HealthCare Partners: Multi-State Expansion using

FRM

Centricity™ LIVE: May 1, 2015

Orlando, FL

•2

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HCP: A History of GrowthLos Angeles Expansion

• Founded in 1992 through the merger of several medical groups in the Los Angeles Metro area

• Acquisitions through 1990’s and early 2000’s concentrated on groups and IPAs in LA County

• Expansion into Orange County, CA, brought first major acquisition with competitive EHR

HCP: From Hillside to Seaside…

HCP: To National Presence

HCP: National Acquisitions - NVFinancial Risk Manager Structure

• IPA and MSO Operations

• Security, operational and reporting separation

• Enrollment structure reflects regional needs

Reg 3 Reg 1-2

Reg 4-7

Reg 3 IPA

All other IPA

NV

HCP: National Acquisitions - AZFinancial Risk Manager Structure

• Focus on IPA Operations

• Decision to build structure single HMO structure for Southwest

HCP: National Acquisitions - FLFinancial Risk Manager Structure

• Focus on Enrollment only

• Challenge in health plan formats and information

HCP: CA Product VariationsNV, FL, AZ

HCP: National AcquisitionsNV, FL, AZ

• New Product Variations

• NV acting as TPA instead of delegated entity

• Varied risk arrangements

• Distinction between plans for enrollment only vs. claims delegation and adjudication

Leveraging Centricity™ Financial Risk Manager (FRM) Platform

Track Attributed and Enrolled Patients

• ACO Attribution

• Enrollment Processing

• Enrollment structure: Capturing PCP, Medical Practice/IPA, Site and Location

Leveraging FRM PlatformBuilding IPA Network Structures

Region VILocation

HCP IPA -Talbert

HCP IPA - AMAEntity

HCP IPA – ARTA

Western MG

IPAsTMG IPA

AMA

TMG IPA -

HCS2000

TMG – IPA

Anaheim

PCP PCPPCPTMG –

IPA Downey

TMG – IPA Long

Bch

TMG – IPA

Orange

TMG – IPA

Tustin

TMG – IPA

Westmstr

PCP PCP PCP

HCP IPA - ARTA

HCP IPA – ARTA Health

Network

Leveraging FRM PlatformReferral and Claims Management

• Finalized Authorizations tracked for adjudication, bed days accruals

• Robust claims engine adjudicates against benefit and contract terms

What’s Next?

Preparing for more growth

• Optum Communications Manager

• Optimization Project

• Percent of Premium Capitation

• Bundled Payment Arrangements