Delivering High Value Care Through Clinical Integration

Triad HealthCare Network Overview Triad HealthCare Network is a new Clinically Integrated Network that has formed in the Piedmont Triad area. THN is a new model of care designed to bring employed physicians, independent physicians, and Cone Health into a more clinically and financially aligned business partnership to improve access, improve quality and lower costs. THN seeks to better prepare its members for the inevitable changes to the nation’s health care system driven by either or both government and market-based reform. 2

Triad HealthCare Network Structure and Governance Board of Managers Operating Committee Nominating Committee Contracting and Finance Committee Quality Credentialing Committee Initial and ongoing membership criteria Set clinical performance criteria and review member performance Look at 3 rd -party agreements and determine potential bonus distributions Assist development of physician board memberships Oversees day-to-day operations 8 members: 3 Physicians (2 Ind./1 Emp.) 2 Cone Representatives 3 Community Representatives 21 members: 17 Physicians (9 Ind./8 Emp.) 3 Cone Representatives 1 Community Representative M ANAGEMENT Executive Medical Director Thomas Wall, M.D. Executive Director Steve Neorr 3

Triad HealthCare Network Proposed Quality Committee Structure Family Medicine Quality Committee Patrick Wright, M.D. – Chairman Mary Jo Cagle, M.D. – Vice Chairman Medicine CPC Carl Gessner, MD John Bednar, MD Primary Care CPC Doug Shaw, MD Yvonne Lowne, DO Heart and Vascular CPC Ed Gerhardt, MD Tom Stuckey, MD Surgery CPC David Newman, MD John Hewitt, MD Women’s and Children’s CPC Kelly Leggett, MD Ron Young, MD Hospital Clinical Services CPC Josh Kish, MD Mark Shogry, MD Internal Medicine Hospital Medicine Gastroenterology Hem/Oncology Infectious Disease Nephrology Rheumatology Dermatology Emergency Medicine Endocrinology Hospital Medicine Pulmonology Neurology Neurosurgery Cardiology Cardiovascular Surg. Vascular Surgery Anesthesia General Surgery Orthopedics Ophthalmology ENT Urology Ob/Gyn Neonatology Pediatrics Pathology Radiology Radiation Oncology Practice Management John Nosek TBD Community Practice Administrators Administrative Chair A DMINISTRATIVE C HAIRS would be composed of Cone Health System employees or non-physician health leaders – Hospital presidents, vice presidents, directors of nursing, practice administrators, etc. Hospice /Palliative Care Administrative Chair Psychiatry 4

Value for Physicians THN to provide value-added services and resources to assist practices – Deployment of Clinical Performance Reporting System to: Capture and analyze clinical data Implement in-office Point-of-Care decision support Generate patient disease registries – Case Management – Assistance to achieve Meaningful Use and Patient-Centered Medical Home recognition – Submission of quality measures for the Physician Quality Reporting System (PQRS) – Joint contracting for quality/cost savings incentive plans with payers 5

Triad HealthCare Network Business Strategy Continue Current Fee-For-Service Claims & Payment Structure Quality Bonus Payout Based On THN Goals and Performance Measures Insurers and Employers Negotiated Incentive-Based Contracts Clinical Performance Reporting System Physicians Claims and EMR Data POC, Registry, Performance Data P4P Shared Savings Gain Sharing 6

Clinical Performance Reporting System is Critical Data from Practice Management Systems Data from EMRs Data from Hospitals Lab data from Reference Labs Pharmacy data Electronic claims data from payers Data is extracted, aggregated, standardized and stored by a third-party intermediary vendor Clinical Data Repository (“CDR”) Clinical Protocol Engine Data is processed through protocols and algorithms to support clinical metrics and benchmarks established by Physicians “Real “ time Patient Summary Preventive Care & CDM Reminders Point-of-Care Decision Support Patient Disease Registries Practice Performance Feedback Community NCQA, BTE PQRS Payers External Reporting Web Portal Access and Reporting 7

Sample Clinical Decision Support at the Point-of-Care Practice Performance Feedback Diagnoses and Meds are prioritized to highlight chronic conditions Goals Not Met are highlighted for quick reference and visibility Targeted reminders for nursing staff allow better leverage of provider time and more efficient workflow Labs, Calculations and Diagnostic Procedures pertinent to the Action Items are displayed for easy reference 8

Information Technology/Analytics Systems PCPs with EMRs Specialists w/ EMRs using POC Data from Hospitals Lab data from Reference Labs Pharmacy data Clinical Data Repository Claims Data from Payers Expertise in clinical data extraction Provides clinical protocol engine Point-of-care reports Patient disease registries “Manual” population analytics Claims data integration Reports compliance with metrics Submits PQRS/ACO data to CMS Community Data Repository All Other PCPs and Specialists Radiology Expertise in community data aggregation Provides longitudinal view of patient across community – all pertinent activity over time Interfaces with EHRs Master Patient Index (“MPI”) Provides portal view to all providers Ability to enter data for non-EMR physicians “Automatic” population analytics - patient stratification Prospective identification of patient risk – case mgmt targets Retrospective analytics – utilization and cost efficiency Admits/1000, hi-tech imaging, ETGs - Episode Treatment Groups Identify opportunity for savings and improvement Case Management module – care documentation, communication Patient portal – patient engagement Clinical Performance Reporting System HIE Health Information Exchange (“HIE”) CPRS Population analytics, utilization, case management module

HIE View 10

HIE View 11

Triad HealthCare Network Membership Requirements –North Carolina Licensure –Board Certification –DEA License –Liability Insurance –Credentialing Requirements –Participation Agreement –Clinical Integration Program –Education –Compliance –Quality Assurance –Provide Claims/Clinical Information –All-Contracts Participation –High-speed internet –Actively Used –Attend Orientation Physician Eligibility Requirements Physician Participation Requirements 12

Opportunities Medicare Shared Savings Program – Submitted application to participate as an “ACO” with Medicare effective July 1, 2012 – Submitted 170 adult Primary Care Physician network with application – 5 counties – will include over 34,000 beneficiaries – Will seek conversion from opt-in to executed participation agreements for specialists by June 30, 2012 – Must report and meet 33 “quality” metrics to access savings All major payers interested in discussing arrangement Cone Health Employee population (12,000+) – Development of THN-based “narrow” network 13

Triad HealthCare Network Value Practice Performance Feedback Physicians Patients Payers Cone Health Physicians PatientsPayersCone Health GIVE GET Financial Support, Resources Commitment, Participation, Leadership Performance Incentive Payments Trust, Proactive Involvement Efficiency, Partnership, Mission Increased Efficiency, Coordination Transparency, Efficiency, Quality Better Health Care 14

Questions? For further information, please visit or call (855) 4 THN NOW ( ) 15