1. 0 0 Arkansas Payment Improvement Initiative (APII) April Statewide Webinar April 17, 2013

2. 1 Contents ▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative ▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder ▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update ▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update  Paula Miller, HP Enterprises Analyst - PAP Report Update

3. Arkansas aims to create a sustainable patient-centered health system SOURCE: State Innovation Plan Enabling initiatives Health information technology adoption Payment improvement initiative Health care workforce development Consumer engagement and personal responsibility Care delivery strategies Episode-based care delivery ▪ Common definition of the patient journey ▪ Evidence-based, shared decision making ▪ Team-based care coordination ▪ Performance transparency Population-based care delivery ▪ Risk stratified, tailored care delivery ▪ Enhanced access ▪ Evidence-based, shared decision making ▪ Team-based care coordination ▪ Performance transparency Objective Accountability for the Triple Aim ▪ Improving the health of the population ▪ Enhancing the patient experience of care ▪ Reducing or controlling the cost of care Focus of presentation Overview

4. 3 Payers recognize the value of working together to improve our system, with close involvement from other stakeholders… Coordinated multi-payer leadership… ▪ Creates consistent incentives and standardized reporting rules and tools ▪ Enables change in practice patterns as program applies to many patients ▪ Generates enough scale to justify investments in new infrastructure and operational models ▪ Helps motivate patients to play a larger role in their health and health care 1 Center for Medicare and Medicaid Services

5. 4 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE We have worked closely with providers and patients across Arkansas to shape an approach and set of initiatives to achieve this goal ▪ Providers, patients, family members, and other stakeholders who helped shape the new model in public workgroups ▪ Public workgroup meetings connected to 6-8 sites across the state through videoconference ▪ Months of research, data analysis, expert interviews and infrastructure development to design and launch episode-based payments ▪ Updates with many Arkansas provider associations (e.g., AHA, AMS, Arkansas Waiver Association, Developmental Disabilities Provider Association) 1,000+ 29 26 Monthly Key Design Elements

6. 5 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Wave (description)Approach Population-based models Episode-based models Population & episode-based delivery systems roll-out: next 3-4 years Timing 1 CPC practice participation as of March, 2013 2 Virtual aggregation of patient panels to meet scale of 5,000 persons 1 Episodes: Retros- pective risk- based 3Q 2012 –- 4Q 2012 4Q 2012 –- 4Q 2013 4Q 2013 –- 2Q 2016 ▪ Multi-payer launch of first 5 episodes (ADHD, URI, CHF, Joint replacement, Perinatal) ▪ Transition to scale while maintaining momentum: 1-2 sub-waves of 5-10 episodes ▪ Accelerate scale up: quarterly launch of 5-10 episodes 2 3 1 Health Homes 1H 2013 –- 1H 2014 2H 2013 –- 2H 2014 ▪ All adult DD providers (children follow 6-12 months) Voluntary enrollment for eligible BH providers 2 1 2Q 2012 –- 3Q 2012 3Q 2013 –- 3Q 2014 3Q 2014 –- 3Q 2015 ▪ 69 CPC enrolled practices, ~230 providers, 100k+ Arkansans 1 ▪ Target voluntary enrollment up to 30% of practices (including “virtual practices,” 2 ), focusing initially on Pediatrics ▪ Target enrollment of remaining primary care practices PCMH 2 3 1 Episodes: Assess- ment based 2H 2013 –- 2H 2014All adult DD and LTSS services (DD kids phase-in 6-12 months behind adult) A Source: State Innovation Model Application

7. 6 Contents ▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative ▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update ▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder ▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update  Paula Miller, HP Enterprises Analyst - PAP Report Update

8. 7 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE For Medicaid, work has occurred on 15 Episodes, with 5 having gone live EpisodeLegislative Review Reporting Period Start Date Multipayer Participation 1 1Upper Respiratory InfectionSpring 2012July 2012 2Attention Deficit Hyperactivity Disorder (ADHD)Spring 2012July 2012 3PerinatalSpring 2012July 2012 4Congestive Heart FailureNovember 2012December 2012 5Total Joint Replacement (Hip & Knee)November 2012December 2012 6ColonoscopyMay 2013Q2 CY 2013 7Cholecystectomy (Gallbladder Removal)May 2013Q2 CY 2013 8TonsillectomyMay 2013Q2 CY 2013 9Oppositional Defiance Disorder (ODD)May 2013Q2 CY 2013 10Coronary Artery Bypass Grafting (CABG)July 2013Q3 CY 2013 11Percutaneous Coronary Intervention (PCI) 12AsthmaJuly 2013Q3 CY 2013 13Chronic Obstructive Pulmonary Disease (COPD) 14ADHD/ODD ComorbidityJuly 2013Q3 CY 2013 15NeonatalQ3 CY 2013H2 CY 2013 …UndecidedQ1 2014… …UndecidedQ1 2014… …UndecidedQ1 2014… …UndecidedQ1 2014… Wave 1a Wave 2a Wave 1b Wave 2b Wave 2c (not started) Wave 1 Wave 2 LivePending legislative review In DevelopmentSeeking clinical input 1 Participation includes development and rollout of episode Episodes Update

9. 8 Contents ▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative ▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update ▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update  Paula Miller, HP Enterprises Analyst– PAP Report Update ▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder

10. 9 PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE PCMH town hall schedule AddressDateLocation April 16 4 – 6 pm Little RockUAMS at I. Dodd Wilson Education Building -- Rooms 126 & 226 4301 W. Markham Little Rock, AR 72205 April 18 4 – 6 pm Mountain HomeArkansas State University-Mountain Home – McMullin Hall 1600 South College Street Mountain Home, AR 72653 April 22 4 – 6 pm Fort SmithGolden Living Building – Rogers Taylor Conference Room 1000 Fianna Way Fort Smith, AR 72919 April 25 4 – 6 pm El DoradoSouth Arkansas Community College – Library Auditorium 300 S. West Avenue El Dorado, AR 71730 May 7 4 – 6 pm Hot SpringsNational Park Community College – Auditorium 101 College Drive Hot Springs, AR 71913 May 9 4 – 6 pm BentonvilleNorthwest Arkansas Community College – Wal-Mart Auditorium 1 College Drive Bentonville, AR 72712 May 15 4 – 6 pm ParagouldArkansas Methodist Medical Center – Auditorium 900 West Kings Highway Paragould, AR 72451

11. 10 Contents ▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative ▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update ▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder ▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update  Paula Miller, HP Enterprises Analyst - PAP Report Update

12. Guideline-concordant treatment pathway for clients diagnosed with ODD SOURCE: Expert Interviews, Journal of Clinical Child and Adolescent Psychiatry and Clinical Guidelines for treatment of ODD, American Academy of Child and Adolescent Psychiatry Assessment & Diagnosis ▪ Thorough assessment is performed ▪ Licensed clinician confirms diagnosis and is responsible for care ▪ Parent/caregiver notification Treatment ▪ Initial treatment plan 1 : 2 visits per week 2 for 12 weeks (based on evidence based programs) – ~40% improve 3 – Re-assess those that do not improve ▪ Second treatment plan 1 : 2 visits per week 2 for 12 weeks (based on evidence based programs) – ~30% improve 3 – Re-assess those that do not improve ▪ Medication may be a useful adjunct (primarily with comorbidities) – For comorbid ADHD/ODD, treatment should address ADHD symptoms first Outcomes ▪ Effectiveness of treatment ▪ Reasons necessitating second treatment plan ▪ Continuing care 1 Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; 2 Visits may include client or parent/caregiver therapy; 3 Expert Interviews PRELIMINARY

13. Distribution of number of non-comorbid ODD clients treated by individual providers Number of clients treated by individual providers (clients aged 6 – 17, no comorbid conditions) 1 # clients 101+ 51-100 21-50 11-20 6-10 1-5 240 Clients treated 40 0 10 50 20 30 Provider count 1 Episode defined as one 90 day program SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy) Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only 54%9%12%13%7%5% PRELIMINARY % of Providers 1.21.62.02.32.62.5 Average episodes per client 1 0.8%2.4%6.1%18.1%26.5%46.0% % of Episodes

14. Assessment 1 $1 M Total $19 M Medication $2 M Non-medication interventionsNon-medication interventionsNon-medication interventions 3 $13 M Office visits $2 M Testing 2 $1 M Concordant with evidence-based programs, the most frequent services provided are non-medical interventions Cost breakdown by service type for ODD episodes (clients aged 6 – 17, no comorbid conditions) Total cost, ($ millions) % total cost 5%6%11%9% PRELIMINARY % episodes with occurrence 69%17%78%39% 68% 92% 1 Represents assessments billed to Medicaid. 58% of spend is from 90885 9 ZZZ, Psychiatric evaluation of hospital records; 42% of spend from 90801 9 ZZZ Psychiatric diagnostic interview exam 2 90% of spend from uncoded claims (no CPT code); 5% of spend from 90801 9 AR1, Psychological testing; 4% of spend from 96101 9 ZZZ, Psychological testing (includes psychodiagnostic tests of emotion); 1% other 3 Non-medication interventions includes all psychotherapy, counseling, community support, and therapeutic activities SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS), Division of Medical Services SFY2011 Claims data (includes pharmacy) Episodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477)

15. Other 1 $0.1M Behavioral health provider organizationBehavioral health provider organizationBehavioral health provider organization $18.5M Physician (PCP or Psychiatrist)Physician (PCP or Psychiatrist)Physician (PCP or Psychiatrist) $0.4M Total $19M Behavioral Health Providers provide the vast majority of ODD care in Arkansas Cost breakdown by provider for ODD episodes (clients aged 6 – 17, no comorbid conditions) Total cost, ($ millions) % total episodes 1.8%98%0.5% 19010,22562 Episode count 1 Other includes FQHC providers, non-behavioral health provider school-based providers, and non-standard providers of care SOURCE: Arkansas Department of Human Services (DHS), Division of Medical Services SFY2011 Claims data (includes pharmacy) Average cost / episode $1,311$1,782$731 PRELIMINARY Episodes ending in SFY 2011 (i.e., one year data), Medicaid only (N = 10,477)

16. A third of clients (32%) are receiving care above and beyond what is recommended in guidelines and evidence-based treatments Episode cost distribution for episodes (clients aged 6 – 17, no comorbid conditions) Average cost / episode ($) Episode count Average cost / episode Dollars More 14,00013,00012,00011,00010,0009,0008,0007,0006,0005,0004,0003,0002,0001,0000 1 Evidence Based programs suggest 1-2 treatments per week for 12-14 weeks = ~30 treatments; Medicaid data shows median cost/treatment = $72; 30 treatments x $72/treatment = $2160 per episode. SOURCE: Evidence Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior; Journal of Clinical Child and Adolescent Psychology and Clinical Guidelines for treatment of ODD, American Academy of Child and Adolescent Psychiatry; Arkansas Department of Human Services (DHS), Division of Medical Services; Arkansas Department of Human Services (DHS), Division of Medical Services SFY2010-SFY2011 Claims data (includes pharmacy) Episodes ending in SFY 2010 – SFY 2011 (i.e., two years of data), Medicaid only Estimated cost of effective evidence based programs 1 These clients represent 63% of spend PRELIMINARY

17. 16 Contents ▪ Dr. Bill Golden, DMS Medical Director - Overview of the Healthcare Payment Improvement Initiative ▪ Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update Shelley Tounzen, Medicaid Health Innovation Unit Public Information Coordinator – Initiative Update ▪ Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder Anita Castleberry and Dr. Justin Hunt, Medical Assistance Manager, BH and ValueOptions Medical Director - Oppositional Defiant Disorder ▪ Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update Sheena Olson, Assistant Director, Medicaid Programs and Provider Management – Patient Centered Medical Home Update  Paula Miller, HP Enterprises Analyst - PAP Report Update

18. 17 Arkansas Health Care Payment Improvement Initiative Provider Report Medicaid Report date: April 2013 Historical performance: April 1, 2012 – March 31, 2013 Medicaid Little Rock Clinic 123456789 April 2013 DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports is neither intended nor suitable for other uses, including the selection of a health care provider. For more information, please visit www.paymentinitiative.orgwww.paymentinitiative.org

19. 18 Division of Medical Services P.O. Box 1437, Slot S-415 · Little Rock, AR 72203-1437 501-683-4120 · Fax: 501-683-4124 Dear Medicaid provider, This is an update on the Arkansas Health Care Payment Improvement Initiative – a payment system developed with input from hundreds of health care providers, patients and family members. Our goal is to support and reward providers who consistently deliver high-quality, coordinated, and cost-effective care. As a reminder, a core component of this multi-payer initiative is episodes of care. An episode is the collection of care provided to treat a particular condition over a given length of time. Since July, Arkansas Medicaid introduced five episodes: Upper Respiratory Infection (URI), Perinatal, Attention Deficit/Hyperactivity Disorder (ADHD), Total Joint Replacement (TJR), and Congestive Heart Failure (CHF), with many more episodes to be added over time. For each episode, the provider that holds the main responsibility for ensuring that care is delivered at appropriate cost and quality will be designated as the Principal Accountable Provider (PAPs). For some episodes in the period covered in the attached report (Jul 2011 to Jun 2012), you were identified as the PAP. After appropriate risk-adjustments and exclusions, your average quality and cost was compared with previously announced thresholds. This determines any potential sharing of savings or excess cost indicated in the report. Note that all information described throughout your report is based on retrospective claims and all providers should continue to submit and receive reimbursement for claims as they do today. The TJR and CHF episodes are currently in the preparatory phase and this current report is historical only, covering episodes completed between Jul 2011 and Jun 2012. The ‘performance period’ for these episodes will start February 1, 2013, and reports reflecting episodes eligible for risk and gain sharing will follow beginning in July 2013, due to time needed for appropriate claims to be received. To aid you in your role as a PAP for future episodes, we have been working hard with providers and other payers to design a set of reports that give you detailed data about the quality and cost of your care as well as how this compares with the range of performance of other providers. As each payer will send a report covering their patients, you may receive similar reports from Arkansas Blue Cross Blue Shield or QualChoice. We encourage you to log onto the provider portal at www.paymentinitiative.org to access your current and previous ‘preparatory period’ reports. As a PAP for either the CHF or TJR episodes, you should begin using this portal to enter selected quality metrics for each patient with an episode of care starting after February 1, 2013.www.paymentinitiative.org We have been working diligently to solicit feedback from the provider community and will continue in our efforts to respond to all questions, comments and concerns raised in a timely and consistent manner. For answers to frequently asked questions regarding the initiative and episodes, please refer to the payment initiative website (www.paymentinitiaitve.org). You can also call us at 1-866-322-4696 or locally at 501-301-8311 with questions or email ARKPII@hp.com. Additionally, be sure to check the website regularly for updates on upcoming informational WebEx sessions, other resources, or to sign up for alerts. Sincerely, Andy Allison, PhD Medicaid Director DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports is neither intended nor suitable for other uses, including the selection of a health care provider. For more information, please visit www.paymentinitiative.orgwww.paymentinitiative.org

20. 19 Table of contents Performance summary Upper Respiratory Infection – Pharyngitis Upper Respiratory Infection – Sinusitis Upper Respiratory Infection – Non-specific URI Perinatal Attention Deficit/Hyperactivity Disorder (ADHD) – Level I Total Joint Replacement Congestive Heart Failure Glossary Appendix: Episode level detail Colonoscopy Oppositional Defiant Disorder Cholecystectomy Attention Deficit/Hyperactivity Disorder (ADHD) – Level II Medicaid Little Rock Clinic 123456789 April 2013 Tonsillectomy

21. 20 Performance summary Episode of Care Quality of Service Share Amount Average Episode Cost Your Gain/Risk Share Upper Respiratory Infection – Pharyngitis Not met$0.00Acceptable Not eligible for gain sharing Upper Respiratory Infection – Sinusitis N/ACommendable Will receive gain sharing $349.50 PerinatalMet$0.00Acceptable Not eligible for gain sharing Attention Deficit / Hyperactivity Disorder (ADHD) – Level II Met$0.00Acceptable Not eligible for gain sharing Quality of services and cost summary 1 Across these Episodes of Care You are Subject to Risk Sharing:-$3,000.00Stop-loss was applied Total Joint ReplacementN/A$0.00Acceptable Not eligible for gain sharing Congestive Heart Failure Not met$0.00Acceptable Not eligible for gain sharing Upper Respiratory Infection – Non- specific URI N/ANot acceptable Subject to risk sharing -$3,844.50 ColonoscopyMet$0.00Acceptable Not eligible for gain sharing Cholecystectomy Met$0.00Acceptable Not eligible for gain sharing TonsillectomyMet$0.00Acceptable Not eligible for gain sharing Attention Deficit / Hyperactivity Disorder (ADHD) – Level I Met$0.00Acceptable Not eligible for gain sharing Medicaid Little Rock Clinic 123456789 April 2013 Oppositional Defiant Disorder Met$0.00Acceptable Not eligible for gain sharing

22. 21 Quality summaryCost summary Key utilization metrics Overview Cost of care compared to other providers 3 1 2 4 5 Summary – ADHD: Level I closed episodes $1547- $1772 $700- $1547 <$700$1772- $1998 $1998- -$2223 $2223- $10157 50 100 You (non- adjusted) You (adjusted) 512,000 466,000 1,750 All providersYou 2,000 Your total cost overview, $ Distribution of provider average episode cost Your episode cost distribution Average cost overview, $ Total episodes: 262Total episodes included: 233Total episodes excluded: 29 Your average cost is acceptable  Selected quality metrics: Met  Average episode cost: Acceptable # episodes Cost, $ You CommendableNot acceptableAcceptable > $4000 38 62 Average number of visits per episode Average number of psychosocial visits per episode All providers You You are not eligible for gain sharing $0 Percentile Gain/Risk share All providers Not acceptableAcceptable CommendableYou < $1,547 > $2,223 $1,547 to $2,223 5000 2500 7500 Linked to gain sharing Avg 0% 50% 100% You % episodes with medication 4.1 3.9 >$10157 100% 50% 0% YouAvg % Level I episodes Avg. physician visits/episode AvgYou 0% 50% 100% Completed certification Standard for gain sharing You achieved selected quality metrics 20 10 0 AvgYou Medicaid Little Rock Clinic 123456789 April 2013

23. 22 Quality and utilization detail – ADHD: Level I closed Metric25th50thYou75th5025 Percentile 0100 Average number of visits per episode 4.1 Average number of psychosocial visits per episode 15386274 2.33.94.3 75 Metric linked to gain sharing You Minimum standard for gain sharing Utilization metrics: Performance compared to provider distribution 2 5025 Percentile MetricYou25th50th75th Percentile 0100 92%50%75%85% with completed certification 75 Quality metrics: Performance compared to provider distribution 1 48%40%52%67% of episodes with medication 25%20%30%40% of episodes that are Level I 4.12.3 3.9 4.3Avg. physician visits per episode 28%10%30%50% non-guideline concordant 15%5%15%25% non-guideline no rationale You achieved selected quality metrics - - - Medicaid Little Rock Clinic 123456789 April 2013

24. 23 189 175 84 97 744 828 1,200 1,120 1,995 2,457 14,904 16,796 552,000 555,450 116,500 128,150 Cost detail – ADHD: Level I closed Care category All providersYou 4% 3% <1% 3% 5% 75% 78% 80% 75% 77% 79% 97% 95% 99% 100% 27 25 84 97 62 69 75 70 95 117 81 76 2,400 2,415 500 550 Total episode included = 233 Inpatient – PAP Outpatient – PAP Ancillary professional Outpatient facility Pharmacy Emergency department Other 233 230 221 184 21 16 12 1 7 # and % of episodes with claims in care category Total vs. expected cost in care category, $ Average cost per episode when care category utilized, $ Inpatient readmission or transfer Primary inpatient admission Medicaid Little Rock Clinic 123456789 April 2013

25. 24 Cost summary Key utilization metrics Overview Cost of care compared to other providers 1 2 4 5 Summary – ADHD: Level II closed episodes 100 50 $7112- $12601 $6543- $7112 $5973- $6543 $5403- $5973 $2223- $5403 <$2223 You (adjusted) 466,000 You (non- adjusted) 512,000 All providers 1,750 You 2,000 Your total cost overview, $ Distribution of provider average episode cost Your episode cost distribution Average cost overview, $ Total episodes: 262Total episodes included: 233Total episodes excluded: 29 Your average cost is acceptable  Selected quality metrics: Met  Average episode cost: Acceptable # episodes Cost, $ You CommendableNot acceptableAcceptable > $4000 38 62 Average number of visits per episode Average number of psychosocial visits per episode All providers You You are not eligible for gain sharing $0 Percentile Gain/Risk share All providers Not acceptableAcceptable CommendableYou < $5,403 > $7,112 $5,403 to $7,112 7500 5000 2500 3.9 4.1 >$12601 Quality summary3 Linked to gain sharing % episodes with medication % Level II episodes Avg. physician visits/episode AvgYou 0% 50% 100% Completed certification Standard for gain sharing You achieved selected quality metrics Avg 0% 50% 100% You 100% 50% 0% YouAvg 20 10 0 AvgYou Medicaid Little Rock Clinic 123456789 April 2013

26. 25 Quality summaryCost summary Key utilization metrics Overview Cost of care compared to other providers 3 1 2 4 5 Summary – Perinatal $3735- $3906 $3906- $5399 >$5399 50 100 $3565– $3735 $3394– $3565 $2000- $3394 <$2000 850,000 You (non- adjusted) You (adjusted) 815,500 3500 3400 YouAll providers Distribution of provider average episode cost Your episode cost distribution 30% 17% C-section rate Avg. number of ED visits per episode Total episodes: 262Total episodes included: 233Total episodes excluded: 29 You achieved selected quality metricsYour average cost is acceptable All providers You Gain/Risk share You are not eligible for gain sharing  Selected quality metrics: Met  Average episode cost: Acceptable # episodes Cost, $ You All providers CommendableNot acceptableAcceptable > $4000 $0 Percentile 12000 8000 4000 Not acceptableAcceptable CommendableYou < $3,394 > $3,906 $3,394 to $3,906 100% 50% 0% AvgYou 50% 0% AvgYou 100% 50% AvgYou 0% 100% AvgYou 0% 100% 50% You 0% Avg 50% 100% YouAvg 50% 0% 100% HIV screening Group B Strep screening Chlamydia screening Gestational DM screening Bacteriuria screening Hepatitis B screening Standard for gain sharing Linked to gain sharing Your total cost overview, $Average cost overview, $ 2.1 1.3 Medicaid Little Rock Clinic 123456789 April 2013

27. 26 Quality and utilization detail – Perinatal 5025 Percentile MetricYou25th 97%50%HIV screening rate Group B strep screening rate87%60% Chlamydia screening rate90%63% You achieved selected quality metrics Metric25th50th C-section rate23%30% % episodes with an ultrasound71%75% 50th 66% 83% 84% 75th 99% 93% 87% You 17% 78% 75th 40% 81% 5025 Percentile Gestational diabetes screening rate 56%42%50%65% Asymptomatic bacteriuria screening rate 90%43%62%73% Hepatitis B screening rate58%41%55%69% Percentile Avg number of ED visits per episode 1.72.11.35.1 - - - - - - 0 0 100 75 Metric linked to gain sharing You Minimum standard for gain sharing Quality metrics: Performance compared to provider distribution Utilization metrics: Performance compared to provider distribution 1 2 Medicaid Little Rock Clinic 123456789 April 2013

28. 27 Questions

29. 28 For more information talk with provider support representatives… ▪ More information on the Payment Improvement Initiative can be found at www.paymentinitiative.orgwww.paymentinitiative.org – Further detail on the initiative, PAP and portal – Printable flyers for bulletin boards, staff offices, etc. – Specific details on all episodes – Contact information for each payer’s support staff – All previous workgroup materials Online Phone/ email ▪ Medicaid: 1-866-322-4696 (in-state) or 1-501-301-8311 (local and out-of state) or ARKPII@hp.comARKPII@hp.com ▪ Blue Cross Blue Shield: Providers 1-800-827- 4814, direct to EBI 1-888-800-3283, APIICustomerSupport@arkbluecross.com APIICustomerSupport@arkbluecross.com ▪ QualChoice: 1-501-228-7111, providerrelations@qualchoice.com