United Healthcare Community Plan Guiding Individuals to High

United. Healthcare Community Plan “Guiding Individuals to High- value Providers” Steve Chakmakian, DO Chief Medical Officer AHCCCS Update Meeting November 16, 2016

Agenda: Guiding members to ‘High Value’ Providers Agenda • How UHCCP is guiding members to high value providers • Who participates in the process of member direction • Unique aspects for guiding members based on the population and the health plan • Steering members to ‘Integrated’ providers, ACOs, VBCs and/or Centers of Excellence • Balancing Act: Guiding to high value providers & ensuring adequate networks for all members • Opportunities encountered along the way 2 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

How UHCCP is guiding members to high value providers Provider Recommendation Engine (PRE) • A data tool that provides PCP recommendations to member services, support staff and UHCCP claims platform • PRE uses predetermined logic, based on quality and utilization, to offer recommendations while taking into consideration location, age, gender, family history, and claims history to recommend Primary Care Providers. • PRE also utilizes claims history to recommend PCPs, based on any known, prior activity. This feature enables us to more accurately assign a member to a PCP he/she has seen before. • PRE has logic to drive PCP assignments based upon provider tiers. In combination with network development efforts, PRE usually can assign to a Tier 1 or Tier 2 provider (highest quality and cost effectiveness) • PRE was implemented May 2015 • Members always retain freedom of choice and can change their PCP after assignment. Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

PRE Performance Measures UHCCP can implement and define performance measures, by plan, with variable targets and goals: CURRENT UHCCP AZ Community Plan MEASURES TARGET Adolescent Well Care Visits AHCCCS MPS Emergency Department AHCCCS MPS Annual Dental Visit AHCCCS MPS Well Child Visits in the First 15 Months of Life AHCCCS MPS Well Child Visits in the Third, Fourth, Fifth and Sixth Year of Life AHCCCS MPS Readmissions AHCCCS MPS Flexible Measure(s) – UHCCP AZ can Add, Delete, Change ANY targeted Performance Measures • Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group. TBD

Monthly UHCCP PRE Assignments Monthly Count by Tier: Oct 2015 to Sept 2016 16, 000 Oct’ 15 Sept’ 16 14, 000 12, 000 10, 000 8, 000 6, 000 Tier 1 Tier 2 Tier 3 Tier 4 Errors Oct. Nov. Dec. Jan. Feb. Mar. Apr. May Jun. Jul Aug. Sep. 8, 002 3, 519 43 151 199 6, 567 2, 794 70 148 208 7, 603 3, 341 33 174 212 7, 083 3, 729 27 178 179 6, 051 3, 770 25 175 168 5, 926 3, 118 31 152 132 5, 861 2, 846 20 136 108 8, 222 2, 025 64 128 114 9, 081 1, 114 117 93 151 9, 227 1, 026 107 61 126 11, 654 1, 367 163 90 153 9, 455 1, 356 151 55 120

Monthly UHCCP PRE Assignments Monthly Percent by Tier: Oct 2015 to Sept 2016 100% 80% 60% 40% Oct. Tier 1 67. 16% Tier 2 29. 54% Tier 3 Tier 4 Nov. Dec. Jan. Feb Mar. Apr. May Jun. Jul. Aug. Sep. 67. 10% 66. 91% 63. 26% 59. 39% 63. 32% 65. 33% 77. 91% 86. 03% 87. 48% 86. 80% 84. 90% 28. 55% 29. 40% 33. 31% 37. 00% 33. 32% 31. 72% 19. 19% 10. 55% 9. 73% 10. 18% 12. 18% 0. 36% 0. 72% 0. 29% 0. 24% 0. 25% 0. 33% 0. 22% 0. 61% 1. 11% 1. 01% 1. 21% 1. 36% 1. 27% 1. 59% 1. 53% 1. 59% 1. 72% 1. 52% 1. 21% 0. 88% 0. 58% 0. 67% 049%

UHCCP Provider Tier Assignments Net Membership Count UHCCP: Oct 2015 to Sept 2016 600, 000 500, 000 400, 000 300, 000 200, 000 12/1/2015 1/1/2016 2/1/2016 3/1/2016 4/1/2016 5/1/2016 6/1/2016 7/1/2016 8/1/2016 9/1/2016 Tier 1 10/1/2015 11/1/2015 26, 145 190, 763 194, 382 198, 629 182, 525 185, 240 186, 758 188, 117 292, 366 297, 220 302, 992 306, 629 Tier 2 237, 604 152, 416 153, 436 152, 685 171, 089 171, 998 170, 824 169, 394 77, 714 77, 425 78, 386 73, 204 Tier 3 19, 713 20, 359 20, 365 20, 162 19, 798 19, 409 19, 395 19, 161 66, 428 66, 603 66, 595 71, 891 206, 164 131, 298 132, 084 131, 607 131, 056 129, 882 130, 051 129, 476 76, 603 76, 333 76, 689 78, 751 Tier 4 • NOTES : 1. New tier file applied to AZ on 5/12/2016 and 8/9/2016; override files were applied on 10/1/2015, 1/23/2016, 5/12/2016, and 8/9/2016. 2. “Unassigned” Providers are not yet assigned a Tier and are considered as Tier 2 in PRE 7 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

UHCCP Provider Tier Assignments Net Membership Percentage UHCCP: Oct 2015 to Sept 2016 100% 90% 80% 70% 60% 50% 40% 30% 20% 10/1/2015 11/1/2015 12/1/2015 1/1/2016 2/1/2016 3/1/2016 4/1/2016 5/1/2016 6/1/2016 7/1/2016 8/1/2016 9/1/2016 Tier 1 5. 27% 38. 09% 38. 37% 38. 97% 35. 69% 36. 09% 36. 36% 36. 67% 56. 56% 57. 00% 57. 63% 57. 25% Tier 2 47. 89% 30. 43% 30. 29% 29. 95% 33. 45% 33. 51% 33. 26% 33. 02% 15. 03% 14. 85% 14. 91% 13. 67% Tier 3 3. 97% 4. 06% 4. 02% 3. 96% 3. 87% 3. 78% 3. 74% 12. 85% 12. 77% 12. 67% 13. 42% Tier 4 41. 55% 26. 22% 26. 08% 25. 82% 25. 63% 25. 30% 25. 32% 25. 24% 14. 82% 14. 64% 14. 59% 14. 70%

UHCCP Provider Tier Assignments PRE Success Summary: In the contract year since PRE implementation: ü 97% of newly assigned members were assigned a Tier 1 or Tier 2, higher-valued provider ü Nearly 125, 000 members were assigned to Tier 1 or Tier 2 providers ü UHCCP has increased the percentage of our membership that is assigned to a Tier 1 or 2 provider, from 54% to 72% An 18% increase. 9 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Who participates and helps to guide members to high-value providers… All UHCCP Health Plans Member Services and Support Centers High Risk / High Needs Case Mangers Health First Steps program (Pregnant members) Accountable Care Communities (directed member engagement) my. Connections (Social Determinants of Health referral network) UHC member portal and provider finder support tools (i. e. Health 4 Me) 10 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Unique aspects for guiding members based on the population Who participates in the process of member direction may depend upon the UHCCP plan: ‘Guide’ Acute CRS Member Ombudsman X X DDD Individual Case Managers Duals X Multi-Specialty Interdisciplinary Centers X Member/Provider Liaison Patient Centered Care Model (RNs; CHWs) LTC X X X Member Navigators 11 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group. X X

Steering members to ‘Integrated’ providers, ACCs, VBCs and/or Centers of Excellence Additional efforts taken to guide members to collaborative partners: Ø ACC (Accountable Care Communities) and IC partners = Tier 1 Ø ACC & IC partners = Value Based Contracts Ø Selective Member Geographic Reassignment: o Example: For an IC, UHCCP identifies members who appear disengaged from the delivery system (not seeing assigned PCP, or any PCP). We then use up to 3 years claims information + blind spot data + predictive modeling to reassign members with greater than average BH risk to the Integrated Clinic close by. The IC collaborates by actively outreaching and engaging members into care. o Example: For a PCP COE (Hemophilia) – Similar process, however UHCCP identifies members with a select medical diagnosis and who may benefit from a PCP with unique clinical expertise. *Members always retain their choice of PCP and can select a different PCP 12 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Balancing Act: Guiding to high value providers & ensuring adequate networks for all members • UHCCP is continually reevaluating our network based on key elements: Provider composition; Utilization; Geographic distribution; Quality; Efficiency; Engagement level; Clinical expertise; Member needs and/or identified gaps; Participation in clinical accountability initiatives (ACOs); and more… • It is not feasible to ensure that every member has access to a provider(s) categorized today as ‘high-value’; however this in no way can mean that members do not, or should not, have access to providers who are properly credentialed, audited, educated and targeted for improvement. • In these efforts, UHCCP must be attentive and respectful of member choice, based on a host of factors (personal needs, preferences, beliefs, primary language, culture, etc. ) 13 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

An opportunity UHCCP has discovered in the process… Assignment and Attribution In an ongoing effort to ensure access to care, improve quality and minimize provider payment disruptions, members are assigned to PCPs, but not ‘locked-in’ to a PCP. UHCCP recognizes this network design choice results in a degree of member/PCP misalignment (i. e. Assignment-Attribution mismatch). This impacts our net effort to guide and keep members properly assigned to ‘high-value’ providers and it impacts our collaborative efforts and programs with providers to maximally impact populations with greater accountability. Data demonstrates that members who are unaligned with the correct assigned PCP, demonstrate worse utilization and quality outcomes. 14 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

An opportunity UHCCP has discovered in the process… Next Steps: • Ensure attribution models and available data most accurately identifies the most accurate PCP for each member; • Select partners with whom we can test and refine a process of periodic member-PCP ‘realignment’ efforts; • Be attentive to the potential impact to members, health plan and practice partner, including but not limited to: ensuing member choice; administrative impact; internal education and communications; accountable care provider data reporting and value based contracts; d. SNP/Medicaid PCP matching; etc. • Once pilot realignment completed, make changes based on lessons learned and extend the effort across the network 15 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Guiding members to ‘High Value’ Providers Thank you for any Questions… Contact Information Steve Chakmakian, D. O. Chief Medical Officer 602 -255 -8205 Steve_Chakmakian@uhc. com Our United Culture. The way forward. ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance 16 Confidential Property of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.