Providers Contracting Directly With Employers

NOVEMBER 14, 2018

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The Current Model

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Direct-to-Employer (DTE) Health Plan

Aligned Incentives – Gain Share

Direct Relationship – “At The Table”

Integrated Data & Analytics

PROVEN POP HEALTH

Transparent - EVERYTHING

Budget Targets Savings

The Market is Changing

✓ Employers are approaching Providers demanding Direct Contracting

✓ Strong desire to reduce healthcare costs by 10%+

✓ Want more than discounts- Improved care and long term savings

✓ Focus on prevention, early detection and better outcomes

Reinventing Healthcare4

Direct-to-Employer (DTE) Health Plan

DTE Strategy:

1. “Directly” contract with self-funded employer(s) for a FFS or a retroactive discount with an upside gain share

2. Medical Provider is the center of the relationship with the employer – not an insurance carrier

3. Gain sharing arrangement

4. Financially incent members to use the sponsoring Medical Provider(s) and adhere to protocols intended to address gaps in care and to manage appropriate utilization

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Direct-to-Employer (DTE) Health Plan

There are 5 main reasons the DTE program is a strategically important:

1. Millions in NEW incremental net revenue

2. Control over YOUR OWN network

3. Employers directly connect with local medical providers without a middle man for better patient care and lower costs

4. Sponsoring Medical Provider has a “low risk strategy” and robust source of new fees and revenues

5. Increases the ability to achieve the Triple Aim – increased satisfaction, better outcomes and reduced cost

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Direct-to-Employer – Medical Provider

Our analysis reveals that you need less than a 1% market penetration to generate Millions in Net Incremental Revenue.

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Direct-to-Employer – Medical Provider

You Pick the Name of the Health Plan

You Determine the Fees Charged

You Practice the Medicine

You Receive the Profits

You Make it Successful

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Benefits for the Employer

✓REDUCED MEDICAL SPEND THROUGH CARE CONTROL

✓“AT THE TABLE” WITH THE MEDICAL PROVIDER

✓INCENTIVIZED MEDICAL PARTNERS

✓IMPROVED AND “SUPERIOR” ANALYTICS

✓COMPETITIVE STOP-LOSS

✓INCREASED FLEXIBILITY

✓INCREASED CASH FLOW & STABILIZATION OF COST

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The LEADING Independent Administrator

✓ Market – Leading Direct Contracting Programs

✓ State-of-the-art Population Management

✓ Replacing current models with collaborative partnerships

✓ Delivery systems built so that Providers can prosper by reducing overall cost of care and improving the quality of care for members

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DTE Model of Collaboration

✓ Stratify entire population by risk and compliance with standards of care

✓ Provide data necessary for medical staff to effect necessary treatment options

✓ Leverage Key Benefit administration• Claims processing

• Customer service

• Sales/ Distribution

• Wrap networks

✓ Contract DIRECTLY with key local providers for optimal rates

✓ TRANSFORM HEALTHCARE as a recognized leader in your commercial market

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DTE Model of Collaboration

Key Benefit

✓Health Plan Administration

✓Acquire & Retain Customers

✓Customer Service

✓Population Management

✓Transparent PBM

✓Stop-Loss

✓Employer/Broker Support

Medical Provider

✓Tier 1 Provider Network

✓Population Management

✓Medical Director oversight

✓Local Provider Recruitment

✓Network Management

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DTE Financial Impact

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Year Membership DTE Net Revenue Incremental Net RevenueYEAR 1 3,500 $ 13,475,458 $ 7,951,051YEAR 2 5,500 $ 21,175,440 $ 12,494,460YEAR 3 12,500 $ 48,126,000 $ 28,396,500

Positive financial impact:✓Medical Provider is the primary medical delivery system ✓ Restrict access to any other providers except in instances of emergency care

or medically approved referrals to any other provider. ✓New revenues from fees:

• Gain share distribution, AND• Medical services not otherwise paid in major medical plans, AND• Network Access Fees

DTE Financial Impact

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3,500 Members

Medical Service Delivery Gross MedicalClaim Revenues

CurrentPassive PPO

DTE NET Direct-to-Employer Plan

DTE NET Incremental Revenues

In-Patient Hospital $ 7,083,462 $ 2,380,043 $ 5,277,179 $ 2,897,136 Out-Patient Hospital 4,871,915 1,636,964 3,629,577 1,992,613 Professional 2,818,010 946,851 2,099,417 1,152,566 Outpatient Surgical 443,766 149,105 330,606 181,500 Emergency Room 489,112 164,342 364,389 200,047 Home Heath 460,219 154,634 342,864 188,230 Laboratory 155,222 52,155 115,641 63,486 Other Unlisted Facility 58,471 19,646 43,561 23,915 Outpatient Dialysis 49,492 16,629 36,871 20,242 Mental/Sub. (In/Out) 9,430 3,168 7,025 3,857 Rehabilitation (In/Out) 2,589 870 1,929 __ 1,059

Total Medical Revenues: $ 16,445,189 $ 5,524,407 $ 12,249,058 $ 6,724,651 Enhanced Revenues

DTE Network Fees N/A -0- 210,000 210,000CDM Regimens of Care N/A -0- 375,480 375,480DTE Gain Share N/A -0- 640,920 640,920

Total “Net” Revenues: $ 16,445,189 $ 5,534,407 $ 13,475,458 $ 7,951,051

PMPM: 391.55 131.53 320.84 189.31

True Population Management

✓ Analyzes all patient data for evidence-based treatment

✓ Stratify risk and identify Gaps in Care

✓ Proven models to change patient behavior

✓ Nurse coaches outreach to identified patients with chronic conditions and comorbidities

✓ Evaluates care and compares to current standards

✓ Proven to reduce overall costs by 11-17%

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Every Member - Every Encounter

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✓ Data Supported by Over 1.5 Million Members Under Management

✓ Encounter Data Regardless of Provider in your DTE

✓ Triage & Referral Mgt.

Every Member - Every Encounter

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✓ Every Disease State Identified

✓ Every Member Defined by Chronic/Acute Conditions

✓ Regimen of Care Identified

✓ Provider Focused

Population Health Results

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$421$411

$342

$439$473

$509

$0

$100

$200

$300

$400

$500

$600

2014/2015 2015/2016 2016/2017

Midwest Multi-Specialty Physician Group4,900+ Members

PMPM Comparison90% Completion Rate for CDM Regimens of Care

Actual PMPM Total Cost of Care AON Hewitt Trend

Cumulative Savings $15.4 Million

Trend: Trend is a forecast of per capita cost increases that takes into account various factors, including price inflation, utilization, government-mandated benefits, and new treatments, therapies, and technology.

Population Health Results

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$362 $327$335

$180

$385 $411$443

$477

$0

$100

$200

$300

$400

$500

$600

2014 2015 2016 2017

Midwest Acute Care Hospital7,800+ Members

80% Completion CDM Regimens of CarePMPM Comparison

Actual PMPM Claims Costs AON Hewitt Trend

Cumulative Savings $47 Million

Trend: Trend is a forecast of per capita cost increases that takes into account various factors, including price inflation, utilization, government-mandated benefits, and new treatments, therapies, and technology.

DTE Program Description - Network

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Out of Network

Wrap Network (Rented)

Friends & Family (Contracted)

YOUR Network

✓ YOUR NETWORK – TIER 1

• The Medical Providers Your Directly Control, or are Part of Your CIN/IPA/PHO/PO. Gain Share distribution!!

✓ Friends & Family Providers – TIER 1 & 2

• Medical Providers that are in your Catchment Area and are Complimentary to Your Medical Services – TIER 1 benefit access through approved referrals from TIER 1 providers

✓ WRAP NETWORK – TIER 1 & 2

• Medical Services from Already Existing PPO Networks for Members that Travel, for Tertiary and Specialty Services You do not provide, and for Employees Residing Outside Your Direct Catchment Area - TIER 1 benefit access through approved referrals from TIER 1 providers

✓ OUT OF NETWORK

• Non Contracted Medical Providers

DTE Program Marketing & Sales

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KEY WORKS WITH YOU TO MANAGE & SELL:✓Branding & Messaging✓Direct & Brokerage Sales Distribution✓Brochures, Web Site, Media, etc.

✓Implement with your Own Employee Benefit Plan

Proven Partner - Direct-to-Employer Market

Key Family:

• 40 Years of a Proven Track Record – 2.5 Million Lives Under Management

• DTE Integrated Reinsurance and Medical Stop-Loss Coverage

• Turn-key and customized Administrative Systems- Claims, Customer Service, Fulfillment, Compliance, Data Reporting, Referral Management Systems, Mobile Apps

• Customized Plan Designs with Provider Attribution and Referral Management Systems

• Comprehensive Data Analytics, including: Risk Stratification, Gaps In Care, Clinically –Based Physician Profiling, Predictive Modeling

• Network Development and Wrap Networks

• One-sided Gain Share and Distribution of Gain Share Disbursements & Reporting

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Proven Partner - Direct-to-Employer Market

Key Family:

✓ Transparent PBM – Low Cost

✓ Integrated Wellness Plans

✓ Mobile Apps

✓ Self-Service IT Apps – Employee-Employer-Provider

✓ Lowest Cost Stop-Loss Insurance Rates

✓ Member Transparency Tools23

A Partner You Can Trust

Key Family

✓Will NOT Compete Against You

✓Our Objectives are Aligned

✓Completely Transparent

✓We have the size, scale, and sophistication of a commercial insurance carrier but without the inflexible and bureaucratic systems

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FIRST STEPS - ASSESSMENT

Determine if you are the right Candidate in the Right Market?

✓ We do a basic analysis of your viability as a narrow network in your primary catchment market and the ability to fill in the gaps in your services offered.

✓ We also do a preliminary analysis of the employer market to determine potential opportunities available.

✓ Once an agreement is signed, a full detailed analysis of all assumptions is begun.

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PHASE 1 – PROGRAM START-UP

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Oversite

Project teams are guided by experienced senior healthcare industry executives

Assessments

We determine your readiness to receive thousands of new health plan members

Goals

Program goals are set and progress closely tracked

The Blue Print

We draft a comprehensive business plan to launch and grow the program

Engagement

Full engagement is achieved though high levels and communication and collaboration

PHASE 2 – ON-GOING PROGRAM GROWTH

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Sales

Sales Plan Implementation

- Professional sales manage-ment

- Agent and broker network

- Prospect identification & targeting

- Sales Goal Tracking

Marketing + Branding

Marketing Plan Implementation

- Program branding- Employer

campaigns- Employer events- Full integration

with Medical Group Marketing

Program Monitoring

Goal Achievement + Reporting

- Goal publishing

- KPI reporting

- Employee satisfaction sampling

- Employer satisfaction sampling

Growth Strategies + Campaigns

Development & Implementation

- Employer Advisory Panel

- Broker/Agent Advisory Panel

- Plan offering optimization

- Eliminate friction in the sales channel

Account Management

Ongoing communication + stakeholder engagement:

- Physician Leadership- Operations Leadership - Physicians- Office Administrators- Marketing- Compliance/ Insurance/

Risk/Legal

FOR MORE INFORMATIONJack Hill

The Key Family - ACSG

Phone: 630.878.7539

Jack.Hill@AccountableCareSG.com

www.accountablecaresg.com

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Key Family

Additional Material

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The OrganizationThe Key Family of Companies Founded in 1979 as a full-service group benefits administration firm specializing in self-funded medical plans. The Key

Family has grown to become one of the country’s largest independently-owned third party administrators, supporting a wide variety of group benefit plans. The Key Family services employer-sponsored plans, medical provider organizations, insurance carriers, and third-party payers throughout the US. With two major locations in Indianapolis, Indiana and Ft. Mill, South Carolina, Key Family has 800+ employees, 4,000+ corporate customers, and 2.2 million+ members under management.

Key Benefit Administrators (KBA)

KBA is one of the nation’s largest privately held third party administrators, providing various functions such as policy issue, billing and collection, customer service, claims management, benefit consulting, administration of employee plans, ancillary plan services and management support services.

American Health Data Institute (AHDI)

The largest and oldest population health database in the country. A pioneer in population health management enabling employers and medical providers to manage the cost and risk of health plan utilization in a way that optimizes benefits to the members. Proven to improve the health care status of the population.

Accountable Care Solutions Group (ACSG)

Consulting and project management services for medical providers desiring to deploy their own health plan strategy effectively creating collaborative community health solutions.

Key Partners, Inc. (KP) Our partner in contracting and maintaining PPO networks, both locally and nationally, with over 85 provider networks under contract.

RGI, LLC The underwriting specialists for medical stop-loss and reinsurance placement.

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Key Family Solutions & Value Proposition

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Solution Set Client FocusKey Family

DifferentiatorsHealth System Value

Direct-to-Employer • Health System Sponsor• Local Employers

• Experienced Population Management System

• Turn-Key• Totally Customizable• Integrated Stop-Loss• Revenue Enhancement

• Surprisingly Low Cost of Entry• Increased Incremental Income• Gain Share with S/F Plans• “At the Table” with Employers• Speed to Market with KBA• Risk/Reward Adjustability

Self Funding Plan Administration • Single Employer or Hospital System’s Plan

• Experience with Employer Plans Hospital clients

• Can Increase Domestic Steerage• Analytics – Proven Results• IT System Capabilities (e.g. reporting,

referrals, plan management, etc.)

• Drive Domestic Steerage• LEARN Population Health• Manage Chronically Ill• Evaluate Physician Practice Partners• More Effectively Utilize Assets of System with

Members

AHDI Analytics & Nurse Coaching • Health Systems• Employers• Providers in Episodic

Care

• Proven Results in Reducing Secular Trend

• Easy Access with Targeted Analytical Information (EZView)

• Superior Analytical Framework across all Member Encounters

• Identifies and Helps Reduce Gaps in Care and Clinically-Based Physician Profiling