1. “The Integrator” Optimal Care for All our Members and Patients
BRENDA BRUNS, MD
EXECUTIVE MEDICAL DIRECTOR, HEALTH PLAN

2. Who We Are Founded 1947 Financing & Delivery System
Consumer Governed, Not for Profit
675,000 Members/patients
Group Practice GH Physicians – 2/3
Contracted Network - 1/3
1,281 Providers (27 Different Specialties) in Group Practice
26 Primary Care sites/4 Multispecialty sites
Contracts with 6,000 physicians & 44 hospitals
$23.4M Research Grants (2008)

3. The Integrator’s Role Responsible for the Triple Aim
Engage Individuals and Families in Their Own Health
Redesign of Primary Care
Population Health Management
Financial Management
Macro System Integration
Proprietary - do not duplicate

4. Our vision is two-fold To have the Best Group Practice in the Country
To Have the Best Overall Network for our Members and Purchasers
GPD performance boosts overall network performance
GHP providers influence coordination & content of care with selected network partners
Our Contracted Network should be at least as good, if not better than other health plans’
Members and Purchasers should have access to a consistent experience and to similar resources

5. Group Health Affordability Goals
A major component of Group Health’s strategic plan has been to achieve a significant (~10%) cost advantage over leading competitor networks
Tactics to “bend trend” have included:
Primary care medical home deployment across entire GPD
System-wide implementation of Emergency department/hospital inpatient (EDHI) initiative
Shared decision making/preference sensitive conditions in GPD and CN
Appropriate reductions in High End Imaging
Contracting strategies to keep “P” at <4% YOY increase
Development of Network Design and Clinical Integration Strategy 5

6. Group Health ACO Strategy
Form key provider partnerships in major markets to control clinical cost trends, improve quality of care and expand Group Health medicine more broadly into the communities we serve
Deploy and build in our best clinical practices; primary and specialty care; information technology; care management; premium, contracts, membership and claims administration; marketing and sales capability as infrastructure to support the partnership network
Build a financial model which yields profitable growth in every market through best medicine at the lowest per capita cost

7. Care Model for Clinical Integration
Patients supported to manage their own care, driven by proactive outbound treatment
Patient centered
Collaborative organizations that are under clinical leadership with aligned management systems and cultures
Practice structure
A single, coordinated, transparent, and evidence-based approach to patient care that supports continuous improvement
Common care approach
Information systems
Entire care team has real-time transparency about patients, with effective coordination
In evaluating integration we have 6 elements: patient centered care, common care approach, payment reform, aligned management systems, IT systems and community partners.
To achieve the vision of integration you need to move on all of these components.
Payment structures
The right payment structures in place to drive alignment on a common care approach
Community partners
A broad set of community stakeholders that are fully aligned on a common care model 7

8. Strategy and Goals
Grow the Group Practice by expanding our footprint in markets and through clinical integration with strategic partners
Engage in markets through a continuum of clinical integration models that control financing and delivery of care
Growth in market share through a coherent network that is attractive and affordable to our members
Improve per capita cost through selective and enhanced strategic partnerships
Improve quality of care through reduction of clinical variation throughout the delivery system
Increase Group Health’s influence on the member experience and how care is delivered 8

9. Group Practice and Community Network Trends
IP days/1,000 are trending down faster in Community Networks (CN) than Group Practice (GP).
GP have Medicare days included so overall levels are higher than CN.

10. Consistent Care Experience
On the outside, the member or purchaser views a gift box that has a distinct, recognizable look (differentiated from other health plans) The inside of the package (caliber of patient experience) differs based on where and how the model is deployed.
The Health plan provides varying levels of support or intervention, based on the type of delivery system
ACO Integrator
Care Gap Report
Disease and Care Management Programs
Predictive Modeling and CMIS
Member Care
1o Care
Spec Care 0%
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