1. Alliance Hill Briefing May 4, 2012 Healthcare Integration: The Behavioral Health Perspective

2. Cenpatico Introducing Cenpatico o Part of Centene Family o Innovative MBHO Centene Philosophy: Centene Philosophy: Integration for Special Populations o Fluid Integration o Understanding Behavioral Health Home Challenges Challenges Outline cenpatico.com 2

3. Specialty Health Solutions 3 Focus on integration of behavioral and physical health and ancillary services cenpatico.com

4. Cenpatico Overview What We Do 4 MBHO MBHO: We are a “Managed Behavioral Healthcare Organization” NCQA Accredited: NCQA Accredited: Quality Organization Core Services Core Services: We focus on delivering behavioral health services to members through our coordination activities, clinical oversight, and our network providers. Schools Schools: Private Day Treatment for children in K-12 (AZ) Specialty Therapy & Rehabilitation Services: Specialty Therapy & Rehabilitation Services: Deliver coordination and utilization management for Physical, Speech, Occupational Therapies for our health plans INNOVATION: INNOVATION: Cenpatico is always focusing on expanding our services. Through our behavioral health expertise, we also deliver services for children in foster care and have begun community re-entry programs. cenpatico.com

5. Confidential and Proprietary Information Current Overview

6. Medicaid recipients with Behavioral Health Disabilities = 15% of all recipients but account for 42% of Medicaid spending cenpatico.com 6 Persons With Chronic Psychiatric Disabilities in Medicaid Healthcare Integration The Behavioral Health Perspective Source: Kaiser Commission on Medicaid and the Uninsured Issue Paper. (Feb 2012) People with Disabilities and Medicaid Managed Care: Key Issues to Consider. Retrieved on 2/17/2012 from: http://www.kff.org/medicaid/upload/8278.pdfhttp://www.kff.org/medicaid/upload/8278.pdf

7. cenpatico.com 7 Healthcare Integration The Behavioral Health Perspective Persons with Behavioral Health Disabilities Require Significant Care Source: Hamblin, A., Verdier, J., & Au, M. (Oct 2011). Technical Assistance Brief: State options for integrating physical and behavioral health care. Integrated Care Resource Center.

8. cenpatico.com 8 Confidential and Proprietary Information 1.Higher rates of diabetes, hypertension, heart disease, acute respiratory disorders 2.Psych meds and weight gain 3.Inability to adhere to treatment plan 4.Presentation confuses treatment Healthcare Integration The Behavioral Health Perspective Here’s What That Means… Seriously Mentally Ill (SMI) correlates with higher rates of numerous Physical Health conditions Seriously Mentally Ill (SMI) correlates with higher rates of numerous Physical Health conditions SMI and Substance Use Disorder (SUD) can contribute to physical health conditions and/or complicate their treatment; and SMI and Substance Use Disorder (SUD) can contribute to physical health conditions and/or complicate their treatment; and Comorbid (physical & behavioral health) conditions can result in inappropriate utilization and higher than necessary medical costs Comorbid (physical & behavioral health) conditions can result in inappropriate utilization and higher than necessary medical costs Interaction of Physical & Behavioral Health Conditions

9. cenpatico.com 9 Confidential and Proprietary Information 1.Unlikely 1.Unlikely to seek out preventative or primary medical care emergent care 2.Typically receive physical health services through emergent care when conditions are more advanced community mental health system 3.Receives services through the community mental health system versus a Primary Care Physician Healthcare Integration The Behavioral Health Perspective Access for SMI Greater training and engagement of Primary Care Physicians (PCPs) Improved prescribing patterns Source: Dickey, B., Normand, S.T., Weiss, R.D., Drake, R.E., & Azeni, H. (2002) Medical morbidity, mental illness, and substance abuse disorders. Psychiatric Services, 53, 861-867. Behavioral Health Home Behavioral Health Home Access for Persons w/ Chronic Psychiatric Disabilities Typical Health Home Typical Health Home Access for Persons With Chronic Psychiatric Disabilities

10. cenpatico.com 10 Healthcare Integration The Behavioral Health Perspective Aged, Blind, Disabled (ABD) and Seriously Mentally Ill (SMI) Enrolled in Integrated Care Management (ICM) 30 Days or More Source: Based on 2011 Centene claims data for SMI/SSI/ABD populations enrolled in ICM for 30+ days in TX, FL, OH, and WI. Result: $3,629,493.85 in 2011 Behavioral Healthcare Savings

11. cenpatico.com 11 Healthcare Integration The Behavioral Health Perspective Source: Based on 2011 Centene claims data for SMI/SSI/ABD populations enrolled in ICM for 30+ days in TX, FL, OH, and WI Note: ER refers to Emergency Room. Result: $873,223.55 in Non- ER Medical Expenses and $150,068.90 in Emergency Room (ER) Expenses Aged, Blind, Disabled (ABD) and Seriously Mentally Ill (SMI) Enrolled in ICM 30 Days or More

12. cenpatico.com 12 Centene serviceexcellence Centene fundamentally focuses on delivering service excellence in three key areas whether Behavioral or Physical Health led : Clinical Effectiveness Provider Education Payment Integrity fluid accessquality Persons with SMI/SUD and the ABD population need a fluid system of care that ensures access and quality first based on their needs… Healthcare Integration The Behavioral Health Perspective

13. cenpatico.com 13 Confidential and Proprietary Information 1. Work Force Issues in BH 1. Work Force Issues in BH - Shortage of psychiatrists, especially child/ adolescent specialists is acute. 2. Eliminate the limitations 2. Eliminate the limitations for Behavioral Health Providers to access Health IT Funds. Healthcare Integration The Behavioral Health Perspective GREATEST CHALLENGES

14. Thank you! SAM DONALDSON, PH. D. President & Chief Executive Officer 504 Lavaca St., Suite # 850 Austin, Texas 78701 512.406.7200 office | 512.431.5894 cell | sdonaldson@cenpatico.com