Alliance Hill Briefing May 4, 2012 Healthcare Integration: The Behavioral Health Perspective

1. Alliance Hill Briefing May 4, 2012 Healthcare Integration: The Behavioral Health Perspective

2. Outline • Introducing Cenpatico • Part of Centene Family • Innovative MBHO • Centene Philosophy: Integration for Special Populations • Fluid Integration • Understanding Behavioral Health Home • Challenges 2 cenpatico.com

3. Specialty Health Solutions • Focus on integrationof behavioral and physical health and ancillary services 3 cenpatico.com

4. Cenpatico Overview What We Do • MBHO: We are a “Managed Behavioral Healthcare Organization” • NCQA Accredited: Quality Organization • Core Services: We focus on delivering behavioral health services to members through our coordination activities, clinical oversight, and our network providers. • Schools: Private Day Treatment for children in K-12 (AZ) • Specialty Therapy & Rehabilitation Services: Deliver coordination and utilization management for Physical, Speech, Occupational Therapies for our health plans • INNOVATION: Cenpatico is always focusing on expanding our services. Through our behavioral health expertise, we also deliver services for children in foster care and have begun community re-entry programs. 4 cenpatico.com

5. Current Overview cenpatico.com Confidential and Proprietary Information

6. Healthcare Integration The Behavioral Health Perspective • Persons With Chronic Psychiatric Disabilities in Medicaid Medicaid recipients with Behavioral Health Disabilities = 15% of all recipients but account for 42% of Medicaid spending Source:Kaiser Commission on Medicaid and the Uninsured Issue Paper. (Feb 2012) People with Disabilities and Medicaid Managed Care: Key Issues to Consider. Retrieved on 2/17/2012 from: http://www.kff.org/medicaid/upload/8278.pdf 6 cenpatico.com

7. Healthcare Integration The Behavioral Health Perspective • Persons with Behavioral Health Disabilities Require Significant Care Source: Hamblin, A., Verdier, J., & Au, M. (Oct 2011). Technical Assistance Brief: State options for integrating physical and behavioral health care. Integrated Care Resource Center. 7 cenpatico.com

8. Healthcare Integration The Behavioral Health Perspective • Interaction of Physical & Behavioral Health Conditions • Here’s What That Means… • Seriously Mentally Ill (SMI) correlates with higher rates of numerous Physical Health conditions • SMI and Substance Use Disorder (SUD) can contribute to physical health conditions and/or complicate their treatment; and • Comorbid (physical & behavioral health) conditions can result in inappropriate utilization and higher than necessary medical costs Higher rates of diabetes, hypertension, heart disease, acute respiratory disorders Psych meds and weight gain Inability to adhere to treatment plan Presentation confuses treatment 8 cenpatico.com Confidential and Proprietary Information

9. Healthcare Integration The Behavioral Health Perspective • Typical Health Home Access for Persons With Chronic Psychiatric Disabilities • Behavioral Health Home Access for Persons w/ Chronic Psychiatric Disabilities Unlikely to seek out preventative or primary medical care Typically receive physical health services through emergent care when conditions are more advanced Receives services through the community mental health system versus a Primary Care Physician • Access for SMI • Greater training and engagement of Primary Care Physicians (PCPs) • Improved prescribing patterns Source: Dickey, B., Normand, S.T., Weiss, R.D., Drake, R.E., & Azeni, H. (2002) Medical morbidity, mental illness, and substance abuse disorders. Psychiatric Services, 53, 861-867. 9 cenpatico.com Confidential and Proprietary Information

10. Healthcare Integration The Behavioral Health Perspective • Aged, Blind, Disabled (ABD) and Seriously Mentally Ill (SMI) • Enrolled in Integrated Care Management (ICM) 30 Days or More Result: $3,629,493.85 in 2011 Behavioral Healthcare Savings Source: Based on 2011 Centene claims data for SMI/SSI/ABD populations enrolled in ICM for 30+ days in TX, FL, OH, and WI. 10 cenpatico.com

11. Healthcare Integration The Behavioral Health Perspective Result: $873,223.55 in Non-ER Medical Expenses and $150,068.90 in Emergency Room (ER) Expenses • Aged, Blind, Disabled (ABD) and Seriously Mentally Ill (SMI) • Enrolled in ICM 30 Days or More Source: Based on 2011 Centene claims data for SMI/SSI/ABD populations enrolled in ICM for 30+ days in TX, FL, OH, and WI Note: ER refers to Emergency Room. 11 cenpatico.com

12. Healthcare Integration The Behavioral Health Perspective Centenefundamentally focuses on delivering serviceexcellence in three key areas whether Behavioral or Physical Health led : Clinical Effectiveness Provider Education Payment Integrity Persons with SMI/SUD and the ABD population need a fluidsystem of care that ensures access and quality first based on their needs… 12 cenpatico.com

13. Healthcare Integration The Behavioral Health Perspective • GREATEST CHALLENGES • Work Force Issues in BH - Shortage of psychiatrists, especially child/ adolescent specialists is acute. • Eliminate the limitationsfor Behavioral Health Providers to access Health IT Funds. 13 cenpatico.com Confidential and Proprietary Information

14. Thank you! SAM DONALDSON, PH. D. President & Chief Executive Officer 504 Lavaca St., Suite # 850 Austin, Texas 78701 512.406.7200 office | 512.431.5894 cell | sdonaldson@cenpatico.com