Summary of open data and using it to benchmark providers to driver membership in government ACA programs. Delivered by Ashley Distler and Bryant Hutson of RowdMap at AHIP.

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Providers as Keys to Success
in Your ACA Markets:
The Impact of Government Benchmark
Data for Your Government Businesses

2. AGENDA
2
The Plan
What’s Out There?
What to Do With It?
Govt Benchmarks in Action
About RowdMap
Q&A
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WHAT’S OUT THERE?
There’s a lot of data and talk out there

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WHAT’S OUT THERE?
Let’s cut
through
the buzz

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Government
performance
data
Government
provider etc.
data
Government
socio-demo
data
Consumer
web / social
data
Analysis-based derived
data
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Sentiment as a Key Driver (psychographic) - measured by Index scores for:
- Domains (chronic, wellness, quality of care, customer satisfaction, customer service);
- Brands (WellPoint, BCBS, your brand)
[Managed via Buoy Platform]
Market Growth; Census;
Healthy Food; County
Health Rankings &
Indicators; Behavioral
Health Factors; etc.*
Dartmouth Atlas; STAR;
Hospital Compare; Actual,
Expected & Predicted
Readmissions; Part B & D, etc.*
STAR; Price, Bid, Rebate;
Hospitals, Nursing
Homes; Market, etc.*
* Dozens of Primary Data Sets, updated at various frequencies
WHAT’S OUT THERE?
When we say a lot…we mean a lot.

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And it’s powerful, disruptive, game changing
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David Wennberg,
RowdMap Advisory Board
Government Data Outperforms Risk Adjustment for MA!
WHAT’S OUT THERE?

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a world where you had access to…
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without the prior written consent of the Company, is prohibited.
WHAT’S OUT THERE?
Referral patterns
for your hospitals

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a world where you had access to…
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without the prior written consent of the Company, is prohibited.
WHAT’S OUT THERE?
Referral patterns
for your hospitals
Well, that world is here, today.
• Even though the AMA fought data releases for 30 years, the
day has finally come.
• You have access to all of these data through government
benchmarks.
• CMS understands data like these are necessary for a
competitive, direct-to-consumer health care market.
• No IT, no integration, no data warehouses—it’s here today.

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Shift to Direct-to-Consumer
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WHAT TO DO WITH IT?
Health plans have to
start behaving like
these guys to succeed
in the Government-
sponsored DTC world.
Now you have data
to win!

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Direct-to-Consumer Q & A
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WHAT TO DO WITH IT?
Q: How do you compete in direct-to-consumer, government sponsored health care?
A: You need new / DTC analytic concepts and accessible benchmark data.
Retention
Market Share Product Funnel
Profit Opportunity
Profit Opportunity
Price Sensitivity
You have both now!

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WHAT TO DO WITH IT?
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without the prior written consent of the Company, is prohibited.
Most data projects…

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WHAT TO DO WITH IT?
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without the prior written consent of the Company, is prohibited.
Most data projects…
All the pieces are there, but it’s still hard.
• Data project are time-consuming and complex
• Almost always questions about where the data is from
• Depending upon who generated it, data is subject
to mistrust between stakeholders

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without the prior written consent of the Company, is prohibited.
FFS Motto:
“Amortize Investment”
WHAT TO DO WITH IT?

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without the prior written consent of the Company, is prohibited.
ACA Motto:
“Transparency is the new black”
WHAT TO DO WITH IT?

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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Client / Your Data
Gov Data
Client / Your Data
Gov Data
Client / Your Data
Gov Data
Client / Your Data
Gov Data
Client / Your Data
Gov Data
Client / Your Data
Gov Data
Benchmarks
and your data:
a great match
WHAT TO DO WITH IT?

16. Here’s why these benchmarks are so powerful
16
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
Government benchmark data serves as the common language
necessary to build relationships with providers to
improve the member experience and profitability
The benchmarks are available today with no IT involvement
The data already have a level of analysis on top,
so you can see if a provider is over/under benchmarks
It’s from CMS; it’s a standard;
it’s already used to day to drive reimbursement

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Evaluate Your Position in your Market
with National Benchmarks
Growth Strategy
Product Design
Contracting Strategy
Post-Discharge Interventions
Use information to inform:
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.

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without the prior written consent of the Company, is prohibited.
Example Strategy & Tactics:
HMO Mindset – Grow into the right providers
(Your Network is disproportionately important to your
success in MA - both in PPO and HMO)
Provider BootCamp - Cultivate a mutually beneficial
relationship around a common language (CMS data)
Commercial Conversion - Age-in to the right providers by
leveraging the strength of your commercial population
Benefit optimization - Design plans in the right
geographies around the right providers
GOVT BENCHMARKS IN ACTION

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Provider Profiles Fairfax County, VA
GOVT BENCHMARKS IN ACTION
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Focus on medical
management
using the PlayBook
These are good Candidates
to focus on Growth
using the PlayBook
Where are providers delivering the
most efficient and appropriate care?

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Intensity of Back Procedure Funnels
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
Where are providers delivering the
most efficient and appropriate care?
National Benchmark
Owensboro, KY
Louisville,
KY

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Network Opportunity Index (NOI)
Illinois
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
Where are providers delivering the
most efficient and appropriate care?

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County Profiles
Maryland
GOVT BENCHMARKS IN ACTION
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Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
Which counties are high/low performers?
What are the characteristics of my counties?
Focus on medical
management
using the PlayBook
These are good Candidates
to focus on Growth
using the PlayBook

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Success Opportunity Index (POI)
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
Which counties are high/low performers?
What are the characteristics of my counties?

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Success Opportunity Index (POI)
GOVT BENCHMARKS IN ACTION
All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
Which counties are high/low performers?
What are the characteristics of my counties?

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Evaluate your Provider Footprint
Hospital Profiles
GOVT BENCHMARKS IN ACTION
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Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
Where are providers delivering the
most efficient and appropriate care?

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Provider Network Patterns
Evaluate your Provider Footprint
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
Where are providers delivering the
most efficient and appropriate care?

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Understand your Portfolio’s Position
Market Cost Footprint
GOVT BENCHMARKS IN ACTION
All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
What price points do I need to hit to be able to grow quickly?
Where do I run the risk of commoditization?

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Understand your Portfolio’s Position
Price Sensitivity Map
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
What price points do I need to hit to be able to grow quickly?
Where do I run the risk of commoditization?

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Understand your Portfolio’s Position
Price Sensitivity Thresholds
GOVT BENCHMARKS IN ACTION
All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
What price points do I need to hit to be able to grow quickly?
Where do I run the risk of commoditization?

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Understand your Portfolio’s Position
New York, NY
United
WellPoint
HealthFirst
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
Winning Patterns
What are the winning patterns that draw growth?
What trade offs should I make?

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Understand your Portfolio’s Position
Benefit Design Patterns
GOVT BENCHMARKS IN ACTION
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What are the winning patterns that draw growth?
What trade offs should I make?

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RowdMap Answers Four Questions
1 - How do we Grow and intelligently expand around providers?
2 - How do we work with providers to improve and drive
meaningful STAR & internal Performance?
3 - How do we use provider and county clusters to price products,
contract with CMS and create profit & maintain Value?
4 - How do we tune our provider Network and develop
strong business partnerships with our key groups?
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without the prior written consent of the Company, is prohibited.
ABOUT ROWDMAP

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
Success Using this Data
• Increased a plan’s membership through smart growth by 40,000
in 12 months; and another plan’s by 40% in the same time
• Reduced membership attrition for a SNP plan in a competitive metro by 20%
• Launched high-end concierge plan that broke member price sensitivity and
generated significant profit, doubling original membership goal
• Launched a purpose-built plan for a curated provider network
• Increased a plan’s Star scores by a full point through provider-centric growth
• Designed product strategy and corresponding benefits for a major metro area
that lead to plan’s first profitable product portfolio in three years
• Aligned a plan’s sales and network team strategy around providers
• Tripled a plan’s original goal of contracting with targeted providers
(and in some cases, out of exclusivity arrangements)
• Shifted a plan’s majority of membership from PPO to HMO, doubling original goal
• Moved a plan’s membership in target providers from 2% to 30%
in target providers in 12 months
• Articulated clear data-driven MA strategy for board-level presentations
that resulted in additional investments
• Developed comprehensive strategy for government affairs that created
an advantageous environment for plan and members
Where we’ve done it…
ABOUT ROWDMAP

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Featured nationally… US CTO on
RowdMap:
“Visionary
Genius”
ABOUT ROWDMAP

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Who are we?
Bryant Hutson – Senior Client Strategist, RowdMap
Recovering health care strategy consultant
Senior Associate @ Optimity Advisors, Washington, DC;
Information Risk and Privacy Research Analyst @ Corporate Executive Board;
B.S. Information Science and Communication @ Cornell University
Ashley Distler – Senior Client Strategist, RowdMap
Thought AHIP was a joint replacement conference… still not sure
Administrative Fellow @ Presence Health, Chicago; Financial Analyst & Director of
Internal Control @ HCA, Nashville; Research Assistant @Cincinnati Children’s Hospital
Medical Center, Cincinnati; B.S. Economics @ Centre College, MHSA/MBA @ Xavier University
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without the prior written consent of the Company, is prohibited.
ABOUT ROWDMAP

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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
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without the prior written consent of the Company, is prohibited.
ABOUT ROWDMAP
Want to see insights RowdMap has
on your plan, your geography,
and your competitors?
RowdMap is holding one-on-one sessions at AHIP’s 2014
National Conferences on Medicare and Medicaid
We can schedule a time at the conference to walk through the benchmark
data we already have about your plan and geography (no IT involved!)