P4P and Group IT Investment Douglas Allen, MD., MMM. November 18, 2004

IT Requirements for High Performance Get Data Get Data Lab Values, Rx, Prof Claims, ?Facility Claims Lab Values, Rx, Prof Claims, ?Facility Claims Therapeutic Class Summary Database Therapeutic Class Summary Database Extraction of Non-Claims Data Extraction of Non-Claims Data Chart Abstraction, ?EMR Chart Abstraction, ?EMR Make Data Good Make Data Good Dash Board Reports Dash Board Reports Internal Investigative Team to Troubleshoot Internal Investigative Team to Troubleshoot

IT Requirements for High Performance Use Good Data Use Good Data Disease Registries Disease Registries Feed Physicians: Patient Negative Lists Feed Physicians: Patient Negative Lists Contact Patients: Education, Reminders Contact Patients: Education, Reminders High Risk Case Manager Work List High Risk Case Manager Work List Physician Specific Performance Measurement Physician Specific Performance Measurement +/- Incentives +/- Incentives Fed Back Blinded/Unblinded Fed Back Blinded/Unblinded Point of Care Support Point of Care Support Physician Reminders Upon Eligibility Checking Physician Reminders Upon Eligibility Checking Lab Values Lab Values

The Cost Ladder Dz Registry Through Vendor $

The Cost Ladder Dz Registry Through Vendor Patient Negative lists $

The Cost Ladder Dz Registry Through Vendor Patient Negative lists Patient Reminders $ $$

The Cost Ladder Dz Registry Through Vendor Patient Negative lists Patient Reminders Internal Data Warehouse $ $$

The Cost Ladder Dz Registry Through Vendor Patient Negative lists Patient Reminders Internal Data Warehouse Dr Financial Incentives $ $$

The Cost Ladder Dz Registry Through Vendor Patient Negative lists Patient Reminders Internal Data Warehouse Dr Financial Incentives Real Time Decision Support $ $$ $$$

The Cost Ladder Dz Registry Through Vendor Patient Negative lists Patient Reminders Internal Data Warehouse Dr Financial Incentives Real Time Decision Support Dz Specific Case Management $ $$ $$$

Investment Cost Ladder Dz Registry Through Vendor Patient Negative lists Patient Reminders Internal Data Warehouse Dr Financial Incentives Real Time Decision Support Dz Specific Case Management Electronic Medical Record (Practitioner) $ $$ $$$ $$$$

Investment Cost Ladder Dz Registry Through Vendor Patient Negative lists Patient Reminders Internal Data Warehouse Dr Financial Incentives Real Time Decision Support Dz Specific Case Management Electronic Medical Record (Practitioner) $ $$ $$$ $$$$ Electronic Medical Record (Group)

GNP Performance VZV90 th %tile VZV90 th %tile MMR85 th %tile MMR85 th %tile Rest of Childhood Imm60 th %tile Rest of Childhood Imm60 th %tile Asthma70 th %tile Asthma70 th %tile Breast Cancer90 th %tile Breast Cancer90 th %tile Cervical Screening90 th %tile Cervical Screening90 th %tile Diabetes90 th %tile Diabetes90 th %tile LDL60 th %tile LDL60 th %tile

GNP Performance (cont) ITMax ITMax Patient Satisfaction (ave)64 th %tile Patient Satisfaction (ave)64 th %tile State wide, but higher for our region

P4P $ (PMPM) to GNP HMO P4P Payout PMPM HMO P4P Payout PMPM Plan 1 $0.25 Plan 1 $0.25 Plan 2 $0.78 Plan 2 $0.78 Plan 3 $0.94 Plan 3 $0.94 Plan 4 $1.30 Plan 4 $1.30 Plan 5 $1.38 Plan 5 $1.38 Plan 6 $1.89 Plan 6 $1.89

What is GNP Investing In? Internal CDR Already Developed Internal CDR Already Developed Expanding the Number of Analysts Expanding the Number of Analysts Converting: SAS to Prof Data Warehouse Converting: SAS to Prof Data Warehouse Internet Connectivity for Physicians Internet Connectivity for Physicians Alone, This Exceeded Full P4P $ Alone, This Exceeded Full P4P $ Real Time Decision Support Real Time Decision Support

Too Few $ For … Full Time Dz Case Management Full Time Dz Case Management EMR for IPA Physicians EMR for IPA Physicians Intensive Patient Satisfaction Intervention Intensive Patient Satisfaction Intervention

Concerns About Future $ No “New” Money No “New” Money Health Plans Bake Into Pricing Model Health Plans Bake Into Pricing Model Base Increases in Premium ? at Risk Base Increases in Premium ? at Risk Including Those Needed to Meet Expenses Including Those Needed to Meet Expenses Health Plan Payout Methodology Health Plan Payout Methodology Top X Percentile Top X Percentile Continued Funding Continued Funding Guarantees, to Offset Premium Increases Guarantees, to Offset Premium Increases

Possible Solutions CAPG Strategy for Transparency CAPG Strategy for Transparency Publicize Health Plan $ and Methodology CAPG Strategy for Payout Methodology CAPG Strategy for Payout Methodology Absolute Performance Payout + Percentile Payout. $2+ PMPM for P4P Metrics. Separate from Base Contract ? Isolate the Funds ? Isolate the Funds Separate Pool Separate Pool Paid Directly by Employers Paid Directly by Employers