1.  2014 Truven Health Analytics Inc. Paul Saucier State Approaches to Integrating Care LTQA/NCHC Capitol Hill Forum April 24, 2014

2.  2012 Truven Health Analytics Inc.  Traditionally, state Medicaid-funded medical systems, long term services and supports (LTSS) systems, and mental health systems have operated on parallel planes, and all 3 of these Medicaid systems have been very separate from Medicare  Increasingly, states are turning to integrated care models to:  Improve outcomes  Enhance experience  Reduce costs  Streamline administration  In particular, states have moved rapidly to integrate LTSS with medical services in Medicaid-only models and Medicaid-Medicare models OVERVIEW 2

3.  2012 Truven Health Analytics Inc. AZ NC WI NY CA 19 STATES HAD INTEGRATED LTSS AND MEDICAL CARE TO SOME EXTENT AS OF APRIL 2014, UP FROM 8 IN 2004 NM MN MI IL WA KS TN TX PA FL DE MA HI 3 RI MLTSS implemented 1989-2004 MLTSS implemented 2005-2014

4.  2012 Truven Health Analytics Inc. THE NUMBER OF LTSS USERS IN INTEGRATED PROGRAMS IS PROJECTED TO DOUBLE THIS YEAR 4 YearStatesLTSS Enrollees 20048105,000 201216389,000 201319554,000 2014 (projected) 241,170,000 Sources: 2004 and 2012: The Growth of MLTSS Programs: A 2012 Update (Truven Health for CMS) 2013 and 2014: Truven Health estimates.

5.  2012 Truven Health Analytics Inc.  Care coordinator role is key:  Assesses the consumer’s needs and preferences  Works with PCP and multiple other parties to plan, authorize and coordinate services  Monitors service plan  Follows consumer across settings and through transitions of care  Uses multiple methods to facilitate information transfer across multiple parties HOW IS CARE INTEGRATED? 5

6.  2012 Truven Health Analytics Inc. POPULAR IMAGE OF AN INTERDISCIPLINARY TEAM MEETING 6    PCP Specialist Physical TherapistDaughterSocial Worker Pharmacy Consultant Care CoordinatorConsumer

7.  2012 Truven Health Analytics Inc. REAL WORLD CARE COORDINATION 7          PCP Care CoordinatorConsumer Rx ConsultantSpecialist Home Care ProviderDaughterSocial Worker State/County Social Services, CBOs Phone F-to-F (home) F-to-F (co-located) Electronic Transfer Phone, Fax F-to-F (office visit) PhoneF-to-F (team mtg) Phone, Fax Internal Info System Phone Electronic Transfer EMR F-to-F (in-home services) Phone F-to-F (office visit) Phone F-to-F (home) Internal Info System F-to-F (team mtg) Phone, Fax Phone, Fax, Electronic Authorization Phone, F-to-F

8.  2012 Truven Health Analytics Inc.  Qualifications  Nurses, social workers, degrees, experience  Contact with consumers  Face-to-face almost always required, but intervals vary  Person-centered planning  Language is prevalent, details are rare  Caseload ratios  If specified, generally differ by risk category  Partnerships with community based organizations that have traditionally provided coordination of LTSS  A few states mandate relationships, but allow discretion in the nature of relationship STATES VARY CONSIDERABLY ON HOW DETAILED THEY MAKE CARE COORDINATION SPECIFICATIONS 8

9.  2012 Truven Health Analytics Inc.  Role of traditional care coordination agencies (AAAs, CILs, and other CBOs)  HIT in LTSS agencies  Interoperability across systems  Measures of integration and LTSS WORK IN PROGRESS 9

10. paul.saucier@truvenhealth.com