Internal Medicine Family Practice Emergency Medicine Cardiology Hematology/Oncology Gastroenterology Neurology Pulmonary/CC 50+ Providers (2/3 PCP) 11 Clinic Locations Imaging Center Urgent Care Sleep Lab GI ASC Integrated EHRAll Providers are MU Experience with PHM Reporting

Entered MSSP April 1, 2012 – Track 1 – No Risk Advanced Payment Model (1) $250,000+$36 Initial Payment $8 Per Beneficiary Per Month 11,000+ Attributed Beneficiaries $100,000,000 Estimated Claims Budget

Watched Program Develop and Discussed with Physician Leadership Assessed Prospects for Success Have Other Groups Succeeded? (2) Part A and B Spending in Area (3) >50% of our Revenue Derived from FFS Medicare Ability to Meet Quality Metrics Commitment/Other Projects

Assessed Risk of Status Quo Attended CMS Sponsored ADLS Helped Inform Physician Leadership Showed CMS’s Commitment to Program Heard from Physicians Practicing in more Highly Managed Markets Advanced Payment Model Offered

CMS Estimates $1.7 Million American Hospital Association Estimates $5.3 to $12.0 million We Spent $ K

Implement Integrated Full Feature EHR Need Discrete Data Populated Problem Lists, Labs, Medications, Etc. Attribute Patients to Provider or Practice (Who is responsible) Begin Reporting Population Quality Measures We used QIO and Regional AHEC Collaborative Report Measures Monthly Utilize Team Approach – (Medicare’s AWV can fund Team Expansion) Don’t wait until it’s all done to Join or Start ACO

Understand Your Market and your referral sources Understand who is forming an ACO Understand that you may be able to join only one ACO

Educated Providers and Staff Review ED and Admission Summaries Established After Hours Nurse Triage Line Hired Care Managers Next Day Appointments Increased Marketing for Our Urgent Care Expanded Urgent Care Access to Imaging and Laboratory

(1) Link to CMS Advance Payment Model Information initiatives/aco/advance-payment/index.htmlhttp://innovations.cms.gov/ initiatives/aco/advance-payment/index.html (2) Spending Differences Associated with the Medicare Physician Group Practice Demonstration – JAMA, September 12, 2012 (3) Institute of Medicine Demographic, Cost, Utilization, and Quality Comparison Information phicVariation/Data-Resources.aspx phicVariation/Data-Resources.aspx