Are You Risk-Ready?

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without the prior written consent of the Company, is prohibited.

Are you Risk-Ready?Using Government Benchmarks to Identify, Quantify and

Reduce Low and No-Value Care to Succeed in Risk

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CMS: 50% of FFS will be gone by 2018

CMS Means Business!

These are just the first pieces to move and transforming

payment across the system!

Current payment models aren’t changing provider behavior. Providers need help.

Effects of Health Care Payment Models on Physician Practice in the United States, May 2015.

CMS and The End of FFSGoals for Value

3

Paid more to perform more & higher intensity services

Investment in capital for higher intensity services to attract profitable service lines

Sicker population may be more profitable

Paid the same regardless of service volume & intensity

Investment in efficient and valuable providers & services

Healthier population is more profitable

FFSStatus Quo

BPCIVoluntary

ValueMandatory

System incentivized to keep people healthy and out of the operating room

and physician office

CJRMandatory

PCMHVoluntary

MSSPVoluntary

Next-Gen

Voluntary

This is only the beginning. CMS is getting more aggressive in pushing providers towards risk with the goal of value/capitation

FFS Reimbursement Experimentation/Bridge the Gap Value-Based

System incentivized to do stuff –Visits, procedures, scripts

System incentivized meet quality outcomes and reduce cost

incrementally

The Future

CMS and The End of FFSGoals for Value

4All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Value-Based ReimbursementFFS Reimbursement

Perc

ent o

f Rev

enue

Time

Identify & Quantity

Value

Population Health as Social

Investment

Profit through bonuses or savings against a flawed

benchmark

Population Health Proficiency as

Profit Driver

Profit through pop health management and low value care reduction

Short Term:Capture Savings from Program Design Flaws

Success driven by market drivers & network performance

Long Term:Success from Efficient Networks

Value driven by overall population health outcomes and system efficiency

Make the leap

Are You Risk-Ready?Making the Leap

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We’ve Been Asking the Wrong Questions

How can we capture value by keeping a population healthy?

The best clinical performers may be generating the most no-value

care because of FFS incentives

Are You Risk-Ready?Ask the Right Questions

6

Are You Risk-Ready?The High Stakes of Low-Value Care

The economic driver for pay for value programs is the ability of a government program or marketplace arrangement to not only achieve Triple Aim goals but to also mitigate Low-Value services, which account for thirty cent of every dollar spent on the delivery of care.

Over $9B in Orange County, CA

$850 Billion Unnecessary Spend in 2014(Institute of Medicine)

Institute of Medicine (IOM) report, “Best Care at Lower Cost,” (Sept. 2012) estimates that the United States lost $750 billion in 2012. (Adjusted in 2013 at $800BB, 2014 at $850BB.)

This is about 3% of GDP or roughly the DOD budget for the Iraq War over an 8 year span.

No-Value Care (30%)

Necessary Utilization(70%)

“It’s generally agreed that about 30 percent of what we spend on health care is unnecessary. If we

eliminate the unneeded care, there are more than enough resources in

our system to cover everybody.”

- Dr. Elliott Fisher,Dartmouth Institute for

Health Policy

“Bigger than higher prices, administrative expenses, and

fraud, however, was the amount spent on unnecessary health-care

services.” In just a single year, up to 42% of patients receive

“No Value” Care.

- Dr. Atul Gawande, Department of Health Policy and

Management at the Harvard School of Public Health &

Department of Surgery at Harvard Medical School

All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents

without the prior written consent of the Company, is prohibited.

CMS is Paying On It

2016 World Economic ForumAnnual Meeting in Switzerland

On track to sunset 50% of FFS

They Mean Business!

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without the prior written consent of the Company, is prohibited.

Media Is Reporting on It

“Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them,

and often cause harm.”Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard School of Public Health & the Department of Surgery at

Harvard Medical School.

As value-based payments increase, physicians will finally be rewarded for quality, rather than quantity of care.

With financial incentives, doctors who practice efficient medicine will get even better, while doctors who have made a living on fee-for-service will have to change their practice patterns, or be left behind.

Our Risk-Readiness® metrics will make your material unique in educating the general public on the changes that are coming to their health care.

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CMS is committed to value-based care.Physicians and Payers know it. Now let’s tell consumers.

Population Health in a Value Based World The High Stakes of Low-Value Care

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Patients Demand It

"It's no secret that patients often undergo unnecessary procedures that can be dangerous and costly." Through our collaboration with RowdMap, we are providing patients with meaningful information about these no- or low-value treatments, allowing them to make better, more informed decisions about their doctors, hospitals and medical care.”

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No Value Care Meets No IT NeededNo Value Care

The economic driver behind both the policy push and market drive towards value based programs, as well as the criteria for success in value based programs is the ability of a government program to reduce Low-Value Services.

Research Evaluating CMS & Private Plan Programs: “Do they reduce Low Value care?”

CMS Critique of Fee for Service: “FFS has too much Low Value care.”

Popular Press Reporting and Provider Rankings:“Consumers are/should avoid Low value care.”

“…care management programs should incorporate a system for evaluating low- or no-value care (i.e., higher intensity treatments that do not yield better outcomes).”

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Leading the way…

US CTO on RowdMap: “Visionary

Genius”

ABOUT ROWDMAPCMS Knows We Help You

…in the shift from fee-for service to pay-for-value.

CMS: 50% of FFS will be gone by 2018 Current payment models aren’t changing

provider behavior. Providers need help.

Effects of Health Care Payment Models on Physician Practice in the United States, May 2015.

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Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.

RowdMap is a Risk Management Tool to match and support the evolution of the payment

system towards paying for long-term value (better health outcomes for fewer $ over time)

RowdMap identifies the fundamental building blocks that enable the consistent delivery of high value care

ABOUT ROWDMAPWhat We Do

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ABOUT ROWDMAPWhat We Do

RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital systems identify, quantify, and reduce delivery of

no-value care—a central tenet of successful pay-for-value programs.

RowdMap has no-value care and population health benchmarks for…

every physician

every hospital

every zip code

…in the United States.

“It’s generally agreed that about 30 percent of what we spend on health care is unnecessary. If we

eliminate the unneeded care, there are more than enough resources in

our system to cover everybody.”

- Dr. Elliott Fisher,Dartmouth Institute for

Health Policy

No-Value Care (30%)

Necessary Utilization(70%)

Did you know that more than $850 billion in no-value care is delivered annually in the U.S?

15All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Health plans and providers in 46 states and the District of Columbia use RowdMap’s benchmarks to reduce the delivery of no-value care.

RowdMap’s benchmarks help manage the $850 billion the nation spends on care that leads to no better outcomes.

The clients RowdMap serves collectively cover the lives of more than 91 million Americans.

RowdMap was founded in 2011 and has grown to more than 30 employees with offices in Louisville, KY and Portland, ME.

ABOUT ROWDMAPRowdMap by the Numbers

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No Value Care Meets No IT NeededUnexplained Variation

Often Low-Value Care is the result of perverse incentives from Fee for Service payment models but identifiable as unexplained variation within practice patterns.

The estimated 30% of medical expense that goes to no-value care.

Unnecessary spending drives billing in a fee-for-serve economic model, but success in pay-for-value comes from managing and mitigating these pockets of variation.

Variation: Unwarranted or Unexplained?Every physician has a unique fingerprint

Economic Drill Down: Example Utilization Review and Actuarial Unit Cost Analysis against Care Intensity Curve across Total Basket of Care

Variation across geographies and within practices across physicians.“Physician-Level Practice Variation: Who You See Is What You Get”

Brian Powers, Sachin Jain, David Cutler, and Ziad ObermeyerHealth Affairs, September 23, 2015

Definitions, research and geocoding by Hospital Referral Regional available via the Dartmouth Atlas for Unwarranted Variation:www.dartmouthatlas.org

NB: Unwarranted variation refers to practice patterns, which hold up across populations but pricing variation may also be unwarranted and marked fluctuates across insurance product and lines and geography. “The Price Ain’t Right.” Cooper, Craig, Gaynor and Van Reenen, 2015.

17All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Providers in a MarketGroups

Individual Physicians

What is driving a provider’s Risk-Readiness®? Is it procedures, prescriptions, referrals or visits?

How big is a provider’s panel?

How ready is a provider to succeed in risk

compared to peers? By specialty?

Within a region?

Finger print with practice patterns that mitigate no-value care = Green Dot

Finger print with practice patterns that create no-value care = Red Dot

Benchmarks for Risk-Readiness®

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

18All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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No Value Care Meets No IT NeededNew Government Data

Referral Files(Patient flows between PCPS, specialists, hospitals and post acute centers)

Dartmouth Atlas of Health Care & Choosing Wisely(Decades of research and data on unwarranted variation by condition and geography to keep things apples-to-apples for comparisons)

CMS FFS Data Sets, CDC Data Sets (MEDPAR, Part B, Part D, BRFSS)(Individual providers, groups, hospitals and post acute centers)

Provider Pattern Intensity Profiles and Risk Readiness® for every provider, hospital, post acute center in the US. All preloaded with no IT.

Affordable Care Act data to determine Risk-Readiness® of Providers / Networks

Trick Is Tying It together

19All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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No Value Care Meets No IT NeededBackend Technology

Your long term approach to Population Health

must emphasize high value networks

above all else.

20

You can’t reach true population health by chasing inconsistent and imperfect experimental programs

Pop Health is only profitable when you are able to identify, quantify and eliminate low value services.

A network built on efficient providers is the key to success in moving towards true population health.

Are you Ready for Risk?Share benchmarks with physiciansIncorporate benchmarks into compensation/gain shareInclude Efficiency criteria in hiring or network inclusion decisions

Are Your Partners Risk Ready?Make a short list of key partnersManage referrals into these key partnersInclude key partners in additional gain share opportunities

What are my best Opportunities for Risk?Assess your Network’s ability to succeed in arrangements/programsStrategically plan for an efficient network and take on more riskLearn to negotiate with payers from a position of strength

Risk-ReadinessⓇ benchmarks answer three questions:

No Value Care Meets No IT NeededEfficiency Networks Drive Value

21All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Are you Ready for Risk?Manage Internal Variation Provider Contracting Strategy Provider Compensation Strategy Process Variation & Improvement Service Line Benchmarking Provider Reporting Provider Recruitment & CIN Build Value Chain & Leakage Reporting Medical Economics Reporting

Are Your Partners Risk Ready?Pick the Best Partners for Risk Arrangements Primary Care Referral Source Analysis Acute Care Partner Reporting Post Acute Partner Reporting Consulting/Specialty Partner Analysis Competing Groups/Orgs Analysis

What are my best Opportunities for Risk?Match Providers to Risk• Risk-Matching to Payers: Government & Private Payers • Payer Negotiation Reporting • Medical Economics Modeling

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

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How do groups and individual providers within the groups compare to their peers and competition?

Share information about a provider’s risk-readiness against peers and competition to compare how well they are able to succeed in value base

and risk arrangements.

Provider ReportingPhiladelphia, PA

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

23All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

PCPs

Regional Benchmarks

Pima Co, AZ

Am I incentivizing providers in a way that will be successful in risk arrangements?

Incentivize individual physicians based on their overall risk-readiness benchmark and their individual drivers (procedures, prescriptions and

referrals) to succeed in value based and risk arrangements.

Provider Compensation Strategy

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Provider Recruitment & CIN Build

How do you design and implement CIN that succeed in value based arrangements?

Select providers that are risk-ready and complement each other’s practice patterns to create a CIN that succeeds in value based and risk

arrangements.

Saint Louis, MO

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Value Chain & Leakage Reporting

Primary Care Docs

Specialist Post Acute Facility

Thickness of lines indicates the number of referrals. Note: Some markets are

oversupplied. This market is controlled by one provider.

Less efficient

More efficient

How does your population flow through the care continuum and when and where do they fall out?

Identify natural patient flows and determine if your network is breaking them or reinforcing high value pathways then incentivize

providers to optimize referrals.

Target this PCP / DX Radiologist to refer more patients to the higher

performing specialist

26All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Value Chain & Leakage Reporting

How does your population flow through the care continuum and when and where do they fall out?

Identify natural patient flows and determine if your network is breaking them and causing leakage address through

contracting, education and incentives.

University of Miami is underperforming and referrals are internal.

This is a concentrated, low value pathway.

Holy Cross has high performing specialists, but its PCPs are referring to a variety of specialists.

This is a fragmented, but high value pathway.

Group Receiving Referrals

GroupSending Referrals

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Medical Economics Reporting

How much no value care are you paying for and how much you can save by line of business and down to individual providers?

Determine the specific economic impact that you create for whoever owns the risk you manage.

Decreased Cost

Average

Increased Cost

Less

Effi

cien

t

1

2

3

4

5

Mor

e Effi

cien

t

$ PMPY per Specialty & Efficiency Score

CARDIAC SURGERY

GASTROENTEROLOGY

ORTHOPEDIC SURGERY

DIAGNOSTIC RADIOLOGY PATHOLOGY

$609 $228 $334 $65 $79

$770 $253 $365 $71 $88

$973 $271 $419 $72 $91

$1,191 $303 $467 $121 $106

$1,299 $387 $624 $245 $212

Cardiac Surgery

Gastroenterology

OrthoSurgeon

Diagnostic Radiology Pathology

Impact on Spend

Risk-Readiness®Benchmark

Florida

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Medical Economics Reporting

How much no value care are you paying for and how much you can save by line of business and down to individual providers?

Identify how much no-value care you are mitigating and the specific cost savings it generates for whoever owns the risk.

$ PMPY per Specialty by County In & Out

Network

In Network

Out of Network

Scenario: Removing the lowest performing physicians

Drill down into Pima County (Phoenix) The highest $PMPY in

Phoenix is with in network GI docs at $643

In this scenario, they would have the greatest drop

in $PMPY at $119. ($634 - $119 = $524)

Arizona

$ PMPY per Specialty & Efficiency Score

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Primary Care Referral Source Analysis

Referrals to Orthopedists

GroupSending Referrals

Group Receiving Referrals

Group Receiving Referrals

Group Receiving Referrals

Group Receiving ReferralsGroup Receiving Referrals

Individual Physicians

Receiving Referrals

Number of Referrals Performance of Physicians Receiving

Referrals

Which PCPs are sending patients to a given specialist and how well do those PCPs perform?

Make sure your PCPs are sending to high performing specialists who are Risk-Ready to succeed in value based and risk arrangements.

30All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Acute Care Partner Reporting

Which Hospitals are Risk Ready and what are the drivers of success?

Identify the hospitals that are risk-ready and the drivers behind their practice patterns to succeed in pay for value and risk arrangements.

California

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Acute Care Partner ReportingCost by DRG

Norton

Medical SurgicalMedical

Surgical

Baptist

Which Hospitals are Risk Ready and what are the drivers of success?

Determine which hospitals are the most efficient and have incentive to work with your specialty in value based arrangements.

32All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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No Value Care Meets No IT NeededIdentifying Success in Pay for Value

Post Acute Care Partner ReportingWestchester County, NY

Which Post Acute Facilities are Risk Ready and what are the drivers of success?

Identify the post acute centers that are risk-ready and the drivers behind their practice patterns to succeed in pay for value and risk

arrangements

Home Health Top ProvidersOrange = Preferred

33All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Regional Benchmarks

Consulting/Specialty Partner Analysis

Which Partners are Risk Ready and what are the drivers of success?

Identify the consulting and specialty partners that are risk-ready and the drivers behind their practice patterns to succeed in pay for value

and risk arrangements

Harris County, TX

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

34All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Risk-Matching to Payers: Government & Private Payers Largest Counties in TX

Regional Benchmarks

Risk Scores Health Rank

Network Opportunity

Profit Opportunity

MA

Profit Opportunity

Exchange

MedicareEligibles /

MA Enrolled

ExchangeSubsidy Eligibles /Exchange Enrolled

MedicaidBeneficiary Eligibles /

Beneficiaries

Which value based programs or risk arrangements will be successful in my population?

Identify my population’s socio-demographics, health behaviors and prevalence that lead to success in specific value based programs and

private payer risk arrangements

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

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Payer Negotiation Reporting

How do I use government benchmark data to negotiate to my strengths and a payer’s weaknesses?

Identify performance against national and regional benchmarks. Highlight where you perform well, addresses and have an explanation

and/or plan for areas that need work.

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

36All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Population Health & Supply Impact on Risk-Readiness®

Risk-Matching to Payers: Government & Private Payers

Which value based programs or risk arrangements will be successful in my population?

You practice in geographies with specific population health profiles and a specific supply of care, so these are the pressures you will face

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

37All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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RowdMap provides data and analysis on Population Health factors that drive success in value-based programs:

Behaviors – Broader Definitions of Health with Behaviors

Utilization – Utilization and Costs of Procedures and Drugs

Prevalence – Major Diseases and Conditions

Supply – Number of Primary Care Physicians and Specialists

Socio-demographics – Income, Environment, etc.

Match your strategies to

your population to succeed in value-based

programs

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

38All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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What is the financial impact of no value care that you create for payers that you are not getting credit for?

Identify performance against national and regional benchmarks. Highlight where you perform well, addresses and have an explanation

and/or plan for areas that need work.

Each dot is a physician.

Groups are created from specialty, network status,

Efficiency score, and geography

Dr. SpockNPI: 15000000123

$PMPY: $874

Savings for removing 5’s

form in Network

Medical Economics Modeling

No Value Care Meets No IT NeededIdentifying Success in Pay for Value

39All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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Find the right value based program based on your provider patterns around no-value care.

Identify the most efficient providers; this may not show up in utilization

review or unit cost analysis. Then negotiate like a pro.

Now, take on risk to capture the value you create through pop health

No Value Care Meets No IT NeededCapture the Value You Create

40All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.

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No Value Care Meets No IT NeededCapture the Value You Create

CMS: 50% of FFS will be gone by 2018

What if you knew which providers would

drive your success?

What if you knew which providers would sink you? WHAT WOULD YOU DO IF YOU KNEW

who will win and who will lose in value based arrangements