variety of benefits including: outpatient surgery, complex and simple diagnostics, emergency room and urgent care.

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1 GENT ADVISOR Summer 2014 Wellness Works in New Small Group Product Plans Vice President s Perspective James M. Repp, Senior Vice President, Sales & Marketing In May, AvMed announced ten additional plans and a chance for participants to earn rewards this year, by taking simple steps toward a healthier lifestyle. Now, every AvMed Small Group plan includes participation in AvMed s Wellness Rewards pilot program. Through November 19, clients and their employees can collect up to $100 in rewards and receive a free activity tracking device to help them reach their fitness goals. They ll also have access to AvMed s enhanced wellness portal, full of selfmanagement tools and healthyliving resources. Using feedback from our agent community, we now feature ten new plan designs. Clients can enjoy the predictability of co-pays before deductibles on a wide variety of benefits including: outpatient surgery, complex and simple diagnostics, emergency room and urgent care. These plans are ideal for clients who want to offer easy, referralfree access to doctors in AvMed s vast network. The new plans empower clients and their employees to save on health care costs. The ten new plans join the 14 existing 2014 Affordable Care Act-compliant Small Group plans in our portfolio. You can view side-by-side comparisons on the Agent portal at AvMed continues to create new, innovative products alongside value-added services and incentive programs that your clients are asking for. We have Agent Advisory Councils around the state, and are keenly aware of what is on your mind. That s why we ve developed our newest group of product offerings and wellness initiatives. You can read more in our cover story. In this issue, we ve also included a Q&A on AvMed s Care Management Programs, staffed by AvMed Care Managers with extensive clinical experience. Whether your clients employees are coping with a complex, life-threatening disease or require specialty care for a chronic condition, we ve designed our program to meet each of their unique needs through ongoing support and advocacy. To keep the momentum going, we ll continue doing our part to help you frame AvMed as the right choice. This includes ranking highest in member satisfaction among Florida health plans for the third consecutive year. We ll continue to look for ways to help you succeed. The door is always open for your suggestions. Thanks for all you do.

2 AVMED UNPLUGGED: AvMed Executives Answer Questions on Agents Minds Teresa Gulino, RN, Vice President of Care Management, talks about how AvMed addresses the needs of members with chronic conditions, specialty care or complex, life-threatening illnesses. Q. What defines AvMed Care Management? A. Our care team has extensive clinical experience and helps patients facing health challenges, to successfully navigate the health care system by providing a helping hand and advocating on their behalf. Chronically-ill members need continuous and thoughtful care. AvMed works proactively with members physicians, existing claims data, and other sources such as sophisticated predictive modeling tools, to identify and assist members who would benefit from an individual care plan. Q. What is included in AvMed s Care Management programs? A. We have specialty programs staffed by nurses who are subject matter experts, and are able to explain targeted interventions based on clinical performance guidelines. AvMed has also forged partnerships in the community, giving us access to additional care specialists, and helping to ensure there are no gaps in our members coverage. Case managers also work closely with primary care physicians or specialists to coordinate care. Below is a breakdown of what we offer. Complex Care For members with complex care issues like cancer or late-stage heart disease, AvMed assists members obtain access to care, services and care coordination. Care Transitions Assists members with transition at discharge from hospital or with care coordination, unless precipitated by complex conditions. We offer other programs, detailed above, featuring more specialized services for those cases. End-Stage Renal Disease Supports members with an end-stage renal failure diagnosis, which requires hemodialysis. Chronic Renal Disease Provides education and interventions for members with chronic renal disease. Maternity Program Provides high-risk pregnancy members with additional support and assistance through coordination of benefits with our OB team through all stages of pregnancy, to ensure the healthiest possible outcome for mother and baby. Transplant Care When needed, members receive help with transplant benefits, authorizations for services and assistance with claims. Wound Care - Promotes effective, evidence-based wound management plans to achieve positive outcomes for members with chronic or non-healing wounds. Welcome Home Calls Out-bound calls within 48 hours of hospital discharge to verify PCP appointment, home health care needs and understanding of medications. Q. How can referrals be made for Care Management? A. AvMed has multiple sources for members to be referred for these services. Referrals can be made in the following ways: Member or Caregiver Referral: Members or caregivers can request a case manager by dialing the number on AvMed s ID card. Practitioner Referral: Articles in our quarterly provider network publication keep independent practitioners informed of the Case Management Program. We also notify practitioners when a case manager enrolls one of their patients. Practitioners can refer members by (CM@avmed.org) or telephone ( ). 2

3 FOCUS ON Community AHA Healthy Family Training Camp AvMed was a proud sponsor of the American Heart Association First Coast Healthy Family Training Camp in Jacksonville, to support families in making healthy lifestyle choices. This partnership is a fun day of physical activity and heart-healthy living. Bike305 Miami-Dade mayors teamed up for the 2nd annual Bike305 Bike to Work Day at the South Miami Metrorail Station. Miami-Dade residents were encouraged to leave cars behind and ride bicycles to work. Park Summit In partnership with The Parks Foundation of Miami-Dade, Miami-Dade County Parks, Recreation & Open Spaces Department hosted the 2014 Great Park Summit, presented by AvMed. AvMed s Chief Medical Officer Dr. Ann Wehr, M.D., spoke to attendees about the importance of healthy living. Dr. Wehr also recognized Morning Milers from the 2013 Fit2Play Summer Camps in Miami-Dade County. For more information about any of these AvMed-sponsored events, visit Health Care Reform UPDATE ACA Interview on Orlando Public Television s WUCF Recently, AvMed s Vice President of Strategic Marketing, Javier Mendoza, was invited to explain the Affordable Care Act to the viewers of a PBS local issues program, Metro Center Outlook. His segment aired alongside expert accounts representing the medical and consumer fields. Watch it at 3

4 AvMed Advantages AvMed Makes it Three in a Row with 2014 J.D. Power Customer Satisfaction Study For the third consecutive year, J.D. Power ranks AvMed highest in member satisfaction among Florida health plans*. In this year s study, AvMed grabbed the highest regional score in a tie, securing another honor for its renowned member-focused efforts. Read more about the J.D. Power Member Health Plan Study results by visiting or visit AvMed s Web Site at: Physician Satisfaction Survey Overview AvMed surveys its physician network to get an objective evaluation regarding satisfaction of services and features among providers. AvMed invited approximately 30,000 physician practices to participate in the 2014 Physician Satisfaction Survey through , blast fax, and the AvMed Web Site. To qualify, participants had to be personally involved and actively working with AvMed and other health plans. AvMed conducted the survey from March 3 rd to April 10 th, 2014, and received 1,250 responses. Here are highlights of the key findings: The percent of participants rating satisfaction with AvMed as very good overall continues to gain year after year and is up to 83% in out of 10 physicians would recommend AvMed to other physicians and to their patients. AvMed continues to compare favorably to key competitors, rating highest in overall opinion. AvMed s overall service ratings increased from 2013 and are strong in all categories. We consistently rank very high for hospital, specialists, primary care network quality and choice. 4 AvMed received the highest numerical score among commercial health plans in Florida in the proprietary J.D. Power and Associates U.S. Member Health Plan StudySM study based on 34,315 total member responses, measuring six plans in Florida (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of members surveyed December January Your experiences may vary. Visit jdpower.com.

5 AvMed Advantages Diving Into IdeaWell An AvMed Research Project Recently, AvMed embarked on a journey to better understand the needs and expectations of its target customers. We procured Communispace, a company that has served many high-profile clients by establishing online communities. AvMed s community, named IdeaWell, gives us a private source of insight from the 300 people participating, representing a mix of AvMed customers and non-customers and a true cross-section of the group and individual lines of business within AvMed s current geo-markets. Each cycle begins with the design of a research project; a series of questions or activities we agree upon through consultation with the vendor, intended to get to the heart of a designated area of curiosity. We ll use the findings to drive the development of products and services. To date, we ve conducted research in five distinct areas which have taught us valuable lessons on building more effective consumer tools and a more attractive member experience. You ll see the impact of this project through the products and services we roll out in the years to come. AGENT ADVISORY COUNCIL WRAP-UP AvMed hosted its latest round of Agent Advisory Council meetings last month and the discussion centered on new rates, new plans, and new struggles with the changing parameters of the Affordable Care Act (ACA). Sales presented a look at AvMed s new Small Group portfolio and announced the inclusion of our new Wellness Rewards program with all new or existing Small Group plans. Underwriting discussed the ACA s change to the definition of Small Groups with the removal of the word eligible from qualifying language, and the impact of the guaranteed issue clause for Large Groups. The Department also reported favorable outcomes of AvMed s annual Large Groups actuarial review, including an attractive base rate adjustment for all new employer groups across the state. The adjustment is so positive, that it completely offsets the cost impact of the Affordable Care Act on medical base rates (removal of Durable Medical Equipment limits, applied drug to Out-of- Pocket Maximum for non HSA plans, etc.) for new Large Groups. Prospective Medical and Rx annualized trend rates also remain very favorable and unchanged. The review also resulted in the updating of Area Factors and County groupings for both medical and pharmacy. Additionally, AvMed further divided its six Super Regions into 12 new Rating Regions. This move will produce more refined rates, which will better reflect actual area cost variations. AvMed s Agent Advisory Councils convene in Miami, Fort Lauderdale, Tampa, Orlando, and Gainesville on a quarterly basis. 5

6 AGENT PROFILE Agent John O Donnell Insurance Consultants of Central Florida Central Florida Agent Advisory Council, 2 years What is the most challenging aspect of Healthcare reform? The ever-changing regulatory climate makes it extremely difficult for insurance agents to offer strategic advice to clients. For example, what may be sound advice one day can immediately change when the government issues different guidance or rules. What does AvMed bring to the Orlando market? AvMed is a competitive carrier in the Central Florida market for groups that value its local and individualized service approach for their employees. How do you spend your free time? I have served in multiple leadership roles for Citrus Civitan of Orlando, a local service club chartered by Civitan International. I am also the Chair of the Florida Hospital Foundation Board for Diabetes and Translational Research, a world-renowned clinical and medical research facility focused on improving the lives of those with diabetes and metabolic disease. My wife, Wendy, and I have three young children together; William, Henry and Claire. AvMed Regional Offices Miami 9400 S. Dadeland Blvd. Suite 370 Miami, FL (305) Fort Lauderdale W. Sunrise Blvd. Suite 370 Sunrise, FL (954) Tampa 1511 N. Westshore Blvd. Suite 450 Tampa, FL (813) Orlando 1800 Pembrook Drive Suite 190 Orlando, FL (407) Gainesville 4300 N.W. 89th Blvd. Gainesville, FL (352) Jacksonville 1300 Riverplace Boulevard Suite 640 Jacksonville, FL (904) GENT ADVISOR President & CEO Michael P. Gallagher Senior Vice President, Sales & Marketing James M. Repp Vice President, Strategic Marketing Javier Mendoza Director of Public Relations & Communications Corey Miller Editor Felicia Lopez-Walker Production & Publications Manager Jean-Naté Fonte Agent Advisor is published by AvMed. To contact our Public Relations Department, write to: AvMed, 9400 S. Dadeland Blvd., Miami, FL Or call: (800) , ext Or avmed.communications@avmed.org