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CAPG Presentation

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CAPG Presentation

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  1. CAPG Presentation Future Outlook for Medicare Advantage • CAPG • Arthur Kummer

  2. 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

  3. 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

  4. 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

  5. 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

  6. Health Net Membership Graph July 2013 - 236,831 Highly Confidential & Proprietary

  7. 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

  8. 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

  9. California Growth Highly Confidential & Proprietary

  10. Market Challenges Opportunity Highly Confidential & Proprietary

  11. 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

  12. 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

  13. 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