 Revenue  Patients  Revenue & Patients  Margin

 Remain Independent  Financial Security  Work / Life Balance  Improved Patient Care  Job Growth

 Improving the Circumstance for Physicians  Improves the Circumstance for Patients  Improving the Circumstance for Patients  Lowers Aggregate Healthcare Spending  Lowering Aggregate Healthcare Spending  Benefits all Stakeholders...

 Understanding the Business Value of the Medical Home Model of Primary Care ◦ Establishing the Value Proposition ◦ Alignment with “Ultimate” Payers for “ROI” ◦ Securing “Featured & Favored” Status  For Primary Care  For Specialists

 “Admitting” Patients  Managing the Relationship with Patients  Implementing Annual “Organizing Visits”  Co-Location of Services ◦ Physical ◦ Virtual  Re-train / Re-deploy Support Staff  Develop “Value Based” Reporting ◦ Changes in Health Status (Circumstance) ◦ Changes in Aggregate Spending ◦ Ensuring High Levels of Patient Satisfaction

Confidential Information of Employer Advantage Health Care Solutions, LLC. Employers Hospitals Primary Care Physicians Primary Care Physicians Outpatient Centers Outpatient Centers Insurance Company Insurance Company Specialty Physicians Specialty Physicians

 Cornell Program for Healthy Living ◦ 12% Year over year increases for Cornell University as an employer ◦ High worker’s comp costs / High rates of absenteeism ◦ High rate of psychotropic drug use  Calsonic Kansei ◦ Maintain 0% benefit plan cost increases ◦ Improve transparency ◦ More “intelligent” benefit plan redesign

 Results ◦ 15 “PHO” affiliated Primary Care Practices were “Featured & Favored” ◦ Approximately 9,000 “New Patients” admitted among the “Featured & Favored”  Out of area PCPs  Medically “Homeless” ◦ $350 Per Patient Per Year – “Organizing Visit” ◦ $1,500 Per Patient Per Year Reduction in Aggregate Spend (4:1 ROI)

 3,538 patient lives (1,717 employees / 4,252 total lives TN, MI, & MS)  Maximized “cost shift”  “On – Site” Clinic  “Wellness Programming”

 The Strategy ◦ Select an “Overflow” Primary Care Practice to “Feature & Favor” ◦ Commence PCMH Transformation with that Practice ◦ Implement Benefit Plan Changes / Incentives ◦ Modify the compensation formula for this “Featured & Favored” practice ◦ “Enroll” New Patients in Tennessee Medicine & Pediatrics – 350 new patients ◦ Implement the “Organizing Visit” Process of Care

 Early Results ◦ 2010 to 2011 (rolling 12 months)  $10,671,542 ◦ 2011 to 2012 (rolling 12 months)  $8,706,936 ◦ Reduction in spending  $1,964,605

 Public & Private Employers (NY, NJ, TN, MI, MS, VA, NC, SC ◦ “Directed Primary Care Program” ◦ “Network” of “High Performing” Primary Care Practices to be “Featured & Favored” / “Preferred Specialists” to be referred to ◦ Targeting “hospital employed” PCP patients through a “vestibule” to care strategy built on the “Organizing Visit” (ACA preventive benefits)

 Family Practice Community / CPHL  Sleep Centers of Middle Tennessee / Calsonic Kansai  Southern Tier Surgical Clinic ◦ Urban Family Practice ◦ Riverdale Family Medicine ◦ Endwell Family Physicians

 Hospital Systems  Health Plans  Employer “Coalitions”  Human Resource Departments  Pharmacies / “Discount Stores”

 Employers – Self-Funded / Experience Rated ◦ Public ◦ Private  “Pure Play” Third Party Administrators  Publicly Funded Programs ◦ Medicaid / Child Health Programs ◦ Medicare  ACOs

 Assess Your Appetite for Innovation / Change  Inventory Existing Patient Population ◦ Employers ◦ Payer Mix ◦ Publicly Funded Programs  Assess Your Practice’s Current Capabilities  Develop a Gap Analysis / Plan for Innovation  Implement the Plan

Jed Constantz