1. TNMGMA 2016 Cover area with cropped image. Do not overlap blue bar.
Completely cover gray area.
TNMGMA 2016

2. Agenda TN Healthcare Innovation Initiative- Episodes of Care Link
UHC On Air
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3. Episodes of Care A Tennessee Healthcare Innovation Initiative
Doc#: Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

4. Innovation Initiative
Tennessee Health Care
Innovation Initiative
“It’s my hope that we can provide quality health care for more Tennesseans while transforming the
relationship among health care users, providers and payers. If Tennessee can do that, we all win.”
– Governor Haslam’s address to a joint session of the state Legislature, March 2013
“We are deeply committed to reforming the way that we pay for healthcare in Tennessee. Our goal is to pay for outcomes and for quality care, and to reward strongly performing physicians. We plan to have value-based payment account for the majority of healthcare spend within the next three to five years.
By aligning on common we will see greater impact and ease the transition for providers. By working together, we can make significant progress toward reducing medical costs and improving care.”
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

5. Tennessee’s Three Strategies
Source of value
Strategy elements
Examples
Maintaining a person’s health overtime
Coordinating care by specialists
Avoiding episode events when appropriate
1. Patient Centered Medical Homes
2. Health homes for people with serious and persistent mental illness
3. Provider alerts via care coordination tool with Hospital and ED admission
1. Encouraging primary prevention for healthy consumers and coordinated care for the chronically ill
2. Coordinating primary and behavioral health for people with SPMI
Primary Care
Transformation
Achieving a specific patient objective, including associated upstream and downstream cost and quality
75 episodes by 2019 rolling out in 11 waves.
2015 has first financial accountability
Retrospective Episodes of Care
Episodes of Care
Provide long-term services and supports (LTSS) that are high quality in the areas that matter most to recipients
1. Quality and acuity adjusted payments for LTSS services
2. Value-based purchasing for enhanced respiratory care
3. Workforce development
1. Aligning payment with value and quality for nursing facilities and home and community based care
2. Training for providers
Long Term
Services & Supports 4

6. Retrospective Episodes: Providers & Patients
1 Quarterback: The designated provider deemed to have the greatest accountability for the quality and cost of care for a patient.

7. Episodes by design year and wave
Updated on June 14, 2016
Episodes by design year and wave
Design year & wave
Design year & wave
Design year & wave
Episode
Episode
Episode
Tonsillectomy
2013 1
Perinatal
2016 5
2018 9
Depression – acute exacerbation
Asthma acute exacerbation
Non-emergent depression
Lung cancer (multiple)
Total joint replacement
Anxiety
Female reproductive cancer
2014 2
COPD acute exacerbation
2016 6
Cellulitis & bacterial skin infec.
Other major bowel (multiple)
Colonoscopy
Neonatal (multiple)
PTSD
Cholecystectomy
HIV
PCI - acute 10
Fluid electrolyte imbalance
PCI – non acute
Pancreatitis
Renal failure
2015 3
GI hemorrhage
Diabetes acute exacerbation
Liver & pancreatic cancer
EGD
2017 7
Medical non-infec. orthopedic
Hepatitis C
Respiratory Infection
Schizophrenia (multiple)
GERD acute exacerbation
Pneumonia
Spinal fusion exc. cervical
Drug dependence
UTI - outpatient
Lumbar laminectomy
GI obstruction
UTI – inpatient
Hip/Pelvic fracture
Rheumatoid arthritis 4
ADHD
Knee arthroscopy
2019
CHF acute exacerbation 11
Bipolar - chronic
Wave 5
Expanded the names of the breast cancer episodes. Previously stated “Breast cancer (multiple)”. Updated to “Breast cancer, mastectomy” and “Breast cancer, medical oncology”
“Chronic depression” was updated to state “non-emergent depression” per the TAG’s recommendation
Wave 6
Diabetes acute exacerbation moving from Wave 7 to Wave 6
Moving Pancreatitis from Wave 10 to Wave 6
Moving Hepatitis C from Wave 6 to Wave 10
Bronchiolitis/RSV removed from list as these were included as triggers in the Pneumonia episode 8
Hemophilia & other coag. dis.
ODD
Bipolar – acute exacerbation
Anal procedures
CABG
Conduct disorder
Colon cancer
Valve repair and replacement
Epileptic seizure
CAD & angina
Bariatric surgery
Hypotension/Syncope
Hernia procedures
Kidney & urinary tract stones
2016 5
Breast biopsy
Cardiac arrhythmia
Other respiratory infection
Breast cancer, mastectomy
Sickle cell
Dermatitis/Urticaria
Breast cancer, medical oncology
Pacemaker / Defibrillator
Otitis media
Updated June 14, 2016

8. Performance Years Begin Performance Years Begin
Perinatal, Asthma Acute Exacerbation, Total Joint Replacement
Colonoscopy, COPD Acute Exacerbation, Cholecystectomy, PCI
EGD, Pneumonia Respiratory Infection, Outpatient UTI, Inpatient UTI, GI Hemorrhage
ADHD, ODD, CHF Acute Exacerbation, CABG, Cardiac Valve, Bariatric Surgery
2015 WAVE 1
2016
WAVE 2
2017 WAVE 3
2017
WAVE 4
Preview period:
5/ /2014
Preview period:
5/ /2015
Preview period:
5/ /2016
Preview period:
5/ /2016
Performance Years Began
January 1, 2015
Performance Years Begin:
January 1, 2016
Performance Years Begin
January 1, 2017
Performance Years Begin
January 1, 2017
Final Report with financial accountability issued in August of following year
Final Report with financial accountability issued in August of the following year
Final Report with financial accountability issued in August of the following year
Final Report with financial accountability issued in August of the following year

9. Exclusions from Episodes
Business Exclusions
Inconsistent Enrollment
Third-Party Liability
FQHC/RHC Status for PAP
Incomplete Claims
Death
Left AMA
High Cost Outliers
Clinical Exclusions
Vary depending on the episode
May include age, co-morbidities, or clinical course

10. Risk Adjustment
Allows for cost comparison across the state Specific to each episode based on factors that affect cost For some episodes, may include codes that providers may not typically add to claims Examples: BMI Smoking status Substance Abuse

11. Principal Accountable Provider: Quarterback

12. Link

13. Accessing Link UnitedHealthcareOnline.com is your entry to Link
To complete transactions using applications on Link, please sign in to UnitedHealthcareOnline.com using your Optum ID .
Read slide, encourage viewer to select the different sublinks (training, FAQs etc) on the page to learn more. In the next few slides lets view some key areas LINK supports:
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14. Link Access Link via UnitedHealthcareOnline.com
Need an Optum ID to access Link
Make sure your address is correct by signing in to UnitedHealthcareOnline.com>My Account
Optum Support Center
Quickly move between apps
Customize your own screen
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

15. Link Useful and Time Saving Applications
Over 170 applications accessible
Check Benefits/Eligibility for all lines of business
Claims Reconsideration
Claims Status
Appeals with attachments
Online prior authorization requests with attachments
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

16. UHC On Air

17. UHC On Air Tennessee Market * Six Dedicated Channels:
- Provider Resource Center
- Behavioral Health
- Innovative Medicine
- Claims Processing and Payment
- UHC Insider
- Healthcare Now

18. UHC ON AIR
UHC On Air has information on many topics impacting all different providers across the state of TN. These educational topics include session on our various lines of business like Medicare, Commercial, Medicaid, to daily operational topics, clinical topics, and what is hot in the healthcare news now.

19. UHC On Air
Utilized for provider education on all lines of UHG business
Allows for a greater outreach and more convenient way for providers to receive UHC news
Ability to develop short, specific trainings as well as longer, more extensive meetings
UHC On Air is a web-based communication platform that allows healthcare providers to view interactive live and on-demand video presentations from UHC. UHC On Air allows providers to connect with UHC representatives and engage on a multitude of topics through highly interactive broadcasts.

20. UHC On Air
Offers live and pre-recorded presentations that are accessible on-demand
Offers interactive functionality with audience through polls, taking questions and surveying
Reporting features from high level usage data to individual provider detail
Accessible via computer, smart phone, tablet, etc.
Programs are broadcasted live and then are available on demand.
Some programs are pre-recorded and go straight to on demand for viewing
Once on demand, programs are available 24/7 and can be accessed from any smart device or computer

21. UHC On Air
1. Login to Link Dashboard 2. Single Sign On to UHC On Air Tile
The provider will be able to access the tool from the Link Dashboard, utilizing a single sign on with their Optum ID.
When the application launches in September there will be 13 states included (phase 1), additional phases will occur throughout the year.
MI has their own network on the Link Dashboard due to C&S contract requirements to be available prior to the National launch.
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22. UHC On Air- Dashboard
Once the viewer clicks on the UHC On Air tile they will come to the main dashboard
Employees will have an additional channel “Internal News” for internal UHC education
National topics will be housed in “UHC News Now”
Each state will have their own channel with state specific programming
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23. UHC On Air
Once the viewer selects a state channel, they will see series. A series can represent a line of business or other program topic like Provider Information Expos
Clicking on the desired line of business will display the programming for that channel
All series are the same color in each channel to help viewer quickly identify what they are looking for, e.g. red is Commercial, green is Medicare, purple is Community Plan, orange is Provider Information Expo, etc.
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24. UHC On Air Programs will be offered live and On Demand for viewers
Live programming allows the viewer to interact with presenter by submitting questions in the “Ask a Question” box
On Demand programming also allows for the viewer to enter a question and it will be ed to the presenter
Programs also allow the ability to upload applicable handouts in the handout folder for the viewer to access during and after the program
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25. TN Provider Information Expos
November 2nd- Memphis November 3rd- Jackson November 8th- Nashville November 16th- Johnson City November 17th- Knoxville November 18th- Chattanooga
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26. Questions