The document summarizes the 2014 Partners Summit hosted by Altegra Health in Las Vegas. Approximately 100 guests from 40 health plans, 10 external speakers, and various provider and industry organizations attended. Altegra Health provides analytics, data management, and clinical services to health plans. The summit addressed current market observations including uncertainties from healthcare reform, the transition from ICD-9 to ICD-10 coding in October 2014, and a growing need for data analytics and quality reporting capabilities.

1. 2014
Partners
Summit
Welcome
&
Market
Observa;ons
Las
Vegas,
NV

2. Who’s
Here
for
the
Partners
Summit?
! Approximately
100
guests
! 40
health
plans
! 10
external
speakers
! Several
provider
organiza?ons
! Industry
alliances
and
associa?ons
! Consul?ng,
analy?cs
and
marke?ng
firms
! Leading
healthcare
journalist
and
author
! Top
Wall
St
analyst
2

3. Who’s
Not
Here?
3
Any
of
the
es+mated
500+
Elvis
impersonators
in
Las
Vegas
today

4. Welcome
Outcomes
Health!
4

5. Why
Outcomes
Health?
5
Analy;cs
&
Data
Management
Member
Engagement
Chart
Retrieval
&
Clinical
Review
Exper;se
&
Consulta;ve
Approach
• Superior
client-­‐facing
transparency
&
repor?ng
technology
tools
• Sophis?cated
analy?cs
to
priori?ze
member
chart
chases
• Ability
to
license
soNware
(coding
&
abstrac?on)
• Expanded
geographical
footprint
&
scope
for
in-­‐home
clinical
care
visits
• Expanded
member
outreach
with
dedicated
clinical
resources
• Industry
leading
geographical
footprint
for
retrieval,
coding
&
abstrac?ons
• Increased
capacity
&
scale,
including
offshore
opera?ons
center
• Deep
domain
exper?se
in
quality
measurement
&
risk
adjustment
for
Medicare
Advantage
&
Managed
Medicaid

6. Altegra
Health
at
a
Glance
6
Los
Angeles
Phoenix
San
Juan,
PR
Mt
Laurel
Miami
Lakes
Chicago
Minneapolis
Headquartered
in
Miami
Lakes,
FL,
with
eight
regional
offices
&
opera;ng
in
all
50
states,
Puerto
Rico,
&
the
Philippines
Atlanta
Manila,
Philippines
ALTEGRA
TEAM
–
over
3,100
total
team
members

7. Altegra
Health
Vision
7
To
be
the
most
trusted
and
valued
partner
in
helping
healthcare
organiza?ons
improve
their
performance
and
the
health
and
well
being
of
the
individuals
they
serve.

8. Market
Observa;ons
! Near
term
uncertainty
about
health
care
reform
! ACA
requirements
&
?melines
up
for
grabs
! CMS
2015
Advance
No?ce
! Medicare
Advantage
rates
! Home
assessments
! Transi?on
from
RAPS
to
EDPS
! Long
Term
Perspec?ve
! Con?nued
growth
in
Medicare,
Medicaid
and
Dual
segments
! Increasing
dominance
of
government-­‐funded
health
care
8

9. Market
Observa;ons
! Health
Insurance
Exchanges/Marketplaces
! Slightly
nega?ve
to
neutral
near
term
financial
impact
! Plans
posi?oning
to
par?cipate
more
broadly
long
term
! ACA
provides
for
a
“permanent”
risk
adjustment
program
! Some
similari?es
to
Medicare
! Significant
similari?es
to
Medicaid
! Risk
adjustment
payment
transfer
9

10. Market
Observa;ons
10
Individual
and
Small
Group
Market
Risk
Adjustment
Payment
Transfer
Formula

11. Market
Observa;ons
! Quality
(HEDIS
–
STARS)
! Fully
incorporated
into
the
health
plan
RCM/finance
narra?ve
! Has
the
complete
aeen?on
of
the
health
plan
C-­‐suite
! Implementa?on,
execu?on
and
?melines
challenging
! Provider
abrasion
and
‘data
intermediary’
complica?ons
! Healthcare
Data
Analy?cs
! Increasing
emphasis
on
internal
and
outsourced
capabili?es
! Na?onal
Provider
Iden?fier
(NPI)
challenges
abound
! Predic?ve
modeling,
screening
and
targe?ng
more
cri?cal
11

12. Market
Observa;ons
‘I
fell
out
of
bed,
hit
my
head,
slipped
down
the
stairs,
rolled
out
the
front
door,
and
crashed
into
my
car’
12

13. Market
Observa;ons
‘I
fell
out
of
bed,
hit
my
head,
slipped
down
the
stairs,
rolled
out
the
front
door,
and
crashed
into
my
car’
Guess
what?
13

14. Market
Observa;ons
‘I
fell
out
of
bed,
hit
my
head,
slipped
down
the
stairs,
rolled
out
the
front
door,
and
crashed
into
my
car’
There’s
an
ICD-­‐10
code
for
that!
14

15. Market
Observa;ons
! ICD-­‐9
to
ICD-­‐10
Transi?on
! 14,500
ICD-­‐9
codes
increasing
to
70,000
ICD-­‐10
codes
! Industry
readiness
unclear,
par?cularly
among
providers
! Financial
impact
unknown
to
many
! Demand
for
coders
rising
rapidly
15
“The
industry
is
thousands
of
coders
shy
of
the
figure
necessary
to
fully
support
the
transi?on
to
ICD-­‐10
before,
during,
and
aNer
Oct.
1,
2014.
Demand
has
been
slowly
increasing
during
the
last
90
days
and
will
skyrocket
in
the
fourth
quarter
of
2014.”

16. Thank
you
for
joining
us.
Kevin
Barre^
Kevin.Barree@AltegraHealth.com