From: Sent: Ziemer, Scott A [Scott.Ziemer@umr.com] 5/19/2020 5:58:29 PM To: CC: Subject: Haben, John M [john_m_haben@uhc.com] Paradise, Rebecca B [rebecca_paradise@uhc.com]; Aue, Bobbie J [bobbie_j_aue@umr.com] RE: ASO migration off R&C Attachments: 20200518 UMR OON Strategy Overview.pptx Hi John, Attached is abbreviated presentation that we have been using to explain the strategy. Long story short we are going to force a change in 2021 for the clients using R&C. We are changing our legacy CRS program starting on 1/1/21 and clients in that will get our new OON solution called CRS Reference. It uses Medicare pricing with Advocacy in lieu of Fair Health. Clients will have to opt out if they want to keep Fair Health. For clients using Fair Health in our current CRS program, they will get a renewal with CRS Reference starting with 1/1/21 renewals. Again, they will have to opt out if they have to keep Fair Health. We have been leading with a non-Fair Health solution since 5/1/19 on new business. Again expectation is that client would have to require us to offer Fair Health. Goal is that any client who has Fair Health (1.81M) will be off of it by 1/1/22, unless they have required us to keep them on it. Not sure what the exception rate will be, but I would hope that 75+% of the membership will off. Let me know if you have any questions or would like me to walk you through the strategy. I’ve talked to Matt P about this last week and am talking with Saurabh and Neil Brok! on Friday with Hogan/Freiberg, etc… From: Haben, John M Sent: Tuesday, May 19, 2020 2:20 PM To: Ziemer, Scott A Cc: Paradise, Rebecca B Subject: RE: ASO migration off R&C Importance: High Scott, Do you have a sense of the total volume of members you will have moved off R&C by 1/1/2021 and how much will you have still have on R&C? Also, do you think you’d get all those clients off R&C by 1/1/2022? Trying to reflect where you’d be in the UHN business plan for 2021. John From: Ziemer, Scott A Sent: Monday, May 11, 2020 4:31 PM To: Haben, John M Cc: Paradise, Rebecca B Subject: RE: ASO migration off R&C John, here you go: CONFIDENTIAL Plaintiffs’ Exhibit 304 Cause No. CJ-2019-482 UHC_PA_00388957 P304.001
As of April 2020 1.81M on R&C 2.185M on non R&C 413k on client directed solution We have plans to materially change one of our legacy CRS programs – we’ve talked to Becky about the strategy in our monthly calls – and we expect that it will have big impact for 1/1/21. We’ve not made the announcement to the field yet, but will be coming shortly. If you have questions, please let me know. Thanks, Scott From: Haben, John M Sent: Monday, May 11, 2020 1:28 PM To: Ziemer, Scott A Cc: Paradise, Rebecca B Subject: RE: ASO migration off R&C Scott, Do you have updated numbers for the May report? John From: Ziemer, Scott A Sent: Tuesday, April 14, 2020 8:39 AM To: Haben, John M Subject: RE: ASO migration off R&C John – here you go. No material changes as the majority of business renews on 1/1. As of February 2020: 1.84M on R&C 2.14M on non R&C 413k on client directed solution As of January 2020: 1.87M on R&C 2.12M on non R&C solution 422k on client directed solution As of December 2019 2.32M on R&C 1.5M on non R&C 417k on client directed solution From: Haben, John M Sent: Monday, April 13, 2020 4:26 PM To: Ziemer, Scott A Subject: RE: ASO migration off R&C Scott, Any updated numbers to report (similar to the data/format below) for February and/or March? CONFIDENTIAL UHC_PA_00388958 P304.002
John From: Ziemer, Scott A Sent: Thursday, February 20, 2020 4:09 PM To: Haben, John M Subject: FW: ASO migration off R&C John, per your IM. As of January 2020: 1.87M on R&C 2.12M on non R&C solution 422k on client directed solution As of December 2019 2.32M on R&C 1.5M on non R&C 417k on client directed solution Don’t know truly what moved on 1/1 but right now the 342k is probably in the ballpark. From: Ziemer, Scott A Sent: Monday, December 09, 2019 3:40 PM To: Paradise, Rebecca B; McDonnel, Lisa M; Beecy, Steven ] Cc: Haben, John M Subject: RE: ASO migration off R&C Becky – we have tried to leverage information we are getting through notifications we have received as well as approved changes to the database that identifies all of the products that a client buys. This information is incomplete and therefore these numbers should be considered projections – expect the numbers to be higher because this is only what we can confirm. We will have firm data in February as we will be able to tie the OON programs to what has actually been implemented for 1/1. Scott 2.2M on R&C (various effective dates) 342k moving off on 1/1 1.85M unknown Actuals for 1/1 will be reportable in February. From: Paradise, Rebecca B Sent: Monday, December 09, 2019 1:19 PM To: McDonnel, Lisa M; Beecy, Steven J; Ziemer, Scott A Cc: Haben, John M Subject: ASO migration off R&C Importance: High HI – below is a current view of the great progress to date to move R&C clients to OCM ne/MNRP packages. In looking towards 2020 do you have estimate of what will be left on R&C by 1/1/21? I think the original target was ~80% adoption? CONFIDENTIAL UHC_PA_00388959 P304.003
OCM/MNRP Case Count Est Members Adoption as of Key National UMR Key National UMR 12/3/2019 Total Clients 599 298 TBD 1,152,666 4,905,332 1.2M W R&C Sold 88 40 TBD 202,033 937,974 Estimated Remaining 60,000 moved. 387 155 TBD 730,929 2,781,717 Actuals will be Leads Exceptions (not in 124 103 TBD 219,704 1,185,641 scope for reported in December due to reporting restrictions change) Becky CONFIDENTIAL UHC_PA_00388960 P304.004
UnitedHealthcare OON Program Strategy May 2020 2018 United Health Care Services, Inc. Proprietary information of United HealthCare Services, Inc. Co not clatibute or reproduce without express permission of United HeathCare Services, Inc. UMR ATTORNEYS’ EYES ONLY UHC_PA_00388961 P304.005
OON Strategy UMR Eliminate Fair Health by 12/31/21 and Leverage More Aggressive Programs ⚫ UMR and UHC have worked collaboratively to develop similar OON programs OON program differences driven by system differences, client needs and development requirements Overall goal is to: Eliminate the use of Fair Health (R&C) as a method to determine an allowable Encourage adoption of more aggressive OON programs * Phase 1: Since 5/1/19 UMR has led with our CRS Benchmark program (-Option L- OCM) for all new business. For existing business proposed leveraging CRS Benchmark Training and strategy rolled out to UMR SAE’s and Health Plans in April 2019 75% of 1/1 new business membership was in CRS Benchmark 500k fewer members in OON solutions that use Fair Health (R&C) – Dec19/Jan20 ⚫ Phase 2: Strategy for 2021 is force clients to move to more aggressive programs Reconfigure our Legacy CRS program and leverage Medicare based pricing in-lieu of Fair Health/R&C. Membership in CRS Legacy (~1.4M) and CRS w Fair Health/R&C (~972k) renewed using CRS Reference No impact to ID card, client gets lower fee and a fee cap, advocacy and improved savings Use of Fair Health will be exception only (labor/collective bargain, client requirement, etc.) going forward. 2018 United Health Care Services, Inc. Proprietary information of United HealthCare Services, Inc. Co not clatibute or reproduce without express permission of United HeathCare Services, Inc. ATTORNEYS’ EYES ONLY UHC_PA_00388962 P304.006
:: 2021 UMR OON Product Continuum UMR CRS (SSPE) The program is designed for clients who have limited tolerance for members being balanced billed Leverages secured and some unsecured savings (RAPLE). If program not successful relies on MNRP for most clients. Fair Health on exception Exception Only Average Reduction 46% 30% with $50k savings cap. CRS Reference (7-130-) The program s designed for clients looking to 33ply a Reasonable reimbursement, but want to maximize secured savings to lat member disciption Leverages secured and unsecured savings. 3 chances to take secured reduction. Relies on Medicure RBP Advocacy rather Standard Offering Average Reduction: 54% 25% with $50k savings CRS Benchmark (-OCM-L) The programs designed for clients looking to apply a reasonable reme Usement to out of Betwork claims and advocate for members f a balance billing Stuation occurs. Leverages secured and unsecured savings { what to th secured reduction Relles on Delalê 1 ¡llAdvocJŁY ather than U&C Standard Offering Average Reduction 60% Non Par Cost Containment MNRP w OCM. D) The program s designed for cristo walio Want a Medicare like SON program wit INTRIN encourage members to Leverages a Only services that the Sil pave In and the prouders that વિકા બાઇક રે આ કાસણી પ્રસંગ્રાહ – અક્ષર OON ER Only esigitor sheepiso Kante dadosare like AME IS W Enkou Jon Members in critichot Only emergency services are blissed dur member advocacy Exception Only Lowest Standard Offering 30% with $50% savings сар Average Reduction. S400 PEPM 22″ with Member Impact – Client Savings ©2018 United Health Care Services, Inc. Proprietary information of United HashCare Services, Inc. Co not clauibute or reproduce without express permission of United HealthCare Services, Inc. Highest ATTORNEYS’ EYES ONLY UHC_PA_00388963 P304.007
UMR OON Programs and Crosswalk UMR New and Existing Business UMR Retiring/Exception CRS w MNRP NPC2 CRS Benchmark 2021 OON Solutions CRS Reference OON ER Only Customer Specific Legacy CRS Legacy w Legacy w MNRP CRS with R&C R&C UHC Compare Membership* Pricing Similar to SSP 835k 30% of svgs Similar to SSP 539k 30% of svgs Similar to SSPC 972k Similar to SSPC 506k Similar to Option D 208k Similar to Option L 932k Similar to Option L Estimate:2.3M S’milar to Option D+ 413k 30% of svgs w $50k cap 30% of svgs w $50k cap $4 PEPM plus 22% of 22% of svgs with svgs w $50k cap $50k cap 25% of svgs with $50k $10 PEPM cap Strategy CRS Legacy program not available for new business effective 10/1/18 New Business: Effective 5/1/19 all new business quoted using CRS Benchmark. NPC2 avaliable based on client requirements. CRS available as exception for client requiring MNRP or R&C CRS Legacy to be reconfigured to 2019/2020 Existing Business: Effective 5/1/19, UMR recommending all CRS and CRS Legacy clients become CRS Reference on move to either CRS Benchmark or NPC2 upon renewal 2/1/21. CRS Reference will have no reliance on Fair Health 2020/2021 Existing Business: CRS Reference will be quoted on all CRS Legacy groups as part of their 2021 renewal. CRS Reference will be quoted on all groups using CRS w R&C in their 2021 renewal Membership (April 2020) excludes United Healthcare Shared Services and HealthSCOPE UHSS is designed to allow external entities access to UHC networks. Access to CRS Legacy available. HealthSCOPE has various OON programs but primarily leverage their Claim Pars solution (similar to Option L or CRS Benchmark). 2018 United Health Care Services, Inc. Propietary information of United HealthCare Services, Inc. Co not distribute or reproduce without express permission of United Health Care Services, Inc. Exception Only ATTORNEYS’ EYES ONLY UHC_PA_00388964 P304.008
Close ×