Medical Directors Council Fall 2013 Meeting September 30 – October 2, 2013 Portland, Oregon 1

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

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ACHP Members 7 Capital District Physicians’ Health PlanAlbany, NY Capital Health Plan Tallahassee, FL CareOregon Portland, OR Dean Health PlanMadison, WI 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

8 ACHP’s Mixed Delivery Models * Source: Based on self-reported estimates from ACHP plans reflecting 2012 data. * This chart shows the percent of enrollees cared for by employed versus contracted physicians. The information reflects physician care only and not hospital care.

9 ACHP Distribution of Enrollment * Source: Based on self-reported estimates from ACHP plans reflecting 2012 data.

2012Total Enrollment Distribution Among ACHP Member Plans 10

NCQA’s Health Plan Rankings – Proven Quality 11 On the 2013 NCQA Health Plan rankings, ACHP plans were: 17 of the top 25 commercial plans 16 of the top 25 Medicare plans 8 of the top 25 Medicaid plans ACHP Member PlanCommercialMedicareMedicaid CDPHP18 & 1999 CDPHP PPO26 Capital Health Plan156 Fallon Community Health Plan34151 Geisinger Health Plan227 Group Health 5212 GHCSCW21 HealthPartners3014 Independent Health Kaiser Permanente CO134 Southern CA171 Northern CA72 Northwest23 Hawaii2552 Mid-Atlantic168 Ohio 1011 Priority Health Security Health Plan Tufts Health Plan6 Tufts Health Plan PPO8 Network Health (Tufts Health Plan) 3 UPMC Health Plan11 & UPMC Health Plan PPO4840

ACHP’s 2013 Goals ACHP members: Lead improvements and innovation in accountable community systems of care Demonstrate distinctive value and performance; provide leadership toward greater affordability of coverage & care Successfully compete in their markets Influence public policy outcomes on issues that are central to business and mission success ACHP: Effectively communicates our leadership role as an organization of the nation’s highest performing health plans 12

Implementing the ACHP Agenda 13 Accelerated Learning Improvement Tools Public Policy Development & Advocacy Communicating Distinctiveness, Leadership

ACHP Work Groups  Behavioral Health Directors  Compliance Officers  Communications Leaders  Legal Counsel  Marketplace Leaders  Medical Directors 14 ACHP has various work groups that meet periodically throughout the year:

Medical Directors’ Agenda: Affordability Aligning our work to drive more attention to total cost of care without compromising quality 15 Lower cost, improved health and care Primary care Payment reform Greater transparency Focus on high cost areas and populations Population health Pharmacy Directors - Primary Focus Areas

Best practice sharing Focused working groups Telling our story Multi-year, multi-lever work 16 Levers for Influence Quantitative proof of differen- tiation Best practice sharing  Bi-annual meetings  Innovation webinars Focused working groups  Pharmacy Directors  Specialty Drug  Opiates  Behavioral Health Directors  Medicaid/Duals Telling our story Primary Care Transformation Curbing Opioid Overuse in Communities Payment roundtable and testimonies  Innovations in MD payment Quantitative proof of differentiation  Specialty drug and opiate data collection and analysis

Pharmacy Directors’ Collaborative: Work Summary Launched the Specialty Drug Management workgroup – Fall 2011 –Created a utilization and drug spend benchmarking tool –Data collection and analysis –Convened at bi-annual meeting to discuss key topics and share best practices Launched second workgroup on Opiate Management – Spring 2012 –Developed utilization tool for frequently prescribed narcotics –Highlighted existing and planned initiatives around narcotic use Continuous information exchange –Member inquiries –Bi-weekly workgroup planning calls –Pharmacy Directors’ Collaborative workgroup calls –Online learning sessions on focused topic areas –Surveys (e.g. Specialty Drug Benefit Design Survey) 17

18 ACHP is the collective voice for mission- driven organizations focused on providing high-quality health care and improving the health of their communities with greater affordability.

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ACHP.org 20

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Opioid Issue Brief Ensuring Safe and Appropriate Prescription Painkiller Use: The Important Role of Community Health Plans 26 Outlines the issue Highlights the initiatives in place at ACHP member plans that appear to reduce doses of opioids used to safer levels, improve coordination of care and patient-physician communication, and lower costs Stresses the key role health plans play in ensuring safe and appropriate use of opioids

Medicaid/Dual Eligibles Workgroup Created by ACHP Medical Directors in 2012 as a learning group, due to Medicaid expansion under the ACA, growth of Medicaid Managed Care products among our plans, and challenges in caring for Medicaid and dually-eligible patients. Will meet every other month for discussion-based learning sessions. –These will be led by a member plan but focused on sharing experiences, ideas and challenges among all participants on the call 27

Health Plan Innovations in Patient-Centered Care: Primary Care Transformation A report by ACHP, found that health plans can strengthen organized systems of care through primary care transformation, and can ensure that such transformation is successful, sustainable and scalable by focusing on three core elements: 1. collaboration; 2. sharing of tools and resources with practices; 3. building on the existing cultures and characteristics of the health plan, providers, patients and community. Outcome: All 17 member organizations profiled increased quality care, improved patient and/or provider experience and/or lowered costs and/or improved patient or provider experience. Many did all three, demonstrating that health plans and provider groups do not have to sacrifice quality and patient experience for cost. Release date: March 7,

ACHP Contacts  Jennifer Phillips, Manager, Innovation Programs  Lynne Cuppernull, Director, Clinical Learning & Innovation  Stephen Cox, Senior Business Analyst  Lindsay Arrington, Administrative Coordinator, Learning & Innovation A full list of staff members can be found at Phone: Fax: Web: Address: 1825 Eye Street, NW Suite 401 Washington, DC

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