Michael Lundberg, Executive Director

2 VHI’s Mission To create and disseminate health care information To promote informed decision making by Virginia consumers and purchasers, and To enhance the quality of health care delivery

VHI Represents all Health Care Stakeholders 3  VHI is an independent, nonprofit, 501(c)(3) health information organization established in 1993  Formed to administer Virginia Health Care Data Reporting Initiatives to benefit Virginians

4 VHI Publishes Business and Consumer Guides, Reports and Information at

Information VHI Collects & Publishes 5

6 APCD Implementation Process Source Data to Milliman for Initial Review Send Threshold Results to Data Submitters Complete Data Mapping and Data Audit Data Roll-Up and Validation Complete Data Available To Customer Membership (Patient, Group, Provider) Medical Claims Data Pharmacy Data MEDINSIGHT DATA WAREHOUSE Data Audit Analysis Data Mapping Other Data We are Here

Slide 7 APCD Quality Audits

Exemption Summary May Field Level Exemptions Provider DEA Number27 Provider State License Number25 Provider Specialty23 Provider Office Zip19 Provider Office State19 Categories of Exemption Accommodation for historical data29 Improvement plan in place49 Not applicable for Medicare/Medicaid42 Not collected82 Submitted when collected216

9 MedInsight® Analytic Platform  Population and benefit driven including:  Age  Gender  Geography  Benefit design  Benchmark detail:  DRG  Procedures  Drugs  Episodes  Chronic conditions  Based on Milliman Health Research Database of 45M members MethodologiesBenchmarks *Courtesy of Milliman MedInsight Health Cost Guidelines Evidence Based Measures Milliman Advanced Risk Adjustors Chronic Conditions Hierarchical Groups (Disease Identification) Global RVUs (Standardized Proxy Reimbursement) Member and Provider Crosswalking Provider Attribution Provider Affiliation into Group Practices NYU Avoidable Emergency Dept. visits Episode Grouping - Truven MEGs

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11 Milliman, Top-ranked for H.C. Industry Analytics

Section 4.3 – Scope – Data Submission: 12 Amendment to Data Submission and Use Agreement. Each of the plans that participates in the APCD executed a Data Submission and Use Agreement (“DSUA”) with VHI effective as of January 1, The enclosed draft Amendment to the DSUA is intended to amend the original DSUA as follows: 1. The DSUA currently provides that Data Suppliers are not required to submit Data Claims files related to Medicare Advantage or FEHBP. However some of the plans have submitted claims data related to both Medicare Advantage and FEHBP. VHI suggests that the parties remove the exclusion of Medicare Advantage data and change the language surrounding FEHBP data to include such data unless the US OPM otherwise prohibits its inclusion. 2. Section 4.3 requires each participating plan to submit to VHI an updated Health Plan Adoption Form in the form of Schedule A to the Amendment. As you will recall, each plan submitted a similar form at the time the DSUA was executed. The new form provides more examples of categories of types of business in response to questions to Data Suppliers. See next slide

Revised form for determining % of population covered by APCD 13 Could be revised to indicate covered Virginia resident lives to clarify differences between this and reporting to SCC.

14 Section 5.1 (e) – Uses and Disclosures; Review Period and Corrections Adds the phrase “to the general public” to clarify that Reports can be released to the Data Suppliers and Data Subscribers prior to the expiration of the 60 day review period provided their use of the data is otherwise in compliance with the DSUA or DSA, as applicable.

15 Section 7.1 – Term. Extends the term of the Agreement from July 1, 2015 through June 30, 2018 to match the updated APCD Expense Budget. Exhibit 2 (2015) – Business Associate Agreement. The form of Business Associate Agreement executed between VHI and each of the Data Suppliers has been updated to incorporate certain changes from the HIPAA Omnibus Rule.

16 Exhibit 3 (2015) – Data Subscriber Agreement The form of Data Subscriber Agreement (“DSA”) attached to the original DSUA as Exhibit 3 has been revised as follows: Section 2.C. - Rights on Termination of License: Adds more specific requirements and processes for return or destruction of De-Identified Data or reports when a DSA is terminated. Section 3.B. – Disclosure of De-Identified Data: Adds language to ensure that subcontractors or independent contractors of Data Subscribers are bound to a Confidentiality Agreement restricting their use and disclosure of data and further confirms that written permission from VHI is necessary for disclosures to third parties. Section 3.E – Responsibility for Data Subscriber’s Users and Unauthorized Users. Adds language to specifically prohibit any attempt by Data Subscribers or their Users or agents to identify individuals whose data resides in the APCD.

17 Exhibits to Data Subscriber Agreement Exhibit A to DSA - Data Subscribers Authorized Users to APCD: Exhibit A was revised to allow for more detailed User and contact person information. Exhibit B to DSA – Vendor Confidentiality Agreement: This new Exhibit is the form of Confidentiality Agreement that Data Subscribers are required to enter into with “vendors” – their subcontractors and independent contractors (accompanies changes to language in Section 3.B.). Exhibit C to the DSA - Equipment Specifications: Additions to this Exhibit detail minimum computer equipment specifications for access to online system.

Exhibits to Data Subscriber Agreement - Continued 18 Exhibit 4 (2015) – Permitted Uses of Actual Reimbursement Data: This revised Exhibit retains the prohibition on disclosure of provider-specific, facility-specific or payer-specific reimbursement information or any information capable of being reverse-engineered, combined, or otherwise used to calculate or derive such reimbursement information. However to assist in measuring the impact of VDH population health improvement efforts, reports may currently be generated by VHI for VDH on the cost burden of a disease, chronic disease, injury or health condition across the state and by Health Planning Region. The revision, requested by VDH expands the geographic areas to also include as appropriate Health Planning District, City, County or Zip Code as long as the prohibitions described above are adhered to.

Section 6.1 – Funding 19 Section Funding: this section has been updated since initially provided to Data Suppliers and reflects a reduction in the subcontract with Milliman. As now modified, this section will be revised to updates the Data Supplier’s individual APCD expense funding obligation for the 36 month period commencing July 1, New Section 6.1 provides that the Data Supplier’s aggregate funding obligation for the 36 month period is $ 189,976. As you may know, pursuant to the Participation Agreement, the plans that chose to participate in the APCD were responsible, as a group, to fund 40% of the APCD expense budget for the initial 30 months of the APCD. At the time that the DSUA’s were prepared, it was believed that 10 plans would participate; however only 9 plans ended up participating. As a result, the funding provided by the participating plans for the initial 30 months of the APCD was short of the plans’ aggregate 40% obligation. The $189,976 includes a one-time, catch-up payment of $14,591 and 12 quarterly payments of $14,615 (assuming only 9 plans participate). In the event 10 plans participated each plans allocable portion of the expense would be reduced to $170,978 ($13,153 per quarter).

1st Contract vs Renewal Contract Costs by Stakeholder Group 20 VAHPVHIVHHA Individual Member Payment (Quarterly)* Individual Member Payment (Total) Total for all Members QuarterlyTotalQuarterlyTotal 1st Contract- 30 months (1/1/ /30/2015) $ 14, $ 145, $ 1,312, $ 65, $ 656, $ 131, $ 1,312, Renewal- 36 months (7/1/15-6/30/18) $ 14, $ 175, $ 1,578, $ 65, $ 789, $ 131, $ 1,578, % Difference 0.2%20.3% 0.2%20.3%0.2%20.3% *1st Contract number includes 1 time catch up as 10 health insurance companies were budgeted but 9 plans actually participated

Category FY 2016 Ongoing Development, Submission of Data, Operation and Reporting FY 2017 Ongoing Development, Submission of Data, Operation and Reporting FY 2018 Ongoing Development, Submission of Data, Operation and Reporting Totals Legal $29,000$25,000 $79,000 VHI Staff-Existing 2.5 FTEs: Analyst, Program Manager, Sr. Management/Indirect 389,241327,615343,995$1,060,851 Data Processing and Analytics – negotiated amount 906,000$906,000 $2,718,000 Travel $3,500 $10,500 Insurance- based on current amounts $25,000$25,250$27,563$77,813 Totals $1,352,741$1,287,365$1,306,058$3,946,164 REVISED APCD Budget for FY 2016 – 2018 (July 1, 2015-June 30, 2018) REVISED APCD Budget for FY 2016 – 2018 (July 1, 2015-June 30, 2018)

Category Total 30 Month Budget (Jul 11-Jun 15) Actual Direct Expenses as of May 19, 2015 with projections and indirect $ Difference Budget vs Actual % Difference Actual to Budget *Data Processing – subject to vendor contract negotiations $ 1,600,000 $ 764,250 $ 835,750-52% Consultants- RFP development & evaluation for data processing, hosting & analytics $ 70,000 $ 46,450 $ 23,550-34% Analytics – reports, access to data, data extracts – subject to vendor contract negotiations $ 1,000,000 $ 764,250 $ 235,750-24% Travel $ 4,500 $ 4,698 $ (198)4% *VHI Staff-Existing 1st 6 months Up to 2 FTEs +.35 for second and third twelve month periods $ 562,000 $ 812,160 $ (250,160)45% Legal- for Data Submission and Use Agreements $ 45,000 $ 150,878 $ (105,878)235% Accounting (indirect of non-restricted) unbudgeted $ 3,749 unbudgeted Depreciation (indirect of non-restricted) unbudgeted $ 14,164 $ (14,164) unbudgeted Insurance (direct for E&O, indirect of non-restricted) unbudgeted $ 62,727 $ (62,727) unbudgeted Marketing (indirect of non-restricted) unbudgeted $ 3,004 $ (3,004) unbudgeted Office Expenses (indirect of ie copier, graphic design & printing, network, postage, building, supplies, website) unbudgeted $ 2,068 $ (2,068) unbudgeted Consultants (indirect of database mgr & govt relations) unbudgeted $ 27,209 $ (27,209) unbudgeted Total $ 3,281,500 $ 2,655,607 $ 633,392-19% Minus Health Plan Unbilled $ (131,260) Adjusted Total $ 3,150,240 $ 2,655,607 $ 494,633-16% Budget for Thirty Month APCD Expenses Comparison to Actual Amount Spent

23 Next Steps VHI will incorporate any revisions to the documents and send them to representatives. Please review each of the referenced documents in their entirety. Upon acceptance, please: Execute the Amendment to the Data Submission and Use Agreement; Complete the Health Plan Adoption Form attached to the Amendment as Schedule A; Execute the Business Associate Agreement attached to the Amendment as Exhibit 2 (2015); and Return the foregoing documents to Wyatt Beazley at

Closing Remarks 24

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Budget for Thirty Month APCD Expenses Comparison to Actual Amount Spent 26 Category 1 st Six months After Signing of Data Submission and Use Agreements* (Jul 13-Jun 14) Next 12 months Development, Submission of Data, Operation and Report Design (Jul 14-Jun 15) Next 12 months of Operation and Report Development Total 30 Month Budget (Jul 11-Jun 15) Actual Direct Expenses as of May 19, 2015 with projections and indirect % Difference Actual to Budget $ Difference Budget vs Actual *Data Processing – subject to vendor contract negotiations N/A $ 800,000 $ 1,600,000 $ 764,250 $ 835,750-52% Analytics – reports, access to data, data extracts – subject to vendor contract negotiations N/A $ 500,000 $ 1,000,000 $ 764,250 $ 235,750-24% Consultants- RFP development & evaluation for data processing, hosting & analytics $ 30,000 $ 25,000 $ 15,000 $ 70,000 $ 46,450 $ 23,550-34% Travel $ 1,500 $ 4,500 $ 4,698 $ (198)4% *VHI Staff-Existing 1st 6 months Up to 2 FTEs +.35 for second and third twelve month periods $ 62,000 $ 250,000 $ 562,000 $ 812,160 $ (250,160)45% Legal- for Data Submission and Use Agreements $ 25,000 $ 10,000 $ 45,000 $ 150,878 $ (105,878)235% Accounting (indirect of non-restricted) $ 703 $ 1,479 $ 1,567 unbudgeted $ 3,749 unbudgeted Depreciation (indirect of non-restricted) $ 3,373 $ 5,327 $ 5,465 unbudgeted $ 14,164 $ (14,164) unbudgeted Insurance (direct for E&O, indirect of non-restricted) $ 1,300 $ 31,747 $ 29,680 unbudgeted $ 62,727 $ (62,727) unbudgeted Marketing (indirect of non-restricted) $ 538 $ 1,296 $ 1,170 unbudgeted $ 3,004 $ (3,004) unbudgeted Office Expenses (indirect of ie copier, graphic design & printing, network, postage, building, supplies, website) $ 18,545 $ 36,043 $ 32,088 unbudgeted $ 2,068 $ (2,068) unbudgeted Consultants (indirect of database mgr & govt relations) $ 4,258 $ 10,842 $ 12,108 unbudgeted $ 27,209 $ (27,209) unbudgeted Total $ 147,216 $ 1,673,234 $ 1,658,579 $ 3,281,500 $ 2,655,607 $ 633,392-19% Minus Health Plan Unbilled $ (131,260) Adjusted Total $ 147,216 $ 1,673,234 $ 1,658,579 $ 3,150,240 $ 2,655,607 $ 494,633-16%

27 APCD Heath Plan Funding 9 plans10 plans VAHP Total1,578, Per plan175, , Plus 1 time payment189, , APCD Budget FY MonthsVHHA (40%)VAHP (40%)VHI (20%) FY161,352, , , FY171,287, , , FY181,306, , , Total3,946, ,578, , # of Plans # of Payments 1x Payment12xTotal 12x-1xTotal (36 months) 91214, , , , ,709, , , , , ,709, Total131, Plus One Time$131, Total1,709,784.60