Entering the South Carolina market in January 2014 A “Consumer operated and oriented health plan”

1. Entering the South Carolina market in January 2014 A “Consumer operated and oriented health plan” Or “Co-OP”

2. What this presentation will address • What is a “CO-OP”? • How did it develop in South Carolina? • Who owns and manages it? • What is its Mission? • How will it relate to Providers • What differentiates it?

3. Consumer Operated and Oriented Plan A “CO-OP” is: • the private sector alternative to “public option” in the ACA • Not for profit • Funded by Federal loans paid back over 30 years • Governed by its Beneficiaries, including network physicians and hospitals • Mandated to develop low cost options for individuals, small groups, and to encourage the uninsured into the market

4. Consumers’ Choice Development

5. Senior Management Jerry Burgess, Chief Executive Officer David Young, Chief Financial Officer Judy Slagle, Chief Operating Officer Jerry Reeves, MD, Chief Medical Officer Francis G. Middleton, M.D., VP Network Development Kimberly Coad-Ascue, Director Network Development Robin Tester, Consultant for Network Development

6. Mission • Provide affordable benefits for individuals and small groups through the public exchange • Reduce the ranks of the uninsured • Engage consumers in their health • Provide a platform for providers’ innovations

7. The Role of Providers 1. InGovernance- Three board seats will be held by network providers 2. AsAdvisors -Network Providers, through a Medical Advisory Committee, will report directly to the Chief Executive Officer 3. As Network providers

8. Promote Medical Homes Support and reward “medical homes” processes • Enhanced access • Population management via robust analytics • Care plans supported by health care coaches • Engaging community support • Tracking and coordinating care • Continuous improvement in measures and outcomes

9. Promote Medical Homes • Referral Authority – PCP (not plan) • PCP/Patient contract and care plan supported by Nurse Coach • Plan supports PCP to achieve three aims: • Cost Management • Quality Measures • Patient Satisfaction

10. Summary of Contracting Principles • Finding partners who share our vision • Gain sharing for quality improvement and efficiency • Promotion of clinical coordination: - medical home and nurse coach - medical home, specialists and others - “accountable care organizations”

11. Patients have Responsibilities, too We will develop incentives designed to promote: • patient compliance with care plans • Engagement with nurse coach • improvements in health status

12. Consumers’ Choice Differentiators • Gains go back to the community of providers and members • Focus on reducing ranks of the uninsured • Providers participate in governance • Strong support from the provider and business communities

13. A Fresh Start Help us to get it right

14. To discuss Network participation, contact: Kimberly Coad-Ascue, Director, Network Development 843.732.0393 kascue@consumerschoicesc.org Robin Tester, Consultant for Development 803-466-4896 Rob.tester.10@gmail.com Francis G. Middleton, M.D., VP Network Development 843.608.9540 fmiddleton@consumerschoicesc.org