Changing Nature of Managed Care OrganizationProvider Relationships WAMSS

Changing Nature of Managed Care Organization-Provider Relationships WAMSS Conference April 28, 2017 Andrew Nelson, Vice President, Provider Network Management Molina Healthcare of Washington

Company History Founded in 1980 by Dr. C. David Molina with a single clinic Provide quality healthcare to those most in need and least able to afford it Serves more than 4. 2 M Medicaid, Medicare, Duals and Marketplace members Serves more than 775, 000 members in Washington State 16 states and two territories 2 Molina Medical Group Clinics in states Hospital Providers 101 PCPs 5, 470 Specialists 12, 780

HCA’s “Value-Based Purchasing” goals 2021 90% state-financed 50% commercial In 2021, at least 90% of state-financed health care payments and 50% of commercial health care payments are linked to quality and value through Alternative Payment Mechanisms (APM) (Categories 2 c-4 b) Washington’s annual health care cost growth will be below the national health expenditure trend. Tools to accelerate VBP and health care transformation: • • • 3 2014 Legislation directing HCA to implement VBP strategies State Innovation Model (SIM) Round 2 grant, 2015 -2019 DSRIP Medicaid Transformation Demonstration Project, 2017 -2021

What is “Value”? What is “Paying for Value? ” 4 • • • Patient experience HEDIS Avoidable emergency room visits or readmissions • • Medical cost ratio Per member per month

Provider relationships focus on value • Emerging focus on specific populations – Share, not shed, risk with providers who manage populations with complex needs, AH Blind Disabled and Medicare (DSNP) • Evolution from volume to value-based relationships – Focus on long-term relationships, not just ‘contracts’ – Path-to-Value – Gain-sharing and risk-sharing on population –based outcomes performance. We have capitation arrangements with some integrated delivery systems – Not all providers are ready – Meet providers where they are at and start there • Increasing transparency into Provider Performance – Quality outcomes, cost, member satisfaction – Member self-direction & choice of provider and health plan • Aggregation of groups combine forces to create scale 5

Molina’s Value-Based Care “Path to Value” Approach Shared Savings and Quality • Savings shared relative to a medical pmpm or medical cost ratio target • Savings tied to achievement of 4 -6 HEDIS targets Shared Risk and Quality Global Risk and Quality • Greater shared savings potential in exchange for shared downside risk • Savings tied to achievement of 4 -6 HEDIS targets • Provider takes global risk as percent of premium • A portion of premium is tied to achievement of 4 -6 HEDIS targets • Delegated functions such as UM, CM and claims 6

Challenges and opportunities in achieving a successful Value -Based Care relationship 7

An Aligned Culture of Quality Know and Engage the Patient Managed Care Organization • Share lists of nonengaged members • Shared outreach Provider • Patient outreach and engagement • Provide appointment access Sharing Information & Resources Promote Best Practice Leverage Technology Managed Care Organization • Timely access to actionable data • Missing HEDIS services • HEDIS reporting • Align to provider workflow • Case Management Managed Care Organization • Align Prior authorizations and Utilization Management functions to reduce barriers and promote consistent quality of care Provider • Share EMR Access • Member Satisfaction • Case Management Provider • Clinical pathways Managed Care Organization • Molina Virtual Care • 24 /7 access • Shared documentation • CM referrals • My Molina – PHR • Care Team Integration • Pre. Manage (EDIE) Provider • Pre. Manage (EDIE) • Clinical. Data Repository 8

VBC HEDIS Provider Performance Reporting 9

VBC HEDIS Provider Performance Reporting 10

EMR Chart Retrieval Analysis: HEDIS 2016 • The rainbow colored column represents “compliance rate” by methodology • “Full” remote access benefits both providers and MCOs 11

VBC Medical Cost Provider Performance Reporting Key Data Categories • Member Months • Premium • Capitation Amounts • Care Coordination Costs • Inpatient Hospital • Outpatient Hospital • Professional Services • Rx • Incurred But Not Reported Claims • Medical Cost Ratio 12

Future of Strong MCO-Provider Relationships • Open communication on common goals Quadruple Aim • Quality focused approach • Establishing trust and credibility • Focus on the relationship just the contract not 13

Contact information Andrew Nelson Molina Healthcare of Washington Andrew. nelson@molinahealthcare. com 14

Questions?