1. P R O V I D I N G P O W E R F U L S O L U T I O N S Will you be Health Systems to become a payer?

2. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Todays Agenda Is becoming a payer worth the risk? What does Network Adequacy mean? What is my marketable service area? What is the financial opportunity with Medicare Advantage? Do I have the right mix and enough providers? Where is my network lacking? How do I fill deficiencies? 3. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Here to Guide theWay Whats your Quest? Darren Huff, East Region Sales Darren.Huff@QuestAnalytics.com Contact us at: 920.739.4552 4. Worth the Risk? 1 in 5 Health Systems to Become Payers by 2018 A growing number of health systems are deciding that it is worth the risk. In a June survey of more than 100 hospitals and health system across the country, 34 percent responded that they already own health plans. Another 21 percent said they plan to launch a health insurance plan by 2018, according to the Advisory Board. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 http://www.healthleadersmedia.com/page-1/HEP-295415/1-in-5-Health-Systems-to-Become-Payers-by-2018 That equates to 55% of todays health systems will be Payers by 2018 5. When is Network Adequacy Required? PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 DOI Commercial Insurance Market Medicaid Programs Medicare Programs FFM & SBM 6. What is Network Adequacy? PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 7. Its like you wouldnt want to buy a car without an adequate engine. You dont want to buy an insurance plan that doesnt have an adequate network, because when you actually go to use that product, its not going to work. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Claire McAndrew, private insurance program director at Families USA, told AISs Health Reform Week. 8. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Insurance Departments 9. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Commercial Market 10. Medicaid Requirements PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 201.4 11. Minimum number of providers Must contract with sufficient numbers of each provider specialty type Must contract with sufficient number of each HSD facility type Maximum Travel Time & Distance to Providers/Facilities 90% of beneficiaries have access to at least one provider/facility Contracted providers are not limited to the boundaries of the county or counties as long as the provider is within the time & distance requirement CMS ADEQUACY PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 12. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 2015 PROVIDERT/D Requirements Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) Time (minutes) Distance (miles) 001 General Practice 002 Family Practice 003 Internal Medicine 004 Geriatrics 005 Primary Care - Physician 006 Primary Care - Nurse S03 Primary Care 10 5 15 10 30 20 40 30 70 60 007 Allergy and Immunology 30 15 45 30 80 60 90 75 125 110 008 Cardiology 20 10 30 20 50 35 75 60 95 85 010 Chiropractor 30 15 45 30 80 60 90 75 125 110 011 Dermatology 20 10 45 30 60 45 75 60 110 100 012 Endocrinology 30 15 60 40 100 75 110 90 145 130 013 ENT/Otolaryngology 30 15 45 30 80 60 90 75 125 110 014 Gastroenterology 20 10 45 30 60 45 75 60 110 100 015 General Surgery 20 10 30 20 50 35 75 60 95 85 016 Gynecology, OB/GYN 30 15 45 30 80 60 90 75 125 110 017 Infectious Diseases 30 15 60 40 100 75 110 90 145 130 018 Nephrology 30 15 45 30 80 60 90 75 125 110 019 Neurology 20 10 45 30 60 45 75 60 110 100 020 Neurosurgery 30 15 60 40 100 75 110 90 145 130 021 Oncology - Medical, Surgical 20 10 45 30 60 45 75 60 110 100 022 Oncology - Radiation/Radiation Oncology30 15 60 40 100 75 110 90 145 130 023 Ophthalmology 20 10 30 20 50 35 75 60 95 85 025 Orthopedic Surgery 20 10 30 20 50 35 75 60 95 85 026 Physiatry, Rehabilitative Medicine 30 15 45 30 80 60 90 75 125 110 027 Plastic Surgery 30 15 60 40 100 75 110 90 145 130 028 Podiatry 20 10 45 30 60 45 75 60 110 100 029 Psychiatry 20 10 45 30 60 45 75 60 110 100 030 Pulmonology 20 10 45 30 60 45 75 60 110 100 031 Rheumatology 30 15 60 40 100 75 110 90 145 130 033 Urology 20 10 45 30 60 45 75 60 110 100 034 Vascular Surgery 30 15 60 40 100 75 110 90 145 130 035 Cardiothoracic Surgery 30 15 60 40 100 75 110 90 145 130 2015 Provider Time and Distance Requirements Metro Micro Rural Specialty Geographic Type CEACLarge MetroCMS Code 13. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 2015 FACILITYT/D Requirements Number/ 1,000 Maximum Time (minutes) Maximum Distance (miles) Maximum Time (minutes) Maximum Distance (miles) Maximum Time (minutes) Maximum Distance (miles) Maximum Time (minutes) Maximum Distance (miles) Maximum Time (minutes) Maximum Distance (miles) 040 Acute Inpatient Hospitals 12.2 20 10 45 30 80 60 75 60 110 100 041 Cardiac Surgery Program NA 30 15 60 40 160 120 145 120 155 140 042 Cardiac Catheterization Services NA 30 15 60 40 160 120 145 120 155 140 043 Critical Care Services Intensive Care Units (ICU)NA 20 10 45 30 160 120 145 120 155 140 044 Outpatient Dialysis NA 20 10 45 30 65 50 55 50 100 90 045 Surgical Services (Outpatient or ASC) NA 20 10 45 30 80 60 75 60 110 100 046 Skilled Nursing Facilities NA 20 10 45 30 80 60 75 60 95 85 047 Diagnostic Radiology NA 20 10 45 30 80 60 75 60 110 100 048 Mammography NA 20 10 45 30 80 60 75 60 110 100 049 Physical Therapy NA 20 10 45 30 80 60 75 60 110 100 050 Occupational Therapy NA 20 10 45 30 80 60 75 60 110 100 051 Speech Therapy NA 20 10 45 30 80 60 75 60 110 100 052 Inpatient Psychiatric Facility Services NA 30 15 70 45 100 75 90 75 155 140 054 Orthotics and Prosthetics NA 30 15 45 30 160 120 145 120 155 140 055 Home Health NA 056 Durable Medical Equipment NA 057 Outpatient Infusion/Chemotherapy NA 20 10 45 30 80 60 75 60 110 100 061 Heart Transplant Program NA 062 Heart/Lung Transplant NA 064 Kidney Transplant Program NA 065 Liver Transplant Program NA 066 Lung Transplant Program NA 067 Pancreas Transplant Program NA 2015 Facility Time and Distance Requirements Specialty Micro Rural CEACMetro CMS Code Large Metro Geographic Type 14. FFM & SBM PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 .Unlike the certification process for benefit year 2014, CMS will no longer simply utilize issuer accreditation status, identify states with review processes at least as stringent as those identified in 45 C.F.R. 156.230(a), or collect network access plans as part of its evaluation of plans network adequacy. Rather, CMS will assess provider networks using a reasonable access standard, and will identify networks that fail to provide access without unreasonable delay as required by 45 C.F.R. 156.230(a)(2). In order to determine whether an issuer meets the reasonable access standard, CMS will focus most closely on those areas which have historically raised network adequacy concerns. 15. SBM: Exchange Requirements PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Compliance with the distance standards will be achieved if 95 percent of the population of the geographic service area or existing HMO membership is within the distance standards of the providers with whom the Carrier contracts. The minimum distance standards for PPO insureds will be achieved if 50 percent of the population of the geographic service area or the Carriers enrolled membership is within the distance standards of the providers with whom the Carrier contracts. Specialty Urban Rural Frontier Ratio Time Distance Time Distance Time Distance Adult PCP 2500 45 45 60 60 100 120 OBGYN 2500 45 45 60 60 100 120 Pediatrics 2500 45 45 60 60 100 120 Urgent Care 5000 45 45 60 60 100 120 Emergency Medicine 5000 30 30 60 60 75 90 Mental Health 30000 30 30 60 60 90 90 Substance Abuse 30000 30 30 60 60 90 90 Cardiology 7500 60 60 90 90 180 180 Dermatology 17500 60 60 90 90 180 180 Gastroenterology 25000 60 60 90 90 180 180 Hematology/Oncology 17500 60 60 90 90 180 180 Nephrology 10000 60 60 90 90 180 180 Ophthalmology 27500 60 60 90 90 180 180 Orthopedics 10000 60 60 90 90 180 180 Otolaryngolgoy 25000 60 60 90 90 180 180 Pulmonology 20000 60 60 90 90 180 180 Surgery 12500 60 60 90 90 180 180 Urology 25000 60 60 90 90 180 180 *Essential Community Hospitals 60 60 90 90 180 180 16. How can I evaluate my current provider network to know if I meet Network Adequacy? PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 17. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 18. Where do I start? PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 19. What is my marketable service area? PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 20. Why isnt DC a slam dunk? PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 21. Revenue Opportunity HSD Reference File Reimbursement Rates 22. Revenue Opportunity PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 23. Do I have the right mix and enough providers? PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 24. Quest Analytics PROVIDER IMPACT ANALYSIS Additional Services 25. PROVIDER RANKING Any single provider at one of these locations would provide access to 90% of membership. Very little or no impact, not worth the effort. Have an impact, but would not meet by their single location. Results of a provider ranking analysis report based on a recruitment list. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 26. MEASURING IMPACT PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 27. MEASURING IMPACT across counties PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 28. UTILIZATION/COST/QUALITY PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 29. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 30. BUILT withVISION QUEST ANALYTICS SUITE The industry's only software solution that has continued to evolve to meet the changing demands of Network Adequacy. The Quest Analytics Suite fully integrates; Access, Disruption, Network Adequacy (Medicare and Custom), Address-level Geocoding and Hospital Quality Analysis into one easy to use suite. 31. QUEST ANALYTICS SUITE ACCESS ANALYSIS Access Analysis I Access Comparison I Mapping ADEQUACY ANALYSIS Medicare Advantage I Medicaid I Dual Eligibles I Exchanges I Commercial GEOCODER & DATA STANDARDIZATION Address-Level Accuracy I Data Standardization I Zip Correction DISRUPTION ANALYSIS Transparency & Confidence I Provider Change Analysis QUALITY NETWORK ANALYSIS Hospital Quality I Tiered Networks PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 32. Quest Analytics THE QUEST CLIENT FAMILY Absolute Total Care AcariaHealth Adena Health Plan Advantica Advicare Aetna AlwaysCare American Republic AmeriGroup AmeriHealth Mercy AmeriHealth NJ Ameritas Amida Arcadian Health Plan Archcare Argus Argus Dental Arkansas BCBS Assurant Health Atrio Health Plan Aultman Avesis AvMed Bay Care Physicians BeechStreet Benecard PBM BeneCare Blue Cross Idaho BCBS Arizona BCBS Kansas City BCBS Michigan BCBS Nebraska BCBS North Carolina BCBS Tennessee Bluegrass BlueShield CA Mount Carmel MVP Health Care Navitus Neighborhood Rhode Island Network Health MA Network Health Plan of Wisconsin Nevada COOP New Mexico Health Connection NorthShore LIJ Health System NovaSys Health OnPoint OptiCare Managed Vision PacificSource Palladian Parkview Health Plan PatientChoice Peach State Health Plan Physicians Health Physicians United Plan Piedmont Community Premier Access Premier Eye Care Premiere Health Prime Therapeutics PrimeWest Principal Priority Health Regence/Cambia ReStat Revolv Sanford Health SCAN Scion Dental Elderplan ElderServe Encore Evolent Fallon Community FamilyCare-OR Family Health Network Fidelis Florida Combined Life Florida Health Care Plus Freedom Health Gateway Geisinger GemCare Glenridge Healthcare Gorman Granite State Health Plan Group Health Coop Guardian Harvard Pilgrim HFN HHH HSAG HealthNet HealthNow HealthPartners MN Health Partners PA Health Plan of MI Health Smart HealthSpan Health Spring Health Velocity Heritage Health 33. Quest Analytics Health Systems Aultman BayCare Health System Catholic Health Initiatives Geisinger Health System Memorial Hermann Healthcare System Mount Carmel North Shore-LIJ Health System, Inc Parkview Health Sanford Health Trinity Health & Catholic Health East University of Arizona Health Virginia Premier 34. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Partnerships 35. Quest Analytics VALUE PROPOSITION 36. Providing Network Adequacy SOLUTIONS Competitive Edge Network Adequacy Pass/Fail Results with MA Provider and Facility Tables Market Opportunity Return on Expansion Government Programs & Commercial All in One Solution-Access/Adequacy/Disruption/Geocoder/Quality Meeting Needs Across Departments-IT/Sales/Contracting/Member Services A long-term solution in place to meet current and future needs with automation and integration options Desktop API/Server Cloud An Industry Partner Software updates, including year-over-year criteria changes Innovation (Optional) Provider Impact Analysis Services 37. TRAINING & SUPPORT Onsite, Hands-on Training Regular Data Updates Feature Additions and/or Enhancements LinkedIn Support Group Whats New Web Overviews with New Releases Unlimited phone, email and web-based support - all US based. Annual User Conference PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 38. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Q&A Whats your Quest? Darren Huff, East Region Sales Darren.Huff@QuestAnalytics.com Contact us at: 920.739.4552 39. QUALITY UNDERSTANDING EVOLVING SUPPORT TEAM Network Adequacy Experts Providing POWERFUL I CONSISTENT I PROVEN Solutions