The Alithias Transparency Platform Healthcare Work Confidential, Alithias, Inc.

Alithias provides cloud based enterprise software that helps self-insured employers and their employees save money.

Milwaukee, Wisconsin based company >20,000,000 claim records in SE Wisconsin The only transparency platform: – Based on a program proven to reduce healthcare costs – That can support PPO pricing, Direct Contracts, Reference Based Prices and Medicare Plus plans – Incorporating quality data from the Wisconsin Health Information Organization Confidential, Alithias, Inc. The Alithias Platform

Some of our clients… 4

Alithias means… Truth In Healthcare

Agenda 1.The Case for Transparency 2.Transparency Platforms: 1.The Good 2.The Bad 3.The Ugly 3.What is “Quality?” 4.Expected Utilization 5.Making Transparency Work Confidential, Alithias, Inc.

The Case for Transparency Confidential, Alithias, Inc. Employees are shouldering more healthcare costs 36% of employees are enrolled in HDHPs $6,000 - $12,000 deductibles are common

Case Study: CEO, St. Lucrative Challenge: Increase revenue and profit in a competitive, flat market Few Options 1.Raise retail prices 2.Become more efficient 3.Generate more revenue from your current customers See more patients Increase RVUs – See more patients – Bill more Health systems act like any other for profit business Confidential, Alithias, Inc. The Case for Transparency

Confidential, Alithias, Inc. The Case for Transparency High Deductibles Not understanding benefit coverage for preventative care Delaying or not seeking care 78% of respondents said they would have made a different decision had they known the cost of care beforehand. Healthsparq survey, 2015

Transparency Solutions The Good, The Bad and The Ugly Confidential, Alithias, Inc. Not all transparency solutions are equal

Solutions Most major carriers provide some type of transparency tool – Utilization = 3% - 5% – No customization – Can’t accommodate direct contracts – Will not support incentives or tiered networks Confidential, Alithias, Inc.

 Customized to Client  Analytics  SSO links to benefits  Direct Contracts  Incentive Management  Health literacy  WHIO Quality Data in WI  Provider information  Utilization Reporting  Advocacy Transparency Solutions: The Good

Confidential, Alithias, Inc. Transparency Solutions: The Bad “Average” Prices No Locations No Networks No Providers

Confidential, Alithias, Inc. “Total Hip Replacement” “The Procedure Cost is the facility amount billed to Medicare for this procedure, as reported to the U.S. government. The data is publicly available from the Center for Medicare and Medicaid Services” Transparency Solutions: The Ugly Retail Amounts Mean Nothing Facility Fee Only

Correct coding to ensure proper billing is very complex Most transparency platforms don’t consider provider technique Definitions of an “episode” differ, but should include – Physician fee – Facility fee – Anesthesia – Lab – DME – Imaging Fixed, bundled prices are the only way to be certain you are receiving healthcare value. Confidential, Alithias, Inc. The Alithias Platform

What About Quality? National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity - Health Affairs, May 2015 National CMS Data: “Good, but…” – Metrics vs. Outcomes – No Provider specific – No ASC quality scores – Scores often incongruent with other quality evaluations Confidential, Alithias, Inc.

The Truth About Quality CMS Quality Data are not correlated to the procedures consumers are actually SHOPPING for. – Infection Rates: Before Jan. 1, only those infections in eligible hospital's intensive care units showed up in the Medicare database through the Inpatient Quality Reporting (IQR) program on Hospital Compare. – Mortality Rates based on: Acute Myocardial Infarction COPD Heart Failure Pneumonia Stroke CABG surgery Confidential, Alithias, Inc.

Quality Data Limitations Confidential, Alithias, Inc. …which runs approximately two (2) years behind the current calendar year

The Truth About Quality How does an intensive care unit central line infection rate have anything to do Colonoscopies, Imaging or Orthopedic procedures? No one is checking a website when they are having a heart attack or searches for low cost stroke care. Confidential, Alithias, Inc.

Quality Scores and Reality 1)There are few standards for measuring quality 2)Comparisons across quality information providers is not helpful 3)If your local health system won’t provide basic quality information they are low quality 4)Procedure volume is the best surrogate Confidential, Alithias, Inc.

Alithias Reporting: 400 employee company (Market A) Data are for demonstration purposes only

Additional 2% - 8% of total medical spend – Depends on your local healthcare market – 35% of medical spend is for shoppable procedures – 30% - 50% average savings per procedure – 10% - 30% engagement or “behavior change to use high value services” Effective Steerage – Serigraph Year 1 = 5% engagement Year 6 = 70% engagement Confidential, Alithias, Inc. Potential Savings from Transparency

Making Transparency Work 6 Requirements 1.Access to data (Medical, Rx) 2.Adjust plan design and incentives 3.Frequent and regular communications 4.Fixed, bundled prices are the only way to provide perfect transparency 5.Care Navigation support provided by an advocate, HR or Administrator 6.A BROKER to hold service providers accountable – something Zenefits can not do! Confidential, Alithias, Inc.

Results Employees using the Alithias platform save an average of $2,000 per procedure. Providers are more willing to contract directly or reduce their price in markets where transparency tools are used. Prices for certain procedures have dropped >30% in some markets due to consumer demand. Transparency is a great way to maximize the benefits of direct contracts or consumer driven plan design. Confidential, Alithias, Inc.

Alithias makes managing healthcare costs easy. Ross Bjella Ross Bjella