Trends & Transitions: Future for Long Term Care Tom Wilfong VP Medicare Medicaid Programs COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

LTSS Goals Improve health outcomes through integration of all health care services Focus on living independently in the community Provide the right amount of services at the right time in the right setting Help the state obtain budget predictability and savings 2 COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Who We Are WellPoint has over 16 years of experience in managed Long Term Services and Support (LTSS) programs WellPoint serves over 350,000 SSI members and provides over 60,000 members with managed LTSS services in seven states Our care coordination staff is experienced and knowledgeable in providing the right care and services to our members using automated tools and systems 3 COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Value Proposition of Integrated MLTSS Program Members Providers State Increase in access to care Improves health outcomes Higher satisfaction with health care Stable and/or improved functional ability Increases in community- based services to support independent living Potential to eliminate the waiting list Easier system to navigate with all services integrated Increases support for family members and caregivers Increases support for members with chronic conditions Increases availability of services & coordination of care Reduces administrative burden Increases provider satisfaction Improves quality results Increases nursing home diversions Decreases institutional care and increases community care & settings Reliable health care data on results of members and plans Accountability for all health care of members Eliminates fragmented and duplicative services Provides budget certainty Savings in tax dollars 4 COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

What Are Other States Doing? Plan Design Best Practices 5 COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Types of Integrated Programs in Other States LTSS with Primary and Acute Care Dual Integration for Medicare and Medicaid Texas Tennessee Kansas* New York Florida California New Jersey Virginia California New York Texas *(Includes Physically Disabled, Older Adults, Intellectual and Developmentally Disabled, Nursing Facilities, and Self-direction) COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Managed Long Term Care: Quality Improvements and Cost Savings Texas STAR + PLUS Program 38% increase - members accessing community-based adult day care 32% increase - members accessing personal assistant services 28% decrease - inpatient length of stay Average length of stay reduced from 7.39 days under FFS Medicaid to 6.08 days 40% decrease - ER utilization 1505 members were diverted from entering nursing homes 1186 individuals have transitioned from nursing homes to the community Savings of $123 million = $92 per member per month = 17 percent below FFS projections Sources: Texas A&M Public Policy Research Institute independent assessment and State of Texas staff report as documented in: “Medicaid Managed Care Cost Savings: A Synthesis of Fourteen Studies.” (Lewin Group, July 2004.) COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Managed Long Term Care: Quality Improvements and Cost Savings New York MLTC Quality Performance Results from Year 1: 70% of enrollees received the annual flu shot 80% of enrollees had no reported falls in the past six months 80% of enrollees’ overall functional ability was stable or improved over a six or 12-month period Less than 2% of enrollees were admitted to NFs 86% rated their care manager as good or excellent WellPoint performed better than the state expected on successfully avoiding hospitalizations 84% of enrollees rated their health plan as good or excellent 8 COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Tennessee Choices Membership: 2010 thru 2013 82% 57% Group 1 Member who are receiving Medicaid-reimbursed care in a NF. Members can be eligible for Medicaid in ANY eligibility category regardless of age or condition, so long as such persons meet NF LOC. Member must have completed the PASRR process – and have been determined suitable for NF placement. There are NO limitations on the number of members who can be enrolled in Group 1. Within Group 1 – there are two sub-groups: Group 1a – Members who are receiving Level I (or intermediate) NF services. Group 1b – Members who are receiving Level II (or skilled) NF services. March 2010 December 2010 December 2011 December 2013 Note: Group 1=Nursing Facility members Group 2 and 3= HCBS members COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Service Coordination Workflow Reassess and Evaluate Service coordinators contact the member and reassess his or her needs and functional capabilities Service coordinators and members evaluate and revise service plans as needed Identify Needs Members are contacted and screened for complex needs and high-risk conditions as soon as possible Members with complex and high-risk conditions and LTSS members are identified for a home visit Identify Needs WellPoint Service Delivery Members select providers from our network Service coordinators work with our care team to authorize and deliver services Service coordinators ensure all appropriate services are authorized and delivered according to service plans Service Plan Service coordinators: Make home visits and conduct comprehensive assessments of all medical, behavioral, social and functional needs Work with a team of experts to develop service plans to meet members’ needs Contact members’ primary care physicians for concurrence Members and members’ families review and sign all service plans Family Members Service Plan Reassess and Evaluate CBOs Providers Service Delivery COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

What Are the Necessary Steps? Making the case for change State Spending on LTC 5 year projections Identify potential savings Waiver discussions with CMS Engage stakeholders Legislature, agencies, advocates, individuals and families, providers, and health plans Create participatory process for input and review Design program Maximize integration of services Learn from other states Texas, New Mexico, Florida, Virginia, New York, Massachusetts, Arizona, Tennessee 12 - Month Process Develop RFP Solicit input to a draft Issue RFP Issue RFP and award bid Readiness Review for Go Live COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Summary: Benefits to the State of an Integrated Managed Care Program Improved health care outcomes and quality performance More clients living in the community and fewer in institutions Potential to eliminate the waiting list for the waivers More clients getting access to primary and preventive care Less use of ER and hospital care Access to all long term services and support that includes all services in one program Higher client and provider satisfaction with the Medicaid program Long-term budget predictability for the state with all clients and services in a managed care system Projected savings for the state: $ 183.8 million over 5 years 12 COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY