Evolving the Oncology Medical Home Dr. Michael Kolodziej, National Medical Director, Oncology Solutions, Aetna Kathy Lokay, President and CEO, Via Oncology Barry Russo, CEO, The Center for Cancer and Blood Disorders Maria Sipala, Director, Strategic Planning, National Network Contracting, Aetna Amy Supraner, Strategic Planning Manager, National Network Contracting, Aetna Dr. Ira Klein, National Medical Director, Clinical Thought Leadership, Aetna

3 We, too, can evolve further!

In the Beginning, a study: ↑ Adherence to EBM had ↓ cost with no negative impact on treatment efficacy – Study: “Cost Effectiveness of Evidence-Based Treatment Guidelines for the Treatment of Non–Small-Cell Lung Cancer in the Community Setting” (NSCLC) – Published: Journal of Oncology Practice (American Society of Clinical Oncology Peer Reviewed Journal), 1/19/2010 No change in overall survival between the study groups Source: “Cost Effectiveness of Evidence-Based Treatment Guidelines for the Treatment of Non– Small-Cell Lung Cancer in the Community Setting”. Journal of Oncology Practice. January Volume 6. No.1. p Significantly lowered cost in the case group vs. The control group Purpose: Evaluate the cost effectiveness of evidence-based treatment pathways for NSCLC patients Conclusion: Results of this study suggest that treating patients according to evidence-based guidelines is a cost-effective strategy for delivering care to those with NSCLC. Overall survival by Pathway status. 4

5 We All Derived a Similar Equation Regarding Cost and Efficacy in Cancer Care V = Q C Guideline Based Therapies Targeted Impact Low Toxicities Improved Survival Improved QOL Best Supportive Care Avoidance Hospital Days Avoidance ED Visits Site of Service Costs ↓ Medically Unnecessary Care ↓ at EOL

Aetna Developed a Payer Strategy around this, and so did everyone else…..but not all the same Drive efficient use of evidence-based medicine –platform that provides content and workflows –integrate into the Aetna and provider systems –simplify the administrative processes for providers Avoid waste and misuse of medical services –better provider alignment (e.g., Oncology Patient Centered Medical Home), –better network (narrow, tiered) –better decision support strategies Leverage and integrate the many current (and future) medical and pharmacy cancer-care initiatives –seamless, end to end cancer experience for Aetna members and providers 6

7 Who’s got Clinical Decision Support (CDS) available in the Marketplace?

Where Aetna has been with “pilots” in order to prove out theoretical concepts: Can CDS tools alone, without other inducements beyond minimal workflow improvements, influence NCCN guideline compliance in all pop., no additional economic incentives? Do Pathways tools (clinical decision support, or CDS) + oncology medical home resources make economic sense, contract in commercial pop.? Will CDS tools and medical home resources and tight healthplan linkages and reporting improve value parameters in Medicare pop., blended contract? Can CDS tools alone + altered drug fee schedules improve value parameters, pay for value contract, all pop.? TX Oncology pilotCardinal/P4 pilotEviti pilotTX Oncology pilot, #2

FFS payments to physicians Total physician payment All other payments Current ModelProposed Model Current Model Proposed Model Total Cost of Cancer Care Total physician payment All other cancer care spending elements Total physician payment All other Cancer care Spending elements FFS payments to physicians Care coordination fee Case management payment Payment for all other cancer care Payment for all other cancer care Waste and inefficiency The Goal is to Achieve Meaningful Payment Reform Total Payments for Cancer Care The Brookings Institution, Washington, D.C.

Next Step: the Oncology Medical Home

11 What’s Needed for Practices to meet the Aetna Criterion for OMH Contracting: Market level conditions Practice Volume Oncology Medical Home Solution Practice IT & other capabilities  Aetna Breast, Lung, Colorectal Cancer patients and $ K per year spend on them.  Must use Clinical decision support tool.  Perform enhanced triage, both telephonic and in-office  Nurse Navigator.  Can conduct and collate results of a patient satisfaction survey.  Can do PDCA style quality improvement program.  Membership in Market.  Market buy-in.  Is there a mandatory CDS program in state?  Is practice in ACO/PHO?  Infusion Suite in office (buy and bill model) vs. sending to outpatient infusion center.

Aetna Oncology Medical Home payment for oncology care means growth instead of shortfall Sustainable Future Performance *Ultimately, this becomes a better “reset” baseline for episodes and/or bundles Current Fee for Service Model Invest in New processes Shared Savings on improvement from baseline outcomes Enhanced drug fee schedule Changes in pre-cert model alter FTE’s S-codes for quality processes that have meaning HIT Office workflow efficiencies *Diagram is illustrative and for discussion purposes only Our goal is to create a sustainable business model designed around new sources of value that will be resilient through and post health care reform. Growth Future Base Model(s) Without Medical Home-like contracts Revenue Gap (e.g., private payer and CMS induced)

Practice Demographics Market Benchmarks Savings Calculations Aetna Shared SavingsPractice Shared Savings Reconciliation: Practice, Market Level Benchmarks, Financials

The Future: Move Providers up the Value Chain with multiple support efforts Vendor Oncology Programs Oncology Medical Homes Bundles/ Episode Payments OMH, ACOs, Bundles Vendor based programs introduce Clinical Pathways and Measure Adherence along with Quality Measures More sophisticated Practices move from vendor based Clinical Pathways programs to Oncology Medical Homes (OMH) Smaller Practices work with Education Oncology programs such as NJ ION program Create episode and bundling methodology test with OMH, as well as deployed in ACO Provider engagement Index Low Touch High Touch Some Clinical Engagement OMH deployed in 65% of markets and ACOs by 4Q15 More Clinical Engagement High Clinical Engagement Cardinal, New Century Health, Innovent