Presentation from a super duper special event at Health Datapalooza with Bryant Hutson and Ashley Distler, Senior Client Strategists at RowdMap. Has Open Health Data produced any successful new companies? Come see a company founded on open health data that has taken the market by storm. RowdMap, an Ernst and Young EY Entrepreneur of the Year® winner works with payers and providers in 48 States covering 100MM Americans. Is Open Data just for consumer apps or traditional B2B problems? Come see open health data used by payers and providers to move from FFS to value based care. 30 Cents of every dollar spent goes to care that doesn’t produce improved outcomes based in FFS. RowdMap identifies and quantifies low value care for virtually every provider the country, then works with payers and providers to reduce it through value based care. One of our country’s most significant challenges is the 30 cents of every dollar to goes to low-value care, or care that doesn’t produce any better outcomes than lower-cost, lower risk alternatives. Low value care accounts for $850BB a year or 3% of GDP and historically has been driven by Fee for Service billing. The promise of data liberation was for new businesses to solve major challenges, and, while there’s been plenty of aspiration and hype, after seven years, meaningful success stories are few and far between. One notable exception is RowdMap, Inc., an Ernst and Young EY Entrepreneur Of The Year® winner, that uses public HHS data to help providers and payers reduce low value care. RowdMap’s clients use HHS data to move from FFS in 48 states, covering 102MM patients and members across provider organizations of all types and payers in exchange/marketplace, commercial, Medicare, Medicaid. RowdMap’s clients includes payers in all lines of business (Marketplace / Exchange, Commercial, Medicare Advantage and Medicaid) and providers in all shapes and sizes (Clinically Integrated Networks, Primary Care Provider Groups, Speciality Provider Groups, Accountable Care Organizations). RowdMap is also the official partner of US News and World Report, publisher of Best Doctors and Best Hospitals.

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Hi, We’re
Ashley &
Bryant

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HEALTH DATAPALOOZA
Summary
Learn more about how both payers and providers are using HHS data to identify, quantify and reduce low-value services as
they move from Fee for Service to Pay for Value arrangements.
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 uses public data including Part B, D and A and referrals as well as BRFSS and other CDC data, viewed in light of
the Dartmouth Atlas for Unwarranted Variation to determine which geographies and providers will likely succeed in the
movement from Fee for Service to Pay for Value and Risk Arrangements.
RowdMap is using HHS data with clients in 48 states and the District of Columbia covering over 100MM members and
patients, with Payers across all lines of business including MA, Medicaid, Exchange/Marketplace, Large Group & Small
Group populations and with Providers including Specialty Groups, PCP groups, CINs, ACOs and Hospital-based systems.
Payers let RowdMap help them use HHS data to move to value based arrangements by building and optimizing networks
then growing through the best providers; Providers let RowdMap help them use HHS data to calculate their real impact of
their practice patterns for whoever owns the risk, using a different approach than traditional utilization or actuarial unit
cost analysis. Providers then pick value-based programs, negotiate with Payers, and make changes to individual
providers and their delivery to succeed in the shift from FFS to Risk.
For helping both Payers and Providers in health care market use HHS data to move from Fee for Service to Pay for Value
arrangements, RowdMap has been named Ernst and Young EY Entrepreneurs of the Year®. RowdMap has also partnered
with US NEWS to help consumers make more informed decisions and avoid low value services by using HHS data.

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HEALTH DATAPALOOZA
What We’re Not Interested in
Learn more about how both payers and providers are using HHS data to identify, quantify and reduce
low-value services as they move from Fee for Service to Pay for Value arrangements.
Not advocating for policy/programsNot selling you anything
Not exploiting models/mechanics for short term gain
Bundle-O-MaticACOs-R’-USData/Claim Systems

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HEALTH DATAPALOOZA
What We Are Interested in
Learn more about how both payers and providers are using HHS data to identify, quantify and reduce
low-value services as they move from Fee for Service to Pay for Value arrangements.
Want to share where your data is being used by payers and providers to
move out of FFS and take on shared risk, sometimes working together with
HHS data as common basis for partnerships and shared risk arrangements.
Used to design networks, change practice patterns and manage care, select
government programs or risk arrangements, pick partners and negotiate
risk, design financially viable products and as evaluate criteria to for success
value based arrangements.
Want to share your data holds up extends to providers and payers in
marketplace/exchange, commercial large/small group, etc.
Want to advocate for continued data releases.
Basically, encourage HHS & the market to keep rocking the mike!

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HEALTH DATAPALOOZA
Who Uses HHS Data for Real Strategy & Ops?
Learn more about how both payers and providers are using HHS data to identify, quantify and reduce
low-value services as they move from Fee for Service to Pay for Value arrangements.
Health plans and providers in 48 states and the District of Columbia
use RowdMap and HHS data to reduce the delivery of no-value care.
The clients RowdMap serves collectively cover the lives of
more than 100 million Americans.
Here’s where HHS Data is being used to move from FFS to Value Base Arrangements
(not ‘pilot’ or ‘innovation’ programs) but active operational programs.
Clients using HHS data include National, Regional & Boutique
Payers in Marketplace/Exchange, MA, Medicaid,
Commercial and Government Programs as well as
Providers including PCP & Specialty Groups, CINs & Systems,
ACOs, Bundles & other CMMI Program Participants.

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HEALTH DATAPALOOZA
Low-Value Services: Why You Should Give a Darn
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.
Over $9B in
Orange County, CA
$850 Billion Unnecessary Spend in 2014
(Institute of Medicine)
Institute of Medicine (IOM) report, “Best Care at Lower Cost,” (Sept. 2012) estimates that
the United States lost $750 billion in 2012. (Adjusted in 2013 at $800BB, 2014 at $850BB.)
This is about 3% of GDP.
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
“Bigger than higher prices,
administrative expenses, and
fraud, however, was the amount
spent on unnecessary health-care
services.” In just a single year,
up to 42% of patients receive
“No Value” Care.
- Dr. Atul Gawande,
Department of Health Policy and
Management at the Harvard
School of Public Health &
Department of Surgery at
Harvard Medical School

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HEALTH DATAPALOOZA
Low-Value Services: Broad, Increasing Interest
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.
Research Evaluating
CMS & Private Plan Programs:
“Do they reduce
Low Value care?”
Popular Press Reporting and
Provider Rankings:
“Consumers are/should
avoid Low value care.”
Critique of
Fee for Service:
“FFS has too much
Low Value care.”
RowdMap
partner
Recommended
evaluation criteria for
value based plans from
payers/providers

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HEALTH DATAPALOOZA
Low Value Services: Payment Model-Driven
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.
Asking a different question: We’re not trying to change provider behavior,
but rather create a virtuous economic cycle where docs who mitigate low-value
services get paid more and pull in more patients / members
Okay, explain what we’re trying to do

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HEALTH DATAPALOOZA
Low Value Services: Practice Variation
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.
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, & Ziad Obermeyer Health Affairs, 09.23.15
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.

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HEALTH DATAPALOOZA
RowdMap’s Risk-Readiness® Benchmarks
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.
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
Risk-Readiness® Benchmarks

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HEALTH DATAPALOOZA
Data Sources & Uses
RowdMap uses public data including Part B, D and A and referrals as well as BRFSS and other CDC data,
viewed in light of the Dartmouth Atlas for Unwarranted Variation to determine which geographies and
providers will likely succeed in the movement from Fee for Service to Pay for Value and Risk Arrangements.
Happy to go through deep methods in alternative format; essentially we’re taking a different approach.
Rather than a typical diagnosis/risk/spend association model, we’re following a population-based, top-down approach
to hot spot and drill into unexplained variation, then attempt to explain it through financial/contracting and
clinical/population drivers.
In specific cases, we do run client claims data and have their financials (MLR, actual profitability, provider contracts,
etc.) but to validate/calibrate benchmarks and to “explain” the variation.
We are not grouping episodic treatments to see what spending belongs which event, nor are we looking at individual
patients with a bottom up total cost of care model, but rather we are taking a population-based approach, comparing
practice patterns across procedures, prescriptions, visits and grouping physicians with similar profiles and asking how
to they spend their time and on what compared to their peers within a region.
We essentially bin providers using the HHS benchmarks then adjust and measure them in different ways, sometimes
with a client’s particular methodology. Sometimes profiling the same providers from two separate vantage points, on
behalf of a payer and a provider within the same market, or a PCP groups and specialty group in the same market.
In other words, we are looking at ratios around unexplained variation and within an episode or across a total basket/
bundle of care is there too much/little low-value service given the patterns. For instance, is there too little pain
management give the volume and intensity of specific surgeries, which leads to excess readmissions. Sometime the
variation is unwarranted; sometimes it is explained via financials and contract incentives.

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HEALTH DATAPALOOZA
Data Sources & Uses
RowdMap uses public data including Part B, D and A and referrals as well as BRFSS and other CDC data,
viewed in light of the Dartmouth Atlas for Unwarranted Variation to determine which geographies and
providers will likely succeed in the movement from Fee for Service to Pay for Value and Risk Arrangements.
Medicare DocGraph
Referral file
(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

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HEALTH DATAPALOOZA
Data Sources & Uses
RowdMap uses public data including Part B, D and A and referrals as well as BRFSS and other CDC data,
viewed in light of the Dartmouth Atlas for Unwarranted Variation to determine which geographies and
providers will likely succeed in the movement from Fee for Service to Pay for Value and Risk Arrangements.
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.
BRFSS etc. to
minimize observation
intensity bias (HCCs) and
match strategies to a
population to succeed in
value-based programs
David Wennberg, MD
RowdMap Advisory Board

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HEALTH DATAPALOOZA
Data Sources & Uses
RowdMap uses public data including Part B, D and A and referrals as well as BRFSS and other CDC data,
viewed in light of the Dartmouth Atlas for Unwarranted Variation to determine which geographies and
providers will likely succeed in the movement from Fee for Service to Pay for Value and Risk Arrangements.
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

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HEALTH DATAPALOOZA
Market Adoption
RowdMap is using HHS data with clients in 48 states and the District of Columbia covering over
100MM members and patients, with Payers across all lines of business including MA, Medicaid,
Exchange / Marketplace, Large Group & Small Group populations and with Providers including
Specialty Groups, PCP groups, CINs, ACOs and Hospital-based systems.
Facilitating structured conversation between payers and providers to take on
shared risk using HHS benchmark data as a common foundation.
Goal is virtuous cycle of best docs getting paid more with more members (30
cents per $ allows much more to play with).
Removes contention as at the end of the day if the parties don’t agree,
they can write risk contracts to address any issues of disagreement.
Summary of Adoption:

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HEALTH DATAPALOOZA
Market Examples – Compensating Providers
Payers let RowdMap help them use HHS data to move to value based arrangements by building and
optimizing networks then growing through the best providers; Providers let RowdMap help them use
HHS data to calculate their real impact of their practice patterns for whoever owns the risk, using a
different approach than traditional utilization or actuarial unit cost analysis. Providers then pick value-
based programs, negotiate with Payers, and make changes to individual providers and their delivery to
succeed in the shift from FFS to Risk.

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HEALTH DATAPALOOZA
Market Examples – Network Optimization
Payers let RowdMap help them use HHS data to move to value based arrangements by building and
optimizing networks then growing through the best providers; Providers let RowdMap help them use
HHS data to calculate their real impact of their practice patterns for whoever owns the risk, using a
different approach than traditional utilization or actuarial unit cost analysis. Providers then pick value-
based programs, negotiate with Payers, and make changes to individual providers and their delivery to
succeed in the shift from FFS to Risk.

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HEALTH DATAPALOOZA
Market Examples – Value-Based Care Chains
Payers let RowdMap help them use HHS data to move to value based arrangements by building and
optimizing networks then growing through the best providers; Providers let RowdMap help them use
HHS data to calculate their real impact of their practice patterns for whoever owns the risk, using a
different approach than traditional utilization or actuarial unit cost analysis. Providers then pick value-
based programs, negotiate with Payers, and make changes to individual providers and their delivery to
succeed in the shift from FFS to Risk.

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HEALTH DATAPALOOZA
Market Examples – Virtuous Growth Cycle
Payers let RowdMap help them use HHS data to move to value based arrangements by building and
optimizing networks then growing through the best providers; Providers let RowdMap help them use
HHS data to calculate their real impact of their practice patterns for whoever owns the risk, using a
different approach than traditional utilization or actuarial unit cost analysis. Providers then pick value-
based programs, negotiate with Payers, and make changes to individual providers and their delivery to
succeed in the shift from FFS to Risk.

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HEALTH DATAPALOOZA
Market Examples – Ensure Financial Viability
Payers let RowdMap help them use HHS data to move to value based arrangements by building and
optimizing networks then growing through the best providers; Providers let RowdMap help them use
HHS data to calculate their real impact of their practice patterns for whoever owns the risk, using a
different approach than traditional utilization or actuarial unit cost analysis. Providers then pick value-
based programs, negotiate with Payers, and make changes to individual providers and their delivery to
succeed in the shift from FFS to Risk.

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HEALTH DATAPALOOZA
Market Examples – Design Profitable Products
Payers let RowdMap help them use HHS data to move to value based arrangements by building and
optimizing networks then growing through the best providers; Providers let RowdMap help them use
HHS data to calculate their real impact of their practice patterns for whoever owns the risk, using a
different approach than traditional utilization or actuarial unit cost analysis. Providers then pick value-
based programs, negotiate with Payers, and make changes to individual providers and their delivery to
succeed in the shift from FFS to Risk.

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HEALTH DATAPALOOZA
Market Examples – Achieve Financial Viability
Payers let RowdMap help them use HHS data to move to value based arrangements by building and
optimizing networks then growing through the best providers; Providers let RowdMap help them use
HHS data to calculate their real impact of their practice patterns for whoever owns the risk, using a
different approach than traditional utilization or actuarial unit cost analysis. Providers then pick value-
based programs, negotiate with Payers, and make changes to individual providers and their delivery to
succeed in the shift from FFS to Risk.

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without the prior written consent of the Company, is prohibited.
HEALTH DATAPALOOZA
You Rock
For helping both Payers and Providers in health care market use HHS data to move from Fee for Service
to Pay for Value arrangements, RowdMap has been named Ernst and Young EY Entrepreneurs of the
Year®. RowdMap has also partnered with US NEWS to help consumers make more informed decisions
and avoid low value services by using HHS data.
This is a win from establishment
outside healthcare recognizing
the power of HHS data to positively
transform the market & economy
This is consumers demanding
to make informed decisions
using HHS data and providers
internalizing impact
This is start ups making real
impact and traditional market
powers adopting HHS data to
move from FFS to Pay for Value

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HEALTH DATAPALOOZA
You Rock
For helping both Payers and Providers in health care market use HHS data to move from Fee for Service
to Pay for Value arrangements, RowdMap has been named Ernst and Young EY Entrepreneurs of the
Year®. RowdMap has also partnered with US NEWS to help consumers make more informed decisions
and avoid low value services by using HHS data.
Told
‘ya
Market
Incentive
Open
Data
Positive Disruption in
a Complex System

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No-Value
Care (30%)
Necessary Utilization
(70%)
Care That Doesn’t Produce Better Outcomes
$850 Billion Unnecessary Spend in 2014
(Institute of Medicine)
No-Value Care:
.30 / Each $ Is Wasted
Low Value Care
Drives Billing in
Fee for Service
“#1 Weakness of FFS
Payment System Is
Excess Use of
Low Value Services”
Dr. Patrick Conway,
Chief Medical Officer, CMS

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:
CMS Is Paying on It
2016 World Economic Forum
Annual Meeting in Switzerland
On track to
sunset 50% of FFS

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without the prior written consent of the Company, is prohibited.
“Millions of people are receiving drugs that aren’t
helping them, operations that aren’t going to make
them better, and scans and tests that do nothing
beneficial for them, and often cause harm.”
Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard
School of Public Health & the Department of Surgery at Harvard Medical School.
No-Value Care:
Media Is Reporting on It

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without the prior written consent of the Company, is prohibited.
"It's no secret that patients often undergo unnecessary procedures that can
be dangerous and costly." Through our collaboration with RowdMap, we are
providing patients with meaningful information about these no- or low-value
treatments, allowing them to make better, more informed decisions about
their doctors, hospitals and medical care.”
No-Value Care:
Consumers Demand It

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without the prior written consent of the Company, is prohibited.
RowdMap has no-value care and
population health benchmarks for…
every physician
every hospital
every zip code
…in the United States. What if you knew which
providers would
drive your success?
No-Value Care:
RowdMap Has It

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ABOUT ROWDMAP
What We Do
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.

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Leading the way…
US CTO on
RowdMap:
“Visionary
Genius”
ABOUT ROWDMAP
Market & Media Response
…in the shift from fee-for
service to pay-for-value.
And featured in… RowdMap Partner

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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