March 7-10, 2012 Manchester Grand Hyatt San Diego, CA Making Care More Affordable Thorough Quality Improvement At Park Nicollet Health Services March 7-10, 2012 Manchester Grand Hyatt San Diego, CA Head + Heart, Together

Park Nicollet ACO Located in the west metro of Minneapolis/St.Paul Serves ~500,000 unique patients/ year Employs 8,300 people, 1,300 are providers 1 Hospital (~22K inpatient admissions/yr) 25+ Locations with Primary, Specialty and Surgical Specialty Care Clinics (~2.2M ambulatory visits/yr) PNC Fun Fact: 2011 TOUR DE CLINIC CAMPAIGN David Abelson, CEO and avid cyclist, spent 3 days riding his bike 200+ miles to 21 of our PNC sites, raising more than $55K Head + Heart, Together

Park Nicollet Total Cost of Care Contracts Pioneer ACO Head + Heart, Together

Standardized and Complete All Payer and All Claims Data Source Ideal TCOC Measure Standardized and Complete All Payer and All Claims Data Source Accurate Risk Adjustment and Fair Attribution Methodologies Head + Heart, Together

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Driving TCOC Measures Risk Adjusted Inpatient Utilization (i.e. admits) Per 1000 Risk Adjusted LOS per 1000 Risk Adjusted ER Utilization Per 1000 Risk Adjusted Spend of Top 5% Risk Adjusted High Cost Procedure (e.g. spine surgery, HTDI) Utilization Per 1000 Risk Adjusted Ambulatory Care Sensitive Admission Utilization Per 1000 Per 1000 person years Also Consider high risk population admits per 1000, scripts per 1000, generic %, cost of utilization, % patients dying in hospital, % ICU days. Head + Heart, Together

Park Nicollet Pioneer ACO Drivers to Accomplish Our Aim Triple Aims and Measures 1. Improve CG-CAHPS measure from X to Y by 12/31/2012 2. Attain more than 90% of Pioneer ACO quality measures benchmarks in PY 2 3. Maintain cost growth more than 3% below national benchmark during Pioneer ACO PY 1 Patient experience process of care measures from X to Y by 12/31/2012 Patient experience specific intervention measures TBD Develop Epic operational reports for falls, adult weight, and depression screening by 12/31/12 Implement fall, weight, and depression screening protocols by 12/31/2012 Decrease CHF ambulatory care sensitive admissions from X to Y by 12/31/2012 Increase Pioneer ACO enrollment in Telassurance from X to Y by 6/30/2012 Develop protocols for referral to and graduation from CHF clinic by 6/30/2012 Decrease COPD ambulatory care sensitive admissions from X to Y by 12/31/2012 Implement case management program for high-risk COPD population by 12/31/2012 Decrease all cause readmission from X to Y by 12/31/2012 Implement X of Y readmission reduction strategies by 12/31/2012 with focus on Pioneer ACO population Decrease ER utilization from X to Y by 12/31/2012 Implement case management program for >1% of high-risk Pioneer ACO population by 6/30/2012 and >2% by 12/31/2012 Increase Pioneer ACO patient’s with advanced care directives from X to Y by 12/31/2012 Increase number of advanced directive facilitations from X to Y by 12/31/2012 Total Cost of Care Measures Head + Heart, Together