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HodgePodge Health

Hospitals ACA

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Medicare Advantage

ACOs

32 of these organizations were approved CMS in 2011, only 23 exist today.

What are Pioneer ACOs? The highest performing Pioneer ACO in the

country is our client, Montefiore. Nine dropped, but seven reformed as MSSP

ACOs.

ACOs are measured on this many quality metrics to

determine a shared savings amount?

What is 33? A fully deployed platform of Jiva can assist an ACO

in all 33 metrics.

ACOs focus on the Medicare population. As of today, this many

lives are covered by ACOs?

What is 5.3M?

In the ACO world, there are advanced payment ACOs,

Pioneer ACOs, and this type with two tracks.

What is Medicare Shared Savings Plan (MSSP)?

Two tracks:

Upside only, less money (50%)

Upside and downside, more money but more risk with shared losses (60%)

606

What is the total number of public and private ACOs

today?

On the MA 5 Star Ratings System, if a plan performs less below three stars for this many years, CMS can

pull their contract.

What is 3 years?

2014 is the “contract” year or last year for the three your bonus plan to incent quality. Plans that achieve 4

stars will receive this bonus percentage.

What is 5%

- Measures for Hospital Inpatient Quality Reporting

- Use of Highly rated hospitals by plan

- Survey measures of care coordination from CAHPS

- MTM

- Grievance per 1000

- Reportable Adverse events

- SNP Care Management measures

What are the new proposed measures

for 2014 MA Plans?

In 1965, under the leadership of President

Johnson, Congress created entitlement law

for age 65 and over.

What is Medicare?

The number of Medicare Advantage contracts in 2014.

What is 725?

On the 5 Star Ratings System, if a plan performs

less below three stars for this many years, CMS can cancel

their contract.

What is three years?

In Medicare Advantage, this is the 6 week window to enroll

new patients.

What is AEP (Annual Enrollment Period)?

Go to CMS.gov to find membership numbers (updated

monthly) and star ratings.

True or False. A citizen has to 65 years or older

to enroll in Medicare Advantage?

What is False?

Roughly 20% of Medicare Advantage members qualify

through ESRD or other Special Needs provision.

In total, MA plan enrollment rose by 8.9 percent to 15.9 million enrollees, up from 14.6 million in 2013. This represents ____ % of the

eligible population.

What is 30 percent of all eligible Medicare

beneficiaries. This market will continue to flourish.

New in 2014, plans with this many stars can enroll new patients at any time

throughout the year.

What is 5? Plans striving for 5 stars represent an

opportunistic market for ZeOmega as they strive for this competitive advantage.

Of:

7600

5700

4000

3300

, this is the Number of US Registered Hospitals in the US in 2014

What is 5,700 or 5,723 hospitals to

be exact.

2,894 or 1,068. This is the number of investor-

owned (for profit) in the US.

What is 1,068? Nearly triple the amount of non-profits, which was 2,894

in 2014.

True or False. According to the AHA, 3,007, or roughly 53 percent of hospitals are

part of a health system.

What is the truth?

The average cost per inpatient day is $2,025 for nonprofit

hospitals and $1,629 for for-profit hospitals. What is the

average length of stay?

The average length of stay for an acute-care hospital admission is 4.8

days. With proper care management and care transitions,

Jiva can drive down LOS costs.

The numbers represent the US average hospital _____.

•Medicare: 40.9 percent

•Medicaid: 17.2 percent

•Blue Cross Blue Shield, other private insurance: 16.5 percent

•HMO or PPO: 14 percent

•Self-pay: 4.9 percent

•Worker's compensation and other government programs: 2 percent

What is payer mix?

•Medicare: 40.9 percent

•Medicaid: 17.2 percent

•Blue Cross Blue Shield, other private insurance: 16.5 percent

•HMO or PPO: 14 percent

•Self-pay: 4.9 percent

•Worker's compensation and other government programs: 2 percent

The market of healthcare wherein the prices it bills for procedures and exams are set by a formula that is somewhat based on

what these instruments of health care actually cost. With private insurance

hospitals and doctors have much more leverage to set prices.

What is Medicare?

This market segment comprises 13% of the population but account for 30% of health

care spending

What is 65 +?

The healthcare system costs around $2.6 trillion in 2012 and is expected to rise to $4.8 trillion by 2021. It is estimated that much is considered waste: 20%, 30%, or

40%

30%

30% of $4.8 trillion is

$1,440,000,000,000.00

__ of 10 Americans have a pre-existing condition.

What is 5?

It’s the year 2020, she will continue to serve ZeOmega’s

strategy as the company’s Chief Growth Officer, although she has had this role, too, since founding

the company in 2001.

What is 10?

Make your wager

If we were to fix a health system by 2021, and eliminate just 3% of the waste through optimized care management, or

what others call population health, the US system would savethis much?

$144 billion