1. Youngstown State University September 2018 HCAC Meeting

2. Agenda Network Access - AXA Transplant Network Changes
Health Risk Distribution
October Agenda

3. Network Access
National Network - Outside of Ohio Network Access Partnership
Enhancement with minimal disruption
01/01/2019 Target Date
New Cards for all members
Ohio Residents – Network Access on back of card
Non-Ohio Residents- Network Access on front of card
Same Outstanding Service from Medical Mutual
Talking Points:
MMO has been working diligently to get the network access right and you’ve experienced some changes in late 2017 with the addition of UPMC, but we had to remove Allegheny at that time.
MMO has partnered with AXA – Company that offers health plans access to national networks and acts as a TPA and network aggregator.
Through this partnership your members will have access to the Aetna Open Choice PPO network providing greater access to care and provides cost savings. You may be familiar with First Health as the current Network outside of Ohio in the PA area.
Aetna Open Choice PPO adds Allegheny back in the network, while maintaining access to UPMC.
Providers have been notified of the termination with First Health.
In Ohio and 3 counties in Kentucky, near Cincinnati, your members will continue to have access to the Supermed PPO network.
Out of State Dependents – Card will mirror your card, but dependent will continue to have access to Supermed PPO as well as Aetna Open Choice PPO networks.
We anticipate the provider lookup capabilities will be available 10/01/2018 on My Health Plan.

4. Transplant Network Changes
Enhancement to Current and Future Transplant Services in Ohio
Effective 09/01/2018
MMO Clinical Team will work with OPTUM to provide member guidance
Manage Cost
Quality
Member Experience
Transplant Services Prior Auth Criteria and Medical Policies apply
List of Providers
MMO is always looking for opportunities to enhance our services while continuing to manage cost, quality and improve the member experience.
We currently work with OPTUM in other capacities and will now engage OPTUM to enhance our current and future transplant services in Ohio.
We have provided a copy of the OPTUM Transplant Network in Ohio for your review along with the OPTUM flier – How COE help improve quality and control costs.
We have identified one YSU member with an approved transplant through Jan 2020 and it appears they are already receiving care from a provider on the list provided.
MMO is evaluating the 1/1 network access change with the transplant changes and will communicate any additional information when it becomes available.

5. Health Risk Distribution
YSU Risk Categorization
9.7% - 57% cost
21.8% % cost
68.5% - 15% cost
Last month we had an opportunity to present an Employer Profile Report to the HR, Wellness and benefit teams.
This report identifies the health risk distribution by member and the health risks are defined by OPTUM and the risk does not change.
The information is based on medical and pharmacy data.
We wanted to give you a quick overview of the health risk distribution based on this report.
The colored graph is a guideline of OPTUM’s risk categorization
The numbers to the right is the distribution of YSU’s risk along with cost
The High risk patients are those identified with one complex illness or multiple co-morbidities. 9.7% of YSU’s members fall into this category and account for 57% of cost. Our goal is to ensure these members are being managed properly and are receiving the right care at the right time for the right condition.
The risk rising patients are those identified with chronic, aging, or unmanaged chronic conditions % of YSU’s members fall into this category and account for 27.8% of cost. Our goal is to manage the rising risk by implementing available programs such as DM, CM and RX programs to help members comply with their standards of care.
The Low risk patients are those identified as healthy or managed chronic conditions % of YSU’s members fall into this category and account for 15% of cost. Our goal is to increase this category and this is accomplished through education, wellness programs and engagement in our DM programs.
As you can see, the smallest population of high risk accounts for the largest amount of claims. Next month we will dig a little deeper to help determine what can be done to create the shift.
The smallest population of high risk, accounts for the largest amount of claims.

6. October Agenda Employer Profile Report Educational Opportunities
Medical Cost Utilization
Quality Measures
Health Risk Distribution
Educational Opportunities
Focus on Wellness
As stated previously we reviewed the Employer Profile Report and we will bring the report to discuss the numbers in more detail.
Look at areas of need for education about available programs such as; Nurse Line, DM, Case Management.
Determine the areas of focus and how it ties into the YSU Wellness program.