welcome and market observations

2014  Partners  Summit    Welcome  &  Market  Observa;ons  

Las  Vegas,  NV  

Who’s  Here  for  the  Partners  Summit?    

!   Approximately  100  guests  

!   40  health  plans  

!   10  external  speakers    

!   Several  provider  organiza?ons  

!   Industry  alliances  and  associa?ons  

!   Consul?ng,  analy?cs  and  marke?ng  firms    

!   Leading  healthcare  journalist  and  author  

!   Top  Wall  St  analyst  

  2  

Who’s  Not  Here?      

3  

Any  of  the  es+mated  500+  Elvis  impersonators  in  Las  Vegas  today  

Welcome  Outcomes  Health!  

4  

Why  Outcomes  Health?  

5  

Analy;cs  &  Data  Management  

Member  Engagement  

Chart  Retrieval  &    Clinical  Review  

Exper;se  &  Consulta;ve  Approach  

•  Superior  client-­‐facing  transparency  &  repor?ng  technology  tools  •  Sophis?cated  analy?cs  to  priori?ze  member  chart  chases  •  Ability  to  license  soNware  (coding  &  abstrac?on)  

•  Expanded  geographical  footprint  &  scope  for  in-­‐home  clinical  care  visits  

•  Expanded  member  outreach  with  dedicated  clinical  resources  

•  Industry  leading  geographical  footprint  for  retrieval,  coding  &  abstrac?ons  

•  Increased  capacity  &  scale,  including  offshore  opera?ons  center  

•  Deep  domain  exper?se  in  quality  measurement  &  risk  adjustment  for  Medicare  Advantage  &  Managed  Medicaid    

Altegra  Health  at  a  Glance  

6  

Los  Angeles  Phoenix  

San  Juan,  PR  

Mt  Laurel  

Miami  Lakes  

Chicago  

Minneapolis  

Headquartered  in  Miami  Lakes,  FL,  with  eight  regional  offices  &  opera;ng  in  all  50  states,  Puerto  Rico,  &  the  Philippines  

Atlanta  

Manila,  Philippines    

ALTEGRA  TEAM  –  over  3,100  total  team  members  

Altegra  Health  Vision  

7  

To  be  the  most    trusted  and  valued    partner  in  helping    

healthcare  organiza?ons  improve  their  performance  

and  the  health  and  well  being  of  the  individuals  they  serve.  

Market  Observa;ons      

!   Near  term  uncertainty  about  health  care  reform  

! ACA  requirements  &  ?melines  up  for  grabs  

! CMS  2015  Advance  No?ce  

! Medicare  Advantage  rates  

! Home  assessments  

! Transi?on  from  RAPS  to  EDPS  

!   Long  Term  Perspec?ve  

!   Con?nued  growth  in  Medicare,  Medicaid  and  Dual  segments  

!   Increasing  dominance  of  government-­‐funded  health  care    

8  

Market  Observa;ons      

!   Health  Insurance  Exchanges/Marketplaces  

!   Slightly  nega?ve  to  neutral  near  term  financial  impact  

!   Plans  posi?oning  to  par?cipate  more  broadly  long  term  

!   ACA  provides  for  a  “permanent”  risk  adjustment  program  

!   Some  similari?es  to  Medicare  

!   Significant  similari?es  to  Medicaid    

!   Risk  adjustment  payment  transfer  

      9  

Market  Observa;ons  

10  

Individual  and  Small  Group  Market  Risk  Adjustment  Payment  Transfer  Formula  

Market  Observa;ons      

!   Quality  (HEDIS  –  STARS)  

! Fully  incorporated  into  the  health  plan  RCM/finance  narra?ve  

! Has  the  complete  aeen?on  of  the  health  plan  C-­‐suite  

! Implementa?on,  execu?on  and  ?melines  challenging  

! Provider  abrasion  and  ‘data  intermediary’  complica?ons  

!   Healthcare  Data  Analy?cs  

! Increasing  emphasis  on  internal  and  outsourced  capabili?es  

! Na?onal  Provider  Iden?fier  (NPI)  challenges  abound  

! Predic?ve  modeling,  screening  and  targe?ng  more  cri?cal  

 11  

Market  Observa;ons  

‘I  fell  out  of  bed,  hit  my  head,  slipped  down  the  stairs,  rolled  out  the  front  

door,  and  crashed  into  my  car’  

12  

Market  Observa;ons  

‘I  fell  out  of  bed,  hit  my  head,  slipped  down  the  stairs,  rolled  out  the  front  

door,  and  crashed  into  my  car’  

Guess  what?  

13  

Market  Observa;ons  

‘I  fell  out  of  bed,  hit  my  head,  slipped  down  the  stairs,  rolled  out  the  front  

door,  and  crashed  into  my  car’  

There’s  an  ICD-­‐10  code  for  that!  

14  

Market  Observa;ons    

!   ICD-­‐9  to  ICD-­‐10  Transi?on    

! 14,500  ICD-­‐9  codes  increasing  to  70,000  ICD-­‐10  codes  

! Industry  readiness  unclear,  par?cularly  among  providers  

! Financial  impact  unknown  to  many  

! Demand  for  coders  rising  rapidly    

15  

“The  industry  is  thousands  of  coders  shy  of  the  figure  necessary  to  fully  support  the  transi?on  to  ICD-­‐10  before,  during,  and  aNer  Oct.  1,  2014.    Demand  has  been  slowly  increasing  during  the  last  90  days  and  will  skyrocket  in  the  fourth  quarter  of  2014.”  

Thank  you  for  joining  us.  

Kevin  Barre ̂  Kevin.Barree@AltegraHealth.com