UK Health Benefits Task ForceUK Health Benefits Task Force

October 24, 2001October 24, 2001

Agenda

CHA Health Profile

Current Relationship

Future Relationship

Questions & Answers

CHA Health Profile

Profile Roots began back in 1991 when a group of rural

healthcare providers in Eastern Kentucky approached UK Hospital about working together to develop an integrated healthcare delivery system

Network was known as CHA Provider Network

1995, CHA Health was created and licensed as an HMO by the Commonwealth of KY to offer fully insured health benefits to employers

CHA Health also maintains a Third Party Administrator (TPA) License for self funded administrative services

Profile

CHA Ownership– University of Kentucky Hospital 84.7%– Appalachian Regional Hospitals 9.6%– St. Luke Hospitals 3.4%– Our Lady of Bellefonte Hospital 0.9%– Pattie A. Clay Hospital 0.7%– Gateway Regional Health 0.4%– Rockcastle Hospital 0.3%

Profile Executive team and structure

Chief ExecutiveOfficer

Mark D. Birdwhistell

Chief FinancialOfficer

Dale Fisher

DirectorInternal AuditKen Taylor

Director Govt. Relationsand Legal AffairsShawn Crouch

Director of Corp. &Plan Development

Matt Sanger

Executive AssistantSharon Scales

Accounting

Chief OperatingOfficer

Brent Barber

Chief HealthServices OfficerTim Costich MD

Chief MarketingOfficer

Mark Lamberth

Claims

Member Services

Compliance/Appeals

Information Services

Medical Management

Quality Improvement

Pharmacy

Sales

Provider Relations

Marketing & Communications

Director of Human Resources

Kim Nesbitt

Premium BillingLegal Affairs

Financial Analysis

Account Services

Network Development

CredentialingUnderwriting

Profile

Mission Statement– Improve health and healthcare by providing value

and exceptional services

Vision Statement– CHA Health is the trusted leader serving the

community by making healthy living easier

Profile

CHA Network

Profile

347

2,410

1,214

472205

1,191

7,111

581686

6,025

343145

592

1,404

550

2,690

123178

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Total - AllRegions

CHA

Target

Kentucky Regions

Network Strength

Profile Total Membership

– 147,600

120,000

130,000

140,000

150,000

Mem

ber

s

Sep-00

Oct-00

Nov-00

Dec-00

Jan-01

Feb-01

Mar-01

Apr-01

May-01

Jun-01

Jul-01 Aug-01

Sep-01

Profile Member Satisfaction

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Ove

rall

Rat

ing

2001 CHA Health

Quality Compass Average (NCQA)

Health Plan Overall

Claims Processing

Customer Service

Profile

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ove

rall

Rat

ing

2001 CHA Health

Quality Compass Average (NCQA)

Getting Care

Quickly

Courteous and Helpful Office

Staff

Overall HealthCare

Provided

Specialist Care Overall

Personal Doctor Overall

Profile HEDIS Results

Cardiac Quality of Care Improvements

MeasureCHA2000

Threshhold2000

CHA2001

Threshhold2001

Beta Blocker Treatment After Heart Attack 80.65% 25-50% 98.67% > 90%

Cholesterol Mgmt. After Cardiovascular Event (LDL-CScreening)

64.16% 25-50% 80.42% 75-90%

Cholesterol Mgmt. After Cardiovascular Event (LDL-CControl)

33.53% 10-25% 61.54% 75-90%

Controlling High Blood Pressure 35.52% 10-25% 64.48% > 90%

Interventions: Cardiac Disease Management (DM) Program DM Program Education to all PCPs One-on-one communication with PCP (RE: specific DM program member outcomes)

Targeted Preventive Quality of Care Improvements

MeasureCHA2000

Threshhold2000

CHA2001

Threshhold2001

Breast Cancer Screening 72.67% 25-50% 75.66% 50-75%Cervical Cancer Screening (CM) 66.91% 10-25% 78.27% 75-90%Eye Exam 36.25% 25-50% 41.85% 25-50%

Profile

$0

$5

$10

$15

$20

$25

$30

Net

wor

th in

Mill

ions

1998 1999 2000 Aug-01

Regulatory Requirements Net Worth

Statutory Net Worth

Profile Received B++ Financial Rating from A.M. Best

– B++ is considered “very good”– Plans with B+ or higher are considered “secure”

Plans have a strong or good ability to meet their long-term obligations to members

Maintain a level of financial strength that can withstand unfavorable changes in the business, economic or regulatory environment

– Heavy emphasis is placed on financial rating by Consultants and Brokers

– “…rating formally ratifies the significant improvements that have taken place…”

Current Relationship

Current RelationshipUniversity of Kentucky

(Self Funded Employer)*Maintains Risk

UK Health Care Plans

PPO Plan UKHMO

Humana CHA Health Subcontracted Services

Subcontractors

Current Relationship

UKHMO has had a contract with CHA Health to provide certain Administrative Services for UKHMO Lexington Service Area (LSA) and Regional Service Area (RSA) members since July 1997

Obligations are different between LSA and RSA

Current Relationship

LSA RSA

Current Relationship LSA

Services Performed

UK HMO CHA Health

1. Payment settlement of all claims, 1. ID card production and COC

excluding OOA emergency and DME distribution

2. Member Services 2. Access to PBM

3. Utilization Management 3. Network Access and Provider

4. Financial Accounting Directory development/distribution

5. Benefit Administration 4. Utilization Management for OOA

6. Formulary Management and emergencies and DME claims

PBM Interface 5. Membership eligibility and

7. Service Area determination reconciliation

8. Member Appeals

Current Relationship RSA

Services Performed

UK HMO CHA Health

1. Financial Accounting 1. Payment settlement of all claims

2. Benefit Administration/Determination 2. Preparation of financial statements

3. Formulary Management and 3. All Utilization Management

PBM Interface 4. Coordination of appeals process

4. Service Area Selection 5. Member Services

6. ID card production and COC distribution

7. Access to PBM

8. Network Access and Provider Directory development/distribution

9. Reporting

10. eHealthConnectsm

access

11. Membership eligibility/ reconciliation

Profile UKHMO’s relationship allows for access to technology and

reporting capabilities that require economies of scale1. eHealthConnectsm

– CHA Health’s online service for members and providers that allows them to access key information

Members

– Order replacement ID card– View claims status– Verify member eligibility– Change PCP– View member benefit

information

– Available 24 hours a day, seven days a week

Providers– View claim status and

authorizations

– Verify member eligibility

– PCP access to patient list

– View patient benefit information

2. CHA Health’s Reporting Module– Allows for real-time ad hoc reporting

Profile

UK HMO has access to all these services at competitive marketplace pricing

Future Relationship

Future Relationship Today, UK Health Care Plans has 13,729

employees participating with its Plan– 98% reside in the Commonwealth of Kentucky

CHA Health is well positioned as a locally owned Managed Care Organization to meet the needs of UK Health Care Plans– In addition to the UKHMO RSA, CHA Health

Provider Network could accommodate a PPO product that would cover 96% of the UK employees

Future Relationship Distribution of UK employees by county

– 96% reside in CHA Health service area

Warren

Logan

Hickman

Carlisle

Ballard

Graves

McCracken

Calloway

Marshall

Livingston

Lyon

Trigg

Crittenden

Caldwell

Christian

Todd

Hopkins Muhlen- burg

Union

Webster

Henderson

McLeanOhio

Daviess

Grayson

Hancock

Brecken- ridge

Hardin

Meade

Larue Marion

Bullitt

Nelson Wash-ington

Spencer

Shelby

Oldham Henry

Trimble

Carroll

Butler

Simpson Allen Monroe

Edmon- son

Barren

Hart

Met-calfe

Adair

Taylor

Russell

Wayne

Casey

WhitleyBell

Knox

Lincoln Rock- castle

Clay Leslie

Boyle

Jackson

Garrard

Mercer

PerryKnott

Pike

Harlan

Letcher

Laurel

Owsley

Lee

Estill

Breathitt

Floyd

WolfePowell M

agoffin

Madison

Cumber- land

Jefferson

Pulaski

McCreary

Green

Clinton

Martin

John- son

Morgan

Menife

eClark

Montgom

ery

Lawrence

Greenup

Elliott

Carter

Lewis

Rowan

Fleming

Bath

Nicholas Bourbon

Mason

Bracken

Harrison

Pendleton

Scott

Fayette

Jessa-mine

Owen

Grant

Frank- lin

Wood- ford

Anderson

Gallatin

Boone Kenton

Campbell

Robertson

86

65

8,723

4

4

2

4107

20

9

22

12

3

10

951

16

3

5

6

10

8119

15

9

5

12

466

78

4

7

11

6

14

6

5

6

3

4 2

3

4

2

4

4 20

6

157

12

23

16

9

7

22 96

19

773

129

41

17

24

10

2

79

13

304

81

57

5

19

641

66

226

253

17

62

26

20

11

6 4

13

9

8

86

36 8

5292

24

853

2710

12

2

3

21

3

24 210

2 45

17184

99

13

4

13

4

12

3

76

166

12

20

Fulton

Boyd

Future Relationship

Partnership

Questions & Answers

YOUR KIND OF PEOPLE.YOUR KIND OF CARE.