Feedback Drives Design

250+ Interviews Conducted Prior to MissionPoint Launch

Network Physicians Members Employers • Significant behavior change will only occur with “payer” control of 30 – 50% of a physician’s patient panel • Models that require physicians to “do more” are at significant risk • Primary Care Physicians favor capitation, as it evens out cash flow and allows them to meet productivity and financial goals without over scheduling • • • Non-clinical indicators are strongly predictive of cost Low percentage of patients account for high percentage of cost. Significant impact can be achieved by correctly identifying and working with these individuals Improvements in most clinical outcomes do not correlate to short-term cost savings • • • Regional or National networks are required to cover 70% of employees that live outside a single market Willing to pay for access, but quality should be expected TPAs provide a variable amount of analytics to employers depending on size; however, data is not actionable and employers lack resources for effective interventions 2

Engaging Patients Across All National Markets

Market Segmentation Requires Unique Management Strategies

Coverage Type Cost Per Beneficiary Number of Beneficiaries Market Size

Self-Insured Fully- Insured Medicare (Traditional) Medicare Advantage Medicaid $4,547 $4,292* $9,702 $8,467 $6,982 74 Million 74 Million^ 34.2 Million 14.6 Million 54.7 Million $332 Billion $318 Billion $332 Billion $127 Billion $382 Billion

Total Market: $1.5 Trillion

Medicare: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/ http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/FFS-Data.html

FFS Datat, 2008-2011 Medicare Advantage: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/ http://kff.org/medicare/fact-sheet/medicare-advantage-fact-sheet/ Medicaid: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/Downloads/MedicareMedicaidSummaries2012.pdf

PG 29 Self-Insured: http://www.healthcostinstitute.org/files/HCCI_HCCUR2011.pdf

http://www.ebri.org/pdf/publications/facts/fastfacts/fastfact05282008.pdf

Fully –Insured: • estimate based on premium level • ^estimate based on US Population 3

Managing HealthCare Cost Growth

Progressive Employers Looking for Provider Partners

Comparative Annual Health Cost Growth

Employers Surveyed

10.3% Study In Brief

18 th Annual Towers Watson/National Business Group on Health Employer Survey

5.9% 2.2%

Low Performers Median Best Performers Adopt new accountable payment models Contract directly with hospitals, physicians, ACOs Offer incentives for care coordination Offer performance-based payments

Best at Holding Cost Growth More Likely to Focus on Provider Strategies 16% 2% 4% 5% 7% 13% 16%

Best Performers Low Performers

22%

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Products and Services

Diversified Product Offerings Designed to Meet Employer’s Unique Needs

Engage Survey

Bio Metric Screenings Health Risk Assessment PCP Connect

Support

Virtual Care Network Complex Case Management Population 360 Environmental Design OnSite Clinics Smoking Cessation Healthy Eating These products are focused on helping clients gain intelligence about the risks and opportunities in their population. We use a combination of clinical, claims, and non-clinical data to define each opportunity.

Primary Care Membership Stress Management Readmission Program This set of products is presented based on the risk and opportunity profile of each employer. Each product has a flexible pricing model based on geographic, risk, and cost profile of the defined population.

Clinically Integrated Network Clinical Management These are the products we’re best known for. These products are often a blend of shared savings and PMPM pricing plus implementation fee – with full at-risk models available for certain clients in 2015. 5

MissionPoint Member

Custom Network Design

Per Member Per Month Payment Shared Savings Pool

Additional Physician Incentives

Extended Weekend Hours Open Saturdays Open Sundays Email with Patients Comprehensive Medication Review Medical Home Internal Med and Family Practice Specialists Outpatient Facilities

MissionPoint Provider Network

Inpatient Facilities

Personal Care Team

Population Identification and Stratification Care at a Distance Wellness Partners and Services

MissionPoint Health Partners

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Provider Flexibility

Contracts Standard Yet Flexible

Physician Master Agreement

• • • Meets Clinical Integration Safe Harbor: Committee Participation Shared Quality Information Care Collaboration • • • Addenda Provide Freedom and Flexibility: Physician can decide what populations to participate in Each Addendum contains different rates, shared savings amounts and quality metrics Addenda can have different terms and “opt-out” provisions 7

Health Partner Solutions

Diverse Focus Areas Addressed on Three Health Partner Teams

Patient Connects to Health Partner:

Physician Referral Self Referral Hospital Discharge ED Visit Transitional Ambulatory Integrated Care • Hospital Discharge • Long-term Care • Skilled Care • Home Visits • ED • Disease Management • Wellness • Psychosocial Needs • “Life” Resources • “Family” Resources 8

Employee

Creating Value for the Ecosystem

Payer TPA Pays Claims and Network Service Fee Self Insured Employer Provides Shared Savings Option

Options During Open Enrollment Preferred Network (MPHP)

Narrow Network Dedicated Medical Home Low Co-Pay Levels Leveling Monthly Premiums Coordinated Patient Record Deep Wellness Support

In-Network

Narrow Network Expected Co-Pay Levels Rising Monthly Premiums Wellness Support

Out-of-Network

Wide Open Network High Co-Pay Levels High Monthly Premiums Low Coordination Little Wellness Support Employee Selects Medical Home Primary Care Physician Virtual “Medical Home” Employee/ Member MissionPoint Health Partner Partner C Partner B Partner A Alliance Network Specialty A Specialty C Specialty B Specialty Care 9

MPHP Strategic Approach

Targeted, Fact-Based Solutions to Manage Populations

Getting to know you:

• Personal Health Reports • Clinical Population Analysis • Demographic Review

Personalized Plans

• Type of Engagement • Frequency • Intensity • Duration

Right Time, Right Place

• Quarterly Monitoring • Strategy Adjustments • Quality Reviews Identify Segment Prescribe Engage Sustain

Analytics and Aspirations

• Utilization Costs • Location Costs • Avoidable Events • Behavior Modification • Care Experience

Find the Right Strategy:

• Health Assessments • On-Site Clinics • Health Partners • Telehealth • Narrow Networks 10

Benefit Design Steers Members Towards Optimal Use of MissionPoint Network

Managing Patient Risk

Patient Data Maximized to Guide Effective Interactions

High Risk Patients

Prioritize Highest Risk Members:

Immediately deploy Health Partners to patients during “trigger events” Rising-Risk Patients Low-Risk Patients

Target Members Showing Warning Signs:

Track future risk scores and population trends for pro-active Health Partner engagement

Create Opportunities Across Members:

Leverage highly effective, low cost screenings and preventative care for optimal health outcomes across members 11

Tracking Progress

Continuous Improvement in Self-Insured Population

Medical Per Member Per Month Cost Trend Quality Metrics by Year

Chronic Disease Spend Above Benchmark

71,28% 95,99% 36,30%

% Avoidable Admissions

2,23% 3,29% 4,50% 2011 2012 2013

ED Visits per 1,000

30-Day All Cause Readmission Rate 8,99% 7,85%

% Generic Utilization Nov. 2011-Oct. 2012 Nov. 2012-Oct. 2013

65% 77% 81%

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