RowdMap delivered a presentation at the California Association of Health Plans around designing networks around Risk-Readiness. Rather than cutting providers the key is to identify which physicians will work in which arrangements. As Fee for Service is sunset, match doctors, value propositions and pay for value arrangements will turn networks from a need to have to a strategic advantage and building strong relationships with the right docs is key.

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From JV to Varsity: Using Government Benchmarks
to Find Risk-Ready Providers for Your Team

2. QUESTION
2
Why should you pay attention
for the next few minutes?
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3. AGENDA
3
The Plan
What’s Risk-Readiness?
What’s Out There?
What to Do With It?
Govt Benchmarks in Action
About RowdMap
Q&A
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4. 4
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WHAT’S RISK-READINESS?
Your world is
changing…
Adequacy is just the tip of the ice berg

5. 5
How do we navigate the changing
business environment ahead?
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Most of your payments go to FFS
with maybe some going to P4P
bonus
Payments will be much more diverse including
FFS, P4P bonus, bundled payments,
shared savings, and global payments.
Payments Today Future Payment Mix
WHAT’S RISK-READINESS?
How do you turn network into a strategic
advantage in this context?

6. 6
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WHAT’S RISK-READINESS?
Risk-
Readiness = Provider
Patterns
Your
Geography
Risk-Readiness describes matching
collective practice patterns and the
characteristics of the geographies they serve with
pay-for-value programs.
+

7. 7
Every doctor practices medicine differently.
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Some doctors prefer starting with lower intensity approaches…
…while others might jump right to surgery or narcotics.
The collective nuances of how each doctor practices can
be aggregated into a unique practice pattern fingerprint.
WHAT’S RISK-READINESS?

8. 8
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Treatment Patterns highlight differences in
pace and intensity of back pain treatment
Each doc has a unique practice pattern. Some docs
tend go more quickly to higher intensity options
Figure out your providers then
match the revenue models
WHAT’S RISK-READINESS?

9. 9
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Individual provider’s performance
compared to geographic benchmarks
Build Relationships Put on Notice
Some Doctors tend go more quickly
To higher intensity options
WHAT’S RISK-READINESS?

10. 10
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Identify & cultivate providers for risk
This doc is making money for whoever owns the risk
This type of doc is disproportionately important to your network/group
She might not be the highest
producing and may cost more…
…but she’s disproportionately
reducing unwarranted costs
and unnecessary negative
impact and patient experience
WHAT’S RISK-READINESS?

11. 11
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Great profile for
aggressive risk
Tread carefully for
some risk
Choose the right arrangement / mix
Based on Your Market and Your Provider risk readiness
benchmarks (practice pattern intensity)
WHAT’S RISK-READINESS?

12. 12
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WHAT’S OUT THERE?
There’s a lot of data and talk out there

13. 13
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WHAT’S OUT THERE?
Let’s cut
through
the buzz

14. 14
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.

15. 15
And it’s powerful, disruptive, game changing
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David Wennberg,
RowdMap Advisory Board
Government Data Outperforms Risk Adjustment!
WHAT’S OUT THERE?

16. New Government
Released Referral Data
(Patient flows between
PCPS, specialists, hospitals
and post acute centers)
Dartmouth Atlas for
Unwarranted Variation
(Decades of research and data on
unwarranted variation by condition
and geography to keep things
apples-to-apples for comparisons,
hence “Unwarranted” in the name)
New Government
Released Performance Data
(Individual providers, groups,
hospitals and post acute centers
including the new part B&D)
Provider Pattern Intensity Profiles and
Risk Readiness for every provider,
hospital, post acute center in the US.
All preloaded with no IT.
OPEN DATA
Affordable Care Act data to determine
Risk-Readiness of Providers / Networks
WHAT’S OUT THERE?
16

17. 17
a world where you had access to…
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WHAT’S OUT THERE?
Referral patterns
for your hospitals

18. 18
a world where you had access to…
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WHAT’S OUT THERE?
Referral patterns
for your hospitals
Well, that world is here, today.
• Even though the AMA was skeptical about these data
releases for 30 years, the day has finally come.
• You have access to all of these data through government
benchmarks.
• CMS understands network 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.

19. 19
Get to know risk data for your network biz
Rank your markets and docs by Risk-Readiness
Match your docs with the right arrangements
Build your business around your network
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WHAT TO DO WITH IT?

20. 20
WHAT TO DO WITH IT?
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Most data projects…

21. 21
WHAT TO DO WITH IT?
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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

22. 22
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FFS Motto:
“Amortize Investment”
WHAT TO DO WITH IT?

23. 23
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WHAT TO DO WITH IT?
ACA Motto:
“Transparency is the new black”

24. 24
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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?

25. 25
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This is a better approach
New government data outperforms claims data
Patient
records & claims
Practice profiles
Geographic profiles
Market / population
profiles >
David Wennberg, MD
RowdMap Advisory Board
WHAT TO DO WITH IT?

26. 26
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This is a shift
How is variation informing your business model?
Focus here
Cite 20% of patients
/ 80% cost rule
1990s Today &
tomorrow
Say “risk strat” a lot
Use big IT systems Wear Hammer pants
Focus on all
the pieces
including the
deep drivers
using patterns
and profiles
Use decades or research and
brand spanking new data
WHAT TO DO WITH IT?

27. If Dr. Berlin had same ratio as Dr. Milan:
• His decompression rate would drop from
6.01 to 0.436 per patient.
• Which translates to 2,608 fewer
decompressions per year.
• At an average cost of $332 per
decompression, this represents potential
savings of over $850K
If Dr. Berlin's decompression to fusion rate
were average for orthopedic surgeons:
• He would have 1629 fewer
decompressions for a potential savings
of $540K.
For every 10 back fusions Dr.
Berlin* does 103 decompressions
For every 10 back fusions Dr. Milan*
does 2 decompressions.
WHAT TO DO WITH IT?
27

28. If Dr. Berlin had same ratio as Dr. Milan:
• His decompression rate would drop from
6.01 to 0.436 per patient.
• Which translates to 2,608 fewer
decompressions per year.
• At an average cost of $332 per
decompression, this represents potential
savings of over $850K
If Dr. Berlin's decompression to fusion rate
were average for orthopedic surgeons:
• He would have 1629 fewer
decompressions for a potential savings
of $540K.
For every 10 back fusions Dr.
Berlin* does 103 decompressions
For every 10 back fusions Dr. Milan*
does 2 decompressions.
WHAT TO DO WITH IT?
Magnitudes of order larger savings than traditional utilization,
fraud/waste/abuse or compliance/gap closure.
For example, 1 doc in 1 county on 1 DRG funnel
= $850k unwarranted / unexpected spend.
This will not show up in traditional utilization review
or actuarial analysis.
If only 5% of your book is at risk, you don’t care; but
when you move to pay-for-value, this will sink your battleship.
28

29. Here’s why these benchmarks are so powerful
29
GOVT BENCHMARKS IN ACTION
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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

30. 30
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KEY QUESTIONS:
Where is the demand?
Where is the supply?
Which docs match which risk arrangements?
How do I structure my business around this?
(growth alignment, benefit design, STAR/QRS)
GOVT BENCHMARKS IN ACTION

31. 31
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County Health Factors Average Risk Scores
GOVT BENCHMARKS IN ACTION
Population Demand & Provider Supply
Where is health risk underrepresented or under-coded?
Which areas have lower risk scores than their behavioral profile / cost drivers.
In other words, where does the population sees providers less and therefore
has a lower risk profile based on the geography’s ‘supply’.

32. Health Opportunity Index
32
Cost Projection & Network Demand
GOVT BENCHMARKS IN ACTION
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Which counties are high/low performers?
What are the characteristics of my counties?

33. 33
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Diabetes Prevalence –
LA County
PCP Density –
LA County
Income
Obesity
Depression
Population Demand & Provider Supply
GOVT BENCHMARKS IN ACTION
Proximity to provider is more important for this geography.
Is my network aligned to not only meet adequacy
but to reflect my member demographic?

34. 34
Network Opportunity Index (NOI)
GOVT BENCHMARKS IN ACTION
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Where are providers delivering the
most efficient and appropriate care?

35. 35
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Which providers match which arrangements
Good candidates for full
cap and aggressive risk
arrangements
Tread carefully and ramp
up with upside here
GOVT BENCHMARKS IN ACTION
Provider Risk-Readiness
Los Angeles County, CA

36. 36
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without the prior written consent of the Company, is prohibited.
What’s driving a specific provider’s
performance in comparison to peers?
GOVT BENCHMARKS IN ACTION
Los Angeles County, CA
Provider Benchmarks

37. 37
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These are good
Candidates
To focus on Growth
using the Growth
PlayBook
Los Angeles County, CA
Individual Physicians
These are good
Candidates to
focus on
Efficiency using
the Network
PlayBook
GOVT BENCHMARKS IN ACTION
Physician Risk-Readiness

38. 38
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without the prior written consent of the Company, is prohibited.
What’s driving a specific provider’s
performance in comparison to peers?
Los Angeles County, CA
Physician Benchmarks
GOVT BENCHMARKS IN ACTION

39. 39
Market Share & Hospital Benchmarks
Hospital Profiles
GOVT BENCHMARKS IN ACTION
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Cedars Sinai
Medical Center
Los Angeles County, CA
Where are providers delivering the
most efficient and appropriate care?

40. 40
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How do my hospitals perform against national benchmarks?
EOL Hosp Days: Which hospitals fewer end-of-life days than their peers?
Chronic Admits: Which hospitals see their most chronic population repeatedly/ with the most frequency?
Cardiac Imaging: Which hospitals are more likely to over-utilize cardiac imaging compared to their peers?
GOVT BENCHMARKS IN ACTION
Hospital Profiles and Risk Drivers

41. 41
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How do my post acute centers perform against national
benchmarks? How are my hospitals routing, especially those
with poor chronic readmits & post discharge rates?
GOVT BENCHMARKS IN ACTION
Post Acute Center Benchmarks

42. Spending 1-30 Days Post Discharge
Olympia Med Center
Readmissions
42
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What are the
patterns of care and
preferred pathways?
GOVT BENCHMARKS IN ACTION
Hospital Risk Drivers

43. 43
Population Demand & Risk Alignment
GOVT BENCHMARKS IN ACTION
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Price Sensitivity
What price points do I need to hit to be able to grow quickly?
Where do I run the risk of commoditization?

44. 44
Market Portfolio Position
GOVT BENCHMARKS IN ACTION
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What price points do I need to hit to be able to grow quickly?
Where do I run the risk of commoditization?
Portfolio Positioning & Risk Alignment

45. 45
GOVT BENCHMARKS IN ACTION
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without the prior written consent of the Company, is prohibited.
Benefit Configuration & Risk Alignment
What are the winning patterns that draw growth?
What trade offs should I make given my network?
Avg
Pay Later
Pay Now
Typical Markets have at least
two ‘Winning Patterns:’
Pay Now & Pay Later
HealthNet
HealthNet
Aetna
Los Angeles

46. 46
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without the prior written consent of the Company, is prohibited.
Does my Network meet adequacy standards?
It is optimized for Risk-Readiness?
Adequacy Optimized
for Risk-Readiness
GOVT BENCHMARKS IN ACTION
Adequacy & Referrals

47. 47
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without the prior written consent of the Company, is prohibited.
How aggressively are my PCPs referring patients to specialists?
Do the specialists focus on pain management or surgery?
Are the specialists in or out of my network?
How are the specialists performing?
Key Marker:
Referral to Pain Management vs. MRI
Primary Care Physicians (% of Back-related Referrals)
In
Network
Out of
Network
In
Network
Out of
Network
In
Network
Out of
Network
In
Network
Out of
Network
In
Network
Out of
Network
In
Network
Out of
Network
This PCP sends lots of patients to
In-Network surgeons who perform poorly
GOVT BENCHMARKS IN ACTION
Referrals and Risk-Ready Networks

48. 48
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without the prior written consent of the Company, is prohibited.
Los Angeles, County
What is the actual,
not necessarily the contracted,
patient flows between providers
(paths of least resistance) in my market?
Inbound Referrals
Outbound ReferralsInformal Network
1
Informal Network
2
Informal Network 3
Informal Network
4
GOVT BENCHMARKS IN ACTION
Natural Networks and Risk-Readiness

49. 49
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PCPs
What is the actual,
not necessarily the contracted,
patient flows between providers
(paths of least resistance) in my market?
Radiologist
Ortho
GOVT BENCHMARKS IN ACTION
Care Paths and Risk-Ready Networks

50. 50
Growth and Risk-Readiness
GOVT BENCHMARKS IN ACTION
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Which counties will likely generate profit in a P&L
given my network’s characteristics?
California

51. 51
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Top Rep / Broker aligned with
Most Risk-Ready Provider
Bar = Provider and Membership; Color = Producer
No alignment between sales and network
(looks like a pack of skittles blew up)
Alignment between sales and network
(looks like Legos making solid color bars)
Align your best reps with your best providers to build meaningful
relationships and grow into the right providers. This is more what it
should look like. The best producer is concentrating his efforts on
the most Risk-Ready providers.
GOVT BENCHMARKS IN ACTION
Growth and Network Risk-Readiness

52. 52
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Provider A Provider B
Throttle efforts between sales and network on select providers
based on Risk-Readiness to maximize profitability.
GOVT BENCHMARKS IN ACTION
Growth and Network Profitability

53. 53
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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

54. 54
Founders & Team – Multiple Successful
Analytic Companies
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without the prior written consent of the Company, is prohibited.
Melanie Rosenthal – CEO
Co-Founder & CEO @ Sprigley [acquired by Eliza Corporation, 2008]; VP of Product Ops @ Eliza [Majority Equity
Investment Parthenon Capital, 2011]; Health Dialog, Yale, Human Genome Project, Tufte, Solstice Capital
Burak Sezen – CIO
Co-Founder & CTO @ Sprigley [acquired by Eliza Corporation, 2008]; Platform Architect @ Eliza [Majority Equity
Investment Parthenon Capital, 2011], Health Dialog, Pricewaterhouse Coopers; Ernst & Young; Standards Committees
Joshua Rosenthal, PhD – CSO
Co-Founder & CSO @ Sprigley [acquired by Eliza Corporation, 2008]; VP of Product Ops @ Eliza
[Majority Equity Investment Parthenon Capital, 2011], Fulbright, Sorbonne (Applied Institute for Advanced Studies),
HHS/CMS/ONC/NCHVS Public Adviser (Technology & Innovation, Market & Policy, Data Access)
Speaker/Guest Lecturer/Guest @ Harvard, Johns Hopkins, MIT , SXSW, HDI, RWJ, AF4Q, NPR (with US CTO and HHS CTO)
Kimberly Spalding, CPA – CFO
Co-Founder Tech Republic [acquired by CNET, 2001]; Co-founder & CFO Narrowcast
[acquired by QuinStreet, 2011]; Ernst &Young’s Entrepreneurial Services
Bryant Hutson & Ashley Distler – Senior Client Strategists
Cornell, Xavier; Cincinnati Children’s Hospital, Optimity Advisors, Presence Health; Skydiver, Travel Connoisseur
Industry-Leading
Advisory Board
ABOUT ROWDMAP

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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.
Featured Nationally US CTO on
RowdMap:
“Visionary
Genius”
ABOUT ROWDMAP

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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.
ABOUT ROWDMAP
Want to see insights RowdMap has
on your network, your
geography, and your competitors?
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!)

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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.