Private and Confidential CHRONIC CARE MANAGEMENT CPT: 99490 Dennis Mihale, MD, MBA dennis.mihale@caresync.com Private and Confidential

PRIVATE & CONFIDENTIAL A technology-enabled services platform for providers to offer a Chronic Care Management program to eligible Medicare patients. PRIVATE & CONFIDENTIAL

Private & Confidential Healthcare Today This causes: increased health expenses, unengaged patients, fragmented health data, and poor health outcomes. Private & Confidential

CMS Creates A Massive Market Private & Confidential

Chronic Care Management (CCM) Agenda: Overview of CareSync Chronic Care Management (CCM) Code CCM Services and Technology Rules How CareSync Works How to Get Started Questions

Overview of CareSync CareSync is the leading patient-centered engagement solution that combines technology with 24/7 nursing services to facilitate care coordination among patients, family & caregivers, and all providers. CareSync provides turnkey Chronic Care Management services and a software-only option, allowing practices of any size to easily meet the billing requirements for CPT code 99490. We began offering our CCM services 2 years before CMS announced the new code. CareSync’s certified technology makes it simple for providers to meet Meaningful Use 2 for Data Exchange, Messaging, and Timely Access. CareSync patients are at the center of their healthcare, with access to health information, actionable goals, and Comprehensive Care Plan tasks, and as a result, are experiencing more productive medical appointments and better health outcomes.

Chronic Care Management New for 2015! For the first time ever, CMS has started paying monthly reimbursements to providers who perform non face to face chronic care coordination services. CPT Code: 99490 Pays approximately $46 (in CT) per month to providers who deliver 20+ minutes of non-face-to-face chronic care coordination to eligible Medicare beneficiaries. Requirements While a great new opportunity, CPT Code 99490 comes with a set of strict technology and services requirements. The good news? You can outsource them, and reap the benefits of this great new program.

Dr. Dennis Mihale Introduction Directly works with CMS CCM team FSCO/DSO (MAC) CCM team Cover 12 southern states Medicare Admin Contractor Noridian (MAC in Northwest) 10 million lives CMS Physician Champion for ICD-10 in Florida Dennis and CareSync are front and center for CMS and for thousands of practices Founded multiple technology healthcare companies caresync Private and Confidential

What is so Good About This New Code? What’s In It For Me? What is so Good About This New Code? EVERYTHING

What’s In It For Me? Revenue, Respect and Recognition Get paid for the services you provide Be recognized and valued for your work Do it before someone poaches your patient A Complete Picture of My Patient (Finally!): Other doctors, visits, labs, tests, medications Things that happened between visits Enlist the aid of family, friends and caregivers Your Patient Values Your Work

What’s In It For My Practice? Help other physicians taking care of my patient Access to critical information including medications Avoid duplicate tests Medication reconciliation and treatment adherence Much easier if you know what other docs are prescribing Medications only help if your patient takes them Meaningful Use Compliance Core Measurements 7 and 17 These are the two tough ones HEDIS Compliance COPD, Colonoscopy and DM Management

What’s In It For My Patients? Benefits to Patient & Family Patient Centric Care Access - Understanding - Use Fewer ER visits and Admissions Improved Self Management Administrative Services delivered at home: patient avoids travel Clinical visit focuses on patient care, treatment and improvement Ability for patient and family to participate in care All patient information in one secure place Improved outcomes and patient satisfaction  helps with STARS 24/7 Access to Healthcare Assistants (CareSync)

Chronic Care Management Billing Protocols 24/7 patient access to clinical staff to address urgent chronic care needs Continuity of care through access to established care team for success routine appointments Ongoing care management for all chronic conditions, including medication reconciliation and a regular patient assessment A comprehensive, patient-centered health summary and care plan that includes all patient records from all providers Private and Confidential

Chronic Care Management Billing Protocols Management of care transitions between and among all providers and settings using the electronic transmission of information Coordination with home and community based clinical service providers Patient and caregiver access, with opportunities for all relevant caregivers to communicate about the patient’s care Private and Confidential

Eligible Patients & Chronic Conditions Medicare beneficiaries with two or more chronic conditions These are conditions that are expected to last at least 12 months, or until the death of the patient. They must put the patient at significant clinical risk: acute exacerbation, worsening of symptoms and/or death What conditions count? CMS maintains a Chronic Condition Warehouse with 22 chronic conditions listed, however, it is not an exclusive list. Website: https://www.ccwdata.org/web/guest/condition-categories

Eligible Providers Physicians (regardless of specialty) Advanced Practice Registered Nurses Physician Assistants Clinical Nurse Specialists Certified Nurse Midwives Non-physician practitioners and limited-license practitioners such as social workers and clinical psychologists, are not eligible to bill for CCM

When You Cannot Bill CCM When your patient is in the hospital (inpatient) When the patient is in a Skilled Nursing Facility When the patient is in a Nursing Home When the patient is under Hospice care supervision When Transitional Care Management services are billed The rationale for these exclusions is that the services provided significantly overlap with care management activities that are included in the facility payments.

Patient Consent You must obtain the patient’s written consent, confirming that the following has been explained to the beneficiary: An overview of Chronic Care Management How the CCM service may be accessed That only one provider can perform CCM services at a time That information will be shared among all of the patient’s providers That the patient may terminate the CCM service at any point in time by revoking consent That the patient will be responsible for any associated copayment or deductibles. For those without a supplemental plan, it’s roughly $9. Once consent has been obtained, a copy must be stored in the patient’s medical record. If a patient revokes consent, you may not bill for CCM after the month the revocation was made. If 20+ minutes has already been completed, you may bill for that month.

The Comprehensive Care Plan The patient-centric Care Plan: The spirit of 99490 Should include all of the patient’s healthcare providers, family & caregivers, all health conditions, and must be aligned with the patient’s choices and values. CMS recommends: Comprehensive problem list Symptom management and planned interventions Accessible community and social services Plan for care coordination among all providers Medication management and adherence tracking Designated person responsible for each intervention Requirements for regular review/revision

The Comprehensive Care Plan: Technology The Care Plan must be created using some form of electronic technology, but CMS recognizes that current EHR technology is limited in its scope to support electronic care plans. Three Requirements: All “care team members” must have 24/7 electronic access The billing provider “must electronically share care plan information as appropriate with other providers” who are delivering care to the patient (no fax allowed). The billing provider must provide a paper or electronic copy of the care plan to the patient.

Technology Requirements They do not make it easy, do they? You must use Certified EHR technology For 2015, this includes any EHR that has met the 2011 or 2014 criteria of the EHR Incentive Program. You must generate a patient-centric Care Plan with records from all providers and all disease states You must make the Care Plan available to the patient and all other providers. They do not make it easy, do they? Can do more here. Just wanted to get some stuff down.

Additional Requirements 24/7 access to the care team To address urgent chronic care needs Facilitate care coordination An answering service does not meet this requirement Transitional Care Management You must facilitate all transitions of care You may not bill for CCM during the same month as TCM Care Coordination You must have the ability to coordinate care with home and community based providers, including home health, nutrition services, outpatient therapies, and transportation services, to name a few. Communication must be documented

CareSync and Chronic Care Management CareSync’s CCM solution has the perfect fit for practices of all sizes. Complete Chronic Care Management CareSync technology + turnkey CCM services We provide the service every month, you bill Software as a Service (SaaS) Use of the CareSync web, iOS, and Android technology You meet CMS’ requirements for services provided and use CareSync to bridge any gaps in your existing technology Private and Confidential

Examples of CCM Activities Getting all patient records from all providers Creating the patient centric comprehensive care plan Scheduling appointments with any provider Helping patient fill out insurance forms Speaking to patient about their medications and overseeing patient self-management of medications Taking calls on evenings and weekends Reconciling medications Ensuring receipt of all preventive services Monitoring patient conditions—Physical, mental and social

What Revenue Is In It For Me? Revenue varies by Medicare Region It is approximately $46 per member per month For 100 members enrolled in CCM  $24,000 per year* For 1,000 members enrolled in CCM  $240,000 per year* There are costs associated with deploying this solution Staff to provide the service, unless you have people sitting around doing nothing. Yeah – like that ever happens. Costs to meet technology requirements (* Approximate revenue net of CareSync’s full service fees)

CCM: Benefitting Providers and their Patients Comprehensive picture of a patient’s health Complete medication reconciliation and adherence Healthier, happier patients Generating new, recurring revenue Patients All health information in one secure place Personalized Care Plan with actionable goals and tasks Improved health outcomes and satisfaction Family & caregiver access like never before 24/7 access to Health Assistants Private and Confidential

Getting Started is Easy We’re ready to get you started today! No burden to you or your staff No disruption to existing workflows No cost to you Implementation takes a few hours, not days, weeks or months! CareSync is designed to work with your existing technology Trained Care Coordinators are equipped with proven tools to onboard your eligible patients Private and Confidential

Private and Confidential Welcome Kits Private and Confidential

Private and Confidential Resources and contact information For more information, view our resource page http://info.caresync.com/csms-ipa Contact: Rosemary P. Hokanson Physician Network Education Manager Phone: 860-573-2580 rhokanson@csms-ipa.com caresync Private and Confidential

Private and Confidential CHRONIC CARE MANAGEMENT CPT: 99490 Dennis Mihale, MD, MBA dennis.mihale@caresync.com Private and Confidential

Private and Confidential APPENDIX caresync Private and Confidential

How can they do it for Only $9.20? It’s CareSync Magic APPENDIX A: The Co-Pay Only if no supplemental and no Medicaid CMS values this at $46 per month They are asking you to only pay $9.20 a month What are you getting for this $9.20? 24/7 access, even when it is not urgent Your Family Physician knows what is happening with all other providers just by you signing up No matter where you are in USA, doctors can access all your medical information with your permission Help you take your medications on time Help you with insurance forms and surveys Answer questions about your insurance Remind you about doctor visits, labs and tests How can they do it for Only $9.20? It’s CareSync Magic caresync Private and Confidential