CHAIRPERSON’S WELCOME & OPENING ADDRESS  Sy Zahedi, President  MedXM Sy Zahedi  President & Chief Executive Officer  As the CEO and President of MedXM, Sy brings a unique blend of business development in the medical industry dating back over twenty-five years. His significant background as an entrepreneur and experience in expanding distribution channels, instituting new technology platforms accompanied with developing strategic business and operational plans for new ventures has placed this company on the forefront of healthcare. It's his belief in patient education, prevention and early detection accompanied with technology creation, value and delivery that drives this company into this new era in healthcare. 10 YEARS OF STAR RATINGS: HOW CAN WE LEARN FROM THE PAST AND BUILD FOR THE FUTURE?  Melissa Smith, Senior Quality Performance and Improvement Consultant  GORMAN HEALTH GROUP Melissa Smith is a Senior Consultant with Gorman Health Group (GHG). She brings over 20 years of healthcare experience to GHG, more than five of which have been in an operational leadership capacity in Medicare Advantage and Part D health plans. Melissa has extensive experience developing strategic and tactical solutions to maximize performance within quality measurement programs. Melissa also has a strong background of building productive partnerships across internal teams and with external vendors, and has successfully worked with independent providers, large health systems and PBM’s to improve health plan performance on Part C and D quality measures. Melissa’s unique background of business process, regulatory compliance, and healthcare quality offers our clients the opportunity to maximize quality performance and revenues. 6/13/2016 10 YEARS OF STAR RATINGS: LEARNING FROM THE PAST, BUILDING FOR THE FUTURE MELISSA SMITH SENIOR CONSULTANT JUNE 27, 2016 WHO IS GORMAN HEALTH GROUP? Gorman Health Group is the leading solutions and consulting firm for government-sponsored health programs Government Programs Leading enterprise of national consulting services and software solutions for payers and providers Our Mission Our mission, as the industry’s most active professional services consultancy and provider of technology-based solutions, is to empower health plans and providers to deliver higher quality care to beneficiaries at lower costs while serving as valued, trusted partners to government health agencies Washington, DC Headquartered in Washington, DC, with more than 200 staff and contractors nationwide with over 2,000 combined years of Government Programs experience Leadership Deep payer and provider knowledge coupled with Centers for Medicare & Medicaid Services (CMS) regulatory expertise Privately Owned Founded in 1996 Copyright © 2016 Gorman Health Group, LLC 1 6/13/2016 BROAD SERVICES Our clients have one-stop access to expert advice, guidance, and support, in every strategic and operational area for government-sponsored programs, across seven verticals. CLINICAL Changing how you approach Medical Management, Quality and Stars. COMPLIANCE Offering guidance and support in every strategic and operational area to ensure alignment with CMS. PHARMACY Leading experts in Part D, PBM, formulary and pharmacy programs. OPERATIONS Bringing excellence to every aspect of your implementation from enrollment to claims payment. HEALTHCARE ANALYTICS & RISK ADJUSTMENT SOLUTIONS Implementing cross-functional risk adjustment programs for medical trend management and quality improvement. STRATEGY & GROWTH Driving profitable growth and member retention PROVIDER INNOVATIONS through strategic marketing, sales, and product Supporting network design and medical development. cost control implementation. Copyright © 2016 Gorman Health Group, LLC 3 STAR RATINGS: BRINGING IT ALL TOGETHER Membership Accounting Star Ratings Risk Mastery Adjustment Analytics Compliance “Make It Work” Proactive Care Member Svc. & Management Support Collaborative, Accountable Providers Copyright © 2016, Gorman Health Group, LLC 4 2 6/13/2016 ACHIEVING THE GOAL 2016 2015 2014 AVG STAR RATING AVG STAR RATING 4.03 3.92 AVG STAR RATING 3.84 Final Year of 40% of MA-PDs 49% of MA-PDs (179 Star Ratings earned ≥4 Stars contracts) earned ≥4 Demo Stars 60% of MA-PD enrollees are in 71% of MA-PD contracts with ≥4 Stars enrollees are in contracts with ≥4 Stars CCooppyyrriigghhtt ©© 22001156,, GGoorrmmaann HHeeaalltthh GGrroouupp,, LLLLCC 5 ACHIEVING THE GOAL 2016 2015 2014 AVG STAR RATING AVG STAR RATING 4.03 3.92 AVG STAR RATING 3.84 Final Year of 40% of MA-PDs 49% of MA-PDs (179 Star Ratings earned ≥4 Stars contracts) earned ≥4 Demo Stars BUT….. 60% of MA-PD -369 plans were rated in 2016. enrollees are in 71% of MA-PD -188 more are on contracts with ≥4 Stars enrollees are in the chase. contracts with ≥4 Stars CCooppyyrriigghhtt ©© 22001156,, GGoorrmmaann HHeeaalltthh GGrroouupp,, LLLLCC 6 3 6/13/2016 THE GAME IS GETTING TOUGHER 20 4-Star 5 thresholds increased in 2016 Part D measure Very little low- average ratings 10 hanging fruit increased remains Part C measure average ratings Noncompliance increased 1 Star! Copyright © 2016, Gorman Health Group, LLC 7 IT’S TAKEN 10 YEARS TO GET HERE, BUT… THE PAST & PRESENT THE FUTURE 2006 2015 2016 2017 2018 2019 2020 2021 MA Star Ratings MA Quality QHP QRS QHP QRS CMS to release Medicare FFS MMC QRS program created Bonuses paid pilot in 5 implementation to guidance on the merit-based must be only to high states be completed MMC QRS the incentive implemented Star-Rated measures & payments MA plans MMC QRS Inaugural methodologies (MIPS) begin regulations Medicare FFS for comment issued MIPS/QPP measurement Medicare FFS period begins QPP created TRANSFORMATIONAL DEPLOYMENT OF HIGH-ROI QUALITY IMPROVEMENT ACTIVITIES Copyright © 2016, Gorman Health Group, LLC 8 4 6/13/2016 MEASURE UPDATES: THE AGILITY TEST CONTINUES 7 8 9 1 NEW MEASURES UNDER 1 NEW MEASURES UNDER 1 NEW MEASURES UNDER 0 CONSIDERATION: 0 CONSIDERATION: 0 CONSIDERATION: 2 None 2 Medication Reconciliation 2 Statin Therapy measures Post Discharge& (Part C and D), potentially Hospitalizations for Asthmaand Depression Potentially Preventable measures (Part C) Conditions RETIRED MEASURES: RETIRED MEASURES: RETIRED MEASURES: Improving Bladder Control High Risk Medication TBA measure to be temporarily measure to be temporarily moved to Display Page moved to Display Page. Others TBA POTENTIIAL UPDATES: Slight methodology changes POTENTIAL UPDATES: POTENTIALUPDATES: for several measures. MPF Price Accuracy; NCQA TBA to evaluate Colorectal Cancer Screening& Fall Risk Mgmt based on USPTF recommendations. Copyright © 2016, Gorman Health Group, LLC 9 MEASURE UPDATES: THE AGILITY TEST CONTINUES 7 8 9 1 NEW MEASURES UNDER 1 NEW MEASURES UNDER 1 NEW MEASURES UNDER 0 CONSIDERATION: 0 CONSIDERATION: 0 CONSIDERATION: 2 None 2 Medication Reconciliation 2 Statin Therapy measures Post Discharge& (Part C and D), potentially Hospitalizations for Asthmaand Depression Potentially Preventable measures (Part C) Conditions RETIRED MEASURES: Have you upRdEaTtIeRdE Dyo MuEr ASStaUrR REaSt:ings work planR?ETIRED MEASURES: Improving Bladder Control  Statin ThHeirgahp Ry imske Maseudriceast iroenq uire coordinated TreBpAorting and outreach to measure to be temporarily membersm &ea psruorvei dtoe rbse atecmropsosr ainritley rnal and PBM teams. moved to Display Page  Depressimonov mede atos uDriespsl areyl yPaogne e. l ectronic capture of patient-reported Others TBA outcomes as calculated through providers’ use of PHQ-9 tool.  Asthma measures report dispensing of appropriate medications that the member remained on during the treatment period and the ratio of POTENTIIAL UPDATES: Slight methodology changes controllePr mOTeEdNicTaItAioLn Us PtoD tAoTtaElS a:sthma medicatPioOnTsE. N TIALUPDATES: for several measures. MedicaMtiPoFn sP rbiceec Aocmcuer amcyu;c NhC mQoAr e integratTeBdA via new measures. Measuremtoe nevt aplueariteo dCso lcooreucltda l begin as soon as 1/1/17 -are you ready? Cancer Screening& Fall Risk Mgmt based on USPTF recommendations. Copyright © 2016, Gorman Health Group, LLC 10 5 6/13/2016 2017 AND BEYOND: THE STAR RATINGS TARGET IS BROAD •Care Coordination (Data- Physician- Driven) •Post-Discharge Influenced Medication Reconciliation* •Asthma Medication Fill/Adherence •MPF Price Accuracy •Asthma Treatment •Initiation and •Reminders for •Depression Care Engagement of Immunizations, •Hospitalization for Alcohol or Other Screening Tests, and Potentially Preventable Drug Treatment Appointments Complications* •Pharmacotherapy •Reminders to Fill •Statin Therapy Mgmt of COPD PMreedsiccraiptitoionnss or Take •High Risk Med Updates Exacerbation •Disenrollment Reasons •Pain Management •Transition Monitoring •Pharmacotherapy Mgmt Member- of COPD Exacerbation Plan- •Reminders for Influenced Immunizations & Appts Influenced •Computer Use During Office Visits * May be introduced as 2018 Star Measure (based on 2016 services) Copyright © 2016, Gorman Health Group, LLC 11 EVOLUTION = MEASURING NUANCES = 2016 5 Star cutpoint 95% = 2016 4 Star range = 2016 3 Star range 90% = 2016 2 Star range 85% 80% 2016 Average: 3.4 75% 2D0o1n5 ’3At .Fv4oe5rraggeet:: Members often don’t differentiate 70% between Part C & Part D! Getting Needed CareGetting Appts & Care QuCiucsktloymer Service Rating of Health Care QRuaatliintyg of Health PlanCare CoordinationRating of Drug PlanGetting Needed Drugs Copyright © 2016, Gorman Health Group, LLC 12 6