AAHCM May, 2015 ©AAHCM Christopher Van Antwerp Director, Managed Care Contracting US Medical Management No Disclosures

©AAHCM Change  The Medicare-eligible population is shifting  Medicare Advantage Plans represent 30% of total  From 2010 to 2013 there was a 28% increase in MA enrollment  CBO predicts another 30% in growth by 2020  Duals plans will have up to 2M patients

©AAHCM Race to the Bottom Value Based Reimbursement Low Risk High Risk Status Quo FFS P4P Gain Share Risk Share Incentives Capitation Time Efficient Care Delivery High Quality Evidence Based Best Practice Innovation X Y1 Y2

©AAHCM So What is Different?  Consumerism  Out-of-pocket spending on the rise  Exchanges allow people to shop  Transparency compares providers on price  Hospitals move toward market share protection and growth

©AAHCM Managed Care Organizations Change  ACA Brings New Forces  Mandated benefits and limits on underwriting  Quality goals – HEDIS and Stars  Member satisfaction becomes paramount  Diversity of network offerings a necessity

©AAHCM Duals Plans – MCO Perspective  Three party contract  Enrollment  Opt-in followed by passive  Not as many as hoped  Enhanced benefits – dental, vision, hearing, palliative care

©AAHCM Duals Plans – Financing (one state example) Capitated Reduction to MCO Yr1 Yr2Yr3 1% 3% 5% Baseline New Baseline? Yearly Withhold Incentive payment

©AAHCM Contracting with MCOs  Giving us leverage  Their focus has changed  Cost pressure is huge  Patient satisfaction matters like never before  Hospitals looking to reduce utilization  Change is good

©AAHCM Negotiation - what is different?  Partnerships  MCOs need help  Old school negotiation is out  Risk is back in (but doesn’t need to be complex)

©AAHCM Negotiation – who is best to speak to? CEO CFO VP Medicare Advantage CMO Contractor Provider Representative

©AAHCM Negotiation - what do MCOs like?  Healthcare is local 1. Relationships, Relationships, Relationships 2. Market share 3. Cost reduction results 4. Patient satisfaction 5. Delivery on quality metrics 6. You maximize your current contracts 7. You are part of the larger picture 8. You talk their language

©AAHCM Negotiation - Preparation 1. What do you want and what do you need? 2. Research the MCO 3. Expect the results you want 4. On specific terms: What can you justify? What is your floor? 5. What can’t you give away? What can you trade? What is in your pocket? 6. Test it with a colleague and discuss technique 7. Data 8. Use time and control environment 9. Leverage their competition and bureaucracy 10. What is your limit and how will other people to help?

©AAHCM Negotiation 1. It is all about the patient and the business – it is not all about you 2. Keep it professional 3. Try not to burn relationship equity, but know that you might have to 4. Ask a ton of questions – expose their limits 5. Keep track of what is on the table and what is off the table 6. Change conflict into problem solving 7. Time can be a good thing 8. Be creative

©AAHCM Questions? Christopher Van Antwerp Director, Managed Care Contracting US Medical Management USMMLLC.com