Welcome Lakeland Care Network Annual Payor Conference October

Welcome! Lakeland Care Network Annual Payor Conference October 17, 2018

Lakeland Care Network - Update • Spectrum Integration • Affirmant – Blue Cross Blue Shield – Medicare Advantage PPO – Blue Care Network – Medicare Advantage HMO – ACO • Managed Care Distributions – 2017 – 2018 $900, 000 Better • Monthly Payor Meetings – 4 th Tuesday

Quality & Care Management Team • What we do: – We are SMEs in the following programs: • CPC+ • PGIP • Payer programs • CMS programs • Patient satisfaction • Practice transformation • Dual eligible groups – Aetna & Meridian • Care management onboarding • Etc. – Provide quarterly outreach – Update EBGs and protocols for Quality Committee approval • Contact sheet is available on the Lakeland Care table

Occupational Medicine • Occupational medicine is the medical specialty devoted to prevention, treatment and management of workplace injury and illness and the promotion of health and productivity of workers, their families, and communities. • Dr. Cathy Boomus, MD, MPH – Ursula Adent – Supervisor – Amanda Stevens - Manager • 2500 Niles Ave, St. Joseph • Open late November, 2018

Spectrum Health Lakeland – Benefits 1/1/19 • Medical Plan: Priority Health will be our new third-party administrator replacing ASR. • Prescription Drug Plan: Express Scripts will replace Envision. Rx as pharmacy benefit manager. • Flexible Spending Accounts: Infinisource will become our new administration replacing ASR. • • • ID Cards Will be re-issued by mid to end of December Medical ID Card – Issued by Priority Health Prescription Drug Card – Issued by Express Scripts Flexible Spending Account Debit Card – 2 new debit cards will be sent from Infinisource

Spectrum Health Lakeland – Benefits 1/1/19 • • Medical Plan Group Number: 792792 Employee premiums will increase slightly in 2019 Spectrum will become as tier 1 provider, no extended network referral required • Emergency Room Co-Pay • The ER co-pay will increase from $150 to $200 for 2019

Spectrum Health Lakeland – Benefits 1/1/19 • Deductible and Out of Pocket Changes • The changes to the Traditional Plan deductible and out of pocket maximus are outlined below. There are no plan changes to the High Deductible plan.

Spectrum Health Lakeland – Benefits 1/1/19 • Prescription Drug Plan • Express Scripts will become our new pharmacy benefit manager effective January 1, 2019. You will be receiving a new pharmacy benefit ID card by mid-December. the burden of covering these medications has become increasingly difficult. Lakeland has put several programs in place such as step therapy, pre-authorizations to help contain costs.

Spectrum Health Lakeland – Benefits 1/1/19 2019 PRESCRIPTION DRUG PLAN OVERVIEW Lakeland Pharmacy Prescription Type Non-Lakeland Pharmacy Generic 30 Day Supply 15% Cost of Rx Min: $2 / Max: $100 90 Day Supply 15% Cost of Rx Min: $5 / Max: $200 30 Day Supply Only 30% Cost of Rx Min: $10 / Max: $400 Preferred Brand 25% Cost of Rx Min: $10 / Max $200 25% Cost of Rx Min: $20 / Max: $600 35% Cost of Rx Min: $25 / Max: $400 Non-Preferred Brand 35% Cost of Rx Min: $20 / Max: $300 35% Cost of Rx Min: $40 / Max: $600 35% Cost of Rx Min: $35 / Max: $400 Specialty 35% Cost of Rx Min: $100 / Max: $400 Not Available Rx Out of Pocket Maximum-Traditional Plan: $2, 900 -single $5, 800 -2 person/family

Lakeland Care Operations • List of contracted payors • Credentialing News: – – • • • Midlevels Mental Health CAQH Reminders in the mail Notification of Changes / Workday CHAMPS deadline 1/1/19 GMS reminder Update requests www. lakelandcare. com – – – News Search for providers Print a directory Contracted payor list Provider portal links Team contacts