Medical Directors & Pharmacy Directors Fall 2011 Meeting

ACHP Mission ACHP and its members improve the health of the communities we serve and actively lead the transformation of health care to promote high quality, affordable care and superior consumer experience. 2

ACHP Member Organization Attributes Quadruple Aim: Focus on health of populations, optimal patient experience (outcomes, quality, satisfaction), affordability, and community benefit. Community-Based: Build communities to better health. Loyal to our communities and inspiring loyalty in return. Provider Partnerships: Partner closely with dedicated and contracted physician groups to improve health and health care delivery. Accept risk and share it with providers through payment strategies to achieve high performance and delivery system reforms. Non-Profit Orientation: The community is the chief stakeholder in our plans’ success. Make decisions that keep consumers healthy for the long-term. Provide community benefit.

Who are ACHP Members? 4 Capital District Physicians’ Health PlanAlbany, NY Capital Health Plan Tallahassee, FL CareOregon Portland, OR Fallon Community Health Plan Worcester, MA Geisinger Health Plan Danville, PA Group Health Seattle, WA Group Health Cooperative of Madison, WI South Central Wisconsin HealthPartners Minneapolis, MN Independent Health Buffalo, NY Kaiser Foundation Health Plans Oakland, CA and the Permanente Federation Martin’s Point Health CarePortland, ME New West Health ServicesHelena, MT Presbyterian Health PlanAlbuquerque, NM Priority Health Grand Rapids, MI Rocky Mountain Health PlansGrand Junction, CO Scott & White Health PlanTemple, TX Security Health Plan Marshfield, WI SelectHealthMurray, UT Tufts Health PlanWaltham, MA UCare Minnesota Minneapolis, MN UPMC Health Plan Pittsburgh, PA

Where are ACHP Members? 5

ACHP’s Mixed Delivery Models 6 * Source: Based on self-reported estimates from ACHP plans reflecting data. * Information does not reflect the percent of members seen by owned/affiliated hospitals or specialists, which may vary considerably from the PCP figures.

ACHP Total Membership Distribution 7 * Source: Based on self-reported estimates from ACHP plans reflecting data. * Other Non-Medical enrollments reflect lives ACHP plans touch through other arrangements such as third-party administrators and dental coverage.

NCQA’s Health Plan Rankings – Proven Quality 8 On the Health Plan rankings, ACHP plans were: 16 of the top 25 Medicare plans 10 of the top 25 private plans 5 of the top 25 Medicaid plans Plan Name MedicareCommercialMedicaid CDPHP 156 Capital Health Plan 14 Fallon Community Health Plan 381 Geisinger Health Plan 105 Group Health Cooperative - SCW 7 Group Health – Seattle 11 HealthPartners 19 Independent Health Kaiser Permanente 2,4,5,8,12, 14,18,19 9, 212 Priority Health 13 Security Health Plan 6 Tuft’s Health Plan 72 UPMC Health Plan 10

ACHP Medical Directors: How We Work Sharing Innovation Collaborative, outcomes oriented initiatives Enhance ACHP visibility by demonstrating differentiation We aim to strike a balance between these three areas – and enhanced patient care at affordable cost remains our end game.

Medical Directors Goals for 2011 Delivering high value patient- centered care and telling a compelling story to policy makers –We will document and publish results for our primary care innovation work: medical home and transitions of care ─ We will create templates of value-based reimbursement pilots for plan adoption as part of our ACO-focused work ─ We will define the role of the integrator in ACO’s and identify options for ACHP members, including functions to “migrate” ─ We will share best practices in leading community initiatives to achieve the triple aim ─ We will define the pharmaceutical opportunity for ACHP and launch this work Experience Health Cost

(projection) Healthcare Costs for American Families – Projection to 2021 Source: 2011 Milliman Medical Index

RFI on VBID Describe in general terms Specifically what value based benefits do members receive for what – Pharmacy – Visits – DME – Other What, if any, differential benefits exist for overutilized conditions, e.g. higher coinsurance if conservative route not done prior to surgery What incentives are being offered to members (e.g. premium relief) What requirements are placed upon members (PHA, PCP identification, etc.)