1. JPS & MedStar Patient Navigation Funding Approach March 25, 2014

2. Patient Navigation Overview Intervention of low acuity 911 calls to direct care to right setting in the right timing 911 Nurse Triage Up to 5 day program to provide in home support to until patient gets to next step in care Observational Admission Avoidance 30 day program to assist CHF patients post discharge with accessing appropriate care CHF In-Home Management 90 day program to train high ED utilizer patients with accessing care in the appropriate settings High Utilization Group Goals Reduce Avoidable Admissions Improve access to care in the right setting and right time Decrease 30 day readmissions (CHF) Goals Reduce Avoidable Admissions Improve access to care in the right setting and right time Decrease 30 day readmissions (CHF)

3. Section 1115 Research and Demonstration Projects Section 1115 of the Social Security Act gives the Secretary of Health and Human Services the authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs. In general, section 1115 demonstrations are approved for a five-year period and can be renewed, typically for an additional three years. Demonstrations must be “budget neutral” to the Federal government, which means during the course of the project Federal Medicaid expenditures will not be more than Federal spending without the waiver. Patient Expansion Expanding eligibility to individuals who are not otherwise Medicaid or CHIP eligible Service Expansion Providing services not typically covered by Medicaid Innovation Using innovative service delivery systems that improve care, increase efficiency and reduce costs.

4. Year 1 Community Need Assessment Project Identification & Submission Year 2 CMS Approval Project Planning Year 3 Process Milestones Patient Care Begins Baseline Established Year 4 Patient Care Outcome Measures Reported Improvement Cycles Year 5 Patient Care Outcome Measures Improvement Cycles 1115 Waiver – 5 year process

5. Payment Mechanics 1115 Waiver payment to Providers from CMS are based on: RequirementDetails.40 cents of each dollar drawn down from CMS is required to have a match If 1 Million CMS valuation, 400K must be provided from organization to draw down funds Committed Project Milestones must be presented yearly Example deliverables would include Needs Analysis, Project Planning documentation Completing Quantifiable Patient Impact commitments yearly 1500 phone calls, 350 patients seen in one year Delivering on committed outcomes of each program Example: In year 4, reduce admissions for Ambulatory Care Sensitive Conditions by 5% Payments from JPS to MedStar are based on: Per patient payment - monthly Shared outcome pool - yearly

6. Project Vision Why Did JPS partner with MedStar? -Proven results on small scale pilot -Shared values of getting patients the right care in the right setting -Existing infrastructure of 24x7 response within the community -Through collaboration we can better impact patient outcomes for shared patients