The document discusses how payers and providers can capture financial value from population health initiatives through value-based payment arrangements rather than traditional fee-for-service models. It notes that publicly available government benchmark data allows for analyzing performance in value-based programs and risk-sharing contracts. The document argues that successfully undertaking population health requires addressing perverse incentives inherent in the fee-for-service system and shifting to a model where keeping populations healthy is the driver of both social good and long-term profitability.

1. 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.

2. 2
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.
No Value Care Meets No IT Needed
Summary
Population Health is more than public and social good, but creates
significant financial benefits through value based arrangements.
Newly released government benchmark data allows
providers and payers to determine whether they will succeed and
how to flourish in pay for value and risk arrangements.
Data have revolutionized technology and other verticals, now open
data from the government and the Centers for Medicare and
Medicaid Services comes to healthcare.
Virtually every provider in the US and their practice patterns and
referrals are available with no IT integration needed.
Build the right network, group, CIN to capture the value you create
through population health programs through shared risk.

3. 3
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.
No Value Care Meets No IT Needed
Why You Should Listen
Learn How to Use Public Government Data to Capture Value from
Population Health through Pay for Value Programs and Risk Arrangements
Not advocating policy/programs servicesNot selling you anything
Bundle-O-MaticACOs-R’-USData/Claim Systems

4. 4
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Why You Should Listen
We’ve done it for 5 years in 42 States, covering over 75MM patients across
and winning financial awards and inking partnerships to help consumers
Won Ernst and Young Entrepreneur
of the Year for financial impact and
public and social good
Doing this with payers covering
all P&Ls and providers of all
types directly and via partners
Partnering with US News (Best
Hospitals and Doctor Finder) to
help patients make good choices

5. 5
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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.
No Value Care Meets No IT Needed
Why You Should Listen
Since this is HIMSS, business need may not be enough, so here’s the
Chief Technology Officer of the United States…
US CTO on
RowdMap:
“Visionary
Genius”
Leading the shift from
fee-for-service to
pay-for-value.

6. 6
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.
No Value Care Meets No IT Needed
Summary
Population Health is more than public and social good, but creates
significant financial benefits through value based arrangements.
Newly released government benchmark data allows
providers and payers to determine whether they will succeed and
how to flourish in pay for value and risk arrangements.
Data have revolutionized technology and other verticals, now open
data from the government and the Centers for Medicare and
Medicaid Services comes to healthcare.
Virtually every provider in the US and their practice patterns and
referrals are available with no IT integration needed.
Build the right network, group, CIN to capture the value you create
through population health programs through shared risk.

7. 7
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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
I have better
engineering / architecture
Hmm, ‘fixing the pipes’
was not the answer
It’s Not a Technology Problem

8. 8
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
It’s Not a Design Problem
I have better
design & experience
Hmm, the pretty colors
on my social app didn’t stop me

9. 9
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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
It’s Not a Data Problem
My data is bigger than yours Hmm,
this fixation indicates...
Silly boys

10. 10
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
It’s Not an ‘Innovation’ Problem
Speaking at a major health care conference near you

11. 11
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
It’s Not a Need another App Problem
*Direct-to-Consumer Note:
People don’t like to pay
out of pocket for something
they don’t like to do or
don’t want to know about
Pro Tip – Average family income in US is ~$42k
and greatest challenges for the least affluent

12. 12
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Capturing Value from Population Health
It’s a Perverse Incentivization Problem
* Source: Dartmouth Atlas for Unwarranted Variation

13. 13
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
It’s a Perverse Incentivization Problem
Keep patients away?!?
I was trying to book you for an extra night!

14. 14
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
We’ve Been Asking the Wrong Questions
How can we capture value by
keeping a population healthy?
The best clinical performers may
be generating the most no-value
care because of FFS incentives

15. 15
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Capturing Value from Population Health
Payers and providers have financial incentives to undertake population health at a
meaningful scale due to the ascendency of value-based programs and risk-bearing
arrangements. These models represent a fundamental change from previous Fee
for Service economic arrangements.

16. 16
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Capturing Value from Population Health
FFS Pay for Value
Two Models for Financing Population Health
VS.
‘Bolt-on’
Social good
Systemic
Social Good

17. 17
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
FFS Pay for Value
Crank out
“Wellness Visits”
Risk Split Upside
(Problem is rolling population
vs. time horizon to capture it)
Marketing /
Enrollment Bump
& Coding ‘bump’
Risk Split Upside
(Problem is rolling population
vs. time horizon to capture it)
Two Models for Financing Population Health

18. 18
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
Majority of
book in FFS
arrangement
Majority of
Book in Pay
for Value
Today
Paid more to perform
more & higher
intensity services
Sicker population may
be more profitable
Paid the same
regardless of service
volume & intensity
Healthier population
is more profitable
Population
Health as Social
Investment
Population
Health Proficiency
as Profit Driver
Upside Up/Downside Full Cap
Low-Value Services
Driving Billing
Low-Value Services
Reduce Profit
MSSP ACO Flat Payment
Government Program
Private Market Arrangement
% of Revenue
Time

19. 19
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
Rating areas with good
population health and
networks
Rating areas with short-
term profitability based
on flawed
reimbursement models
Rating areas
with current
and long-term
profitability
Profitable in the long term.
Profitable today, based on
flawed risk-adjustment.
Going forward, one strategy is to identify and prioritize
growth in these rating areas by reducing premiums in these
long-term profitable rating areas relative to the competition.
Year 1 Year 2 Year 3
Profit from
Reimbursement
Flaws
Profit from
More Efficient
Networks

20. 20
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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.
No Value Care Meets No IT Needed
Capturing Value from Population Health
So how do you succeed at
value based arrangements in
order to capture the value you
create with population health?

21. 21
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.
No Value Care Meets No IT Needed
Summary
Population Health is more than public and social good, but creates
significant financial benefits through value based arrangements.
Newly released government benchmark data allows
providers and payers to determine whether they will succeed and
how to flourish in pay for value and risk arrangements.
Data have revolutionized technology and other verticals, now open
data from the government and the Centers for Medicare and
Medicaid Services comes to healthcare.
Virtually every provider in the US and their practice patterns and
referrals are available with no IT integration needed.
Build the right network, group, CIN to capture the value you create
through population health programs through shared risk.

22. 22
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.
No Value Care Meets No IT Needed
No Value Care
Over $9B in
Orange County, CA
$850 Billion Unnecessary Spend in 2014
(Institute of Medicine)
No-Value
Care (30%)
Necessary Utilization
(70%)
“It’s generally agreed that about
30 percent of what we spend on
health care is unnecessary. If we
eliminate the unneeded care, there
are more than enough resources in
our system to cover everybody.”
-Dr. Elliott Fisher,
Dartmouth Institute for
Health Policy
The economic driver for pay for value programs is the ability of a government program or
marketplace arrangement to not only achieve Triple Aim goals but to also mitigate Low-Value
services, which account for thirty cent of every dollar spent on the delivery of care.

23. 23
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
No Value Care
Often Low-Value Care is the result of perverse incentives from Fee for Service payment
models but identifiable as unwarranted variation within practice patterns.
The estimated 30% of medical expense
that goes to no-value care.
Unnecessary spending drives billing in a
fee-for-serve economic model, but success
in pay-for-value comes from managing and
mitigating these pockets of variation.
Variation: Unwarranted
or Unexplained?
Every physician has a unique fingerprint
Economic Drill Down: Example Utilization Review and Actuarial Unit
Cost Analysis against Care Intensity Curve across Total Basket of Care
Variation across geographies and within practices across physicians.
“Physician-Level Practice Variation: Who You See Is What You Get”
Brian Powers, Sachin Jain, David Cutler, and Ziad Obermeyer
Health Affairs, September 23, 2015
Definitions, research and geocoding by Hospital Referral Regional
available via the Dartmouth Atlas for Unwarranted Variation:
www.dartmouthatlas.org
NB: Unwarranted variation refers to practice patterns, which hold up
across populations but pricing variation may also be unwarranted and
marked fluctuates across insurance product and lines and geography. “The
Price Ain’t Right.” Cooper, Craig, Gaynor and Van Reenen, 2015.

24. 24
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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.
No Value Care Meets No IT Needed
No Value Care
The economic driver behind both the policy push and market drive towards value based
programs, as well as the criteria for success in value based programs is the ability of a
government program to reduce Low-Value Services.
Research Evaluating
CMS & Private Plan Programs:
“Do they reduce
Low Value care?”
CMS Critique of
Fee for Service:
“FFS has too much
Low Value care.”
Popular Press Reporting and
Provider Rankings:
“Consumers are/should
avoid Low value care.”

25. 25
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.
No Value Care Meets No IT Needed
Summary
Population Health is more than public and social good, but creates
significant financial benefits through value based arrangements.
Newly released government benchmark data allows
providers and payers to determine whether they will succeed and
how to flourish in pay for value and risk arrangements.
Data have revolutionized technology and other verticals, now open
data from the government and the Centers for Medicare and
Medicaid Services comes to healthcare.
Virtually every provider in the US and their practice patterns and
referrals are available with no IT integration needed.
Build the right network, group, CIN to capture the value you create
through population health programs through shared risk.

26. 26
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.
No Value Care Meets No IT Needed
New Government Data
CMS has made historic data releases both relevant both for a populations health and behaviors as
well as the practice patterns of providers across the healthcare delivery system, allowing resource
allocation and quantitative measurement of the impact of a given population health initiative.
Open Weather Data Open Health DataOpen Geo-Location Data
Gov Data Powering
a Marketplace
Gov Data Powering
a Marketplace
Gov Data Powering
a Marketplace

27. 27
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
New Government Data
Here’s why these benchmarks are so powerful
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

28. 28
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
New Government Data
Referral Files
(Patient flows between
PCPS, specialists, hospitals
and post acute centers)
Dartmouth Atlas of Health Care &
Choosing Wisely
(Decades of research and data on
unwarranted variation by condition
and geography to keep things
apples-to-apples for comparisons)
CMS FFS Data Sets, CDC Data Sets
(MEDPAR, Part B, Part D, BRFSS)
(Individual providers, groups,
hospitals and post acute centers)
Provider Pattern Intensity Profiles and
Risk Readiness® for every provider,
hospital, post acute center in the US.
All preloaded with no IT.
Affordable Care Act data to determine
Risk-Readiness® of Providers / Networks
Trick Is Tying It together

29. 29
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
New Government Data
Go ahead and Try Your Hand at It
DIY-ers Guide to
Identifying No-Value Care:
http://bit.ly/1QmNzWE

30. 30
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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.
No Value Care Meets No IT Needed
Summary
Population Health is more than public and social good, but creates
significant financial benefits through value based arrangements.
Newly released government benchmark data allows
providers and payers to determine whether they will succeed and
how to flourish in pay for value and risk arrangements.
Data have revolutionized technology and other verticals, now open
data from the government and the Centers for Medicare and
Medicaid Services comes to healthcare.
Virtually every provider in the US and their practice patterns and
referrals are available with no IT integration needed.
Build the right network, group, CIN to capture the value you create
through population health programs through shared risk.

31. 31
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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
An Example: Live in 42 States with 75MM Patients
RowdMap’s Risk-Readiness® benchmarks help health plans, physician
groups, and hospital systems identify, quantify, and reduce delivery of
no-value care—a central tenet of successful pay-for-value programs.
RowdMap has no-value care and
population health benchmarks for…
every physician
every hospital
every zip code
…in the United States.
“It’s generally agreed that about
30 percent of what we spend on
health care is unnecessary. If we
eliminate the unneeded care, there
are more than enough resources in
our system to cover everybody.”
-Dr. Elliott Fisher,
Dartmouth Institute for
Health Policy
No-Value
Care (30%)
Necessary Utilization
(70%)
Did you know that more than $850 billion in
no-value care is delivered annually in the U.S?

32. 32
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Providers in a Market
Groups
Individual Physicians
What is driving a provider’s Risk-Readiness®?
Is it procedures, prescriptions, referrals or visits?
How big is a
provider’s panel?
How ready is a provider
to succeed in risk
compared to peers?
By specialty?
Within a region?
Finger print with
practice patterns
that mitigate
no-value care =
Green Dot
Finger print with
practice patterns
that create
no-value care =
Red Dot
Benchmarks for Risk-Readiness®

33. 33
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Great profile for
aggressive risk
Tread carefully for
some risk
Match Provider Practice Patterns
with Value Based Programs
based on Population Health Behaviors

34. 34
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
RowdMap provides data and analysis on Population Health
factors that drive success in value-based programs:
Behaviors – Broader Definitions of Health with Behaviors
Utilization – Utilization and Costs of Procedures and Drugs
Prevalence – Major Diseases and Conditions
Supply – Number of Primary Care Physicians and Specialists
Socio-demographics – Income, Environment, etc.
Match your
strategies to
your population
to succeed in
value-based
programs

35. 35
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Are you Ready for Risk?
Manage Internal Variation
§ Provider Contracting Strategy
§ Provider Compensation Strategy
§ Process Variation & Improvement
§ Service Line Benchmarking
§ Provider Reporting
§ Provider Recruitment & CIN Build
§ Value Chain & Leakage Reporting
§ Medical Economics Reporting
Are Your Partners Risk Ready?
Pick the Best Partners for Risk Arrangements
§ Primary Care Referral Source Analysis
§ Acute Care Partner Reporting
§ Post Acute Partner Reporting
§ Consulting/Specialty Partner Analysis
§ Competing Groups/Orgs Analysis
What are my best Opportunities for Risk?
Match Providers to Risk
• Risk-Matching to Payers: Government & Private Payers
• Payer Negotiation Reporting
• Medical Economics Modeling

36. 36
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Harris County, TX
Regional Benchmarks
Am I contracting the right providers?
Look at a provider’s panel size, overall risk-readiness benchmark and it’s
individual drivers (procedures, prescriptions and referrals) to determine if
they are a good fit for an overall strategy and a specific contract.
Provider Contracting Strategy
Groups

37. 37
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
PCPs
Regional Benchmarks
Pima Co, AZ
Am I incentivizing providers in a way that will be
successful in risk arrangements?
Incentivize individual physicians based on their overall risk-readiness
benchmark and their individual drivers (procedures, prescriptions and
referrals) to succeed in value based and risk arrangements.
Provider Compensation Strategy

38. 38
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Service Line Benchmarking
What lines of business are the most risk ready and which need
improvements?
Look at a line of service and the overall risk-readiness benchmark and
the individual drivers to identify outliers, best practices and areas to be
improved to succeed in value based and risk arrangements.
Sports Valley
Medicine, LLC

39. 39
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
How do groups and individual providers within the groups compare to
their peers and competition?
Share information about a provider’s risk-readiness against peers and
competition to compare how well they are able to succeed in value base
and risk arrangements.
Provider Reporting
Philadelphia, PA

40. 40
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Provider Recruitment & CIN Build
How do you design and implement CIN that succeed in value based
arrangements?
Select providers that are risk-ready and complement each other’s
practice patterns to create a CIN that succeeds in value based and risk
arrangements.
Saint Louis, MO

41. 41
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Value Chain & Leakage Reporting
Primary Care
Docs
Specialist
Post Acute
Facility
Thickness of lines indicates
the number of referrals.
Note: Some markets are
oversupplied. This market is
controlled by one provider.
Less efficient
More efficient
How does your population flow through the care continuum and when
and where do they fall out?
Identify natural patient flows and determine if your network is
breaking them or reinforcing high value pathways then incentivize
providers to optimize referrals.
Target this PCP / DX Radiologist to
refer more patients to the higher
performing specialist

42. 42
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Value Chain & Leakage Reporting
How does your population flow through the care continuum and when
and where do they fall out?
Identify natural patient flows and determine if your network is
breaking them and causing leakage address through
contracting, education and incentives.
University of Miami is underperforming
and referrals are internal.
This is a concentrated, low value pathway.
Holy Cross has high performing specialists, but its
PCPs are referring to a variety of specialists.
This is a fragmented, but high value pathway.
Group Receiving Referrals
Group
Sending
Referrals

43. 43
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Medical Economics Reporting
How much no value care are you paying for and how much you can
save by line of business and down to individual providers?
Determine the specific economic impact that you create
for whoever owns the risk you manage.
Decreased
Cost
Average
Increased
Cost
Less Efficient
1
2
3
4
5
More Efficient
$ PMPY per Specialty & Efficiency Score
CARDIAC
SURGERY
GASTROENTER
OLOGY
ORTHOPEDIC
SURGERY
DIAGNOSTIC
RADIOLOGY PATHOLOGY
$609 $228 $334 $65 $79
$770 $253 $365 $71 $88
$973 $271 $419 $72 $91
$1,191 $303 $467 $121 $106
$1,299 $387 $624 $245 $212
Cardiac
Surgery
Gastroent
erology
Ortho
Surgeon
Diagnostic
Radiology
Pathology
Impact on
Spend
Risk-Readiness®
Benchmark
Florida

44. 44
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Medical Economics Reporting
How much no value care are you paying for and how much you can
save by line of business and down to individual providers?
Identify how much no-value care you are mitigating and the specific
cost savings it generates for whoever owns the risk.
$ PMPY per Specialty
by County In & Out
Network
In Network
Out of Network
Scenario:
Removing the lowest
performing physicians
Drill down into
Pima County (Phoenix) The highest $PMPY in
Phoenix is with in network
GI docs at $643
In this scenario, they would
have the greatest drop
in $PMPY at $119.
($634 -$119 = $524)
Arizona
$ PMPY per Specialty & Efficiency Score

45. 45
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Primary Care Referral Source Analysis
Referrals to Orthopedists
Group
Sending
Referrals
Group Receiving Referrals
Group Receiving Referrals
Group Receiving Referrals
Group Receiving ReferralsGroup Receiving Referrals
Individual
Physicians
Receiving Referrals
Number of Referrals Performance of
Physicians Receiving
Referrals
Which PCPs are sending patients to a given specialist and
how well do those PCPs perform?
Make sure your PCPs are sending to high performing specialists who
are Risk-Ready to succeed in value based and risk arrangements.

46. 46
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Acute Care Partner Reporting
Which Hospitals are Risk Ready and what are the drivers of success?
Identify the hospitals that are risk-ready and the drivers behind their
practice patterns to succeed in pay for value and risk arrangements.
California

47. 47
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Acute Care Partner Reporting
Cost by DRG
Norton
Medical Surgical
Medical
Surgical
Baptist
Which Hospitals are Risk Ready and what are the drivers of success?
Determine which hospitals are the most efficient and have incentive to
work with your specialty in value based arrangements.

48. 48
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Post Acute Care Partner Reporting
Westchester County, NY
Which Post Acute Facilities are Risk Ready and
what are the drivers of success?
Identify the post acute centers that are risk-ready and the drivers
behind their practice patterns to succeed in pay for value and risk
arrangements
Home Health Top Providers
Orange = Preferred

49. 49
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Regional Benchmarks
Consulting/Specialty Partner Analysis
Which Partners are Risk Ready and what are the drivers of success?
Identify the consulting and specialty partners that are risk-ready and
the drivers behind their practice patterns to succeed in pay for value
and risk arrangements
Harris County, TX

50. 50
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Risk-Matching to Payers: Government & Private Payers Largest Counties in TX
Regional Benchmarks
Risk Scores
Health
Rank
Network
Opportunity
Profit
Opportunity
MA
Profit
Opportunity
Exchange
Medicare
Eligibles /
MA Enrolled
Exchange
Subsidy Eligibles /
Exchange Enrolled
Medicaid
Beneficiary Eligibles /
Beneficiaries
Which value based programs or risk arrangements will be
successful in my population?
Identify my population’s socio-demographics, health behaviors and
prevalence that lead to success in specific value based programs and
private payer risk arrangements

51. 51
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Population Health & Supply Impact on Risk-Readiness®
Risk-Matching to Payers: Government & Private Payers
Which value based programs or risk arrangements will be
successful in my population?
You practice in geographies with specific population health profiles
and a specific supply of care, so these are the pressures you will face

52. 52
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Payer Negotiation Reporting
How do I use government benchmark data to negotiate to my
strengths and a payer’s weaknesses?
Identify performance against national and regional benchmarks.
Highlight where you perform well, addresses and have an explanation
and/or plan for areas that need work.

53. 53
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
What is the financial impact of no value care that you create for payers
that you are not getting credit for?
Identify performance against national and regional benchmarks.
Highlight where you perform well, addresses and have an explanation
and/or plan for areas that need work.
Each dot is a physician.
Groups are created from
specialty, network status,
Efficiency score, and
geography
John Dorchak
NPI: 1528000379
$PMPY: $874
Savings for
removing 5’s
form in
Network
Medical Economics Modeling

54. 54
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Network Development
Create a Risk-Ready Network
• Network Explorer
• Network Builder
• Network Optimizer
• Network Calculator
Product Design & Risk
Design Profitable Products
• Competitive Benefit Design Analysis
• Network Based Benefit Design
• Population Health Based Product Analysis
Sales & Marketing
Grow into Profitable Membership
• Network Based Growth Analysis
• Provider Growth Analysis
• Measuring Growth Analysis

55. 55
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
How do I create my Risk-Ready® network and
which physicians do I need to succeed in Pay-for-Value arrangements?
Optimize your specialist network through PCP referrals. Educate and
contract to create high value specialist networks or design products to
mitigate risk and downstream costs.
Network Builder General Cardiology

56. 56
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Network Calculator
Average Network
efficiency:
$414 PMPY
Market Baseline:
$488 PMPY
Average Network
efficiency:
$208 PMPY
-25%
Removed:
90 physicians
Added:
84 physicians
Removed:
Additional
34 physicians
Added:
Additional
37 physicians
-50%
Average Network
efficiency:
$311 PMPY
Actual Scenario 1 Scenario 2
What are the financial impacts of my decisions and
what does this mean for our 1-year, 5-year, or 10-year forecasts?
Bay Area, CA

57. 57
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Network Based Benefit Design
Premiums relatively low to network performance.
Likely underpricing that will lead to lower profitability.
Premiums relatively high to network performance.
Likely overpricing and losing out on membership.
How do I design benefits to match provider performance
while optimizing profitability?
Design products to drive membership where you have the most efficient
providers. Savings from high performing providers offset lower prices and
create a virtuous cycle of growth.
Network
Efficiency
Rating Area

58. 58
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
How do I design benefits to match population demand
while optimizing profitability?
Determine how the population’s health behaviors, prevalence and
economics impact your profit. Grow into areas that are profitable today
with good drivers for long term sustainability.
Population Health Based Product Analysis
Population
Behaviors
Premium
Variance
Competition
Health Opportunity Index:
Prevalence, health
behaviors & socio-
economic factors
Relative view of client
premiums and captures
the assumed cost of
providing health benefits
to given geography
Premium
Variance
Internal
MLR
Variance
Membership
/ Subsidy
Eligible
Strategy from
Benchmark &
Internal Data
Rating Area
Your Data Goes Here
Benchmark CMS Data
Difference in pre risk
adjusted and post risk
adjusted MLR

59. 59
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Measuring Growth Analysis
Equally Allocate Sales and Marketing EffortsScenario 1
Scenario 2
By targeting marketing efforts around the
highest performing practices how much money will I save?
Targeted Sales and Marketing with Highest Performing Practices
Combined
Average
Efficiency
PMPY:
$238
Combined
Average
Efficiency
PMPY:
$189
-20.6%
Targeted marketing
examples:
• Focused brokers
• Co-marketing
• Affiliation Letters
• Preferential
benefit design

60. 60
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
5 4 3 2 1
Efficiency Score
Membership
Volume/Episodes
Shifting Members and
percentages of care interactions
into our Physicians with
Efficiency Scores of 1-3

61. 61
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Membership & Service Density Change Tactics
Recommended tactics to shift patient interaction flows
Network
• Adding and/or removing providers. Adding high performers, cutting low performers
• Incentivizing efficient referral chains
• Clinical Management of shifting most intense patient encounters to highest performers
Product Design
• Designing products to shift member behavior
• Design products to disproportionately draw members in advantageously by market
• Design products to drive membership where you have the most efficient providers
Sales & Marketing
• Allocate resources strategically in Sales & Marketing efforts to shift membership to high
performers in your network.
• Promote your highest performing providers

62. 62
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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.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Over / Under Coding
County & Zip Code
Under Coding Over Coding
Under-coding
Jacksonville
Overs-coding
Miami
Health Factors
Average Risk Scores
Watch a 2 minute video on the method & concept:
www.bmj.com/content/348/bmj.g2392
RowdMap uses public data on population behaviors within a socio-demographic cohort and risk band to
determine which geographies and providers will likely succeed in the movement from Fee for Service to
Pay for Value and Risk Arrangements.

63. 63
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
Months 1-3 Months 4-6 Months 10-12Months 7-9
Months 1-3 Months 4-6 Months 10-12Months 7-9
Opportunity Assessment
No Deliverables
Initial Findings/
Documentation
Project
Sale/Start
Field Team
On-site – On going
No Value-Add
Team Ramp-Up Period
Value-Add, Actionable Recommendations, Solving Business ProblemsCustomized
Deliverables –Day 1
Pre-Kick Off
Analytics
Client
Kick-Off
Project 1 –
Completed,
Deliverable Submitted
Project 2 –
Completed,
Deliverable Submitted
Project 3 –
Completed,
Deliverable Submitted

64. 64
No Value Care Meets No IT Needed
Identifying Success in Pay for Value
The ACA at your finger tips

65. 65
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Summary
Population Health is more than public and social good, but creates
significant financial benefits through value based arrangements.
Newly released government benchmark data allows
providers and payers to determine whether they will succeed and
how to flourish in pay for value and risk arrangements.
Data have revolutionized technology and other verticals, now open
data from the government and the Centers for Medicare and
Medicaid Services comes to healthcare.
Virtually every provider in the US and their practice patterns and
referrals are available with no IT integration needed.
Build the right network, group, CIN to capture the value you create
through population health programs through shared risk.

66. 66
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Capture the Value You Create in Pop Health
Bridge the Gap in the
Med Economic Transition
By identifying, quantifying and
reducing low value care

67. 67
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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.
No Value Care Meets No IT Needed
Capture the Value You Create in Pop Health
Find the right value based
program based on your provider
patterns around no-value care.
Identify the most efficient providers;
this may not show up in utilization
review or unit cost analysis.
Then negotiate like a pro.
Now, take on risk to capture the value
you create through pop health

68. 68
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without the prior written consent of the Company, is prohibited.
No Value Care Meets No IT Needed
Capture the Value You Create in Pop Health
CMS: 50% of FFS will
be gone by 2018
What if you knew which
providers would
drive your success?
What if you knew which
providers would sink you? WHAT WOULD YOU DO IF YOU KNEW
who will win and who will lose in
value based arrangements