Population Health The Road to 2020 & The Path to Value Dr. Matthew Wayne Chief Medical Officer, New Health Collaborative & Summa Physicians September 16, 2015

Who We Are NewHealth Collaborative (NHC): Clinician-led collaborative founded in January We partner with communities to compassionately care for and serve our populations. We do so in an accountable, value- and evidence-based manner. More than 90,000 patients & $700 million in total annual medical spend. The only Accountable Care Organization (ACO) in Ohio to achieved shared savings two years in a row. 3.8% in savings on total cost of care in FFS 2

What Our ACO Looks Like ProvidersHospitals/SystemsPayers Mercy Professional Care Corp. Mercy Medical Center - Canton MMO HealthSpan Physicians, LLCCrystal Clinic Orthopedic Center Medicare Independent physician practices Summa HealthSummaCare Summa Physicians, Inc.Humana HealthSpan

Our Success $10,225,342 $11,796,182 $306,829,999 $295,033,817 $275,693,772 $265,468,431 * 2013 measurement year ran from 7/1/12 through 12/31/13, and 2014 measurement year ran from 1/1/14 through 12/31/14

2014 Quality Scores by Domain % NHC Quality Score 33 Quality measures are separated into four key domains that serve as the basis for assessing, benchmarking, rewarding and improving ACO quality performance

How did we do it? 6

Risk Stratification 7

Tools and Strategies 8 In-Network Care Coordination Integrated Care Management Clinical Communication Center Primary Care Transformational Goals Primary Care Transformational Goals

Example: Integrated Care Management 9 Outcomes Patient and physician satisfaction, reduced unnecessary hospital admissions and emergency room encounters Follow Up CM works the plan of care with patient including: in person & phone encounters, home visits, community referrals, visits w specialists. warm handoffs with other service providers CM communicates and documents care updates, clarifications, community linkages in EMR and by phone Plan of Care Plan of care problems and and goals are discussed and documented in EMRPt receives written plan with goals (see form) and patient education as needed Comprehensive visit Attended by PCP, CM and patient/family30 minute visit3 Patient problems and goals are highlighted Outreach to Patient PCP Office phones patient using scriptingIntroduces CM & Schedules Comprehensive Visit Validate and Collaborate Care Manager, Primary Care Physician and Office Champion review high risk listPrioritize patients; CM investigates pertinent history Identify the High Risk Patient List generated from payer data and PCP input. High Risk defined by cost, patterns of care, utilization, co-morbidity

Example: Outcomes for Integrated Care Management 13 Integrated RN Care Managers supporting all primary care offices within NHC Populations currently under focus: – High risk/fragile patients – Diabetics in poor control Patients under management as of June: 1,923 Average patients/care manager: 148 Outcomes Jan - June 2015: – 247 admissions avoided – 227 ED visits avoided – High levels of provider and patient satisfaction 10

Why is this important? 11

Why Population Health? Fee-for-service payment model is unsustainable – Outcomes do not support the cost Opportunity to reengineer how healthcare is delivered to drive Triple Aim outcomes… – Cost, Quality and Patient Experience And thereby create value

Value Equation in Healthcare: The Triple Aim Restated Adapted from: Porter ME, Lee TH. "The Strategy That Will Fix Health Care: Providers Must Lead The Way In Making Value The Overarching Goal". Harvard Business Review, October 2013 & Healthcare Financial Management Association “Value in Health Care: Current State and Future Direction” June 2011

The Road to 2020 Two Provisions in FY State Budget Sec (A) Not later than July 1, 2018, each medicaid managed care organization shall implement strategies that base payments to providers on the value received from the providers' services... AND Not later than July 1, 2020, each medicaid managed care organization shall ensure that at least fifty per cent of the aggregate net payments it makes to providers are based on the value received from the providers' services. 14

New Health Collaborative Value Proposition Provider based organization – Patient centered solutions – EHR and analytics – Clinical standards Medicaid solutions – Same principles, different strategies – Women and children – Disabled – Dual eligible 15

What Does It Look Like? Common EHR and analytics Integrated data for clinicians and patients regardless of site Agreed upon clinical standards Teams of clinicians working collaboratively to treat patients More care delivered outside of hospitals – Hospitals move from revenue generator to cost center Financial burden of healthcare decreased – For Summa, employers, government, & patients

Challenges How do you pay for value? Aligning excellent care with payer approaches that recognizes value Developing synergy with managed care organizations (MCO) – Who leads? – Where is there duplication in services and how do we reconcile that? – Where are there care gaps and who is responsible for eliminating the care gap? – Each MCO operates differently 17

QUESTIONS? 18