SNP Alliance Stars Improvement Collaborative Report to Fall Leadership Forum October 29, 2010

Contents The Process SNP Stars Data Opportunities © Ingenix, Inc. 1

Findings and Recommendations SNPs are systematically disadvantaged in Stars rating system Providers somewhat “flat footed” There is neither silver bullet nor one-size-fits all solution Recommendations Policy engagement Focusing the model of care on stars has promise “Restless Innovation”, ie multiple concurrent pilots © Ingenix, Inc. 2

The Process

Collaborative Project Phases Prioritization Phase # 1: Self Assessment Kickoff Phase # 2: Physician Survey Instrument & Report Phase # 3: Facilitated Meetings Phase # 4: Best Practices Sharing Introduction & Project Overview National Data Competitive data Analysis of opportunities Self-Assessment Template Data Analysis of Stars measures One-on-one discussions with participants Use of survey instrument Physician perspective Front line staff perspective Identification of sample size and components Optional Report on physician responses Biweekly meetings to discuss key findings and progress on Key Stars Initiatives Summary report and presentation at Fall Forum Follow up telephone conferences Report on findings at the Fall Forum from the Project © Ingenix, Inc. 4

Ingenix Consulting Engagements With SNP Plans SNP Alliance Collaborative 5 Participating Plans Membership breakdown Plan 1: 1 contract; 100% Institutional Plan 2: 1 contract; 100% Dual Eligible Plan 3: 2 contracts 1 Dual Eligible Only contract, 100% SNP 1 Dual Eligible & Chronic contract, 100% SNP Plan 4: 2 contracts 2 Dual Eligible contracts, 100% SNP Plan 5: 4 contracts 3 Dual Eligible Only contracts, 8% SNP, 92% Non-SNP 1 Dual Eligible & Institutional contract, 96% SNP, 4% Non-SNP © Ingenix, Inc. 5

States Represented © Ingenix, Inc. 6

SNP Stars Data

2010 Part C Summary Scores © Ingenix, Inc. 8

Membership Characteristics Impact Stars Scores Educational Attainment DSNP Black © Ingenix, Inc. 9

Impact of Selected Other Variables on Part C Scores NCQA Accreditation NS For-Profit Status -0.5 Growth NS Commercial Plans NS Medicare Market Share 0.04 All results show coefficients from IC regression analysis of 2010 stars summary score data linked with US Census and NCQA data © Ingenix, Inc. 10

Opportunities

What We Know: Network is Key Variable Percent of variation in HEDIS scores explained by plan, providers, and other. Easiest strategy is to terminate low performing docs Sources: Baker and Hopkins. “The contribution of health plans and provider organizations to variation in measured plan quality.” International Journal for Quality in Health Care. March 18, 2010, p 1-9. Solomon, Zaslevsky and Landon. “Variation in patient-reported quality among health care organizations.” Health Care Financing Review. Summer, 2002. v 23, no. 4, p 85-100. © Ingenix, Inc. 12

SNP Alliance Provider Survey: Providers Vary Providers mixed in their ability to help vulnerable members navigate and access care: Flu shot results… Providers vary in their awareness of the model of care © Ingenix, Inc. 13

What We Know: Care Management Matters From a review of 57 QI interventions to control Blood Pressure: “QI Strategies are associated with improved hypertension control. A focus on hypertension by someone in addition to the patient’s physician was associated with substantial improvement.”* * Walsh, Judith, et al. “Quality Improvement Strategies for Hypertension Management: A Systematic Review.” Medical Care. July 2006. Vol 44 no 7, pp 646-657 © Ingenix, Inc. 14

Resource Allocation Standard Patient Stratification Model Distribution of Acuity Dosage of Care Management © Ingenix, Inc. 15

SNP Challenges Are Well Understood…. Provider Engagement Small panel size Growth strategy Burdensome population Information overload Member Engagement Mobility, contact info Psychosocial complexity Medical complexity Burden of mental illness Linguistic, cultural issues © Ingenix, Inc. 16

We Know What We Want Model of care Provider Engagement Inform provider of care opportunities Effect change in provider behavior Member Engagement Track member for communication Educate member on health conditions and benefits Motivate Mitigate barriers Assist in navigation Supplement providers Complex case management, etc. © Ingenix, Inc. 17

Nobody Knows How to Get There Great New Ideas Embed outreach workers in community Embed nurses in high volume practices Create educational materials on Rx benefits for insertion in patient charts Concierge services The tried and true (on other populations) Care opportunities reporting for providers Patient reminders, outreach letters and calls Contact point mapping, exploiting all contact opportunities Evolving ideas P4P ACO © Ingenix, Inc. 18

QIPs Tend to Follow the Same Script…. Sample QIP: Not from SNP Alliance Member © Ingenix, Inc. 19

Culture Matters Results from QIP Self Assessment Questionnaire © Ingenix, Inc. 20

Conclusion: Restless Innovation Multiple, concurrent pilots Rigorously evaluated Replicate the winners, scrap the losers Collaboration has multiplier effect © Ingenix, Inc. 21

Contact Information Eric E Cahow, Ph.D. Eric.cahow@ingenixconsulting.com 860-707-9440 Stephen P Wood Stephen.wood@ingenixconsulting.com 312-429-3906 © Ingenix, Inc. 22