Shift in the Payer Movement in the Provider Space to Augment the Movement of Value Based Integrated Payments - The Evolution to Health Solutions presented by Jon Gavras, MD at the FLAACOs Fall 2014 Conference

1. Shift in the Payer Movement in the Provider Space to
Augment the Movement of Value Based Integrated
Payments
The Evolution to Health Solutions
Jonathan B. Gavras, MD
President, GuideWell Health
September 29, 2014

3. How Health Care Is
Changing…

4. A HEALTH
SOLUTIONS
COMPANY
A leading innovator enabling healthy
communities through new solutions that improve
health outcomes and access while driving down
industry costs.
Integrated HealthIntegrated Health
SolutionsSolutions
Health InsuranceHealth Insurance
market leadermarket leader
InnovativeInnovative
consumer servicesconsumer services
DiversifiedDiversified
health productshealth products
and servicesand services
Health &Health &
health carehealth care
delivery servicesdelivery services
SOLUTIONS

5. ONE New Enterprise
Structure
Health
Insurance
Company
Health
Insurance
Company

6. GuideWell Health
Leadership
Focused and dedicated assets to drive the
strategic vision of integrated health care
Focused and dedicated assets to drive the
strategic vision of integrated health care
Entrepreneurial
and nimble
approach
Entrepreneurial
and nimble
approach
Strong
M&A
competencies
Strong
M&A
competencies
Tight alignment to
affiliated consumer
company
Tight alignment to
affiliated consumer
company
Culture of
innovation
and execution
Culture of
innovation
and execution
Assimilation of
experienced and
proven talent
Assimilation of
experienced and
proven talent
Possesses Key Requirements to WinPossesses Key Requirements to Win
Leverage existing
successful provider
models and talent
Leverage existing
successful provider
models and talent

7. Marketplace Overview
Health reform is changing the health delivery system. The system is being turned upside down
with the power shifting from Payers and Facilities to Patients and Primary Care Physicians
Provider Convergence and Consolidation in the Marketplace - PwC
Characteristic` Current Delivery System Future Delivery System
Focus Provider and Payer Patient
Aim Price Reductions Population Cost Reduction
Financial Intent Grow Volume Find Savings and Efficiencies
Quality Quality Assurance Quality Dependent Payment
Contracts Fragmented Agreements Single Integrated Contract
Physician Focus Specialists Primary Care Physicians

8. Market Trends
Highest proportion
of deal activity
occurred within the
Integrated
Delivery System
Domain
With almost 64% of
the deal volume and
close to 46% of the
deal value
Consumerism/
retail
experienced the
second highest
deal volume
With almost 20%,
but only 1.4% of
the total value
Consumerism/
retail
experienced the
second highest
deal volume
With almost 20%,
but only 1.4% of
the total value
The cost
containment deal
value heavily
influenced by
the $34B
acquisition of
Medco
The cost
containment deal
value heavily
influenced by
the $34B
acquisition of
Medco
Government
market transactions
account for only 3% of
the volume, but about
14% of the deal value
Health and
wellness accounts
for a higher volume
than Government
market, but only 0.5%
of the total value
Likely indicates
some start-up
activity in this
domain

9. Market Trends
Industry
consolidation
Industry
consolidation
Different
environment from
1990s and 2000s
Different
environment from
1990s and 2000s
Six deal
types
predominate
Six deal
types
predominate
• Seeing both large (Catholic Health East – Trinity) and local
(Baptist – Bethesda) Systems
• Transactions increased 18% in 2012; facilities by 60%
• East and urban markets hottest
• Was response to insurer consolidation
• Now have separation of “have” and “have nots” of hospital
systems
• Revenue and operating models changing
• Inpatient revenue decreasing
• Need for capital
• FFS to VBR
• Distress
• Alliances (usually local)
• Adjacent markets
• Bigger chassis
• Big get bigger
• Academic Medical Centers evolve to Academic Medical
Systems

10. Axioms of Modern Health
Care Industry
 Healthcare is of local relevance to most people
 Reform, consumerism, health needs and cost will require variable access and
price requirements
 Quality (and how measure) will drive a large part of health care financing
 Administrative cost pressure enormous with fixed MLRs
 There will be those that are advantaged moving forward in the
marketplace
 A new delivery system is evolving
– Blurring of provider and payer space
– Non-traditional participants
– “Radical” alliances
– “Mosaic” of delivery system components

11. 3,53,5
4,6,
10, 13
4,6,
10, 13
1, 111, 11
Accountable Care Organizations (ACO)s
1.Baptist Miami/AMS (Oncology)
2.NCH Healthcare (Naples)
3.BayCare Physician Partners
4.Holy Cross Physician Partners
5.H. Lee Moffitt Cancer Center (Oncology)
6.Cleveland Clinic
7.HMA Brevard
8.Orlando Health Physician Partners
9.First Coast Health Alliance (Flagler Hospital)
10.Memorial Health Network (Memorial SFL)
11.Baptist Health Quality Network (Baptist Miami)
12.Physician Health Partners at Munroe Regional
13.Advantage Health Network (Tenet)
Bundled Payment Pilots
1.Mobile Surgical Services
2.Florida Ortho Institute
3.Mayo Clinic
Patient-Centered Medical Homes and
Similar Programs
•>300 Physician Groups
•>2,200 Physicians Participating
Payment Innovation
22
77
88
99
1212
Payment Innovation footprint:
-Population-based payment models in 52 of the 67 Florida counties
-27% commercial spend and 28% Medicare spend is flowing through
these models
Payment Innovation footprint:
-Population-based payment models in 52 of the 67 Florida counties
-27% commercial spend and 28% Medicare spend is flowing through
these models
Hospital Pay-for-
Performance
•33 Hospitals Contracted on
a P4P Model
Medicare
Collaborative Care
Models (CCM)
Currently 35 and
expanding

12. Leon
GuideWell Health – Current
Market Presence
Holly Hill, FL
Volusia
Largo, FL Pinellas
Orange
Winter Park, FL
Tallahassee

13. • GuideWell Emergency Medicine Doctors, LLC (GWEMD) is a non-blue
branded, wholly-owned legal entity that will provide high quality, patient-
centered, advanced urgent care in retail settings for those we serve in
Florida
• All GWEMD sites will be staffed by Crucial Care with Board Certified
Emergency Physicians and will be Joint Commission accredited
• By providing consumers with improved access to emergency medicine
physicians, we are able to treat the right conditions in the right setting
resulting in superior patient experience, quality outcomes and provider-
driven medical savings
Existing Vertical Strategic Entities
• Serves Volusia (Daytona), Flagler, and Seminole Counties,
providing coverage to 51,000 area residents
• NCQA Commendable rating
• STAR rating of 4.5
• A.M. Best Financial Strength rating of “A+”
• Better Business Bureau rating of “A+”
• Voted "Best HMO/Health Plan" for 23 consecutive years
• Gold Level Worksite Wellness Award Recipient
• 15 years as the areas only Healthy Kids provider
• Over 35 years of service to Volusia & Flagler counties
• Provides medical services to 100,000 Pinellas County residents at
5 locations
• Multispecialty practice with 100 providers representing 23
specialties
• Serves as a one stop medical home that leverages technology to
provide comprehensive integrated ambulatory care
• Expanding capabilities in population management and value
based care
• Participates in all lines of business with essentially all payers
• Awarded CMS Medicare ACO with Walgreens
• Awarded NCQA Patient Centered Medical Home Level 2
• Serves the area surrounding Tallahassee, providing
coverage to more than 125,000 members
• Committed to serving as a medical home, focusing on
delivering evidence based care directed by Primary Care
Physicians, in an effective, timely and cost effective manner
• A.M. Best Financial Strength rating of “A+”
• STAR rating of 4.5
• NCQA national ranking - #4 for Medicare; #16 for
Commercial and #1 in Florida for both

14. Delivery System Strategy
Supporting Segment Growth
Provide vertical (owned) delivery system assets to join with virtual (financially aligned) delivery system
assets in creating a mosaic of new models of care that address affordability, create a competitive
advantage or close a competitive gap and brings new innovative products and services to market
Virtual
•Accountable Care Organizations (ACOs)
•Patient Centered Medical Homes (PCMHs)
•Medicare Collaborative Care Models
Alignment of Vertical, Virtual and Other
Healthcare Delivery Solutions
Vertical
Future PartnershipsFuture PartnershipsProvidersProviders
Other Delivery System Solutions
Consumer Engagement, Decision Support, Transparency Data, Member Rewards and Navigation

15. Analytics
Financial
Management
Capability Build Connectivity
2013 2014 2015 2016
Core
Core
Integrated
HealthAlliances
Vertical
Delivery System Future State
Integrated
Health

16. A Health Care Delivery
Challenge
Individual market is going to more than double in the next
3 years due to ACA.
At least half of the growth comes from the uninsured.
2013 pre-ACA uninsured rate of 34% in Miami-Dade.
Significant market churn within the Exchange and Medicaid
and from Groups dropping coverage. The Medicare market will
continue to grow due to aging baby boomers.
Double digit–19% compared to 0.2% non-Hispanic White–Hispanic
population growth in Florida by 2019 particularly from Central
and South American countries

17. Hispanics Dynamic Between the
US and Home Country
Culturally Sensitive Integrated Care in the US and “Home” Country
Presents a Unique Opportunity to Serve Hispanics

18. A GuideWell Health
Solution
 Strategic alliance between GuideWell and Organización
Sanitas Internacional (OSI) to create a new company with
the purpose of offering a culturally relevant health
care delivery model for the important and growing
Hispanic market
 Brings two leading health care brands together
 GuideWell: parent company to a family of forward-thinking
companies focused on transforming health
 Organización Sanitas Internacional: leading health care
business group in Latin America through companies such as
Colsanitas, Medisanitas, Sanitas Venezuela, Positiva Sanitas and
Medisanitas Brasil as well as a wide network of highly recognized
clinics, hospitals and educational institutions

19. OSI Organizations
Footprint
Figures as at Dec. 31/2012

20. A GuideWell Health Solution
• Integrated medical care
centered around patients and
their individual health and
wellness needs
• Incorporating a patient’s cultural
and social needs to deliver
holistic and personalized care
• Timely identification of health
risks and charts a clinical care
pathway to improve health
• One stop shop conveniently
located in dense Hispanic
Miami-Dade areas
• Extended office hours
• Minimize patient wait time
• An ‘in-language’ and ‘in-
culture’ experience that
addresses the differences
in how Hispanics use and
receive health care
services
• Welcome the entire family
into the care experience
since Hispanics see
health as a family issue
Medical Centers Value Proposition

21. Leon
GuideWell Health –
Future Market Presence
Holly Hill, FL
Volusia
Largo, FL Pinellas
Orange
Winter Park, FL
Tallahassee
Miami

22. Geraghty said GuideWell dispatched a team to Latin
America to tour Sanitas’ clinics and hospitals, and they
found a high quality healthcare provider with an innate
understanding of its clientele’s cultural preferences.
“We were impressed with their understanding of how to
treat folks,’’ Geraghty said. “They’re focused on quality.
They’re focused on running efficient organizations. They’re
focused on customer care.
The partnership between GuideWell and
Sanitas is the latest example of the growing
globalization of healthcare, said Steven
Ullmann, a health policy expert at the
University of Miami business school.
But there is also evidence, Ullmann said, that
culturally sensitive healthcare can produce
better outcomes for patients.
“There are studies that have been done that
indicate when patients are culturally
comfortable with their providers that outcomes
become significantly better,’’ he said.

23. Reach Us
Jonathan Gavras
Organization: GuideWell Health
Phone: (904) 436 - 4365
Email:
jonathan.gavras@guidewellhealth.com
Website: www.guidewell.com