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CAPG Presentation. Future Outlook for Medicare Advantage. CAPG. Arthur Kummer. Discussion. Health Net's Product Portfolio & Approch Who we are & what we do What is happening in the market Growth Expectations Funding Changes for 2014 How is Health Net responding?

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Capg presentation

CAPG Presentation

Future Outlook for Medicare Advantage

  • CAPG

  • Arthur Kummer


Discussion

Discussion

  • Health Net's Product Portfolio & Approch

    • Who we are & what we do

  • What is happening in the market

    • Growth Expectations

    • Funding Changes for 2014

  • How is Health Net responding?

    • Local partnership approach with Providers

    • Risk Adjustment & Star Opportunity

  • Highly Confidential & Proprietary


    Health net medicare product portfolio

    High Performance Tailored Network

    (PSP)

    Health Net Medicare Product Portfolio

    High Performance Tailred Network

    Dual Special Need Plans (D-SNP)

    Chronic Special Needs Plans

    Employer Group Medicare Advantage

    Individual Medicare Advantage HMO

    Individual Medicare Advantage PPO

    Medicare Supplement

    Confidential & Proprietary


    Health net medicare programs

    Health Net Medicare Programs

    • Health Net Medicare Programs operates in 4 states , and is the third largest plan in each market Health Net operates

    California

    Arizona

    Oregon

    Highly Confidential & Proprietary


    California 2014 where are we now

    County Served

    MAPD

    PSP

    C-SNP

    D-SNP

    PPO

    Alameda

    n

    Contra Costa

    n

    Fresno

    n

    n

    Placer

    n

    n

    n

    Sacramento

    n

    n

    n

    San Francisco

    n

    n

    n

    n

    San Joaquin

    n

    n

    San Mateo

    Santa Clara

    n

    n

    Santa Cruz

    n

    Solano

    n

    Sonoma

    n

    n

    Stanislaus

    n

    n

    Yolo

    n

    n

    n

    Kern

    n

    n

    n

    Los Angeles

    n

    n

    n

    n

    Orange

    n

    n

    n

    n

    Riverside

    n

    n

    n

    n

    San Bernardino

    n

    n

    n

    n

    San Diego

    n

    n

    n

    n

    Santa Barbara

    n

    California 2014 - Where Are We Now!

    Highly Confidential & Proprietary


    Health net membership graph

    Health Net Membership Graph

    July 2013 - 236,831

    Highly Confidential & Proprietary


    Health net strategy

    Health Net Strategy

    • Health Net’s philosophy centers on a broad product portfolio to serve the whole Medicare population in partnership with delegated capitated networks.

    • Medical group and hospital partners need to be focused on the Medicare business with effective STARS and risk adjustment care gap programs.

    • Health Net is launching three new provider specific plans for 2014

    • Zero member premium is key to growth in most markets

    • Increased data access in both directions is the future.

    Highly Confidential & Proprietary


    Medicare outlook

    Medicare Outlook

    • Projections for 2014 and beyond are uncertain. CBO suggests a more bullish picture, contrary to the Office of the Actuary (OACT). Divergence appears to be on how much pressure reduced payment rates will have on industry.

    Highly Confidential & Proprietary


    California growth

    California Growth

    Highly Confidential & Proprietary


    Market challenges

    Market Challenges

    Opportunity

    Highly Confidential & Proprietary


    Risk adjuster opportunity

    Risk Adjuster Opportunity

    • Actual Health Net data, reflecting the Top-10, and Bottom-10 RAF performers. The variation between top quartile groups drives significant results to the bottom line.

    Highly Confidential & Proprietary


    Capg presentation

    Star Measure Engagement - Provider

    • Providers have a direct impact on 58% of measures included in the Stars Rating Program making HN heavily reliant on the performance of its contracted provider groups (PPGs).

    Highly Confidential & Proprietary

    12


    Capg presentation

    Star Measure Touch Points – Member

    • Targeted Population

    • Vision Benefit Mailer (98k)

    • Silver-N-Fit Fitness Flyer (88k)

    • Preventive Screening Mailer (15k)

    • Disease Mgmt phone outreach

    • Osteoporosis Education Packet (1,500)

    • Cardiovascular Care IVR (95k)

    • SNP Case Mgmt

    • General Member

    • Wellness Calendar (180k)

    • Wellness newsletter (180k)

    • Qtly email newsletter (52k)

    • Flu/Wellness visit IVR (137k)

    Over 30 Initiatives (1 million touches) implemented/integrated into existing touch points ensure an organization-wide approach to improving Star measures and the overall member experience.

    • Targeted Member

    • In-Home Wellness Visits (20k)

    • Care Alerts

    • Rx Refill Reminder Calls (10k)

    • CS scheduling support for Preventive Screenings

    • Inpatient Care Transition Support

    • Follow-up outreach to members who file a CTM

    General Member Outreach Member Specific Outreach

    Highly Confidential & Proprietary

    13


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