1 Passport Advantage A Special Needs Plan for Dual Eligibles April 20, 2006

2 Organizational Structure Robert Slaton, Ed.D. Executive Vice President University Health Care, Inc. dba Passport Advantage Larry N. Cook, M.D. President & Chairman of the Board Region 3 Medicaid Partnership Council Bill Wagner- Chairman AmeriHealth Mercy Health Plan Joyce Hagen - President, Passport Advantage CMS

3 Organization and Governance University Health Care, HMO Risk bearing entity Section 501(c)(3) tax-exempt organization Original Funders –University of Louisville Medical School Practice Association (51%) –Jewish Hospital & St. Mary’s Healthcare (13%) –Norton Healthcare (13%) –University Medical Center, Inc. (13%) –Louisville-Jefferson County Primary Care Association(10%) Family Health Center, Inc. (FQHC) Jefferson County Health Department Park DuValle Community Health Center, Inc. (FQHC) University of Louisville Primary Care Center

4 Region 3 Partnership Council Committee Structure

5 As a result of the Medicare Modernization Act, Passport Health Plan applied to become a Medicare Advantage Special Needs Plan for its aged, blind, and disabled members who are also eligible for Medicare. Absent a CMS contract, Passport Health Plan would have lost the ability to manage pharmacy benefits and ultimately, quality and continuity of care, for these dual eligible members. Why Develop a Special Needs Plan?

6 As a Medicare Advantage Special Needs Plan, Passport Advantage is able to manage both Medicare and Medicaid benefits, thereby providing better coordinated care for this vulnerable population. Passport Health Plan was influential in achieving passive enrollment process

7 Members Eligible to Participate Only dually eligible beneficiaries currently enrolled in Passport Health Plan. All categories of beneficiaries (aged, disabled, and ESRD). Approximately 10,500 members. Passport Advantage provides Medicare Parts A, B & D

8 Members Eligible to Participate

9 Dual Eligible Demographics

10 Implementation Challenges New product – organizational stress. CMS eligibility file delays. –System set-up error. –Original eligibility file received mid-January. (ID card contingency plan, interim payment). –Still resolving last of January 1 eligibility issues. Confusion over Part D eligibility (reconciliation). Eligibility and Part D confusion at retail pharmacy caused greatest operational issues during immediate go-live

11 Provided frequent written communications to inform/educate pharmacists about Part D benefit. Plan staff visited high volume pharmacies to explain Passport Advantage and Part D benefit. List of Passport Health Plan members sent to pharmacies where duals routinely had prescriptions filled to facilitate transition from Passport Health Plan to Passport Advantage. Part D Implementation

12 Part D Implementation Decision made on January 1 to cover prescriptions for Passport Health Plan duals when pharmacy could not confirm enrollment in any Part D plan. Worked closely with PBM (PerformRX) to assure access to prescriptions. Redirected some pharmacy calls from PBM to Plan due to unexpected call volume during first several weeks. Passport Health Plan and Passport Advantage recognized by local pharmacies and legislators as plan with best Part D transition

13 Continuity of Care – Provider Network Non-contracted providers paid 100% of Medicare payment amount. Contracted providers receive higher reimbursement. Minimize member disruption and maintain continuity of care

14 Medical Management Progressive Proactive Approach Health Assessment Member Education Member Empowerment Preventive Health Management Wellness Awareness Disease Management Member Advocacy Predictive Modeling Member Safety Traditional Reactive Approach Utilization Management Case Management Shift in Approach Shift from reactive to proactive approach Care Coordination

15 Health Management Solutions Well Members healthy Now (member educational articles) Preventive health outreach letters, postcards, phone calls, website Health risk assessment at enrollment 24/7 nurse advice line and audio library Low/Moderate Risk Members Utilization management Member outreach via letters, postcards, phone calls Case management High Risk Members Specialized Case Management: i.e., Palliative Care, HIV, Transplant Disease Management Diabetes Asthma COPD CAD Targeted interventions based on member health risk

16 Advocate Community Support Supported advocate education to address confusion over pharmacy benefits transitioning to Part D. Participation on new Medicare Advantage committees. Support of advocates critical for member recruitment and retention.

17 Key Success Factors Provider sponsored. Partnership model. Extensive physician/clinician involvement in developing, implementing and managing the plan. Collaboration with community agencies and health departments. Extensive provider network and enhanced reimbursement. Member satisfaction and involvement. Proactive care coordination model.

18 Questions and Answers