CAPG | Making Medi-Cal Managed Care Work

Making Medi-Cal

Managed Care Work

Advanced Medical Management, Inc.

Kathy Hegstrom

President

Conifer Health Solutions

Megan North

President, Value-Based Care

SynerMed

James Mason

President and Chief Executive Officer

Presented By:

“If your plan is for 1 year, plant

rice. If your plan is for 10 years,

plant trees. If your plan is for

100 years, educate.”

- Confucius

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• Body text goes here

– Bullet text

• Sub bullet

• Body text here

3Winter is Coming?!

4No Need to Lose Your Head

So You Pick Your Path to the Throne … 5

Unfortunately, You Also Get…

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Commercial Break

Advanced Medical Management

• AMM as Management Services Organization (MSO)

– Independent Physician Associations

– Hospitals

• AMM specializes in Niche Clients with Custom Needs

– Language & Cultural (Korean, Vietnamese, Arabic )

– Start-ups (single owner, specialty owners)

– Unique Structures (Performance-based , Closely held)

– Geographic (Rural, Hospital-centric, International)

– Limited Knox Keene

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Advanced Medical Management

• AMM as Fiscal Intermediary (FI)

– Government Programs

• Medically Indigent

• Custodial

• Public Health

• AMM as Contracted Claims Processing

– Health Plans

• Overflow during Rapid Expansion

• Commercial ACO Demonstration

– Hospitals

• Dual Risk

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Our Goal 10

Transforming how care is delivered while keeping physicians “whole”

And engaging individuals to improve the health of populations

Our Footprint 11

Conifer VBC statsValue-Based Care Office

Conifer Health – Service Centers

Revenue Cycle Management Client Locations

Patient Communications Client Locations

Value-Based Care Client Locations

Key

• Service clients in more than 20 states

• 300+ clients

• 4+ million managed lives

• $17+ billion medically managed spend

Value-Based Care Office

Who Benefits from Us 12

Performing on risk

based contracts and

driving alignment of

physicians

Focus on the right

population with

workflow

integration

Personalized

outreach while

controlling

healthcare costs

Conifer Health sells its value based solutions to many of the stakeholders needed to achieve

population health and we are on our way to creating linkages between them

Focusing on Impact 13

IntegratesDisparate

Data

IdentifiesIndividual’s

Needs

DrivesActions to

theCare Team

ProvidesOutcomesFeedback

• Uses risk analytics and predictive modeling

• Segments population by risk levels

• Predicts future costs and utilization patterns

• Proactively manages individuals to improve outcomes

Technology Platform to Improve Performance 14

What We Do

SynerMed provides an agnostic provider network for Plans

• PLANS GET– Low cost, high quality networks

• PHYSICIANS GET– Advanced technology, market leverage and better economics

through population health management

• PATIENTS GET– More choices, high quality networks and a team approach to

medicine

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Vital Statistics

• 400 FTEs

• 800,000 members

• Serving:

• Sacramento

• Fresno

• Madera

• Kings

• San Bernardino

• Riverside

• Los Angeles County

• San Diego County

• Georgia

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• $500 Million in

healthcare spend under

management

• All healthcare products:

• TANF

• SPD

• SCHIP

• Medi-Medi

• Medicare

• Commercial

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Internet of Everything | Healthcare 18

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Back to Your Regular Programming

• SPDs Lessons Learned

• Covered California

– Welcome Mat Effect

• MCEs

• CCI Dual Demo

20The Others! Winter is Coming!

SPDs

• Sicker

• Pent up utilization due to

lack of access

• Dual and Tri DX

• Homelessness or near

homelessness

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• 20% sicker than SPDs

that opted into Managed

Care versus those

passively enrolled

• Gaps in the PCP model

of care

• Is the delegated

risk/revenue ratio

appropriate?

MCEs

• L1s

– Who are they?

• M1s

– What’s the difference?

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• We don’t know yet –

hopefully by the time we

speak, we will know

more about utilization

patterns

• Is the delegated

risk/revenue ratio

appropriate?

Duals

• High-cost, high needs

patient population

• 55% have 3 or more

chronic conditions

• 1 in 6 live in an

Institution

• 50% are Dual DX

• Old model was

fragmented, confusing

and inefficient

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• Part A

• Part B

• MLTSS

– LTC/Custodial

– IHSS

– CBAS

– MSSP

– PACE

Duals Demo

• 456,000 in 8 Pilot

Counties:

– Alameda

– Los Angeles

– Orange

– San Diego

– San Mateo

– Riverside

– San Bernardino

– Santa Clara

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• 4/1 San Mateo

• 5/1 San Diego, San

Bernardino/Riverside

• 7/1 Alameda and

Los Angeles

• 1/1/15 Santa Clara

25Questions?

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