Medicaid Expansion VAHIMSS 2019 Advocacy Day

1. Medicaid ExpansionVAHIMSS 2019 Advocacy Day David Summers – Virginia Premier

2. Discussion Topics

3. Overview of Virginia’s Medicaid Expansion

4. Overview of Virginia’s Medicaid Expansion • Go-Live on January 1, 2019 • Serves both Medallion 4.0 and CCC Plus/MLTSS members • $22.8 billion additional federal funding over next decade • Open enrollment extended through April/May 2019 • Anticipated Phase 1 members 250k-300k • Current Statewide Expansion membership – 250,000 • 65,000 backlogged applications • Governor's Access Plan (GAP) membership automatically enrolled in CCC Plus • Six MCO’s Participating:

5. Adults ages 19 – 64, not Medicare eligible • Income from 0% to 138% Federal Poverty Level Medicaid Expansion: Who’s Qualifies? Proprietary and Confidential

6. Expansion Dashboard: Week of March 8, 2019 Source: DMAS Website

7. Medicaid Expansion: What is Covered? Medicaid Expansion: What is Covered? • Doctor, hospital and emergency services, including primary and specialty care • Prescription Drugs • Laboratory and X-ray services • Maternity and newborn services • Maternity and newborn care • Home health services • Behavioral health services, including addiction & recovery treatment services (ARTS) • Rehabilitative services, including physical, occupational and speech therapies • Family planning services • Medical equipment and supplies • Preventative and wellness services, including annual wellness exams, immunizations, smoking cessation and nutritional counseling • Long-term services and supports (within DMAS coverage criteria and guidelines) • And more Proprietary and Confidential

8. Virginia Premier Overview

9. Overview of Virginia Premier • Established 1995; about 65 employees • We are the second largest Medicaid MCO in Virginia • We serve more than 217,000 members • We cover about 145,000 children (nearly 1 in 4 receiving Managed Care Medicaid) • We have 1,360 active pediatricians in our network • We partner with VCU to serve 6,000 VCC members • We are one of the top-ranked plans in Virginia, NCQA-accredited since 2007 • We are the only university-based, non-profit Managed Care Organization in the Commonwealth • We offer health plan coverage in all six regions NorthernWinchester WesternCharlottesville Central RoanokeAlleghany Southwest Tidewater Proprietary and Confidential

10. Our History Virginia Premier Commonwealth Coordinated Care Program opens enrollment Begins implementation of the Medicare D-SNP plan Begins implementation of commercial Medicare Advantage products Virginia Chartered is incorporated as a partnership between VCU Medical Center and PCP Healthcare Corporation Virginia Chartered becomes Virginia Premier 2018 2013 2016 2017 1999 2000 2007 2014 1996 1995 Begins implementation of Medallion 4.0 Begins implementation of CCC+ Begins providing services through TPA Health Virginia Chartered begins serving Medicaid enrollees Accredited with the National Committee for Quality Assurance (NCQA) Virginia Coordinated Care (VCC) begins providing services, with Virginia Premier as third-party administrator Wholly-owned by VCU Health Virginia Premier Medical Home opens in Roanoke Proprietary and Confidential 10

11. Lines of Business *As of :March 2019 Proprietary and Confidential

12. Quality Improvement Since receiving our National Committee for Quality Assurance accreditation in 2007, we have maintained a focus on improving quality throughout the organization, especially in member care and satisfaction. Top Ranked VA Health Plan 2008 – 2013, 2018 Best PracticeAward Specialty Pharmacy Quality Program Pioneers in Prenatal Programs Innovative Award for ImprovedQuality of Racially and EthicallyDiverse Populations One of the top Health Plans inVirginia The National Committee for Quality Assurance is the industry standard in evaluating clinical performance and consumer experience. Most Female Veterans Hired By Comparably Sized Companies Association of CommunityAffiliated Health Plans (ACAP)Honorable Mention 2017 Proprietary and Confidential

13. Innovations Virginia Premier Neighborhood Health Center Located in Roanoke, the Virginia Premier Neighborhood Health Center was created in response to a shortage of providers in the area. This state-of-the-art clinic serves our members as well as those receiving fee-for-service Medicaid. Infants At Work One of the benefits of working at Virginia Premier is the Infant at Work program, in which new moms and dads can bring their babies to work for up to eight months. The program enables parents to continue their career while spending time with their newborns. Member Transportation Services Virginia Premier provides members with safe and efficient transportation to and from medical appointments, health and wellness events, and educational sessions. Proprietary and Confidential

14. Virginia Premier Preparation for Medicaid Expansion

15. Preparing for Expansion Proprietary and Confidential

16. Virginia Premier’s Medicaid Network • Virginia Premier’s Medicaid network consists of: • 77 Acute Care Facilities • 2,875 Primary Care Providers (PCP) • 16,520 Specialists • 232 Addiction Recovery Treatment Services (ARTS) Providers • 40 Community Service Boards (CSB) • 139 Federal Qualified Health Centers (FQHC) • In addition to those networks on the map, we have: LifePoint, Community Care Network of Virginia, Frontier, Valley Health Systems, Valley Health Plan, Augusta Medical Group, and Eastern Virginia Medical School Virginia Premier Neighborhood Health Center Proprietary and Confidential

17. Community Partnerships Proprietary and Confidential

18. Community Partnerships • Virginia Premier and VCU Health are actively partnering on the following initiatives: • Asthma Management • Cervical Cancer CEU Education Event • Colorectal CEU Education Event with the American Cancer Society • Premier Population Health Events • Diabetes Telemonitoring • Vision by Design Proprietary and Confidential

19. Still working to build relationships in new markets for Virginia Premier (i.e. Kaiser Permanente, Inova, free clinics statewide) Increased demand for medically complex services With the inclusion of additional populations and increase in behavioral health demands and covered services, some challenges exist engaging with providers new to managed care with concepts like billing, credentialing, and member eligibility Partnering with large networks and community providers for telehealth medicine Challenges but not roadblocks… Proprietary and Confidential

20. Success Story • A 60 year old female Medicaid Expansion member with COPD was connected to a PCP and Ophthalmologist to help coordinate necessary healthcare needs. This member also had various social determinants of health such as transportation needs, permanent housing, access to food, and vision impairments. The CM assigned to this member tackled these needs head on by making a referral to a social worker to assist with the member’s limited food resources and housing needs. In addition, transportation services was coordinated and provided to the members scheduled health care appointments. The assigned CM follows up with the member after her scheduled appointments to discuss her routine care plan and medication needs. The member is very thankful for the assistance in getting her on the right healthcare pathway.

21. Thank You Proprietary and Confidential

22. Source: DMAS Website