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‹#› Confidential and Proprietary Information Mariela Leon, Manager Behavioral Health Overview
Team Behavioral Health Lin Alicia Baker Vice President Gary LaFrenais Manager Twynia Filmore Director BEHAVIORAL HEALTH OVERVIEW Key Accomplishments 3.04 million Membership Count What's New/Innovation Metric Goal Actual Service Level –Member (80%/30s) 89.85 % Service Level – Provider (80%/120s) 83.34 % ASA - Member (<=30s) 20 secs ASA - Provider (<=120s) 73 secs FCR - Member (85%) 89.70 % FCR – Provider (85%) 86.10 % Obstacles/Challenges Action Items/Next Steps Call Volume 22,583 Mariela Leon Manager Kevin Argote Director Supported the CalViva DHCS audit as a Behavioral Health Operations SME, partnering with Medical teams to address audit inquiries and demonstrate regulatory compliance. Launched the CA Medicare Provider Availability Check (PAC) Pilot, achieving strong member acceptance and provider match rates while evaluating opportunities to expand the model and enhance Call-to-Care. Supported Health Net’s successful transition to Zelis for ABS claims through targeted training, provider communication, and operational readiness initiatives. Introduced a Line of Business Quick Reference Guide, providing frontline staff with a single source for key operational information across markets. Achieved 100% compliance during the 2026 Health Equity Oversight Audit with no findings or corrective actions required. Successfully migrated Behavioral Health operations to AWS on September 17th following completion of training, testing, readiness activities, and cross-functional implementation support. Oregon Trillium Medicaid Member Support went live on August 27, aligning the Behavioral Health member experience across all Oregon lines of business. Launched Growth Exchange Forums as part of the QA Transformation initiative, to enhance employee engagement. Advanced the Call-to-Care Dashboard initiative, partnering with Workforce Optimization to scale capabilities across markets and strengthen measurements of behavioral health outcomes. Opportunity to refine substance use risk assessments to better distinguish crisis needs from support and service needs. Developed enhanced substance use screening questions to better assess risk and connect members to appropriate services.
‹#› Confidential and Proprietary Information Brian Lopez, Director Medicaid Overview
AWS Modernization | Nevada & Oregon Live Clean cutover Aug 27; two-thirds of Medicaid portfolio now on AWS. New Jersey | BH Integration Phase 1 Approved State-approved, zero disruption; unlocks future phases. Texas | HHSC Audit Passed Zero findings across Member and Provider Services. Michigan | SDoH Outreach Drives 66% Conversion Highest conversion rate this year, strengthening member access. What's New/Innovation Team Matt Morrison Vice President Kyle Schetter Vice President Medicaid Overview Performance Notes Aug Membership 11,880,541 Metric Goal Actual Service Level (80%/30s) 91.0% ASA (30s) 20.6 Quality (95%) 96.0% FCR (85%) 88.4% CSAT (90%) 91.3% Considerations/Monitoring Action Items/Next Steps Member Volume 708,346 Calls Medicaid Line o Gabe Sanchez Vice President Shannon Smalls Senior Director Etiane George Senior Director Pam Alexander Senior Director Will Montes Senior Director Key Accomplishments Real-Time Translation | Florida Pilot Advancing language capabilities for members. Sensentia Pilot | South Carolina & Florida Expanding AI-enabled service innovation. Operata | All AWS Markets Strengthening performance insights and operational management. Rendering Service Tool | Launched Improving operational efficiency. Exceeded all August regulatory SLA targets while advancing AWS, Sensentia, and Operata transformation initiatives. Digital Enablement Rollout of Zelis/ZAP, mobile app, and Zenarate readiness HR1 Readiness and Call Volume Advance Mission Simplify priorities Complete final AWS migrations January 2027 staffing readiness
‹#› Confidential and Proprietary Information Katy J. Makram, Vice President Abby Davis, Senior Director Initiative Update | Duals
CONFIDENTIAL & PROPRIETARY Duals Transformation: 2026 Progress and What Comes Nex 8 States Live 15+ Products / Plans ~83K Members 362K Calls YTD 25+ OMNI Enhancements 2026 | Built the Foundation Established and scaled the Duals operating model, strengthening workflows, advocate support, and operational insights Enhanced member experience and operational efficiency, achieving 93.3% CSAT, 4.7% DSAT, a 9.3% increase in FCR and a 9 1% reduction in AHT Strengthened provider experience, achieving 91.9% CSAT, reducing DSAT by 50%, maintaining a 97.2% service level, and lowering AHT by 3.5% 2027 | Expand and Align New plans - FL FIDE and OH HIDE OR / PA calls transition to dedicated Duals teams with new TFNs 2027 aligned enrollment and 10th Duals indicator enablement 2028–2030 | Scale the Model 8 potential Aligned Integrated Plans in 2028–2029 Remaining 10 aligned states move to the Duals contact center by 2029 Full aligned enrollment for impacted D-SNPs by 2030 Critical Enablers Market Alignment Partnership, alignment, governance Operational Readiness Training, staffing and service delivery Technology Enablement Telephony, CRM and reporting 8
Confidential and Proprietary Information Mahmmod Alabagi, Data Translator MPS Data & Analytics
‹#› Transfer Dashboard Evolution: From Limited Visibility to Deeper Operational Insight Legacy → Current Production → Future State Legacy Limited history and limited interaction detail 6 months of historical data only No breakout of Transfer vs. Consult vs. Conference Limited trending little executive graphical value Limited leader view Limited People Leader breakout Now in Production 1 2 - M o n t h H i s t o r y R o l l i n g 1 2 m o n t h s S u p p o r t s s t r o n g e r t r e n d i n g a n d d e e p e r - d i v e a n a l y s i s E x e c u t i v e S u m m a r y M o M | Q o Q | Y o Y I m p r o v e d e x e c u t i v e c a l l o u t s a n d t r e n d v i s i b i l i t y D e s t i n a t i o n I n s i g h t T o p 1 0 d e s t i n a t i o n s Q u i c k v i e w o f w h e r e i n t e r n a l t r a n s f e r s a r e g o i n g ⇄ Transfer Overview Users can now distinguish: Transfers Consult + Conference Note: Consult and Conference are grouped together in the current production release. ◳ Deeper Operational Analysis Consult / Conference activity can be analyzed by: Line of Business Caller Type Queue Other operational attributes Coming Soon Design and logic underway ⤳ Journey Flow Sankey-style call-flow view Originating queue → destination Frequency of common paths ⌕ Interaction Detail Drill into specific interactions Call-level root-cause analysis Exception & journey diagnostics ▦ Deeper Classification Transfer | Consult | Conference | Fallout Time-based measures per type Expanded trend & destination analysisDeeper drill-down by LOB, caller type, queue, and other operational dimensions Assistance visibility shows where and how often agents require help on calls Stronger executive view combines trend callouts with destination insight Special thanks to the teams and individuals who made this dashboard update possible from the underlying data and technical development through the final visualization, including Jason Atkinson, Sai Dantu, King Gyasi, Chris Lipowsky, and Tim Snyder.
‹#› Confidential and Proprietary Information Rob Rickert, Senior Manager Enabling Team Update | SSOS
• Accelerating strategy into execution as Mission Simplify initiatives transition into active delivery, supported by stronger resource planning, dependency management, and cross-functional coordination. • Evolving from reactive response to proactive intelligence by expanding real-time monitoring, observability, and automated alerting to identify emerging risks before they escalate. • Turning operational data into actionable insights through enhanced dashboards, Quick Insights, and emerging automation capabilities to support faster, more informed decisions. Obstacles/Challenges Action Items/Next Steps Kelley Keele Vice President, Operations Tomese Nalsen Sr. Manager, Project Management Organization Rob Rickert Sr. Manager, Business & Systems Operations TBH Director, Change Management Transformation SSOS Overview Strengthened enterprise portfolio visibility through centralized reporting and Mission Simplify governance, improving alignment, accountability, and execution across strategic and operational priorities. Expanded NextOps to 24/7 operational coverage, strengthening around-the- clock incident coordination, response readiness, and continuity across MPS. Advanced operational intelligence and enablement through enterprise Operata deployment support, enhanced reporting accuracy, and Sales & Broker training, improving access to insights and operational readiness. Key Accomplishments What's New/Innovation Earlier Visibility. Stronger Alignment. Faster Action. SSOS continues to strengthen how MPS identifies opportunities, anticipates operational risks, and translates strategic priorities into action. By connecting governance, operational intelligence, and execution, we are creating greater visibility across initiatives, improving coordination, and enabling more proactive decision- making. Our Impact Expand monitoring, automated testing, and early-warning detection. Complete dashboard deployments and prepare for Quick Insights. Raise risks early and reduce duplicated effort across teams. Action Items/Next Steps Resource capacity is the top constraint; projects share the same SMEs, leaders, and technology teams. Visibility gaps when incidents originate outside traditional IT monitoring channels. Obstacles/Challenges Engage us early, share emerging risks and opportunities, and bring forward ideas that simplify processes or improve the way we work. Strong partnerships and open communication help us reduce duplication, address challenges sooner, and deliver a more consistent experience for our members, providers, and teams How You Can Partner With Us
‹#› Confidential and Proprietary Information Tiffany Stuart, Program Manager III PEEPS Update:
‹#› Are you all ready for some engagement reminde
‹#› Closing Remarks Troy Mills, SVP MPS
‹#›Confidential and Proprietary Information Thank You.
‹#› Appendix
Expanded PMO visibility through centralized portfolio reporting across MOC, PMC, Mission Simplify, and Run-the-Business initiatives. Advanced Mission Simplify by helping establish governance, initiative ownership, sequencing, delivery planning, and PM assignments. Mission Simplify initiatives are moving from planning into active delivery and execution phases, creating additional opportunities for PM partnership and leadership. Increased focus on portfolio-level resource planning, dependency tracking, and capacity management to help teams identify risks earlier and make better decisions. Key Accomplishments Action Items/Next Steps What's New/Innovation 24 Total Projects Obstacles/Challenges Mission Simplify 9 Chelsea Meredith Program Manager IV Warren Triche Program Manager IV Michael Salen Program Manager IV Noah Siegrist Project Manager III Terry Dodd Program Manager III Shelby Maxwell Program Manager IV Michael Hinckley Program Manager IV Alexandra Wright Project Manager IV Stephanie Torres Project Manager III Project Management Organization Tomese Nalsen Monica Buchanan Project Manager II Arrica Cooper Project Manager II Project Category Count Business & Market Transformation 9 AI & Intelligent Automation 4 Telephony & Contact Center 3 Data, Analytics, and Performance 2 Technology & Platform Enablement 3 Operational Excellence 2 Mission Simplify 9 Focus on transparency, partnerships and collaboration. Raise concerns early. Share lessons learned and best practices across initiatives. Look for opportunities to reduce duplication of effort. Resource capacity remains the largest challenge across both PMO- and non-PMO-supported initiatives. Many projects rely on the same SMEs, leaders, and technology teams.
Expanded NextOps to 24/7 operational coverage Assumed CX Portal Submission and Approval ownership for Holiday HOOPs Established stronger holiday readiness and validation bridge processes Strengthened partnerships across ESOC, IT Command Center, Service and Business Partners. Moving from reactive response toward proactive detection Expanding real time monitoring through SKPI, Operata and AWS platform analytics Exploring automated alerting to reduce overnight detection gaps Using operational data to identify patterns, partner trends, and emerging risk before they become major incidents Assisted in launch and implementation of Operata Widget across all LOB’s. NXO will also own reporting and analytics on agent reported issues and will report to all LOB’s specifically. Key Accomplishments Action Items/Next Steps What's New/Innovation Obstacles/Challenges Continue to expand upon monitoring, automated testing and early warning capabilities. Measuring success through faster detection, clearer impact visibility and reduced business disruption Visibility gaps when incidents originate outside traditional IT monitoring channels. Balancing rapid response with proactive monitoring and continuous improvement NextOps Rob Rickert Laura Morgan Lead Contact Center Systems Analyst Destanie Dyer Business Analyst III Lori Patino Business Analyst III Cullen Jones Lead Contact Center Systems Analyst Braden Buchanan Business Analyst III Mireya Delgado Business Analyst III INC Level Count P1 – Critical 7 P2 – High 56 P3 – Moderate 72 P4 – Low 10 P5 – Minimal 85 Total INC 236
Leslie Pepe Business Analyst IV Ben Dobson Business Analyst IV Nathan Swafford Lead Contact Center Systems Analyst Quentin Mendoza Business Analyst IV Veronica (Bonnie) Nold Business Analyst IV Alex Wiebel Senior Business Technical Analyst Randall Borror Business Analyst IV Kevin Hudson Business Analyst IV Grzegorz Kujawa Business Analyst IV Command Center Rob Rickert Improved issue visibility and escalation management with our Medicare and PDP Member Teams through our Operata Widget Transformation Project. Expanded a variety of dashboards to our Sales and Broker team for operational insights across transfers, historical data and real time queue insights. Strengthening classification accuracy and accountability by improving Gold Standards headset reporting Identifying additional data requirements and initiating report enhancements by improving IVR Closed-messaging reporting accuracy. Researching Operata-to-Snowflake integration to enable centralized reporting and deeper analytics. Automating Audio Issue Report (AIR) to provide self-service access to data pertaining to audio issues that are intermittent or reoccur after prior resolution. Launching study aimed at evaluating performance of preferred connection methods against Gold Standards to identify improvement opportunities. Expanding the Lightweight Troubleshooting Study to validate a self-service approach that reduces downtime. Key Accomplishments Action Items/Next Steps What's New/Innovation Obstacles/Challenges Coordinate training schedules and continue dashboard adoption. Advance technical integrations with business and technology partners. Confirm delivery timelines for active workstreams. Training schedules and technical integration dependencies remain active risks. The team identified and reacted to a dashboard outage this week. Our quick reaction allowed for minimal interruption and the dashboard functionality was restored within 90 minutes. Workstream Delivery Date Transfers Q2 2027 Sales and Broker 09/30/2026 Data Partition and Role Creation 10/30/2026 Beehive Historical Trends Q4 2026 Automating AIR Report Q1 2027 CMS Audit Readiness 10/01/2026 NXO Dashboard 01/15/2027