Welcome to Making Sense of Accountable Care. What’s in it

for you?

Lynn Barr, CEO Caravan Health

3

Source: CMS MACRA LAN Powerpoint, October 2015

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Step 1: Pick Your Destination

4

CPC+ MSSP Tracks 1.5, 2&3 Next Gen ACO

Oncology Care Model

Comprehensive ESRD

Cardiac and Joint Bundles

Option 3: MIPS APM (NO RISK)

Option 2: Qualifying APMs

(RISK)

MSSP Track 1

MIPS Option 1: Do Nothing (Death by MIPS)

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Who Wins and Who Loses?

5 Proprietary & Confidential, Not for Distribution

• Program takes $199 million from the bottom 50% and gives to the top 50%. • For five years, the top 10% get another $500 million. • Everyone who takes risk is out of the pool. • In 2018, ~40% of QPP providers will be in Track 1 ACO’s. • Track 1 ACO participants get special scoring:

• Quality scores will average 92%. • Automatic 100% for Clinical Practice Improvement Activities. • Exempt from Resource Utilization Category. • Those that do well on Advancing Care Information will be in the top 10%.

ACO’s Everyone Else

+$199 Million -$199 Million

+$500 Million

I’m Rural, So I’m Exempt, Right?

6

• RHC’s and FQHC’s are exempt from the Quality Payment Program (QPP), except RHC Part B billing

• Providers that work in rural hospitals are not exempt from the QPP.

• Your hospital-based specialists’ scores will be compared to high performing ACO Primary Care Providers.

• After the transition period, you should expect your hospital-based clinicians to pay the penalty.

• Use the MACRA Calculator to estimate the impact. • If your providers are not employed, will you lose access to

them? • How will your community feel about your Physician

Compare scores being in the bottom half, or missing?

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Is Joining an ACO the Answer?

7

What Is A Medicare ACO?

8

• Primary Care Providers are accountable for the cost and quality of care of attributed lives (based on most allowed E&M charges).

• ACO must have at least 5,000 lives (~35 PCPs). • ACO benchmark for spending is based on historic data and

holds steady for three years. • If costs go down compared to the benchmark you can get

50% of shared savings.

• ALL EXISTING REIMBURSEMENT STAYS THE SAME.

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What Is the CPSI Caravan ACO Model?

9

• Community hospital and local providers group themselves as Participants.

• Minimum of three PCPs (~500 lives) per community. • Caravan/CPSI will find other partners to achieve 10,000

lives under an ACO. • Each community has a board seat, equal ownership and

equal voting rights in the ACO. • If ACO gets shared savings, funds are distributed based on

each communities performance. • Providers get ALL CLAIMS DATA and waivers of Stark, anti-

kickback, anti-trust and patient inducement regulations.

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Why ACO Track 1?

10

• 35 early adopter ACOs were comprised of rural, independent and primary care providers (like us).

• Comprised 5% of lives but 22% of savings. • Average shared savings per ACO for Advanced Payment was

$4,045,616. • 3-full years of data proves that the small, rural, independent providers

like us can succeed!

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ALL MSSP

ALL Advanced Pay

Difference

Savings Per ACO Per Year

$1,009,871

$1,975,039

196%

Savings Per Beneficiary Per Year

$58.64

$241.40

412%

Average Savings/Year

0.58%

2.28%

393%

Contribution

Total Beneficiary Years

16,275,327

850,880

5%

Total Savings

$954,328,267

$205,404,040

22%

Shared Savings Payments

$1,298,712,390

$141,596,556

11%

Step 2: Pick Your Traveling Buddies

11

Do It Yourself

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DIY or CPSI?

12

• Creating or joining an ACO is expensive (legal fees, governance rules, comp models, CMS applications, etc.).

• Start up and infrastructure costs average $3 - $4 million. (www.naacos.com)

• Without proper support and accountability, many ACOs have failed to achieve results.

• Most rural providers do not have the required 5,000 lives on their own.

• We can aggregate you with others and provide funding and support to make it work. Proprietary & Confidential, Not for Distribution

http://www.naacos.com

Who Is Caravan Health?

13

• Experienced guides for advanced payment models • Created and directed by rural hospital leaders • Support population health programs in multiple models:

MACRA, ACOs, CPC+, Million Hearts, etc. • 23 ACOs • 278 hospitals • 17,000 providers

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2016 ACO Preliminary Results

14 Proprietary & Confidential, Not for Distribution

• 14/23 ACO's showed savings

• Seven ACO's qualified for shared savings.

• Total savings $27.5 million

• Average savings = $99 per patient

• 3.8 times better results than all ACOs ($26)

• 13.4 times better results than fee for service ($7)

Summary Tables & Charts

ACO IDACO DBA Name* denotes 2015 StarterFinancial BenchmarkInflation & Demographics - Adjusted BenchmarkTotal Cost PPPY BY3**Total Cost PPPY Q3 2016Total Cost PPPY Q4 2016BY3 vs Q4 2016 (%)BY3 vs Q4 2016Q4 2016 vs Benchmark (%)Total IP Cost PPPY Q3 2016Total IP Cost PPPY Q4 2016%ChangeTotal SNF Cost PPPY Q3 2016Total SNF Cost PPPY Q4 2016%ChangeER Visits per K PYs Q3 2016ER Visits per K PYs Q4 2016% ChangeAttribution Q3 2016Attribution Q4 2016% ChangeACOProjected Savings and Lossessavings

A2876Magnolia-Evergreen ACO$10,736$10,692$10,769$9,971$9,791-9.1%-$979-8.4%$2,901$2,832-2.4%$939$896-4.6%844817-3.2%12,43912,122-2.5%A2876$10,670,487

A2860Mountain Prairie ACO$10,462$10,511$10,273$10,082$9,931-3.3%-$341-5.5%$3,141$3,072-2.2%$985$9920.7%813781-4.0%13,18413,018-1.3%A2860$7,348,727

A2861Iowa Rural ACO$9,838$9,852$9,817$9,500$9,356-4.7%-$461-5.0%$2,900$2,854-1.6%$1,148$1,062-7.5%746735-1.5%11,13010,893-2.1%A2861$5,247,899

A2856Prairie Hills Care Organization$10,672$10,704$10,776$10,577$10,283-4.6%-$493-3.9%$3,331$3,199-3.9%$1,092$1,026-6.1%611596-2.5%9,93110,0120.8%A2856$4,086,807

A2680Suburban Health ACO*$7,713$8,083$7,556$7,880$7,8383.7%$282-3.0%$2,387$2,3960.4%$412$412-0.1%6906940.5%15,31715,303-0.1%A2680$3,668,965

A2869Southern Michigan Rural ACO$9,422$9,443$9,294$9,312$9,113-2.0%-$181-3.5%$3,110$3,033-2.5%$481$434-9.7%926916-1.0%9,4209,405-0.2%A2869$3,018,470

A2864Suburban Health ACO 2$10,616$10,716$10,732$10,666$10,272-4.3%-$460-4.2%$3,869$3,623-6.4%$1,526$1,469-3.7%863836-3.2%5,4125,271-2.6%A2864$2,273,492

A2866Indiana Rural ACO$10,863$10,902$10,879$10,913$10,729-1.4%-$150-1.6%$3,705$3,577-3.5%$1,411$1,359-3.8%8699135.0%13,23913,233-0.0%A2866$2,217,864

A2858Great Plains Care Organization$9,058$9,061$8,933$9,025$8,887-0.5%-$46-1.9%$2,877$2,794-2.9%$737$725-1.7%668642-3.8%9,6179,578-0.4%A2858$1,612,997

A2872Ohio River Basin ACO$9,980$9,888$9,903$9,962$9,785-1.2%-$118-1.0%$3,332$3,264-2.0%$801$738-7.9%956932-2.5%14,41214,5440.9%A2872$1,453,786

A2895High Sierras-Northern Plains ACO$10,134$10,115$9,983$9,945$9,940-0.4%-$44-1.7%$3,619$3,6601.1%$680$6891.4%7237260.4%8,3478,315-0.4%A2895$1,422,149

A2852Winding River ACO$9,807$9,785$9,730$10,054$9,605-1.3%-$126-1.8%$3,366$3,079-8.5%$1,031$967-6.2%968930-3.9%6,2336,157-1.2%A2852$1,077,165

A2862Illinois Rural ACO$9,565$9,522$9,558$9,474$9,469-0.9%-$89-0.6%$3,139$3,071-2.2%$1,036$1,001-3.4%863833-3.6%13,37713,3800.0%A2862$696,171

A2871New Hampshire Rural ACO$11,083$11,069$11,137$11,347$11,007-1.2%-$130-0.6%$3,769$3,656-3.0%$1,355$1,275-5.9%838816-2.7%11,67611,478-1.7%A2871$693,927

A2867Greater Michigan Rural ACO$11,195$11,276$11,271$11,699$11,3480.7%$770.6%$3,746$3,645-2.7%$1,201$1,185-1.4%879857-2.5%11,21910,989-2.1%A2867-$769,525

A2892Oregon-Indiana ACO$10,635$10,758$10,506$10,852$10,8943.7%$3881.3%$3,698$3,691-0.2%$1,086$1,066-1.9%815810-0.5%8,2908,182-1.3%A2892-$1,078,800

A2880Hattiesburg ACO$10,099$9,995$10,034$10,329$10,0540.2%$200.6%$2,673$2,625-1.8%$607$576-5.2%788765-2.9%19,54719,6210.4%A2880-$1,126,201

A2890Minnesota Rural ACO$10,482$10,446$10,464$10,904$10,6862.1%$2222.3%$3,862$3,547-8.2%$976$1,0164.0%826806-2.4%4,9874,912-1.5%A2890-$1,144,699

A2882Deep South Regional ACO$10,833$10,751$10,729$11,181$10,9652.2%$2362.0%$3,862$3,847-0.4%$1,021$1,0795.6%932917-1.6%7,3876,905-6.5%A2882-$1,428,235

A2662Texas Rural ACO*$12,429$12,492$12,288$13,561$12,8514.6%$5632.9%$4,444$4,042-9.1%$1,142$986-13.6%949902-5.0%6,7746,584-2.8%A2662-$2,291,442

A2879North Mississippi Connected Care Alliance$9,492$9,411$9,524$9,743$9,5950.7%$711.9%$2,836$2,766-2.5%$939$934-0.6%896869-3.0%18,60818,340-1.4%A2879-$3,288,365

A2893Mountain West$10,107$10,137$10,188$10,568$10,4462.5%$2583.1%$3,457$3,424-0.9%$1,315$1,253-4.8%805801-0.5%11,05211,0620.1%A2893-$3,331,775

A2622Reid ACO*$10,023$10,733$9,845$10,644$11,13413.1%$1,2893.7%$3,893$3,801-2.4%$893$8940.2%845843-0.3%8,9579,0531.1%A2622-$3,536,579

Total Savings Only$45,488,904

Caravan Health$10,160$10,148$10,136$10,212$10,037-1.7%-$99-1.1%$3,273$3,185-2.7%$962$926-3.7%827811-2.0%Total Net Savings$27,493,2843.8076522678

All ACOs in MSSP-$10,072$10,238$10,046-1.9%-$26$3,307$3,200-3.2%$686$675-1.6%694674-2.9%Average$1,195,36013.3563572387

National FFS-$9,757$9,956$9,750-2.1%-$7$3,243$3,157-2.7%$817$797-2.4%676658-2.6%

ACOProjected SS RealizedAIM fundscommunity

A2876$5,228,538$ 1,570,000.00$3,658,538

A2860$3,600,876$ 1,570,000.00$2,030,876

A2861$2,571,470$ 1,570,000.00$1,001,470

A2856$2,002,535$ 1,528,948.00$473,587

A2680$1,797,793$1,797,793

A2869$1,479,050$ 1,486,048.00

A2864$1,114,011$ 945,244.00$168,767

Total$17,794,275

Average$2,542,039

ACO$ Away from SS

A2622$6,466,271

A2662$5,065,957

A2880$4,801,622

A2879$4,329,140

A2867$3,544,989

A2893$3,203,648

A2871$2,906,850

A2862$2,760,817

A2892$2,726,385

A2882$2,462,661

A2872$2,358,495

A2890$1,968,030

A2866$1,700,442

A2895$1,174,918

A2852$1,015,138

A2858$945,931

Total$47,431,295

Average$2,964,456

Caravan Health

Total Assigned Beneficiaries

Total Assigned Beneficiaries

201320142015Q1 2016Q2 2016Q3 2016Q4 2016237610245728257557252598252051250555248357

Total Yearly Expenditures per Assigned Beneficiary

Caravan Health

201320142015Q1 2016Q2 2016Q3 2016Q4 20169703.41106228803449857.992218292913110136.315540779310185.77036843475110186.7600965426510212.10132639231110036.94424292332All MSSP ACOs

201320142015Q1 2016Q2 2016Q3 2016Q4 20169656.73627979999959851.240927599999810072.27784210123.52154610100.4948310238.40503200000110046.180055000001National FFS

201320142015Q1 2016Q2 2016Q3 2016Q4 20169339.25599999999589421.3909999999969757.4089999999969741.899814.06199999999639956.32599999999559749.9689999999955

Total Yearly Expenditures per Assigned Beneficiary

Benchmark Year 3 (BY3)** vs Q4 2016

Total Cost PPPY BY3**A2622*A2662*A2680*A2852A2856A2858A2860A2861A2862A2864A2866A2867A2869A2871A2872A2876A2879A2880A2882A2890A2892A2893A2895Caravan Health ACOsAll MSSP ACOsNational FFS9845.462073999999112288.2437150000017555.99015229999999730.310476410775.6439528932.595699400000710272.6081840000019817.28995799999949558.120560999999710731.91038110878.90304400000111270.7833029294.433688700000911136.9166639903.022174199999410769.3598119524.178314000000710033.66981310728.95010299999910464.27474099999910506.00141210187.7462680000019983.238946310136.31554077930210072.2778429757.4089999999997Total Cost PPPY Q4 2016A2622*A2662*A2680*A2852A2856A2858A2860A2861A2862A2864A2866A2867A2869A2871A2872A2876A2879A2880A2882A2890A2892A2893A2895Caravan Health ACOsAll MSSP ACOsNational FFS11134.22437612851.109537838.13206269999969604.783074099999810282.8614560000018886.81996210000039931.41778899999929355.96754409999999468.728640699999210271.61377899999910729.28158311348.2023369113.100232999999211007.2647300000019785.00621130000049790.59148199999989594.836071199999410053.769610964.56238810685.93940499999910893.88646210446.2237529939.596006600000710036.94424292332210046.1800550000019749.9689999999991

Summary Tables & Charts (2)

ACO IDACO DBA Name* denotes 2015 StarterFinancial BenchmarkInflation & Demographics - Adjusted BenchmarkTotal Cost PPPY BY3**Total Cost PPPY Q3 2016Total Cost PPPY Q4 2016BY3 vs Q4 2016 (%)BY3 vs Q4 2016Q4 2016 vs Benchmark (%)

A2622*Reid ACO*$10,023$10,733$9,845$10,644$11,13413.1%$1,2893.7%

A2662*Texas Rural ACO*$12,429$12,492$12,288$13,561$12,8514.6%$5632.9%

A2680*Suburban Health ACO*$7,713$8,083$7,556$7,880$7,8383.7%$282-3.0%

A2852Winding River ACO$9,807$9,785$9,730$10,054$9,605-1.3%-$126-1.8%

A2856Prairie Hills Care Organization$10,672$10,704$10,776$10,577$10,283-4.6%-$493-3.9%

A2858Great Plains Care Organization$9,058$9,061$8,933$9,025$8,887-0.5%-$46-1.9%

A2860Mountain Prairie ACO$10,462$10,511$10,273$10,082$9,931-3.3%-$341-5.5%

A2861Iowa Rural ACO$9,838$9,852$9,817$9,500$9,356-4.7%-$461-5.0%

A2862Illinois Rural ACO$9,565$9,522$9,558$9,474$9,469-0.9%-$89-0.6%

A2864Suburban Health ACO 2$10,616$10,716$10,732$10,666$10,272-4.3%-$460-4.2%

A2866Indiana Rural ACO$10,863$10,902$10,879$10,913$10,729-1.4%-$150-1.6%

A2867Greater Michigan Rural ACO$11,195$11,276$11,271$11,699$11,3480.7%$770.6%

A2869Southern Michigan Rural ACO$9,422$9,443$9,294$9,312$9,113-2.0%-$181-3.5%

A2871New Hampshire Rural ACO$11,083$11,069$11,137$11,347$11,007-1.2%-$130-0.6%

A2872Ohio River Basin ACO$9,980$9,888$9,903$9,962$9,785-1.2%-$118-1.0%

A2876Magnolia-Evergreen ACO$10,736$10,692$10,769$9,971$9,791-9.1%-$979-8.4%

A2879North Mississippi Connected Care Alliance$9,492$9,411$9,524$9,743$9,5950.7%$711.9%

A2880Hattiesburg ACO$10,099$9,995$10,034$10,329$10,0540.2%$200.6%

A2882Deep South Regional ACO$10,833$10,751$10,729$11,181$10,9652.2%$2362.0%

A2890Minnesota Rural ACO$10,482$10,446$10,464$10,904$10,6862.1%$2222.3%

A2892Oregon-Indiana ACO$10,635$10,758$10,506$10,852$10,8943.7%$3881.3%

A2893Mountain West$10,107$10,137$10,188$10,568$10,4462.5%$2583.1%

A2895High Sierras-Northern Plains ACO$10,134$10,115$9,983$9,945$9,940-0.4%-$44-1.7%

Caravan Health ACOsCaravan Health$10,160$10,148$10,136$10,212$10,037-1.7%-$99-1.1%

All MSSP ACOsAll ACOs in MSSP-$10,072$10,238$10,046-1.9%-$26

National FFSNational FFS-$9,757$9,956$9,750-2.1%-$7

Better Margins – How?

15

1. New Billings: Utilize New Value-Based Strategy to implement pop health nurses combined with new billing codes: Annual Wellness and Prevention, Chronic Care Management, Transitional Care Management, Behavioral Health Integration, Cognitive Assessments, Preventive Screenings, etc.

2. MIPS Bonus: Higher scores = Higher MIPS bonuses, from 5-15% in 2018. Average Caravan Health quality score = 97%. ACOs are exempt from Cost, get 100% for Clinical Practice Improvement. All providers who bill under your TIN get benefit without additional work.

3. Shared Savings Opportunity: Average Shared Savings for Advanced Payment Participants = $163.22 per patient per year.

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Bad for the Hospital?

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• In 2015, ACO inpatient spend was reduced 3% • Caravan’s 30 rural health system CFOs were

surveyed continually about local financial impact.

• “Should your rural health system _______ ?”

STOP = 0 SLOW DOWN = 0 KEEP GOING = 30 BEST YEAR EVER = 6

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CPSI-Caravan Rural ACO Program

17

• Comprehensive, turn-key solution to establish and succeed as an ACO.

• Application and Start-Up: Caravan has helped hundreds of communities to apply and enter ACOs. 100% success rate.

• Governance: Practice, community and ACO-level support. • Coaching: Practice Improvement Coach, Program Manager,

IT and Analytics Staff, CMO. • Education:

– Local quarterly workshops for managers and care coordinators. – Annual national symposium for leaders. – Evidence-Based Medicine Webinars. – Cohort calls. – One on one when needed.

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CPSI/Caravan Rural ACO Program

18

• Analytics Platform: Population health software uses claims for risk stratification, HCC coding, and true patient history

• Access: 24-Hour Advice Nurse Hotline. • New Coding Strategies: More comprehensive Annual

Wellness Visits, chronic care management and behavioral health integration.

• Patient Satisfaction: Provide e-tablets for each office to capture real-time surveys.

• Reporting (Accountability): Assemble all required documentation and report quarterly at practice and board level.

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Mutual Accountability

19 Proprietary & Confidential, Not for Distribution

• Simple Scorecards for Accountability • Minimum engagement level of 80% • Rarely used remediation process

Performance

Category Metric Current Status ScoreCare Coordinator Hired by 4/1/16 Completed 1CC registered for ICCC Health Coaching Course by 4/15/16 Completed 1

Course Status as of 4/30/16 Registered NA22

100%MSSP Application Responsiveness Completed 1Attended PreLaunch Webinar Series Completed 1Financial Consultant Questionnaire Completed by 10/12/15 Completed 1

Financial Consultant Selected by 11/15/15 Completed 1Nursewise Survey Completed by 1/1/16 Completed 1Demographics File submitted by 1/1/16 Completed 1Nursewise Golive Date or have existing 24/7 coverage 03/01/2016 1

Pt Satisfaction Questionnaire Completed by 1/1/16 Completed 1IT Systems Questionnaire Completed by 11/1/15 Completed 1Received Lightbeam User List Completed 1Flat File Status as of 5/6/16 Development 0.25

10.2511

93%Viewed Jan. TCM Billing Webinar Completed 1Viewed Feb. CCM Billing Webinar Completed 1Viewed March AWV/Prev Wellness Webinar Completed 1

33

100%Viewed Jan. Marketing Training Webinar Completed 1Attended Annual Mtg in DC (Extra Credit) Completed 1CEO or Proxy Attended Q1 ACO Board Meeting Completed 1Hosted Launch Meeting Completed 1Viewed EBM AWV Webinar for Physicians Completed 1Viewed April Patient Satisfaction Webinar or have existing tool Complete 1

Viewed May Lightbeam User Group Call (Extra Credit)

Completed 1

Attended April Quality Improvement Workshop Completed 1862

133%

Total Points 21.25Total Extra Credit Points 2Total Possible Points 22Total Score 106.6%

Care Coordination Points

Program Logistics Score

Total Extra Credit Points PossibleEngagement Score

Total Points PossibleInitiative Implementation Points

Total Points PossibleProgram Logistics Points

Care Coordination

Total Points PossibleCare Coordination Score

Total Points PossibleEngagement Points

Initiative Implementation Score

Initiative Implementation

Engagement

Program Logistics

At the 90th Percentile in Caravan Health

1 out of 6 in New Hampshire Rural ACO

New Hospital

New ACO Avg.

New ACO

What does it cost? • Application Fee:

• $10,000 per community hospital including all independent and employed affiliated physicians

• Caravan provides 50% of application fee as a loan • Monthly Management Fee:

• $5.00 per member per month • CPSI provides 40% of monthly fees as a loan

• Interface Fees: • $6,000 per practice (may be covered by TCPI)

• 20% of Shared Savings

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Key Dates/Next Steps

21

• Complete a Letter of Intent (LOI) – April 1st Deadline

• Complete Application – July 1st Deadline

• Caravan Health will walk alongside you (application, set-up, training)

• CPSI Program • CPSI and Caravan Health partnering with you and your ACO

• Available to ALL rural providers, not just CPSI clients

• Not required to purchase any CPSI services

• First 100 LOIs received are guaranteed acceptance in CPSI program

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Questions?

22

What Did We Do & Why?

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• Problem: Providers MUST shift from sickness-volume to wellness-value based care

• ACO Model - Track 1 works! (the data proves it)

• Biggest obstacle to ACO is ‘infrastructure investment’

• CPSI and Caravan Health are investing in new ACOs for the health of the community and the future of rural healthcare

CPSI Launches Rural ACOs in Partnership with Caravan Health Innovative Program to Help Rural Providers Transition to Value-Based Care MOBILE, Ala.--(BUSINESS WIRE)--Jan. 9, 2017-- Healthcare solutions leader CPSI (NASDAQ: CPSI) today announced the creation of the CPSI Rural Accountable Care Organizations (“ACOs”) in partnership with Caravan Health. CPSI and its family of businesses are a leading provider of healthcare solutions for community hospitals and post-acute care facilities nationwide. CPSI now brings its leadership and experience to the value-based care arena through a strategic partnership with Caravan Health, the market leader in rural ACOs and value-based payments.

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www.cpsi.com/aco www.CaravanHealth.com

916.542.4582

Thank You

http://www.cpsi.com/acohttp://www.caravanhealth.com/

Slide Number 1Slide Number 2Slide Number 3Step 1: Pick Your DestinationWho Wins and Who Loses?I’m Rural, So I’m Exempt, Right?Is Joining an ACO the Answer?What Is A Medicare ACO?What Is the CPSI Caravan ACO Model?Why ACO Track 1?Step 2: Pick Your Traveling BuddiesDIY or CPSI?Who Is Caravan Health?2016 ACO Preliminary ResultsBetter Margins – How?Bad for the Hospital?CPSI-Caravan Rural ACO ProgramCPSI/Caravan Rural ACO Program Mutual AccountabilityWhat does it cost?Key Dates/Next StepsQuestions?What Did We Do & Why?Slide Number 24