How to transition intelligently into risk-sharing arrangements by understanding the characteristics of government population and practice pattern analysis. A presentation from Joshua Rosenthal, PhD, Chief Scientific Officer and Co-Founder at RowdMap, Inc., on how doctors and hospitals can use newly released government data to intelligently transition into risk-sharing arrangements and delivering an analysis of providers and their performance against national and regional benchmarks for unnecessary spend and no value care at the 2015 national conference of CAPG – The Voice of Accountable Physicians Group.

1. of Variation:
Building a Network of
High Quality Performers as
You Move into Risk
How to transition
intelligently into
risk-sharing arrangements
by understanding the
characteristics of
government population
and practice pattern
analysis

2. 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.
2
Building a Network of High Quality
Performers as You Move into Risk
Perverse Incentives
Freedom and Fear
Experimentation and Power
Performance on Display
FIFTY SHADES OF VARIATION

3. 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.
3
Building a Network of High Quality
Performers as You Move into Risk
Perverse Incentives
Freedom and Fear
Experimentation and Power
Performance on Display
FIFTY SHADES OF VARIATION

4. 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.
4
CMS Sun-setting FFS
CAPG: Innovative Experimenters
Broader market: From 5% to 50% risk
30 cents / $ from variation drives success in risk
New variation measures and CMS
PERVERSE INCENTIVES

5. 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.
5
The world is
catching up…
Be careful what you wish for
PERVERSE INCENTIVES

6. 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.
6
CMS is actively sun-setting FFS.
You need to become well-versed not just in risk, but in using
government data sets as they will become essential inputs into
running any health plan or risk-arrangement in future years.
PERVERSE INCENTIVES

7. 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.
7
How do we navigate the changing
business environment ahead?
Most of your payments go to FFS
with maybe some going to P4P
bonus
Payments will be much more diverse including
FFS, P4P bonus, bundled payments,
shared savings, and global payments.
Payments Today Future Payment Mix
New and soon-to-be released government programs and
arrangements require new metrics that reflect who creates
value in risk arrangements (vs. operational box checking)
PERVERSE INCENTIVES

8. 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.
8
Goal: Reduce the 30% of the U.S.’s healthcare
spend that on clinically appropriate, but unnecessary care
Over $9B in
Orange County, CA
Want to see how much unnecessary spend is in
your market by condition?
Over $66B in Florida
$850 Billion Unnecessary Spend in 2014
PERVERSE INCENTIVES
This drives Fee for Service billing, and will not show up in a traditional utilization
review or actuarial analysis. Current Pay for Value metrics do not directly address it.
Ortho
Cardio
Readmissions
End of Life
Least Unnecessary
Spend
Most
Unnecessary Spend
Models identify the cost-savings
opportunities in a geography based on the
collective intensity of care delivered by
doctors in that area.

9. 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.
9
PERVERSE INCENTIVES
=
Matching collective provider practice patterns and the
characteristics of the geographies they serve with
appropriate risk arrangements.
+
Risk-Readiness SM
Geographic
Profiles
Provider
Practice
Patterns
Risk
Arrangements
+

10. 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.
10
At the core of Risk-Readiness℠ is
Unwarranted Variation:
RowdMap applies Dartmouth Atlas for Unwarranted
Variation methodologies to data on Medicare Parts B
& D. This research has been repeatedly validated
over the last 30 years and we now have a national
data set to apply the methodologies at a large scale.
The estimated 30% of medical expense that
goes to unnecessary care. This unnecessary
spend drives billing in a fee-for-serve economic
model, but success in pay-for-value comes
from managing and mitigating these pockets
of variation. Every provider has a unique practice
pattern that informs Risk-Readiness
PERVERSE INCENTIVES

11. 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.
* Source: Dartmouth Atlas for Unwarranted Variation
*
Unwarranted Variation
11
PERVERSE INCENTIVES

12. 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.
12
Every doctor practices medicine differently.
Some doctors prefer starting with lower intensity approaches…
…while others might jump right to surgery or narcotics.
The collective nuances of how each doctor practices can
be aggregated into a unique practice pattern fingerprint.
PERVERSE INCENTIVES

13. 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.
13
Treatment Patterns highlight differences in
pace and intensity of back pain treatment
Each doc has a unique practice pattern. Some docs
tend go more quickly to higher intensity options
Figure out your providers then
match the revenue models
PERVERSE INCENTIVES

14. 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.
14
Individual provider’s performance
compared to geographic benchmarks
Build Relationships Put on Notice
Some Doctors tend go more quickly
To higher intensity options
PERVERSE INCENTIVES

15. 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.
15
Identify & cultivate providers for risk
This doc is making money for whoever owns the risk
This type of doc is disproportionately important to your network/group
She might not be the highest
producing and may cost more…
…but she’s disproportionately
reducing unwarranted costs
and unnecessary negative
impact and patient experience
PERVERSE INCENTIVES

16. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
16
PERVERSE INCENTIVES
Great profile for
aggressive risk
Tread carefully for
some risk
Match appropriate risk arrangements based on
provider practice patterns and
Population characteristics within a geography.

17. 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.
17
PERVERSE INCENTIVES
For 50 years, reducing health care spend has
focused on the smallest piece of the spending pie.
“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
Shift focus from clinical edits, audits, and recovery efforts to
identifying care that is clinically appropriate, but unnecessary.
Historical efforts have shown returns, but they only look at a
fraction of total spending. Unnecessary care can account for up
to 30% of total spending and provides significantly larger
opportunities for cost containment and quality improvement.
Fraud, Waste,
and Abuse
$0.5bn
Appropriate Utilization
$3.5bn
Clinically Appropriate,
but Unnecessary Care
$1.0bn

18. 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.
If Dr. Fee for Service had same ratio
as Dr. Pay for Value:
• His decompression rate would drop from
6.01 to 0.436 per patient.
• Which translates to 2,608 fewer
decompressions per year.
• At an average cost of $332 per
decompression, this represents potential
savings of over $850K
If Dr. Fee for Service’s decompression to fusion
rate were average for orthopedic surgeons:
• He would have 1629 fewer decompressions
for a potential savings of $540K.
For every 10 back fusions Dr. Fee
for Service* does 103
decompressions.
For every 10 back fusions Dr. Pay for
Value* does 2 decompressions.
Unwarranted variation = risk in value-based arrangements.
You cannot manage risk without managing this variation
that accounts for 30% of your medical expense.
* Drs. names change to illustrate risk arrangement that matches their practice pattern
PERVERSE INCENTIVES

19. 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.
If Dr. Fee for Service had same ratio
as Dr. Pay for Value:
• His decompression rate would drop from
6.01 to 0.436 per patient.
• Which translates to 2,608 fewer
decompressions per year.
• At an average cost of $332 per
decompression, this represents potential
savings of over $850K
If Dr. Fee for Service’s decompression to fusion
rate were average for orthopedic surgeons:
• He would have 1629 fewer decompressions
for a potential savings of $540K.
For every 10 back fusions Dr. Fee
for Service* does 103
decompressions.
For every 10 back fusions Dr. Pay for
Value* does 2 decompressions.
Unwarranted variation = risk in value-based arrangements.
You cannot manage risk without managing this variation
that accounts for 30% of your medical expense.
* Drs. names change to illustrate risk arrangement that matches their practice pattern
Magnitudes of order larger savings than traditional utilization,
fraud/waste/abuse or compliance/gap closure.
For example, 1 doc in 1 county on 1 DRG funnel
= $850k unwarranted / unexpected spend.
This will not show up in traditional utilization review
or actuarial analysis.
If only 5% of your book is at risk, you don’t care; but
when you move to pay-for-value, this will sink your battleship.
PERVERSE INCENTIVES

20. 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.
20
Building a Network of High Quality
Performers as You Move into Risk
Perverse Incentives
Freedom and Fear
Experimentation and Power
Performance on Display
FIFTY SHADES OF VARIATION

21. 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.
New Data – FOIA
Yes, it’s scary, and naming names
It can be used for poor conclusions
Yes, bad PR releases & news
But it’s important
The information is here and more coming
It can be used to your advantage
You are in the best place to use it
Make sure you use it succeed
21
FREEDOM AND FEAR

22. 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.
22
There’s a lot of data and talk out there
FREEDOM AND FEAR

23. 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.
23
Let’s cut
through
the buzz
FREEDOM AND FEAR

24. 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.
24
Government
performance
data
Government
provider etc.
data
Government
socio-demo
data
Consumer
web / social
data
Analysis-based derived
data
Sentiment as a Key Driver (psychographic) - measured by Index scores for:
- Domains (chronic, wellness, quality of care, customer satisfaction, customer service);
- Brands (parent org and you individually)
Market Growth; Census;
Healthy Food; County
Health Rankings &
Indicators; Behavioral
Health Factors; etc.*
Dartmouth Atlas; STAR;
Hospital Compare; Actual,
Expected & Predicted
Readmissions; Part B & D, etc.*
STAR; Price, Bid, Rebate;
Hospitals, Nursing
Homes; Market, etc.*
* Dozens of Primary Data Sets, updated at various frequencies
When we say a lot…we mean a lot.
FREEDOM AND FEAR

25. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
25
And it’s powerful, disruptive, game changing
David Wennberg,
RowdMap Advisory Board
Government Data Outperforms Risk Adjustment!
FREEDOM AND FEAR

26. 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.
New Government
Released Referral Data
(Patient flows between
PCPS, specialists, hospitals
and post acute centers)
Dartmouth Atlas for
Unwarranted Variation
(Decades of research and data on
unwarranted variation by condition
and geography to keep things
apples-to-apples for comparisons,
hence “Unwarranted” in the name)
New Government
Released Performance Data
(Individual providers, groups,
hospitals and post acute centers
including the new part B&D)
Provider Pattern Intensity Profiles and
Risk Readiness for every provider,
hospital, post acute center in the US.
All preloaded with no IT.
OPEN DATA
Affordable Care Act data to determine
Risk-Readiness of Providers / Networks
26
FREEDOM AND FEAR

27. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
27
a world where you had access to…
Referral patterns
for your hospitals
FREEDOM AND FEAR

28. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
28
a world where you had access to…
Referral patterns
for your hospitals
Well, that world is here, today.
• Even though the AMA was skeptical about these data
releases for 30 years, they are now on board.
• You have access to all of these data through government
benchmarks.
• CMS understands network data like these are necessary for a
competitive, direct-to-consumer health care market.
• No IT, no integration, no data warehouses—it’s here today.
FREEDOM AND FEAR

29. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
Here’s why these benchmarks are so powerful
29
Government benchmark data serves as the common language
necessary to build relationships with providers to
improve the member experience and profitability
The benchmarks are available today with no IT involvement
The data already have a level of analysis on top,
so you can see if a provider is over/under benchmarks
It’s from CMS; it’s a standard;
it’s already used to day to drive reimbursement
FREEDOM AND FEAR

30. 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.
30
Building a Network of High Quality
Performers as You Move into Risk
Perverse Incentives
Freedom and Fear
Experimentation and Power
Performance on Display
FIFTY SHADES OF VARIATION

31. 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.
31
Uses & Tactics
Design networks for populations
Choose the right risk arrangement
Current and new (gov or specific payers)
Setting up your own plan
Manage practice patterns and referrals
Negotiate with payers from authoritative info
EXPERIMENTATION AND POWER

32. Where are populations,
and how healthy are they?
How do we manage practice
variation to contain costs?
How do we highlight our performance
& negotiate with payers?
Where are Risk-Ready SM
providers, and what arrangements will
lead to success?
EXPERIMENTATION AND POWER
32
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.
32

33. 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.
33
County Profiles and Risk Drivers
Which counties will likely generate profit in a P&L
given a payer’s characteristics?
California
EXPERIMENTATION AND POWER

34. 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.
34
County Health Factors Average Risk Scores
Population Demand & Provider Supply
Where is health risk underrepresented or under-coded?
Which areas have lower risk scores than their behavioral profile / cost drivers.
In other words, where does the population sees providers less and therefore
has a lower risk profile based on the geography’s ‘supply’.
EXPERIMENTATION AND POWER

35. 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.
35
Population Demand & Provider Supply
EXPERIMENTATION AND POWER
Chronic Prevalence
Snohomish County, WA
Income
Obesity
Depression
PCP Density
Snohomish County, WA
Proximity to provider is more important for this geography.
Is my network aligned to not only meet adequacy
but to reflect my member demographic?

36. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
36
Population Demand & Provider Supply
EXPERIMENTATION AND POWER
Proximity to provider is more important for this geography.
Is my network aligned to not only meet adequacy
but to reflect my member demographic?
Chronic Prevalence Los
Angeles County , CA PCP Density
Los Angeles County, CA
Income
Obesity
Depression

37. 37
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.
Network Opportunity Index
EXPERIMENTATION AND POWER
Where are providers delivering the
most efficient and appropriate care?

38. Where are populations,
and how healthy are they?
How do we manage practice
variation to contain costs?
How do we highlight our performance
& negotiate with payers?
Where are Risk-Ready SM
providers, and what arrangements will
lead to success?
EXPERIMENTATION AND POWER
38
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.
38

39. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
39
Which providers match which arrangements
Good candidates for full
cap and aggressive risk
arrangements
Tread carefully and ramp
up with upside here
Provider Risk-Readiness
Los Angeles County, CA
EXPERIMENTATION AND POWER

40. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
40
What’s driving a specific provider’s
performance in comparison to peers?
Los Angeles County, CA
Provider Benchmarks
EXPERIMENTATION AND POWER
Tread carefully with
referrals
Drug costs and scripts
per patient driving low
costs per patient

41. Los Angeles County
CareMore Med. Group PhysiciansPhysician Risk-Readiness
Individual
physicians with the
largest panels are
the most risk-ready
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.
41
EXPERIMENTATION AND POWER
Which physicians are driving a group’s risk-readiness?

42. 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.
42
How do local hospitals perform against national benchmarks?
EOL Hosp Days: Which hospitals fewer end-of-life days than their peers?
Chronic Admits: Which hospitals see their most chronic population repeatedly/ with the most frequency?
Cardiac Imaging: Which hospitals are more likely to over-utilize cardiac imaging compared to their peers?
Hospital Profiles and Risk Drivers
EXPERIMENTATION AND POWER

43. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
Spending 1-30 Days Post Discharge
Long Beach Memorial
Med. Center
43
What are the
patterns of care and
preferred pathways?
Hospital Risk Drivers
EXPERIMENTATION AND POWER
Readmissions

44. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
44
Market Share & Hospital Benchmarks
Hospital Profiles
Cedars Sinai
Medical Center
Los Angeles County, CA
Where are providers delivering the
most and the appropriate care?
EXPERIMENTATION AND POWER

45. 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.
45
How do local post acute centers perform against national
benchmarks? How are local hospitals routing, especially those
with poor chronic readmits & post discharge rates?
EXPERIMENTATION AND POWER
Post Acute Center Profiles

46. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
46
Physician
Name
Decompression
/ Fusion
Funnel
Avg Cost
Per
Patient
EXPERIMENTATION AND POWER
Physician Segments by Risk-Readiness SM
Identify providers who are best suited for more
aggressive risk arrangements, curated networks, ACOs
and setting up plans.

47. Where are populations,
and how healthy are they?
How do we manage practice
variation to contain costs?
How do we highlight our performance
& negotiate with payers?
Where are Risk-Ready SM
providers, and what arrangements will
lead to success?
EXPERIMENTATION AND POWER
47
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.
47

48. 48
Least Unnecessary
Spend
Most
Unnecessary Spend
Option 2: Reinforce
highest-performing referral
and care pathways.
Increase the number of patient
interactions with green dot doctors.
Option 1: Improve provider performance
and change provider practice patterns.
Increase the number of green dot doctors.
Zoom to zip
EXPERIMENTATION AND POWER

49. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
Primary Care Dx Radiologist
Green = good performance; red = bad.
Find the highest performing patient flows and
encourage care to happen through those pathways.
Referral Patterns and Physician Value Chains
49
EXPERIMENTATION AND POWER
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
NPI
Neuro or Ortho

50. 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.
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.
Referral Patterns and Physician Value Chains
Identify high performing providers and downstream
referral patterns. Encourage referrals to
high-performing specialists.
50
EXPERIMENTATION AND POWER

51. Where are populations,
and how healthy are they?
How do we manage practice
variation to contain costs?
How do we highlight our performance
& negotiate with payers?
Where are Risk-Ready SM
providers, and what arrangements will
lead to success?
EXPERIMENTATION AND POWER
51
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.
51

52. 52
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.
Put your best foot forward and explain the value you create using
government benchmarks. For example, providers that are risk ready and
limit unnecessary spending will not show up in a utilization review and
may have a higher unit costs but create value for whoever owns the risk.
Highlight high benchmark performers looking to grow. Highlight providers
with large panels with efforts to improve efficiency.
Large panel and
improving.
High performers with
practice patterns out-
performing unit cost
and utilization analysis
due to case mix and
population factors.
Looking to grow.
EXPERIMENTATION AND POWER
Negotiate from Unnecessary Spend

53. 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.
53
Los Angeles, County
What are the natural,
not necessarily the contracted,
patient flows between providers
(paths of least resistance) in my market?
Inbound Referrals
Outbound ReferralsInformal Network
1
Informal Network
2
Informal Network 3
Informal Network
4
Negotiate from Natural Market Control
EXPERIMENTATION AND POWER

54. 54
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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.
Adequacy Optimized
for Performance
Adequacy Met Performance Drivers
EXPERIMENTATION AND POWER
Negotiate from Network Optimization
54
Emphasize your place in an optimized network based on
population health, provider performance, and adequacy
requirements. Supersede adequacy for PCPs in areas with
high chronic populations.

55. 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.
55
EXPERIMENTATION AND POWER
Where are specific payers weak/strong on profit, costs, risk and
network? Where and how are you most needed?
(Health Behaviors
and Costs)
Profit Opportunity
Index (Exchanges)
Network
Opportunity Index
Risk ScoresCalifornia
Payer Profiles and Report Cards

56. Market Portfolio Position
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.
56
Population Demand & Risk Alignment
Price Sensitivity
EXPERIMENTATION AND POWER
Which payers have plans that draw specific patient panels?
How does a payer’s plan positioning affect patients?
Which benefit configuration patterns influence care?

57. 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.
57
Benefit Configuration & Risk Alignment
Avg
Pay Later
Pay Now
Typical Markets have at least
two ‘Winning Patterns:’
Pay Now & Pay Later
HealthNet
HealthNet
Aetna
Los Angeles
EXPERIMENTATION AND POWER
Which payers have plans that draw specific patient panels?
How does a payer’s plan positioning affect patients?
Which benefit configuration patterns influence care?
High vs. low
deductibles are
the difference
between health
plans paying
you versus
chasing patients
for deductibles.

58. 58
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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.
Washington
Which payers are buying membership; how valuable is your panel to
them? Which payers have membership but need to mitigate their own
risk through risk-ready networks with low unnecessary spend; how
valuable is your risk-readiness to them?
EXPERIMENTATION AND POWER
Payer Profiles and Tactics

59. 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.
59
EXPERIMENTATION AND POWER
Payer Profiles and Report Cards
California
Determine which payers have healthy profits and where you contribute
to those. Determine which payers have acute needs and how can you
help them. For example, a payer with low reimbursement, poor
population health scores and poor overall clinical metrics (Star, QRS, etc.)
and a small population, negotiate less from your medical performance
and more from your coding and panel size.

60. 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.
60
Get to know gov data especially variation & risk
Rank your markets and docs by Risk-Readiness
Match your docs & markets w/ the right arrangements
Build your business & negotiate around this
FIFTY SHADES OF VARIATION

61. 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.
61
FIFTY SHADES OF VARIATION
Get Crackin’
[Referrals: http://1.usa.gov/1FzoEOV]
[Variation: http://go.cms.gov/1D8j7LE]
[Shared Savings: http://go.cms.gov/1Hh8vx0]
[Medicare FFS Part B: http://go.cms.gov/OCmyoy]
[Medicare FFS Part D: http://bit.ly/1mGyBxk]
[Medicaid: http://go.cms.gov/1z7b5ic]
[Dartmouth: http://bit.ly/1GXvlJp]
[Behaviors: http://1.usa.gov/1PzcisT]
[Health Data All Stars: http://bit.ly/1GAsVC3]

62. 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.
62
Building a Network of High Quality
Performers as You Move into Risk
Perverse Incentives
Freedom and Fear
Experimentation and Power
Performance on Display
FIFTY SHADES OF VARIATION

63. 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.
63
PERFORMANCE ON DISPLAY
Get Crackin’ CAPG
Appendix
Provider Risk-Readiness SM Profiles

64. 64
How to Read RowdMap’s Provider Risk-Readiness SM Profiles
All metrics are based on “appropriateness of care” as defined by the Dartmouth Atlas for Unwarranted
Variation. CMS data sets (inclusive of Part B and Part D claims) were used to calculate efficiency (this
can be done on individual claims across all lines of business and holds up with astonishing accuracy
across populations as FFS offers the largest national dataset for benchmarking and makes an ideal
target for measuring practices patterns against unnecessary spend with natural referral networks.
All providers are compared against peers or cohorts. Physicians designate a primary specialty with CMS. All
physicians with the same specialty designation are classified as a cohort and peers may be normalized
based on actual practice patterns. For example, a GP is compared with other primary care focused
physicians. This allows apples-to-apples measurement against different specialties. Providers can be
measured against similar specialists in similar geographies or across lines of service.
Procedural efficiency address performance for pertinent procedures; prescription efficiency for
prescriptions; visit addresses visits per patient per condition per provider based on practice pattern;
referrals addresses referrals to specialists belonging to that condition ranked by intensity of specialist
type and practice patterns from target specialists; overall efficiency is composite score (weighting can
be adjusted based on domain, individual drill down metric or individual specialty, DRG or drug class).
A green dot indicates good performance (high efficiency / low unnecessary spend / risk-readiness) and a red
dot indicates low performance (low efficiency / high unnecessary spend / limited risk-readiness). The
dotted line in each profile indicates the national average for the metric (benchmarks can be set against
geographies). (Visualizations can includes dynamic tables, geo-coding, funnels and arcs.)
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.

65. 65
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.
Catholic Health Initiatives
Top Physicians by Volume
Risk-Readiness SM Metrics

66. 66
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.
Catholic Health Initiatives
Top Physicians by Volume
Drill Down Metrics

67. 67
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.
The Everett Clinic
Top Physicians by Volume
Risk-Readiness SM Metrics

68. 68
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.
The Everett Clinic
Top Physicians by Volume
Drill Down Metrics

69. 69
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.
HealthCare Partners
Top Physicians by Volume
Risk-Readiness SM Metrics

70. 70
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.
HealthCare Partners
Top Physicians by Volume
Drill Down Metrics

71. 71
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.
Sutter Health Foundation &
Affiliated Groups (without radiology)
Top Physicians by Volume
Risk-Readiness SM Metrics

72. 72
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.
Sutter Health Foundation &
Affiliated Groups (without radiology)
Top Physicians by Volume
Drill Down Metrics

73. 73
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.
Sharp Community Health Group
Top Physicians by Volume
Risk-Readiness SM Metrics

74. 74
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.
Sharp Community Health Group
Top Physicians by Volume
Drill Down Metrics

75. 75
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.
WellMed
Top Physicians by Volume
Risk-Readiness SM Metrics

76. 76
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.
WellMed
Top Physicians by Volume
Drill Down Metrics

77. 77
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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.
Heritage Provider Network
Top Physicians by Volume
Risk-Readiness SM Metrics

78. 78
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.
Heritage Provider Network
Top Physicians by Volume
Drill Down Metrics

79. Across the board:
Above average Risk-Readiness SM
Overall Risk Readiness performance is better than individual drivers indicating physicians are
providing value beyond measures typically assessed in utilization review or by actuarial
analysis (unit cost, etc.).
This should be highlighted in payer negotiations and likely indicates strong performance in
when moving into very aggressive arrangements including setting up plans.
Notable variation within groups around overall performance and individual performance
domains including referrals.
This indicates greater than average opportunities to contain unnecessary costs based on
internal best practices within a group and across CAPG and should lead to greater than
average performance improvements particularly for specialists.
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.
79
PERFORMANCE ON DISPLAY
CAPG at First Glance