1. Anil Hanuman, DO SMO, CareMore
Value-Based Contracting for Specialty Care
Anil Hanuman, DO SMO, CareMore 1

2. Health Spending & Chronic Disease
15% of the population spends 70% of the dollars (Kaiser Permanente)
70% of all healthcare dollars are spent on chronic diseases (Agency for Healthcare Research and Quality)
Five chronic diseases make up the vast majority of this category*
- Diabetes
- Congestive Heart Failure
- Coronary Artery Disease
- Asthma
Depression
* Hypertension contributes to complications 2

3. CareMore Clinical Model
15% of the members account for 70% of the cost
FRAIL POPULATION
& CHRONICALLY ILL
NON-FRAIL POPULATION
Intensive management of frail and chronically ill members (approximately 15% of members) that account for 70% of medical costs.
Close monitoring of non-frail members to proactively identify at-risk members and aggressive management of chronic conditions to prolong the onset of frailty. 3

4. CareMore offers a broad range of SNPs geared toward the frail and elderly
DIABETES
Chronic SNP
BREATHE
Pulmonary
Chronic SNP
HEART
Cardiovascular
Chronic SNP
ESRD
Chronic SNP
TOUCH
Institutional
SNP
CONNECT
Dual Eligible
SNP 4

5. Successful Congestive Heart Failure (CHF) Monitoring
CHF Weight Program
Wireless scale for weight monitoring at home provided to members with CHF
Alerts CareMore Nurse Practitioner to contact member for rapid weight increase
Same-day appointment at the CareMore Care Center if needed
Program participants
who record daily weights
97%
RESULTS
for program participants
45% fewer hospital days
27% fewer admissions
47% fewer readmissions
CareMore 2013 Program Effectiveness Metrics. Based on program participants with diagnosis of CHF who received Ideal Life wireless scale (In Program) and individuals who did not (Not in Program).
Company Confidential | For Internal Use Only | Do Not Copy | Do Not Share with Current or Potential Members 5

6. Proactive Chronic Obstructive Pulmonary Disease (COPD) Management
COPD Program
COPD Management and Self-Care Education with Nurse Practitioners and Dietitians
Medication Management – routine and rescue meds
Smoking Cessation Class for all smokers interested in quitting
Updated 2/18/14 – Please review.
RESULTS
for program participants
33% fewer admissions
47% fewer hospital days
CareMore 2013 Program Effectiveness Metrics. Based on individuals who receive supplemental oxygen at home who had at least 1 CareMore COPD Program visit (In Program) versus those who did not (Not In Program)
Company Confidential | For Internal Use Only | Do Not Copy | Do Not Share with Current or Potential Members

7. ESRD Program Outcomes RESULTS 37% fewer admissions
64% fewer hospital days
CareMore 2012 Program Effectiveness Metrics. Based on members in the ESRD Program in Medicare average is unadjusted 2010 data from United States Renal Data System ( accessed July 2013.

8. Diabetes Program Outcomes
RESULTS
Amputation rate 65% lower than the national average
Sub-Regions Los Angeles & Orange Counties
CareMore 2012 Program Effectiveness Metrics. Non-traumatic lower extremity amputation rate per thousand members per year, excluding members with ESRD. Medicare average is for FFS beneficiaries, not age adjusted, from American Journal of Preventive Medicine, 2005. 3

9. Value-Based Contracting for Specialty Care
Primary Care
Capitated reimbursement only
Bonus - STARS/HEDIS/Generic %/PAHAF submission
Profit Share - BDK/ER visits
Specialists
Aim for small number/high volume
Need to Understand the CareMore Model
Hospitals
Per diem rate
Profit Share
Need to understand CareMore Model 9