Inside an Insurer’s Debate About Fees

Case 3:21-cv-00535-DJN Document 173-53 Filed 02/10/23 Page 2 of 2 PageID# 4961

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Raha, William T [bill_raha@uhc.com] 12/8/2017 9:34:37 AM

Verga, John F [john_verga@uhc.com]

Serpico, Robert M [robert_m_serpico@uhc.com]; Johannes, Laura [laura_a_johannesthibedeau@uhc.com] RE: NEMF Shared Savings

A couple of preliminary thoughts/questions and I would be happy to discuss with you when you have some time:

When you say “settle on a retroactive basis” how far back are you proposing to go retroactive? I need to understand if you are thinking about 2017 only or also prior years..

I don’t have an option to offer a flat dollar cap or even a PEPM cap. I will need to present that to Albrecht so that he can go to Gehlbach for approval. The last couple of requests have not been approved, so I’m not really sure what is different here. Can you give me a list of all ASO clients in the country with this broker along with an outline of how this would be restricted to just this one client? We have to be concerned about setting precedent and this issue cuts across not only all of Key Accounts, but National Accounts as well. As a company we have been unwilling to enter into one-off agreements that cap our revenue, so we have to be very careful.

Their Shared Savings, on a pepm basis, is not really that high compare with our book of business. For last year, we had 40% of our NY/NJ ASO clients with higher SSP revenue on a pepm basis and 46% of our clients had higher revenue on a PMPM basis. What kind of message are we sending if we return hundreds of thousands of dollars to this client? I think we are implying that they have been overcharged….

The Facility R&C is where their fees have spiked over the last few years. Why not just remove Facility R&C? That would seem to accomplish the same goal without creating a one off arrangement.

From: Verga, John F

Sent: Thursday, December 07, 2017 5:12 PM

To: Raha, William T

Cc: Serpico, Robert M

Subject: NEMF Shared Savings

Hi Bill, have done some homework on the NEMF situation..

They are experiencing a unique situation as it pertains to shared savings due to Carepoint facilities in Hudson County (Bayonne, Christ, Hoboken).

As a result, the fees associated with Shared Savings and Facility R&C have increased over the years.

We have explored some alternatives (ie shared savings limited and MNRP), but, these will not solve their situation since the admits to these facilities are emergencies.

So, we feel the best thing to do is to keep them in their current shared savings model but, try to accommodate their desire to offset some of the additional revenues we are making in some other manner…

How about if we put a total annual cap in place of $400,000 that we could settle to on a retroactive basis.. if we take this approach we can let the current program stay in place, let enrollment fluctuation as it normally does, and give them a feeling that they are somewhat protected from the $600K years they have been experiencing..i am being told we can put something like this in place and administer it for one off situations like this.

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Confidential Subject to Protective Order

UHC00095182