© 2011 Advocate Physician Partners Advocate Accountable Care Carrie E. Nelson, MD, MS, FAAFP Stakeholder Health September 25, 2015

© 2011 Advocate Physician Partners Advocate Health Care 13 Hospitals 10 acute care hospitals 1 children’s hospital 1 critical access hospital 1 clinically affiliated hospital 5 level 1 trauma centers 3 major teaching hospitals 2 physician groups with 1,500 physicians 250 sites of care 34,000 Employees Advocate Physician Partners 4,900 Participating Physicians 25% PCPs / 75% specialists 1400 Employed/3500 Aligned 2 nd Largest ACO in US - 745,000 covered lives 2

© 2011 Advocate Physician Partners Clinical Integration (CI) A structured collaboration among APP physicians and Advocate Hospitals to improve the quality and efficiency of health care. Joint contracting with fee-for-service managed care organizations is a necessary component of this program in order to accelerate these improvements in health care delivery. CI forms the foundation for population health 3

© 2011 Advocate Physician Partners Highlights of 2014 CI Program A Generic Drug Prescribing Rate of 2 Percentage Points higher than the Chicagoland market  >$17 Million of overall health care drug expenditures were avoided by utilizing lower cost, equally-effective generics An Outstanding Asthma Control Rate – 24 Percentage Points Higher than the National Average  Saving ~$17 Million in Direct and Indirect Medical Costs A Diabetes Care Initiative for HbA1c Control  Saving >$1.4 Million Childhood Rotavirus Immunization Initiative: –Exceeded National HMO rates by 9.2% points –Exceeded National PPO rates by 19% points –Saving >$4 Million in Avoided Hospital Costs Combination 3 Childhood Immunization Rates Above the NCQA 75th Percentile for Combined HMO and PPO 4

© 2011 Advocate Physician Partners Our Reimbursement Model is Shifting 5

© 2011 Advocate Physician Partners Accountable Care Entity (ACE) Illinois Medicaid Expansion Bill Signed Into Law July 22, 2013 Created provider-sponsored “Accountable Care Entity (ACE)” to coordinate care for Medicaid eligible individuals ACE as an alternative for providers to reliance on other managed Medicaid organizations Eligible Medicaid populations are children and their family members and Affordable Care Act “newly eligible” beneficiaries 6

© 2011 Advocate Physician Partners Medicaid PCP and OB Capacity 7

© 2011 Advocate Physician Partners APP ACE Eligible Population Family Health Plan – Existing Medicaid FFS Patients Newly Eligible ACA Adults –APP will include this population in ,000 19,500 10,500 Estimated Lives 150,000

© 2011 Advocate Physician Partners ACE 3-Year Risk Pathway – Originally Proposed Program supports transition away from fee-for- service with care coordination fees as ACEs accept more risk Months 1-18: Care coordination fees and shared savings Months 19-36: Prepaid capitation with individual and global stop-loss provided by HFS; transition to Managed Care Community Network (MCCN) or HMO Months 37+: Global capitation 9

© 2011 Advocate Physician Partners Key Considerations in Assuming Risk for Medicaid Best opportunity for provider community to manage Medicaid population Aligned with Advocate mission and vision Further moves the organization to one model of care for all patients –Patients will move in and out of public Marketplace and Medicaid Maintains existing Medicaid lives managed by Advocate providers –Children’s Hospital and residency programs –Half of OB volume in Illinois, similar in Advocate Health Care Aligned incentives Moves the organization progressively toward managing financial risk 10

© 2011 Advocate Physician Partners BUT… Illinois pays among the lowest in the nation for Medicaid Illinois is broke and hasn’t paid the managed care organizations for 3 months Not all our physicians want to do it – some are very vocal 11

© 2011 Advocate Physician Partners So What Did We Do? 12

© 2011 Advocate Physician Partners Why? 13

© 2011 Advocate Physician Partners Medicaid Targeted Initiative: Community Health Worker Program Medicaid ACE program prompted a need to look for new approaches to engage patients Look at two separate models/conditions to gauge effectiveness –Trinity PHO: Asthma (Feb 2015) –Christ PHO: ED Use (2 nd Qtr 2015) Design full program using consulting services from Sinai Urban Health institute Develop new approaches for patient outreach and education

© 2011 Advocate Physician Partners Trinity Pilot: Overview Patients with poor asthma control are visited by CHWs in their homes up to six times during yearlong intervention –Physicians and claims identify patients to participate –Direct recruitment flyer sent monthly to members The CHW is an extension of the care management team The CHW sends physicians a summary of the patient’s evaluation and educational plan Results not yet complete 15

© 2011 Advocate Physician Partners Trinity Pilot: CHW team Wakita Coleman Moet Sims- Denmark Melinda Harville 16

© 2011 Advocate Physician Partners Trinity Pilot: Measuring Success Decrease in asthma ED visits Decrease in asthma hospitalizations % Of patients who demonstrate their ability to control their asthma (measured by ACT) Improvement in quality of life measures Decrease in asthma triggers in home Increase in medication usage Decrease in the frequency of asthma symptoms Stories! 17

© 2011 Advocate Physician Partners Q&A