1. The Role of the Employer: A Strategy for Controlling Healthcare Costs and Improving Quality South Carolina Business Coalition on Health May 10, 2016 Greenville SC Presenter: Orlo “Spike” Dietrich, CEO Employers Health Network Holdings

2. Change is needed to control costs The SCBCH is facilitating employer-provider collaboration to create sustainable change in healthcare delivery and give employers greater direct control over their employee benefit plans.

3. Today’s Environment The self-funded employer is:  Still very concerned about cost  Dissatisfied with fragmentation and unaligned vendors  Dissatisfied with the system’s lack of transparency  Increasing concern about clinical quality, especially as it relates to new strategies and/or products  Demanding more integration and accountability among vendors

4. Healthcare Provider Trends  Accelerating physician practice acquisition by hospitals  Accelerating consolidation among independent physicians (IPAs)  Clinically Integrated Networks (CIN)  Direct provider marketing to employers  Risk-based contracts  Bundled procedures/pricing

5. Network Strategies  Traditional Traditional PPO Network Out-of-Network Repricing Wrap Networks  Emerging High Performance (Narrow) Networks Reference Based Reimbursement Performance and Risk-Sharing Contracts Increased Focus on Clinical Outcomes

6. Integrated Data, Analytics, and Reporting  Increased functionality to support network strategies  Ability to interface with CINs  Primary source data  Support holistic Population Health Management (PHM)  Provider performance intelligence  Predictive modeling

7. Care Management  Migration to on-site, instead of telephonic  Functional integration with provider partners  Increased clinical sophistication  Patient advocacy, engagement and empowerment  Provider accountability for improved outcomes

8. Pharmacy Risk Management  Universal dissatisfaction with existing models  Beginning to understand the “shell” game  Strong focus on specialty  Seek trusted vendors

9. The EHN Difference

10. Provider Network  Partnered with high quality providers statewide.  Focus on quality of care and pay for performance.  Comprehensive network in South Carolina with 18 hospital systems and over 3,000 physicians, including over 600 PCP’s.  Plan governance supported by an provider/employer Advisory Board.

11. Third-Party Administration  National Leaders in self-funding administration.  High levels of claims adjudication integrity.  Fully integrated technology and compliance.  User friendly client and member portals.

12. Health Plans, Inc. – A Harvard Pilgrim Company  More than 35 years self-funding solutions  New England’s largest TPA with locations in SC and FL and growing national presence  A dedicated team of more than 200 professionals  250+ self-funded employers covering 167K+ members  Total medical and pharmacy claims paid in excess of $900M (2015)  96% average client retention rate (77% Nat'l. average)  Market-specific solutions across industries

13. Care Management  Focus on improving member health and managing benefit plan costs.  Strategic management of all phases of care, from wellness through emerging conditions to chronic and catastrophic conditions.  Comprehensive analysis of member gaps in care.  Valuable health improvement programs and coaching.

14. Pharmacy Benefit and Risk Management  Fully transparent financial model.  100% pas through pricing and rebates.  Pharmacist driven clinical management.  Unique specialty pharmacy strategies.

15. Integrated Total Health Management Providing transparent pharmacy benefit management services exclusively for self-funded employer group health plans. Pass-Through PBM

16. Healthcare Data Reporting and Analytics  Full access to integrated data for the plan sponsor.  Data analytics focused on achieving optimal healthcare and financial outcomes.  Clinically integrated electronic medical records.  Analytics team focused on plan improvement strategies.

17. Partner with us. For Information, contact: Lisa Wear-Ellington lwellington@scbch.org