Transition to Value-Based Care - BPCI Advanced Overview Gene Huang & Mary Moscato November 30th Remedy Partners, LLC. All Rights Reserved.

Transition to Value-Based Care - BPCI Advanced Overview Gene Huang & Mary Moscato November 30th 2017 Remedy Partners, LLC. All Rights Reserved.

Agenda 1. Who We Are 1. Our Mission 2. Remedy Partners Overview 2. The Transition to Value-Based Care (VBC) 1. Value-Based Care Landscape 2. Bundled Payments Overview Model 2 and 3 3. Pricing - What is the financial incentive? 4. Strategy- What is the business development incentive? 3. Remedy s Model 3 Program 1. Our Role and Services 2. Program to Date 4. Next Steps 1. BPCI Advanced Timeline 2. Getting Started 2

Remedy Partners delivers technology and services that enable payers and providers to organize and finance a patient s episode of care. 3

Who We Are Remedy Partners at a Glance Remedy Partners is the largest Awardee Convener in the BPCI program. 5,400 Unique physicians initiating episodes 1,300 Post-acute sites at which physician groups initiate episodes 730 Hospitals at which physician groups initiate episodes 410 Skilled nursing facilities initiating episodes 110 Physician groups initiating episodes 340,000 Cumulative BPCI episodes managed to-date $8.4B Cumulative medical spend managed to-date 45 States in which we manage episodes 1,000 Unique EHR Integrations 18M Monthly EHR Transactions Sources: Volume and program size data as of July 2017 reconciliation, 2013Q4-2016Q4, all Model 2 and Model 3 episodes, with retro drops removed. 4 Demographic data as of July 2017 reconciliation, 2016Q1-2016Q4, all Model 2 and Model 3 data.

Who We Are Remedy Partners at a Glance AJAS Overlay Some AJAS members already working with Remedy and with BPCI 2 AJAS Members in Model 3 with Remedy Partners 2 AJAS Members in Model 3 separately 5+ Members already evaluating BPCI Advanced 6+ Facilities working with Remedy Model 2 partners Red = AJAS Members Blue = Remedy Model 3 5

Value-Based Care Landscape 6

The Transition to Value-Based Care Payment Reform is Here to Stay Leading providers and payers have been increasingly shifting away from feefor-service structures and embracing the transition to value-based care through the adoption of Alternative Payment Models (APMs). CMS is Dedicated to Innovation On September 20 th, the Centers for Medicare and Medicaid Services (CMS) published a Request for Information Strengthening Medicare and Medicaid will require health-care providers to compete for patients in a free and dynamic market, creating incentives to increase quality and reduce costs CMS announcement promotes: Consumer empowerment and transparency Increased and continuous competition Use of waivers to enable meaningful innovation Commercial Payers are Following 2018 MA membership moving to VBC 2018 2020 75% Current spend tied to VBC models Payments tied to membership in VBC models: 75% $65B Source: Humana press release, http://press.humana.com/press-release/current-releases/fullwell-enters-new-value-based-agreement-humana-colorado Advisory Board, https://www.advisory.com/daily-briefing/2015/01/29/20-health-systems-insurers-agree 7 Health Payer Intelligence, https://healthpayerintelligence.com/news/unitedhealthcare-cut-costs-through-value-based-care-programs

The Transition to Value-Based Care Bundled Payments Drive Success in Concert with Other VBC Models Million Hearts Cardiovascular Disease Risk Reduction Model Independence at Home Demonstration Comprehensive ESRD Care Bundled payments significantly improve care and cost outcomes and can be integrated into other VBC models to drive greater overall efficiencies. Home Health Value-Based Program Bundled Payment for Care Improvement (BPCI) Initiative Medicare Shared Savings Program IMPROVED PATIENT CARE AND COST OUTCOMES Value Modifier Comprehensive Primary Care Plus (CPC+) Skilled Nursing Facility Value-Based Program Merit-Based Incentive Payment System Hospital Readmissions Reduction Program Comprehensive Care for Joint Replacement (CJR) Oncology Care Model Next Generation ACO 8

The Transition to Value-Based Care The Evolution of Bundled Payment Programs Launched in 2013, the BPCI program is the largest demonstration program in CMS s history covering $8-10B in Medicare fee-for-service payments. Current BPCI Program Four BPCI models offered through the initiative, with more than 75% of participants selecting Model 2 or 3 Model 2 episodes are initiated by an inpatient admission to an acute care hospital and include related care covered under Part A and Part B within 30, 60 or 90 days following discharge from hospital Model 3 episodes include post-acute care following an inpatient acute care hospital stay and all related care covered under Medicare Part A and Part B within 30, 60 or 90 days following initiation of post-acute services Targeted 181 MS-DRGs rolled into 48 Bundles (24 surgical and 24 medical conditions) CMS Awardee Conveners lower the barrier to entry for provider participation by bearing financial risk and operationalizing program administration Anticipated Enhancements to BPCI Advanced Advanced APM status under MACRA BPCI Providers eligible for 5% MACRA bonus Dependent upon certain percentage of Medicare Patients going through an APM New advanced APM designation for BPCI Continued voluntary participation Bipartisan support for voluntary bundles CMS recently scaled back mandatory CJR and Cardiac programs Quality-based performance measures Complications and mortality statistics Patient satisfaction scores Patient reported outcome metrics (where applicable) 9

Skilled Nursing Challenges Remedy Partners understands that Skilled Nursing Facilities (SNFs) are facing a complex market where patient volume and margins are decreasing. Narrowing referral networks Referral streams are decreasing as partners become more selective in which SNFs to send their patients after discharge. SNFs face greater competition for referrals from Home Health Agencies (HHAs) as hospitals push patients to lower cost settings. Downward trend in Length of Stay (LOS) Providers are facing pressure from hospital partners to shorten LOS as much as possible to reduce episode costs while maintaining quality. Declining margins Downward trend in SNF reimbursement rates combined with lower patient census have eroded SNF margins. 10

Increasing Growth and Performance with BPCI BPCI allows SNFs to gain a competitive advantage in their markets. Provides an opportunity to increase margins and revenue SNFs can take control of the bundle and assume risk in Model 3, reaping the financial rewards for effectively managing patients across the episode. Positions SNFs for long term success in the post-acute care market CMS is committed to rewarding providers that accelerate value based care. Model 3 SNFs gain a competitive advantage for increasing hospital referrals, Medicare business and census development. Allows SNFs to gain access to valuable CMS data without cost SNFs gain access to their historical data in the Opportunity Analysis phase of BPCI. Remedy Partners analyzes this information at no cost to determine the financial upside for partners. 11

Remedy s Model 3 Program 12

Our Model 3 Expertise Our expert team utilizes its national expertise and commitment to the SNF market to support provider operations. Largest Model 3 Awardee Convener Remedy Partners is the largest Awardee Convener in the Model 3 program, supporting 400 SNFs. Our scale allows us to finance, structure and deploy bundle payment programs for facilities of varying sizes and geographies with no impact on cash flow. Dedicated Account Management (AM) Team Our account management team focuses on driving operational success with our SNF partners. AMs hold monthly business reviews and provide best practices for managing BPCI operations and meaningful data insights that promote clinical, operational and financial success. Specialized Program Development Our Model 3 project managers utilize data insights to craft specialized programs to improve provider performance based on demand. These programs focus on driving improved care, lowering costs and improving patient satisfaction. 11

Remedy Model 3 Outcomes With our solution, providers have been able to improve quality of care while driving down costs. 16.6% Reduction in 90-day episodes with a 30% 25% 20% 15% 10% 5% 0% readmission 2-10% -5% Range of Program Saving Rates by Remedy SNF System 1 1 CMS 2016Q4 Reconciliation results for Q22015-Q42016; due to low volume includes only SNF systems with 3 or more SNFs live in 2018Q1; savings rate calculated as net payment reconciliation amount as a percentage of target spend, not including CMS 3% discount; Includes all true-up results; some quarters not fully reconciled 2 CMS Monthly claims, compares 2009-2012 baseline period to 2016 live bundles 14

Remedy Model 3 Outcomes We work closely with partners to maintain high program and bundle retention in order to achieve positive financial returns. BPCI Program Retention (2015Q4-2017Q2) 2 100.00% 92% 90.00% 80.00% 70.00% 60.00% Remedy SNF 50.00% 40.00% systems with 30.00% positive financial results 1 20.00% 10.00% 0.00% Providers Retained Remedy Participants Bundles Retained Non-Remedy Participants 1 CMS 2016Q4 Reconciliation results for Q22015-Q42016; positive financial results defined as combined positive net payment reconciliation amount (NPRA) Q22015-Q42016. Includes all true-up results; some quarters not fully reconciled; due to low volume, includes only SNF systems with three or more SNFs live in 2018Q1. 2 Comparison of BPID and Bundle selection counts between CMS Q42015 Analytic File and CMS Q22017 Analytic File; includes all Model 3 provider types 15

Hebrew SeniorLife Experiences of a Remedy Client 16

Hebrew SeniorLife The largest provider of senior care in the Boston metropolitan area A non-profit, non-sectarian, integrated, eight-site system of health care, housing, research and teaching Devoted to innovative gerontology and geriatric research, senior health care, long-term nursing home care, and Greater Boston senior housing communities that improve the lives of older adults Serves people of all faiths and backgrounds An affiliate of Harvard Medical School Housing/ Independent Living Assisted Living Skilled Nursing Long Term Acute Care Long Term Care Outpatient Medicine Outpatient Rehab Day Health Home Health OP Hospice Research

Satter House Center Communities of Brookline (3) Hebrew Rehabilitation Center NewBridge on the Charles Orchard Cove Fireman Community

HSL Did Apply Contracted with outside Convener to assist with data tracking from CMS claims. HSL s IT /Fiscal departments teamed up for improved readiness of tracking costs by patients and conditions HSL s choice of bundles will demonstrate opportunity to reduce Medicare expenses HSL can manage costs after SNF discharge due to ownership of continuum (i.e., Home Care and Outpatient Therapy care) Added Care Transitions Coordinator

Selected Episodes of Care for July 1, 2015 Roslindale 15 selected (only favorable) In-service nursing, rehab, physician, case management and home care teams Created a color-coded spreadsheet of favorable DRGs by location and Episode LOS 4 additional DRGs added in July for October 1, 2015 go live NBOC 18 selected (only favorable) In-service nursing, rehab, physician, case management, and home care teams Created a color-coded spreadsheet of favorable DRGs by location and Episode LOS 5 additional DRGs added in July for October 1, 2015 go live

Morning Meeting and Board Management

Project Manager, Care Transitions and Accountable Care

Remedy Model 3 Benchmark Savings 24

Top 3 Performing Bundles: 2016 Q4 BUNDLES EPISODES NPRA NPRA % Complex non-cervical spinal fusion 2 $40,976 49% Major joint replacement of the lower extremity with hip fracture split 51 $36,852 5% Sepsis 6 $33,166 19% Top 3 Performing Bundles: Program To Date BUNDLES EPISODES NPRA NPRA % Major joint replacement of the lower extremity 222 $208,580 6% Spinal fusion (non-cervical) 37 $176,592 22% Major bowel procedure 15 $120,686 30% 25

Patient ID Accuracy On average, each Remedy Model 3 patient identified in Episode Connect generates $500 in additional savings (NPRA, not winsorized). 2016 Q4 RECONCILIATION PATIENT ID 26

60 Day Bundles 2016 Q4 vs Adjusted Historic 82 Episodes decrease in SNF Covered 15.4% Days percentage point decrease in 3.9% Episodes with a readmission 27

Next Steps 28

CMS Requires indication of interest Remedy s process starts with Non-Binding Letter of Intent (LOI) LOI allows Remedy to include all of your facilities in our application to CMS for BPCI Advanced LOI gives CMS permission to share your claims data and pricing for bundles in your facility with Remedy for analysis on your behalf Non-binding agreement allows you to exit at any time, with no penalties, no fees, no commitments LOI will be followed by Participant Agreement should you want to continue in the program with Remedy 14

Success Starts with Selecting the Right Bundles Our unrivaled expertise in bundle selection methodology for SNFs guarantees providers are primed for success. Preliminary Data Review Before CMS delivers your data, we start with Medicare s national dataset of all providers (LDS). Program Opportunity Analysis Early analysis identifies savings, mitigates risk and accounts for your unique strategic, operational and clinical needs. Operational Readiness Assessment This provides an invaluable head start on implementing your program before receiving CMS pricing data. Final Bundle Selection & Submission Remedy Partners will evaluate BPCI bundles against your historical performance to choose the ideal bundles set for your organization. 14

Remedy Partner Implementation Workflow Our comprehensive implementation approach ensures SNF providers are ready to execute on their bundles. BPCI Program Structure Education and Configuration Program Management Care Redesign Implementation We finalize bundle selection, program goals and identify BPCI champions so your team is ready to execute on your bundles. During this stage, we educate your staff and key stakeholders on BPCI processes through Remedy University and configure Episode Connect. Your team has direct access to our Model 3 team who will finalize your patient identification program and provide support for your clinical, operational, financial efforts. We work with your team to implement care redesign programs to ensure optimal length of stay and effective discharge programs with Next Site of Care (NSOC) are established. 31

Contact Information Gene Huang VP of Business Development Ghuang@remedypartners.com Mcknight s Article by Gene Huang Three Reasons Your SNF Should Sign Up for CMS s BPCI Program 32