Montana Health CO-OP: Who We Are

2 Goals To create value through quality outcomes, efficiency and service Move from silo health care delivery to integrated and coordinated care for population members thus eliminating gaps in care, redundancy and waste To “bend the cost curve” for healthcare To reward the value based services and align financial incentives to achieve the measured goals

3 Activities Development a HPN/ACO Formalizing legal entity Allows for engagement of disparate physician practices with a focus on quality improvement Single organization structure with Regional Service Areas Health Care provider leadership of HPN Opportunity to participate in CMS innovation projects like ACO/shared savings programs Restructure of Pay for Performance program and reimbursement methodologies for self funded and fully insured individuals and employers

4 HPN Structure RSO (Regional Service Organization) HPN RSO1 RSO2 RSO3 CHC (PCP) Clinic (PCP) Acute Care Hospital CAH Specialist Clinic Clinic (PCP) CAH Specialist Clinic Acute Care Hospital 1 Acute Care Hospital 2 Clinic (PCP) Specialist Clinic CAH Acute Care Hospital RHC (PCP) CAH

 Technology enables system to identify gaps in preventative care; use of Evidenced Based Medicine (EBM) standards Patient proactively contacted Better outcomes and lower future costs Examples: Colon cancer screening, mammography, osteoporosis screening, AAA screening, pneumonia vaccine, prostate screening, diabetes screening, eye exams, PCP appointments 5 Care Gaps

6 Gain Share

7 HPN Operational Challenges Ability to share data for defined patient population when participants have: Disparate electronic medical records systems Various practice management systems Non standard clinical nomenclature Separate patient identifiers Differing methods for disease identification & performance measures