Medicaid Expansion VAHIMSS 2019 Advocacy Day - PowerPoint Presentation

Medicaid ExpansionVAHIMSS 2019 Advocacy Day 3/18/2019 David Summers – Virginia Premier

Discussion Topics

Overview of Virginia’s Medicaid Expansion 3/18/2019

Overview of Virginia’s Medicaid Expansion 2 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 PlusSix MCO’s Participating:

Medicaid Expansion: Who’s Qualifies? Adults ages 19 – 64, not Medicare eligible Income from 0% to 138% Federal Poverty Level 3/18/2019 Proprietary and Confidential 5

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

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 therapiesFamily planning servicesMedical equipment and suppliesPreventative and wellness services, including annual wellness exams, immunizations, smoking cessation and nutritional counselingLong-term services and supports (within DMAS coverage criteria and guidelines)And more3/18/2019Proprietary and Confidential7

Virginia Premier Overview 3/18/2019

3/18/2019 Proprietary and Confidential 9 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 2007We are the only university-based, non-profit Managed Care Organization in the CommonwealthWe offer health plan coverage in all six regions Roanoke Alleghany Central Western Charlottesville Northern Winchester Tidewater Southwest Overview of Virginia Premier

Our History 3/18/2019 Proprietary and Confidential 10 Virginia Chartered is incorporated as a partnership between VCU Medical Center and PCP Healthcare Corporation 10 Virginia Chartered begins serving Medicaid enrollees Virginia Chartered becomes Virginia Premier Virginia Coordinated Care (VCC) begins providing services, with Virginia Premier as third-party administrator Accredited with the National Committee for Quality Assurance (NCQA) Begins providing services through TPA Health Begins implementation of the Medicare D-SNP plan Begins implementation of CCC+ Begins implementation of commercial Medicare Advantage products 1995 1996 1999 2000 2007 2013 2014 2016 2017 2018 Begins implementation of Medallion 4.0 Virginia Premier Commonwealth Coordinated Care Program opens enrollment Virginia Premier Medical Home opens in Roanoke Wholly-owned by VCU Health

Lines of Business 3/18/2019 Proprietary and Confidential 11 Medicaid Medicare Exchange Business Services Medallion 3.0/4.0, FAMISVirginia Premier Advantage Elite (HMO D-SNP)Virginia Premier Preferred Gold 1600Virginia Premier AdvisorsCommonwealth Coordinated Care Plus (MLTSS)Virginia Premier Advantage Gold (HMO) Virginia Premier Preferred Silver (6500,4500) Virginia Coordinated Care (VCC) Virginia Premier CompleteCare (VPCC)* Virginia Premier Advantage Platinum (HMO) Virginia Premier Preferred Bronze 6600 Virginia Premier Neighborhood Health Ctr. 254,585* 5424* 4769* *As of :March 2019

Quality Improvement 3/18/2019 Proprietary and Confidential 12 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, 2018Best PracticeAward SpecialtyPharmacy Quality ProgramPioneers in Prenatal ProgramsInnovative Award for ImprovedQuality of Racially and EthicallyDiverse PopulationsOne of the top Health Plans inVirginia Most Female Veterans Hired By Comparably Sized Companies Association of Community Affiliated Health Plans (ACAP) Honorable Mention 2017 The National Committee for Quality Assurance is the industry standard in evaluating clinical performance and consumer experience.

Innovations 3/18/2019Proprietary and Confidential 13 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 ServicesVirginia Premier provides members with safe and efficient transportation to and from medical appointments, health and wellness events, and educational sessions.

Virginia Premier Preparation for Medicaid Expansion 3/18/2019

Preparing for Expansion 3/18/2019 Proprietary and Confidential 15

Virginia Premier’s Medicaid Network 3/18/2019 Proprietary and Confidential 16 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

Community Partnerships 3/18/2019Proprietary and Confidential 17 Partnership Description Region Line of Business School-Based Health Center (SBHC) The City and Schools Partnership in Petersburg and the United Way of Greater Richmond & Petersburg are collaborating to create the first school-based health center (SBHC) in the Commonwealth. In May, Virginia Premier announced it will fund two years of project management functions necessary to create the Petersburg clinic, where students will be able to receive medical services beyond what school nurses can typically provide. A grant from The Cameron Foundation will support technical assistance for planning and implementing the center. Central Medicaid Region Ten Community Service Board (CSB) Virginia Premier delivers behavioral health and substance use services as well as support services for members with Intellectual and Developmental Disabilities ( ID/DD). We have executed a letter of intent to implement the Enhanced Care Coordination program. Charlottesville / Western Medicaid / MLTSS Winchester Community Mental Health Center Virginia Premier provides enhanced care coordination for Targeted Case Management (TCM) beneficiaries, closing care gaps and leveraging the relationships CSB Care Managers have with many of our members. Northern / Winchester MLTSS Child Health Investment Partnership (CHIP) of Roanoke Valley CHIP of Roanoke Valley's home visits help pregnant mothers and children from birth to the first grade, giving them access to medical care needed to manage chronic conditions and support developmental education. Virginia Premier has a referral partnership with the organization, and sponsors many of their events. Roanoke / Alleghany All Lines of Business People, Inc. People, Inc., helps those in the community who want to improve their life or need a second chance. This includes at-risk youth, pre-school children, pregnant women and ex-offenders. Southwest MLTSS Norfolk Community Service Board (CSB) Virginia Premier provides enhanced care coordination for Targeted Case Management (TCM) beneficiaries, closing care gaps and leveraging the relationships CSB Care Managers have with many of our members. Tidewater Medicaid / MLTSS Community Care Network of Virginia (CCNV) Under Community Care Network of Virginia (CCNV), Virginia Premier has contracted with Federal Qualified Health Centers (FQHCs) and health departments across the state to provide embedded case management and embedded preventive care services. All Regions All Lines of Business

Community Partnerships 3/18/2019 Proprietary and Confidential 18 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 TelemonitoringVision by Design 

Challenges but not roadblocks… 3/18/2019 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

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. 5

Thank You Proprietary and Confidential

Source: DMAS Website Virginia's Title XIX Medicaid and Title XXI CHIP Programs SFY18 Annual Unduplicated Enrollment 1,425,899 TITLE XIX - MEDICAID 1,311,637 Aged, Blind & Disabled 332,191Low-Income Families & Children996,385TITLE XXI - CHIP195,549