BANNER AND CARE1ST POPULATION HEALTH MODEL Transitioning to a value based model focused on outcome measures driven by providers and engaged members

BACKGROUND 2 Care1st Health Plan Arizona, Inc

Banner / Care1st Medicaid Contract Global Risk sharing agreement based on total cost PMPM by risk groups for the assigned Acute AHCCCS membership ( excluding NEAD population for minimum year one ) October 1, 2014 Start Date Focused on 5 Banner Primary Care Physician group practices Application of population health strategies to a Medicaid population Adult and Pediatric population Members: 5,374 distributed across Maricopa County Pediatric: 2,470 Adult: 2,904 3 Care1st Health Plan Arizona, Inc

Readiness Elements: April – Oct 2014 Provider Team and Accessibility- Pediatric and Adult Physician Leadership- Champion Operational Resources/Upfront $’s- Dedicated Staff IT/Clinical Data- Sharing of Reports Patient Engagement- Predictive Modeling of HN/HC Shared Governance- Strategic Alignment 4 Care1st Health Plan Arizona, Inc

Structure Implementation Joint Meetings: Clinical Meetings/ Monthly - Improve care delivery through higher quality care, lower inappropriate utilization, and collaboration of joint resources Administrative Meetings/ Monthly - Identify issues and opportunities for financial improvement (OON UM), Pharmacy Trends, Provider Services/ Network Credentialing, IT / receipt of required data files Quarterly Strategic Meetings/ Quarterly - Provide leadership overview of current status of financial and quality metrics outlined in the contract. Develop monitoring activities and track progress against annual strategic plan. 5 Care1st Health Plan Arizona, Inc

Quality Incentive for Year 1 Pediatric Quality Measures Annual Dental Visits (ages 2-20 years) Well Child Visits (first 15 months) Well Child Visits (ages 3–6 years) Adolescent Well Visits (ages years) 6 Care1st Health Plan Arizona, Inc

YEAR ONE 7 Care1st Health Plan Arizona, Inc

Status Prior to Contract Implementation Different decentralized workflows/processes Variable approaches to patient outreach Lack of knowledge of which patients were actively engaged in care management programs Lack of data Lack of staff to implement outreach Different EHR’s across provider groups Lack of understanding of AHCCCS benefits 8 Care1st Health Plan Arizona, Inc

Focus Work Year 1 Work flows Standardize across the multiple health clinics/health centers Improve efficiency Centralize some components Acute setting Improve care coordination/transitions of care Develop common EMR (incidental to system wide initiative) Improve reliability of PCP identification Dental Care Increase awareness and access to information Adolescent Care Strengthen outreach to patient and care givers Improve overall access to care 9 Care1st Health Plan Arizona, Inc

BEST PRACTICES 10 Care1st Health Plan Arizona, Inc

Improve Efficiency Remove the provider as the “data collector” Streamline process for patient call backs and follow ups Coordinate transition care from acute care to ambulatory care 11 Care1st Health Plan Arizona, Inc

Standardized Approach Use a centralized resource Review data Collate per region, practice, provider Designate individual designated as point of contact at each clinic/health center Update bi-weekly to monthly Develop basic workflows Front office Working care gaps Messaging to patients Reporting and communicating to practices 12 Care1st Health Plan Arizona, Inc

Process Work Flow for Ambulatory Setting Reports Generated Care1st Centralized Administrative MA Organizes, Reviews & Pushes to Practice Designated Individual within Practice Identifies Care Gaps, Utilization Concerns Practice Team Works the Report Plan of Care Instituted* * May prompt referral to CM 13 Care1st Health Plan Arizona, Inc

RESULTS 14 Care1st Health Plan Arizona, Inc

Dental: Increased Awareness Work flow in clinics/health centers Reminder every patient/every time about importance of dental care Last dentist visited easily accessible by practice Information given to patient and family Reminder cards Tri-fold dental flyer used to encourage parents to take child to dentist Results to date Tracking to hit target, likely will hit stretch 15 Care1st Health Plan Arizona, Inc

Adolescent Well Care Update to Work Flows to Target Opportunity Increased focus on adolescent care Adolescent well care/sports physical letter sent to parents Providers encouraged to do Adolescent Well Care during sick visits Front office workflow created Results to date Improved, likely to hit target 16 Care1st Health Plan Arizona, Inc

Well Child Visits Well Child visits (first 15 months) Tracking to exceed target Well Child Visits (ages 3 – 6 years) Tracking to exceed target 17 Care1st Health Plan Arizona, Inc

YEAR 2 18 Care1st Health Plan Arizona, Inc

Year 2: Process Changes Developing rolling 12 month quality reports  By region, practice, provider Continue monthly push of Care1st quality data to practice Standardize appointment templates Add PCPs in areas of high need Transition from acute care to ambulatory care Evaluate more efficient utilization via mid-level providers Increasing patient outreach  Appointments made prior to discharge  More frequent appointments o Patients with multiple chronic conditions o High risk for ED use or hospital admissions 19 Care1st Health Plan Arizona, Inc