1. www.optimahealth.com Payment and Delivery Reform Virginia Health Care Conference June 6, 2013

2. www.optimahealth.com Shift to Value Based Outcomes Currently a perverse incentive based on FFS (volume driven) Shift to value-based reimbursement – Quality and Cost (efficiency) Alignment between payers and providers of resources and information around populations Address the entire continuum of care vs episodic care “Better health, better care and reduced cost” Triple Aim

3. www.optimahealth.com Health Plan Market Forces Medical Loss (expenses) Ratio (MLR) Regulation Federal Premium Rate Review ACA coverage expansion Pre-X exclusion Marketplace (exchange) Large Employer/ CMS/ Quality Agencies focused on quality based outcomes (volume to value) Clinically Integrated Networks (CINs)/ Accountable Care Organizations (AC0s)

4. www.optimahealth.com Population Management Collaboration Payer Cost data Utilization data – Medical – Pharmaceutical – Limited clinical – Wellness – Health Risk Assessments Engagement strategies – Incentives/ plan designs Patient satisfaction tool Delivery System Shared decision making tools – Clinical Performance Measurement System (CPMS) – Patient registries – Clinical data (Electronic Medical Record) – Cost/ Quality transparency tools – Quality improvement performance measurement Advanced Care Coordination – Care plans – High Cost/ High Utilizers – Evidence based protocols – Preventive care – Health coaching – Gaps in care Proactive personalized engagement

5. www.optimahealth.com Network Strategy Select Network – Incentive: Premium (contribution) differential – Choice: Time of Enrollment Tiered Network – Incentive: Co-pay differential – Choice: Time of service

6. www.optimahealth.com Why Optima Health Understanding of all stakeholders’ needs – Diverse client portfolio – Appreciation of the delivery system – Part of an Integrated Health Care System Health care is regional Currently operational Collaborative/ nimble