Obesity Symposium-Ignite the fight against Obesity: Advocate’s Approach to Population Health Management September 26 th 2014 Pankaj Patel MD MSc Senior Medical Director, Advocate Physician Partners

“Knowing is not enough, we must apply Willing is not enough, we must do” Goethe

Market Trends and Health Reform: It’s A New Day Pressure on Commercial Payers Medicare Insolvency Medical Inflation>Economic Inflation Population Aging and Uninsured ‘Tragedy of the Commons’ Population Health Patient ExperienceCost Per Capita

Insurers Acknowledge Difficulty in Controlling… Utilization of High End Imaging Readmissions Outpatient Trend New Drugs & Technologies Ambulatory Sensitive Conditions 4

Options Reduce Unit Price ACO with aligned incentives to pursue ‘Triple Aim’ Pankaj Patel Population Health Cost Per Capita Patient Experience

APP’s Reimbursement Model Is Shifting 6

Value Based Agreements 7 14 ContractLivesTotal Spend Commercial410,000$2.0 B Medicare Advantage33,000$0.4 B Advocate Employee27,000$0.1 B Medicare ACO122,000$1.4 B Total592,000$3.9 B ACO = Accountable Care Organization

The Cost Equation to Manage Risk Profit Revenue Cost FFS Surgicenter Imaging PT ED visits Readmissions VBC Appropriate Coding Price Volume Low Cost Centers Standardized Care Approach Surgicenter Imaging PT ED visits Readm issions Avoidable morbidity 8

Population Health Management Source: The Advisory Board, Population health managers, meet the three patient types central to your success, June 14, 2013 PCMH EMR / MU Smart Registries Care Guidelines Behavioral Health Op t. CM Medication Therapy Management Post-Acute Network OP Palliative Care XXXXXXXXX XXXXX XXXXX 9

Evolution of Clinical Integration 5 Performance Domains: – Chronic Disease Care – Health and Wellness – Efficiency – Care Coordination – Patient Experience

Evolution of Clinical Integration Population Based Outcome Metric AdvocateCare Index Length of Stay Admits/1000 ED Visits/ Day Readmissions % Days In-Network Additional sub metric 2015 Total cost of care –Episode –pmpm

Evolution of Clinical Integration Change in Incentive Payment Incentives For All Physicians: Move from pay for performance to pay for value contribution Value Contribution = Performance x Volume of patients managed x Coordination of Care factor

Advanced Analytics and Other Care Management Solutions DART - ActiveHealth (HDMS) Predictive Tools –Readmission Risk - Cerner partnership –Falls Risk - Cerner partnership –Risk Stratification - ActiveHealth (HDMS) –Patient Impactability (under development) Total Cost of Care and Resource Use – Licensed from Health Partners Integrating EMRs - CareNet + Care Management Work Flow Tools - ActiveHealth Referral Management ERMA - APP 13

Advancing Evidence Based Clinical Decisions e University CME Programs Clinical Pathways Development / Point of Care Patient Management Protocols Pharmacy Academic Detailing Learning Collaborative Physician Office Staff Training Patient Outreach and Education Patient Health Coaching Program through Care Management Program Patient Self Management Tools 14

Obesity: Impact on Population Health – BMI>30 results in % increase in Mortality – Increase in HTN, DM, CVD, DJD – 36% increase in Medical costs Gluttony or Sloth or Both – Imbalance: Energy consumed and Used – BMJ 1995 Energy consumed declining but obesity increasing

Obesity Related Measures 2012 – BMI Assessment 2013 and 2014 Adults and Pediatrics – BMI Assessment and Follow Up Plan if abnormal – Exercise Assessment and Counseling 2015 Above Plus – Online CME for Diabetes (includes focus on lifestyle changes and consideration of Bariatric surgery)

BCBS ACO Performance 18

Value-based Agreement Results Commercial ACO Cost Savings –2.0% Improvement in PPO cost trend (Q3 2013) –3.1% Improvement in Combined HMO cost trend (Q3 2013) Quality* –HMO – 6 of 8 key metrics improved, 1 no change, 1 decreased Medicare Shared Savings Program Cost Savings –0%, Flat (Preliminary results, First 12 months, Q2 2013) Quality –Completely and accurately reported all 33 quality measures-100% –Estimated score 79% Patient/Care Giver Experience85%Preventative Health87% Care Coordination/Patient Safety65%At-Risk Population83% *PPO Quality Data is not available due to new cohort measurement. 19

Summary Emerging payment models create a focus on population health management Population health requires –A new focus on wellness and health status –A team approach