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Glenn MacFarlane – Chief Executive Officer October 3, 2017

Value Based Solutions Aetna Better Health of New Jersey

AETNA BETTER HEALTH | Proprietary and Confidential

Glenn A. MacFarlane Chief Executive Officer

Glenn A. MacFarlane was appointed Chief Executive Officer of Aetna Better Health of New Jersey on June 27, 2016. The Plan was launched on January 1, 2015 and currently has approximately 40,000 members and $300 million in Premium and went Statewide 8/28/17. Lines of business include Medicaid, Managed Long- Term Services Supports (MLTSS) and Children’s Health Insurance Program (CHIP).

Prior to joining Aetna, Mr. MacFarlane was the President and Chief Executive Officer at Affinity Health Plan, one of the largest managed care plans in New York City. Mr. MacFarlane joined Affinity in November 2012 as Senior Vice President, Strategy, Business & Product Development, and then assumed the additional role of Chief Financial Officer on January 2014. He became the Chief Executive Officer on January 1, 2015. He also spent 12 years at TIAA-CREF, the Fortune 100 financial services firm based in New York City, where he held numerous senior finance roles in product, asset management and operations.

Mr. MacFarlane began his career at Coopers & Lybrand, one of the then “Big 8” consulting firms, focused on the health care industry. He later held senior finance roles for several years at the Health Insurance Plan of Greater New York (HIP), one of EmblemHealth’s legacy companies, and at a national physical therapy company. He also served as Chief Financial Officer at Horizon Mercy, a joint Medicaid managed care program between Mercy Health Plan of Pennsylvania and Blue Cross/Blue Shield of New Jersey.

Mr. MacFarlane earned a B.A. in business administration from Iona College. He also completed the executive program in managed care at the University of Missouri.

Glenn A. MacFarlane Chief Executive Officer 609-282-8201 office | 609-282-8245 fax MacFarlaneG1@aetna.com

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Statewide Expansion 2016

Live-August 28, 2017

• Passaic • Bergen • Essex • Union • Hudson • Somerset • Middlesex • Camden

ABHNJ is now Statewide

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Clinical Care Management

Overview

Member

Contracting Provider Network

Marketing

Medical Management

Compliance

Provider Services

Claims Management

Member Services

Information Systems

Financial Management

Data Analysis & Reporting

“We put the member at

the center of everything

we do”

Care & Case Management Components • Is member-centered, goal-

oriented, culturally relevant • Addresses prevention, safety,

continuity & coordination of care

• Includes Behavioral health as a primary or secondary diagnosis

• Helps in early identification of special needs

• Assesses member risk factors • Develops a plan of care

• Refers and helps w/ timely access to providers

• Coordinates care actively linking the member to providers, medical services, residential, social and other support services where needed

• Monitors, follows-up and documents interactions and interventions

• Seeks quality-based outcomes: Improved functional/clinical status, quality of life, satisfaction, safety, savings…

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Care & Case Management Components Continued

• Case Management:

• Includes a set of care management activities tailored to meet a Member’s situational health-related needs:

o Situational health needs can be defined as time-limited episodes of instability

• Facilitates access to clinical and non-clinical services by connecting the Member to resources that play an active role in the self-direction of their health care needs

• Works toward an expectation for quality based outcomes

• If you have a member who could benefit from Case or Care management, call 1-855-232-3596 and ask to speak to a Care Manager

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Utilization Management

Utilization Management

• Discharge planning begins on first day of hospitalization to ensure a timely and appropriate discharge plan

• Utilization Management and Case Management staff partner with hospital discharge planners and work together to resolve difficult placement issues

• Acute BH hospitalizations are assigned a designated ABHNJ nurse to collaborate with and facilitate post discharge care

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Medical Prior Authorization

• You may submit prior authorization requests to us 24-hours-a-day, 7-days-a-week through one of the options below:

• Fax 1-844-797-7601 • Phone 1-855-232-3596 Option 6 then Option 5

• Please submit the following with each authorization request: • Member Information (correct and legible spelling of name, ID

number, date of birth, etc.) • Diagnosis Code(s) • Treatment or Procedure Codes • Anticipated start and end dates of service(s) if known • All supporting relevant clinical documentation to support the

medical necessity in legible format • Include an office/department contact name, telephone and fax

number

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Value-Based Solutions

Five Best Practices to Succeed with Value Based Payment (VBP)

• Value-based care requires a different way of approaching the delivery of healthcare services. Incentives must reward better health outcomes and overall improved population health. To improve population health management, health plans are developing new systems to facilitate prevention, wellness, and chronic disease management. In addition, health plans require new and innovative systems to allow compensation for healthcare providers based on value. To successfully navigate this evolving ecosystem, we recommend the following best practices: 1. Assess the current status of provider payment agreements for value-based care

- Understand where you are in the VBP continuum in each of your markets and lines of business

- Determine your timing for reassessment. Assessment is not a one-time activity. Establish a cadence to routinely reassess

2. Develop a strategic roadmap to chart your VBP transition - Identify incremental steps to expand your infrastructure for VBP, starting with the

least complicated VBP models. This will allow you to move toward your goal and accomplish early wins while building your infrastructure to support more complex payment models

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Five Best Practices to Succeed with Value Based Payment (VBP) - Continued

3. Build your operational infrastructure and acquire flexible technology - Build your infrastructure with the proper foundation to support long-term goals and

expansion of capabilities over time - Having dedicated, cross-functional resources supported by consistent policies and

procedures is essential for success

4. Integrate innovative payment solutions with population health management - To integrate payment innovation with population health management, use

consolidated and accurate analytics to evaluate member health risk, gaps in quality care, and provider performance

5. Collaborate with MCO’s to achieve better member/patient health outcomes. Integrate innovative payment solutions with population health management - Develop systems that allow better sharing of data from the health plan to providers

and vice versa to help both partners gain a more holistic view of member/patient health

- Adopt measures for VBP that align with standards in the industry to ease the reporting burden on providers

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Proprietary and Confidential Aetna Medicaid

Fee-For-Service Full Risk

P4Q

Rewards quality improvements and evolving practice transformation

PCMH/ Health Home

Rewards practice transformation

along the continuum

Full Risk/ Bundles/ACO

Progression to increasing risk

share for greater accountability

Help providers progress from Pay-For-Volume to Pay-For-Value

Improving access, quality, and affordability in the healthcare ecosystem

Provider Capabilities/Engagement

Supporting Infrastructure/Technologies

Acknowledges care coordination

efforts

Acknowledges care continuum

efforts

Aetna Medicaid’s Value-Based Solutions

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Proprietary and Confidential Aetna Medicaid Confidential

Key Factors Necessary to Drive Value-Based Solutions Adoption and Success

Goal Alignment

Integrated Care Management

Member Engagement

Analytics & Data Sharing

Provider Engagement

Healthcare Technology

Aligned goals and incentives from the State, payors, and providers to reward quality and value

Empowerment and active participation that promotes self-management

Coordinating the actions of PCMH and PCPs through our Care Management team to drive quality outcomes

Real time, actionable data allows providers to manage member health needs and gaps in care

Meet providers where they are in capabilities with variety of payment models

Innovative tools and apps to enhance provider capabilities and give critical information to members

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Proprietary and Confidential Aetna Medicaid Confidential

Collaboration Process

2017 Patient Centered Medical Home (PCMH) and Health Homes

Data & Reporting

Performance Measurement

Provider Eligibility

• Group practices with 100 or more* Aetna assigned members may be eligible • Plan and Value Based Team may partner with practices to assess and enhance

capabilities • May use assessment tool to assist with initial program eligibility determination • Requires a contract amendment

• PCMH Profile: provides practice, individual practitioner & member-level monthly look into cost, quality and utilization with trends, analytics, member risk scoring, gaps in care; rolling 12 month data

• Outreach on a quarterly basis as needed • Provider Plan Collaboration Team to meet as needed

Payment Model

• Monthly care coordination fee

• Utilization metrics, (e.g. readmission rate, ED visit rate, annual visit rate), cost and quality metrics used to monitor provider performance

• Targets established in recognition of baseline rates and market dynamics • Underperformance could result in removal from program

PCMH/ Health Home

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Proprietary and Confidential Aetna Medicaid Confidential

Collaboration Process

2017 Shared Savings – All Upside

Data & Reporting

Performance Measurement

Provider Eligibility

• All practices with 1000+ assigned Aetna members • Practices/systems identified at the Plan level • Requires contract amendment

• Provider Group Profile: Uses PCMH profiles; provides practice & member-level look into cost, quality and utilization with trending; analytics, member risk scoring, gaps in care, 12 month rolling

• Financial reporting quarterly • Connectivity options may be considered

• Outreach on a quarterly basis as needed • Provider Plan Collaboration Team to meet as needed

Payment Model

• MBR Target Developed based on historic performance or Plan level performance • MBR savings shared dependent on achieving quality and utilization metric targets

• MBR and quality/utilization metrics tracked through the year • Metrics and targets matched to population, market dynamics and historic performance; must be able to

capture data

Shared Savings/ACO

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Proprietary and Confidential Aetna Medicaid Confidential

Collaboration Process

2017 Shared Savings – Up and Downside Risk

Data & Reporting

Performance Measurement

Provider Eligibility

• All practices with 1000+ assigned Aetna members • Practices/systems identified at the Plan level • Requires contract amendment; must involve VBS team lead

• Provider Group Profile: Uses PCMH profiles; provides practice & member-level look into cost, quality and utilization with trending; analytics, member risk scoring, gaps in care, 12 month rolling

• Financial reporting quarterly • Connectivity options may be considered

• Outreach on a quarterly basis as needed • Provider Plan Collaboration Team to meet as needed

Payment Model

• MBR Target Developed based on historic performance or Plan level performance • MBR savings shared dependent on achieving quality and utilization metric targets • Underperformance could result in roll-over of deficit to offset the next year’s

performance*

• MBR and quality/utilization metrics tracked through the year • Metrics and targets matched to population, market dynamics and historic performance; must be able to

capture data

*This is the only difference between All upside and Up/Downside Risk

Shared Savings/ACO

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Proprietary and Confidential Aetna Medicaid

Medicaid Innovation Population Health Management

CareUnify September 2017

20 CONFIDENTIAL

Leading the industry: Engaging a Population Health Specialist

Aetna views our population health strategy as a true partnership with our provider network.

Population Health Specialists are:

• A multi-talented team of experienced clinicians

• Transformation specialists that understand members need help navigating

• Experienced in data driven decisions

Population Health Specialists will: • Act as the dedicated relationship manager and single point of

contact for the health plan • Identify high-risk and emerging-risk patients • Support regular care rounds and key clinical events such as

hospital discharge • Coordinate quality care with health plan care management

team • Support adoption with data analysis and workflow analysis • Provide regular data and metric reviews of performance trends

on total cost of care, utilization trends and quality outcomes • Educate and train the practice team on CareUnify

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Objectives: Population Health Management

Value Based Contract

• Incorporate financial incentives to improve quality and reduce cost

• Targets specific, agreed- upon metrics, but collaboration can extend beyond these metrics

• Includes a phased approach to move providers from initial value based service agreements to risk sharing

Overutilization reduction

• Provide incentives that focus on reducing 30-day inpatient readmits per 1,000

• Offer incentives for decreased use of the ER for non-emergent situations

• Access ADT and member information outside of providers’ “virtual” four walls

Care transition

• Improve member care by allowing all care team members to connect and communicate

• Allows Care Management staff to focus on bridging the gap of bio-psycho-social needs of members

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Objectives: Population Health Management

Improve care quality

• Drive improvement of quality metrics important to the provider and the health plan

• Improve members quality of care through collaboration and cooperation

• Access information to Quality Gaps in Care

Reduce total cost of care

• Manage key clinical events such as: • Hospital and

Emergency Department (ED) admissions

• Readmissions • Medical reconciliation • Open care gaps • Transition of care

Proprietary and Confidential Aetna Medicaid

Aetna Better Health Value Perspective CareUnify Challenges To Be Addressed CareUnify Solution

Deployments can be made in 2- 3 weeks- free of charge to our provider network

Long and costly deployments

Lack of visibility to holistic data

Solution that delivers 360° member view reflecting cost/quality management and VBS incentive opportunities at no cost to Provider

Care Transitions

Gaps-In-Care

Providers operating in silos

Real-time gaps in care notifications and closure toolset

Algorithm to create a connected community of providers based on common patients from claims files

Provides care paths for member’s entire care team to optimize care coordination related to care transitions, address readmissions and ED/inpatient admits

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24 CONFIDENTIAL

CareUnify Ecosystem

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CareUnify A Population Health Tool to Connect the Entire Provider Community

Highly-innovative, proprietary approach designed by Aetna to: • Connect the entire community of

healthcare providers for optimal patient care

• Empower physicians and care teams by providing relevant data for timely health decisions

• Deliver a collaborative data platform to digitally share information across systems and organizations

• Identify high risk members to foster early interventions

Thank you

Copyright 20XX Aetna Inc.