Need to Know Page 4

A Familiar Concept Strictly Confidential – Need to Know Page 5

Benefits of a National Database Preservation of Payer of Last Resort status Eliminate interstate ADAP enrollment Data warehousing enables benchmarking – Cost per client (Direct vs. Rebate or Hybrid) – Client outcomes (tracking CD4 and Viral load) – Enhanced cost modeling Utilizes current data vs. Prior Year Business Continuity and Disaster Recovery Expandable Platform Multiple means of submitting data Defrayed Cost Strictly Confidential – Need to Know Page 6

Historical Concerns and Problems Strictly Confidential – Need to Know Page 7 Privacy and Security Cost Varied technical capacities amongst States Varied quality of data amongst States Lack of consistent support from stakeholders Numerous competitive efforts at State and Federal levels Leadership?

What’s Different Today? Strictly Confidential – Need to Know Page 8 The Affordable Care Act Accountable Care Organizations (ACO’s) Concept of Medical Home More healthcare dollars available Increased need for Case Management Improved Technology – Data Analytics (Big Data) – Cloud Computing

ACA Opportunities – ACO’s Strictly Confidential – Need to Know Page 9 Accountable Care Organizations – Organizations working together to lower cost and improve outcomes – Begins to change the economics of healthcare – CMS has begun ACO payment reform – Platform for Evidence Based care – Chronic conditions require coordination and success measured over time – Ideal ACO organizations

ACA Opportunities – Medical Homes Strictly Confidential – Need to Know Page 10 Concept of Medical Home – Term originally coined in 1967 by American Academy of Pediatrics – Shares some characteristics of ACO’s – More loosely defined than ACO’s – Patient-centric care – Can work hand in hand with ACO’s

ACA Opportunities – Medical Homes Strictly Confidential – Need to Know Page 11 The Seven Tenants of Medical Homes 1.Personal Physician 2.Physician Directed Medical Practice 3.Whole Person Orientation 4.Coordinated and Integrated Care 5.Quality and Safety 6.Enhanced Access 7.Payment Reform

ACA Opportunities – Continued Strictly Confidential – Need to Know Page 12 Greater Healthcare Dollars Available – Mostly through Medicaid – Dramatic increase in number of FQHCs Coordination will require case management Health Information Technology – Can help meet growing case management needs – Interoperability of EMR required for coordinated care – Data Analytics aka “Big Data”

Strictly Confidential – Need to Know Page 13 Potential Short Term Cost Savings Source of valuable utilization and payer data Utilize national data to promote learning, efficiencies and better care Can Start Lo-Tech/low cost while positioning for the future ADAP’s are the largest cost driver in RWHATMA Opportunity to start aligning the RWHATMA with ACO’s and Medical Homes beyond Part B ADAP – The Logical Starting Point

Strictly Confidential – Need to Know Page 14 ADAPs have the opportunity for a leadership role in how ACA will impact RWHATMA ADAPs have access to the data that can demonstrate efficacy of ACO’s and Medical Homes from both cost and quality of care perspectives The extensive national network of HIV/AIDS service providers is an asset that has serviced state governments and communities Ultimate Benefits

The Future Strictly Confidential – Need to Know Page 15 Social Services Pharmacy Benefits Primary Care ADAPs Case Worker Individual Care Plan Mental Health

Strictly Confidential – Need to Know Page 16 ADAPs should look to future of Healthcare in the US Start with and move beyond a national data base – Integrate utilization data (de-indentified) – Integrate EMR data (de-identified) – Implement comprehensive needs assessment – Develop comprehensive case management tools – Develop benchmarks and metrics for best practices – Let the data and lives saved make the case Conclusions

Questions Strictly Confidential – Need to Know Page 17