- GuideWell is a large non-profit health services organization with over $12 billion in revenue serving 15 million people across 14 states, including over 5 million in Florida. It has 11,000 employees and 45 terabytes of data. - GuideWell is shifting from fee-for-service to value-based care through integrated partnerships, population health management, and value-based contracts across products. This allows for better data sharing, coordination, and preventative care. - The benefits of this approach include improved access to data, less siloed care management, and better financial alignment between payors and providers.

1. René Lerer, M.D.
President, GuideWell

2. o Serves 15 million people across 14 states
with over 5 million in Florida
o $12 billion revenue
o 11,000 employees
o A data warehouse with approximately
45 terabytes of data
o Significant available capital
2

3. Health
Insurance
Business

4. Shift to value-based world
4
o Fee-for-service: volume based
o Independent practices practicing
independently, often in silos
o Limited clinical integration &
information sharing
o Reactive “sick-care”
o Aligned incentives via value-based
contracts across multiple products
o Common governance & shared data
o Emphasis on wellness, prevention &
population health management
o Proactive “health care”
o Integrated & aligned partners that
unlock the value of the partnership
o Division of responsibilities to each
party based on who’s best positioned
to serve the patient
o Next-generation insurance products
with unique value propositions &
patient experience

5. What are the benefits?
5

6. o Create value from clinical integration and physician acquisitions
o Better access to longitudinal data & real time information on patient
populations
o Less “mother-may-I” care management
o Better financial alignment with payors and less zero-sum gain
negotiations
What hospitals expect
6
o Reduced bad debt from patient liability
o Solutions that reduce the number of Floridians
without insurance coverage
o Ambulatory care services (rad, lab, surg) in-
migration vs. out-migration
o Support to transition from volume to value

7. o Serve as patient’s health care quarterback in a
model that makes it financially viable to do so
o Improved cost and quality data to make more
informed referral decisions for patients
o Reduced bad debt from patient liability
What physicians expect
7
o Less “mother-may-I” care management
o Technology and back-office solutions that allow the option for
practices to remain independent in an industry that is rapidly
consolidating
o More patient time and less administrative hassle
o Support with coding and documentation for accurate risk adjustment
and STARs performance

8. o Leverage provider partners with feet on the street,
multidisciplinary care management models for
high-risk patients
o Engaged primary care partners and select specialists
to serve as the patient’s medical home
o Mitigation of unit cost pressure
What payors expect
8
o Less provider consolidation for the wrong reasons / price arbitrage
o Delivery partners able to turn their data into patient-specific action
for STARs scores
o Launch next-generation insurance products/solutions that leverage
the value of accountable care

9. 9
Physician-Centered Value-Based
Care
Accountable Care Organizations
(ACOs)
with Major Health System
Using data as an asset: To power accountable care
Data transparency provided in a variety of formats:
Daily
o Inpatient Census Reporting (Admissions &
Discharges for Attributed Members)
Monthly
o Attribution Reports
o Care Gaps
o Attributed Member Participation in DM/CM
Programs
o Raw Claims for Attributed Members
(Medical & Pharmacy)
o Various Utilization Reports (ER, Inpatient,
GDR, No Visits, High Dollar, New Members)
Quarterly
o PMPM Financial Performance Reporting
o Quality Metric Performance Reporting
o Additional Member Level Reports (Chronic vs.
Other Quality Metric and PMPM Performance)

10. What we are looking for in a partner
10

11. Our ACO progress and results…

12. o Industry consolidation: Hospitals, Physicians and Payors
– What is the impact to the consumer?
o A rapidly growing B2C world where consumers’ expectations are
very different than employers’
– How do we meet their needs ?
o The role of:
– Telehealth and remote monitoring
– Retail health: CVS, Walgreens, Walmart, Target, etc.
– Digital engagement, navigation and decision support
o Where does disruptive innovation come from and can the
establishment disrupt itself?
o ACO structures
– Hospital vs. non-hospital led ACOs
Open issues for the Industry
12