tabula rasa healthcare tabula rasa healthcare - cognify ......features benefits offers confidence in...

2019 (NASDAQ: TRHC)Proprietary and Confidential -- © 2019 Tabula Rasa HealthCare, Inc.1

Cognify, Mediture, Peak Health Plan Management, and eClusive Client Update and FeedbackPatty Bailey, CEO, Peak Health Plan Management, eClusive; Mace Wolf, CEO, Cognify, Mediture; and Steve Wosje, COO, Cognify, Mediture


TwoAligned Organizations

Uniting Four Organizations into Two


CognifyMediture

PeakeClusive

Top 3 reasons

1. Synergy results from tight integrations between software systems and TPA workflows.

2. Enable the seamless addition of new lines of business for existing customers1. Software and services enhancements are aligned and coordinated

3. Consolidated business process improvement and support opportunities

Why did we combine these four organizations?


1. Yes• TruChart is much larger outside of PACE versus inside of PACE

• 23000 @PACE versus 34000 @BeyondPACE• We will not mandate that anyone migrates• Customers may select from either EHR approach• Both systems have their advantages / appealing features

2. As we expand/upgrade functionality, we will implement shared modules• e.g., eMAR for TruChart

3. One organization with consolidated operations, two complementary products1. Knowledge sharing!

Will we maintain two HER solutions?


1. We are combining Peak & eClusive into one TPA named Peak TPA

2. We will be implementing a new TPA platform this year

3. Customer migrations starting in Q3 2019

4. All customers migrated by 2020

5. Self-adjudicating customers are part of the plan as well• Plans still being made to address these needs

Will we maintain two TPA services?


1. Medicare Advantage Plans1. FIDE SNP2. D-SNP3. I-SNP

2. Medicaid Advantage Plus (MAP)1. MLTC

New lines of business


TruChart Navigates the Future

1. Lead Management Enhancements2. Enrollment Enhancements3. Premium Billing Enhancements4. TruChart Reporting Migration5. Care Coordination6. Case Management7. Integration with TPA Member and Provider

TruChart Navigates the Future


Enhancements to TPA services

1. SOC 1 Type 2 Audit1. Upstream and Downstream Stakeholders

2. Provider portal

3. Advanced pricers & editors

4. Enhanced EDI

Enhancements to TPA Services


PA C E E M R FEATURES BENEFITS

Offers confidence in solution rated #1 by a large margin – especially in areas of Customer Service and Overall Product Performance. Over 80 total programs are using a CareVention Healthcare EHR platform.

Provides PACE-specific workflows for IDT and participant care; clinic and operational needs supported; solution fully integrates with other essential services like pharmacy or third-party administrator (TPA).

Integrates with internal systems, community partners, HIE, and pharmacy, leading to data transparency across sources.

Provides comprehensive training and best-practice templates developed in conjunction with PACE organizations; Power users can customize the templates to meet individual needs.

Captures data necessary for these and other regulatory reporting (service requests, grievances, appeals, incidents, etc.)

Easy button for CMS Audit Universes and HPMS quarterly reporting

Full support for clinical documentation with 180 IDT-specific templates

Interoperable at all levels

Top-rated PACE EMR in NPA customer surveys since 2012

Integrated PACE workflows for entire IDT including clinic, pharmacy, TPA, and risk adjustment services


PACE EMRFEATURES BENEFITS

PACE organizations have a solution to provide cost-effective high-quality care and services to their participants. Comprehensive, coordinated care is achieved through Mediture’s TruChart LIFE software systems.

TruChart LIFE is the one solution to cover end-to-end needs, from assessments, care plans, authorizations, scheduling, and transportation, to prescriptions, billing and electronic health records.

Web-based care plan is easily accessible to multiple users in multiple. Electronic assessments, progress notes, auth process for ordering and approval of services. Customized portals for participant history for a quick overview.

Patient focused scheduling. Seamless scheduling for visits, transportation and staff. Participant demographics and membership ID cards

Self-adjudication of claims. Classify and establish fee schedules for services provided. Encounter reporting to CMS and state agencies. Exports to external general ledger software.

Integrated Adjudication & Claims Processing

Manage Daily Operations

Designed for IDT Teams

PACE Centric

Single Solution


Health Plan Management Services

Medicare Revenue Cycle management

FEATURES BENEFITS

Optimizes organization’s financial management and fulfill regulatory requirements.

Ensures compliance with government regulations for accurate reimbursement.

Positions Pace Organizations for state encounter reporting.

Collects revenue and coordinates payments, frees in-house staff from managing technicalities of health plan management.

Assures proper payment and compliance for Medicare Part D requirements.

Reduces hassle of receiving monthly Medicare Member Report, assuring appropriate monitoring and accurate payment for services.

Integration with pharmacy, submission of PDE, monthly reporting, assistance with Part D reconciliation and reserve calculation

Enrollment management, payment/accounts receivable, claims adjudication, risk adjustment, Part D, Encounter data submission

Claims adjudication, enrollment management, accounts receivable, CMS data submission, encounter data processing and submission

Third Party Administration Services and “back office” operations


Experienced consultants have worked as PACE providers

FEATURES BENEFITSRisk Adjustment and HCC Coding

Optimizes Risk Score through more accurate documentation; assures compliance.

Captures correct codes for documented diagnoses; ensures submission to CMS.

Ensures submission of all diagnoses prior to CMS deadline.

Offers solutions for success across all aspects of a PACE Organization.

Increases sense of security and ensures organization’s success.

Part D Services, Revenue Cycle Gap Analysis, RADV Simulation and Medical Director Training

Retrospective Reviews for a specific payment year

Concurrent coding within ten (10) business days by Certified HCC Coder

Provider-to-Provider/staff training, monthly chart auditing and quarterly analytics











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Risk Adjustment and HCC Coding













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Technical Assistance Center

Team-focused consultant approach

FEATURES BENEFITS

Provides expert guidance through complex processes; unparalleled knowledge and experience.

Supports sound decision making for new and expansion opportunities; identify and lessen potential operational and financial gaps.

Assures training, identification and meeting of required timelines; assists with implementation of all phases of application (negotiations, CMS and state responses, and program readiness review.

Maximizes program finances, operations and growth opportunities.

Establishes partnership for more permanent impact and benefit.

Improving PACE: Program operations and growth support

Developing PACE: Applications; Training and Support; Operational Design; Implementation; Mock Readiness Review

Exploring PACE: Essential Market and Financial Feasibility Studies

Experienced team of professional and provider consultants with deep PACE experience support organizations through every phase of program development and growth.





Maximizes program finances, operations and growth opportunities






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Technical Assistance Center



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Maximizes program finances, operations and growth opportunities







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