Guiding Individuals to High-Value Providers

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

2. 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 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

3. 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 UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

4. PRE Performance Measures UHCCP can implement and define performance measures, by plan, with variable targets and goals: Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

5. MonthlyUHCCP PRE Assignments Monthly CountbyTier: Oct 2015 to Sept 2016 Oct’15 Sept’16 16,000 14,000 12,000 10,000 8,000 6,000

6. MonthlyUHCCPPRE Assignments Monthly Percentby Tier: Oct 2015 to Sept 2016 100% 80% 60% 40% Tier 1 Tier 2 Tier 3 Tier 4 1.59% 1.53% 1.59% 1.72% 1.72% 1.52% 1.21% 0.88% 0.58% 0.67% 049%

7. UHCCP Provider Tier Assignments Net Membership Count UHCCP:Oct 2015 to Sept 2016 600,000 500,000 400,000 300,000 200,000 Tier 1 Tier 2 Tier 3 Tier 4 • NOTES:

8. UHCCP Provider Tier Assignments Net Membership Percentage UHCCP: Oct 2015 to Sept 2016 100% 90% 80% 70% 60% 50% 40% 30% 20% Tier1 Tier2 Tier3 Tier4

9. UHCCP Provider Tier Assignments PRE Success Summary: In the contract year since PRE implementation: • 97% of newly assigned members were assigned a Tier 1 or Tier 2, higher-valued provider • Nearly 125,000 members were assigned to Tier 1 or Tier 2 providers • 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. Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

10. Who participates and helps to guide members to high-value providers… Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

11. Unique aspects for guiding members based on the population Who participates in the process of member direction may depend upon the UHCCP plan: Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

12. Steering members to ‘Integrated’ providers, ACCs, VBCs and/or Centers of Excellence Additional efforts taken to guide members to collaborative partners: • ACC (Accountable Care Communities) and IC partners = Tier 1 • ACC & IC partners = Value Based Contracts • Selective Member Geographic Reassignment: • 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. • 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 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

13. 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.) Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

14. 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. Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

15. 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; dSNP/Medicaid PCP matching; etc. • Once pilot realignment completed, make changes based on lessons learned and extend the effort across the network Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

16. 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 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.