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[Sanitized] Fortune 500 Company - Presentation: Creating Value Through Leadership

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Creating Value Through Leadership - facilitated, crafted, and designed by Ben Willson - 2017

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[Sanitized] Fortune 500 Company - Presentation: Creating Value Through Leadership

  1. 1. April 2017 ABC Company Conference Creating Value Through Leadership Presenter’s Name & Title Confidential 1 ABC Company
  2. 2. Provider Reimbursement Environment • Made ~ $36 billion in value- based care payments in 2014 • Announced plans to increase value-based payments to providers by 20% in 2015 (more than $43 billion) • 750 New value based arrangements in 2016 • Currently pays $1 out of every $5 of medical claims to value-based programs (~$65 billion) • Engaged with ~700 local value-based programs nationwide • 42 Million Members are enrolled in Value based programs • Plans to increase value- based payments to be greater than one-third of total payments • Signed 60 new contracts with ACOs in 2015 • View the government’s efforts as positive, but would like to move more quickly to value-based care than HHS has committed HHS announced goals and a timeline for shifting Medicare business to value-based care payment models (accountable care organizations (ACOs)) and bundled payments • 30% payments by the end of 2016 • 50% payments by the end of 2018 • 40% Medicare enrollment to MA by 2025 Health and Human Services (HHS) Announcement • 2013 – Nearly three quarters of beneficiaries were in managed care and increased in all years except for 3 from 2000 – 2013 • Managed care expenditures will grow almost 11% per year from 2014 to 2023 Managed Care Transformation Commercial Commitments Government Pledges Medicaid Phil Kamp and R. Todd Stockard, Helping solve the U.S. healthcare crisis, 2015 Financial Risk to Providers SHIFT
  3. 3. Medicare (Breakdown) 3 2017 2020 80% Fee for Service Value Based Payments 30% 20% 70% 3
  4. 4. 4 Managed Care Expenditures Will Grow Almost 11% Per Year From 2014 To 2023 11% 2014 2015 2016 2017 2018 2019 2020 $210B $354B Medicaid (Breakdown)
  5. 5. 5 750 new Alternative Payment Model arrangements have been signed in 2016 by United Healthcare alone; and plans to increase Alternative Payment Models by more than 20% Similar Goals to Shift to Value Based Arrangements Commercial (Breakdown) 5
  6. 6. 6 Incremental Growth in ACO Programs Source: CMS, available at: data.cms.gov, accessed October 3, 2016; Advisory Board, “Where the ACOs are”, available at: advisory.com, accessed October 3, 2016: Health Care Advisory Board interviews and analysis. 220 353 404 474 28 23 15 40 2013 2014 2015 2016 Total Participating Total in Downside Risk Models 2017Advisory Board Advisory.com Overall Participation Continues to Grow Total ACO Participants at End of Each Performance Year CMS Highlights Positive Headlines Total ACOs which earned savings grew by 4% from 2014 to 2015 Medicare saved $55M more in 2015 than 2014 for total savings of $466M
  7. 7. 7 ABC Company is becoming an ACTIVE participant Vs. Being Passive in these New Financial Arrangements.
  8. 8. 8 We Need to Stay Ahead by Assembling a New “Fuel System" on the Car, While Moving OUR COMPETITORS ARE NOT SITTING IDLY BY
  9. 9. Managing Current Portfolio Meeting Market Place Demands Be a Leader NOT Responder Product Development & Risk Division Value Proposition
  10. 10. Alternative Payment Agreements 10 ACO / CIN PHO CAPITATION Pay 4 Performance STIPENDS ABC Company
  11. 11. Establishing a Sustainable Infrastructure 11 ANALYTICS Build reporting capabilities to actively manage and monitor performance of Alternative Payment Models DATA WAREHOUSE Leverage data ware house and data marts to receive and analyze financial and clinical data CORE MEASURES Establish ABC Co. Core measures for all service lines INVENTORY Document current alternative payment agreements and determine common measures
  12. 12. Solutions 12 • Data Warehouse • Payer Claims Data • Analytics Platform 1 • Total Cost of Care • Hospital ACOs • HHS RFI • Bundles of Care 2 • Take on Appropriate Levels of Financial Risk • Private Exchange ACO 3• Health information Exchange • Contracting • Reinsurance • Financial Reporting 4 2 4 3 1 Infrastructure Risk Based Portfolio Provider Sponsored Health Plan Integrated Health Solutions Provider
  13. 13. 13 Deliver a provider sponsored health plan that will allow us to be the leader in integrated health solutions for our Hospital Partners, Patients, Payers, Brokers and Employers by 2020 ULTIMATELY COMMODITY VALUE ABC Company
  14. 14. 14 ABC Company

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