CTC CLAIMS DATA COLLECTION AND ANALYSES UPDATE CTC Steering Committee February 13,

CTC Multi-payer, Multi-year Dataset RI covered lives (residents and nonresidents) Three health plans (Tufts not included) Medicaid FFS (in processing) Medicare FFS (in processing) Receiving quarterly data from the health plans Utilization: 2009 through March 2014 Amounts paid: 2012 through March 2014 Adults only (claims for kids received but not in any analyses) Non-residents excluded (by RTI) if they receive primary care services out of state Unlike the APCD, identifiers are specific to each payer (crossovers appear as multiple individuals) 2

Profile of Data from Three Plan (Adults), 2013 (in thousands) Total All CTC practices Other Medical Homes Comparison practices Attributed outside RIUnattributed Persons Member years Each member is counted the percent of time they were in each group with their total time adding to one person. 2 Each member is counted in only one group per month based on attribution for that month.

CTC Cohort 1: 15 practice sites Blackstone Valley Community Health Care, Inc. Coastal Medical, Inc. - Greenville Coastal Medical, Inc. - Hillside Coastal Medical, Inc. - Narragansett Coastal Medical, Inc. - Wakefield Family Health and Sports Medicine Kristine Cuniff Memorial Hospital Family Care Center South County Hospital Family Medicine South County Internal Medicine Stuart Demirs Thundermist CHC - Wakefield Thundermist CHC - Woonsocket University Family Medicine University Medicine - Governor Street Primary Care 4

CTC Cohort 2: 21 practice sites Anchor Medical Associates - Lincoln Anchor Medical Associates - Providence Anchor Medical Associates - Warwick Aquidneck Medical Associates - Newport Aquidneck Medical Associates - Portsmouth Associates in Primary Care Medicine East Bay Community Action Program - East Providence East Bay Community Action Program - Newport Medical Associates of RI - Bristol Medical Associates of RI - East Providence Ocean State Medical, LLC Tri Town Community Action Program University Internal Medicine University Medicine North Main Street University Medicine - Barrington University Medicine - East Ave University Medicine - Plain Street University Medicine - Warwick Family Medicine WellOne Primary Medicine - Foster WellOne Primary Medicine - North Kingstown WellOne Primary Medicine - Pascoag 5

Metrics For Today All-Cause Inpatient admissions All-Cause ED visits Available Ambulatory care sensitive admissions Possibly preventable ED visits Observation stays 30-day readmissions Stratifications payer type (Medicaid [RIteCare and RHP], Medicare, Commercial) Medical versus surgical procedures Upcoming Costs 6

Default: Rate for Rolling Years (Trailing Four Quarters) Numerator Number of measure-specified events (e.g., ED visits) in the trailing four quarters. Denominator Sum of all time with coverage (in monthly chunks) in the trailing year across the covered population, expressed as 1,000 member-months. 7

CTC Cohort 1 and Comparison Changes 8 Changes Group Year Ending Mar 2013 Year Ending Mar 2014 Difference% Difference (A)(B)(B-A)(B-A)/A All-cause inpatient admissions per 1000 member months: (1) CTC Cohort % (2) Comparison (0.31)(4.13)% Difference (1-2) % All-cause ED visits per 1000 member months: (1) CTC Cohort (0.22)(0.85%) (2) Comparison % Difference (1-2)(0.81)(3.62%)

CTC Cohort 2 and Comparison Changes 9 Changes Group Year Ending Mar 2013 Year Ending Mar 2014 Difference% Difference (A)(B)(B-A)(B-A)/A All-cause inpatient admissions per 1,000 member months: (1) CTC Cohort (0.51)(6.78)% (2) Comparison (0.31)(4.13)% Difference (1-2)(0.20)(2.65)% All-cause ED visits per 1,000 member months: (1) CTC Cohort (0.89%) (2) Comparison % Difference (1-2)(0.42)(1.88%)

Payer Type Mix Cohort 1Cohort 2Comparison Commercial 68%66%71%70%69%68% Medicare Advantage RIteCare RHP Medicaid FFS Medicaid data from EOHHS is in processing

11 All-Cause Admission Rate: All Payers

12 All-Cause Admission Rate: Commercial

13 All-Cause Admission Rate: Medicare Advantage

14 All-Cause Admission Rate: RiteCare

15 All-Cause Admission Rate: RHP

16 ED Visit Rate: All Payers

17 ED Visit Rate: All Payers

18 ED Visit Rate: Commercial

19 ED Visit Rate: Medicare Advantage

ED Visit Rate: RiteCare 20

21 ED Visit Rate: RHP

Limitations Attributing people to practice sites is imperfect (consistent with plan payments) Results are sensitive to sample sizes Changes in rates are relatively small Slightly differential case-mix over time Secular trends affect the rates 22

Next Steps Adding Medicare and Medicaid FFS claims now Compare risk-adjusted (adjusted for age, gender, and health status) rates Program Evaluation Committee focusing on developing a more robust evaluation plan for CTC Comparison groups is slightly different Risk adjustment Meaningful subgroups Statistical tests Accounting for when practices joined CTC 23

Total Cost of Care Measures Measure is dollars per member per month ($PMPM) Raw expenditures based on allowed amounts Price-adjusted measures using HealthPartners Total Cost of Care Methodology (National Quality Forum certified) Risk-adjusted (similar to utilization rates) Currently benchmarking against known expenditures from plans as a validity check Using all costs instead of a subset (utilizations measures have exclusions) 24

25 Behavioral Health Admission Rate: Commercial

26 Behavioral Health Admission Rate: All Payers

27 Behavioral Health Admission Rate: Commercial

28 Behavioral Health Admission Rate: Medicare Advantage

29 Behavioral Health Admission Rate: RiteCare

30 Behavioral Health Admission Rate: RHP

31 Behavioral Health ED Visit Rate: All Payers

32 Behavioral Health ED Visit Rate: Commercial

33 Behavioral Health ED Visit Rate: Medicare Advantage

34 Behavioral Health ED Visit Rate: RiteCare

35 Behavioral Health ED Visit Rate: RHP