1. Deaconess Health System: Journey from Volume to Value
February 2017

2. Discussion Guide Deaconess Health System:
Market Overview & Catalyst for Change
Early Innovation & Testing
Creating the Infrastructure: Approach & Results
Network: Creating & Maturing the Network
Lessons Learned

3. Deaconess Health System (DHS) Overview
Deaconess Hospital
350 beds
Deaconess Cross Pointe
60 beds
Deaconess Gateway Hospital
182 beds
HealthSouth Deaconess
80 beds JV
The Women’s Hospital
74 beds JV
The Heart Hospital at
Deaconess Gateway
24 beds JV

4. Deaconess Health System at a Glance
Background
Not-for-profit, local governance
Size
5500 employees; 250 employed physicians
Competitive Landscape
Key competitor, St. Mary’s, part of Ascension Health. Population Health through MissionPoint. 60% Market Share in PSA
Payer Landscape
Anthem, with ~50% total market share
LOBs
Next Generation ACO
Payer Partnerships (Downside Risk)
EMR
EPIC

5. Discussion Guide Deaconess Health System:
Market Overview & Catalyst for Change
Early Testing & Innovation
Creating the Infrastructure: Approach & Results
Network: Creating & Maturing the Network
Lessons Learned

6. Early Days: The Journey to Value
The Beginning
Strategic Process – 2011
Population Health as a growth strategy
Initial efforts
2012 MSSP Track 1
Commercial Value Contracts
Health Plan Beneficiaries
PCMH
Early Successes
Achieved NCQA PCMH Recognition
Decreased Total Cost of Care for Health Plan Beneficiaries
Commercial Contract: Achieved Shared Savings
Improved Quality Measures for populations
Challenges
Network Growth: Creating Value for our Partners
Expanding Clinical Platform: Rational Use of Resources; Expanding Beyond Epic; Patient Selection
Financial Viability Long Term: Scale; Improved Contract Terms; Efficient Operations
Critical Success Factor: Speed to Market – Ability to execute on deliverables at a rapid pace

7. Partnering To Advance Early Success
The Case for Value
The Execution Playbook
Developing a value business benefits both Deaconess and the broader community
Execution requires network growth, improved payer partnerships and enhancing the clinical platform

8. Discussion Guide Deaconess Health System:
Market Overview & Catalyst for Change
Early Innovation & Testing
Creating the Infrastructure: Approach & Results
Network: Creating & Maturing the Network
Lessons Learned

9. Implementation: Creating the Infrastructure to Execute on Strategy
Achieve sufficient scale through expanded network
Network Contracting & Value Proposition: Providers & Facilities
Scale
Develop a broad network of affiliated PCPs that will be successful in population health. Expanded service area will drive growth
Network Platform
Renegotiate current payer deals. Robust payer partnership model that rewards successful population health. Both commercial and MA plans
Explore launching health plan products with a regional provider-owned payer
Financial Platform
Develop innovative approaches to care that support physicians with transforming cost and quality through incentives, governance, and clinical effectiveness. Must be physician-led
Clinical Platform
Proactively and thoughtfully employ DHS’ change management process, including strong leadership support and integrated communications
Change Management Process

10. Operational Accomplishments: Collaborating to Achieve Success
Expanded Managed Lives from 8.9k to 106.5k
Secured 5 Regional Facility Partnerships
Scale
Expanded ACO PCPs from 69 PCPs to over 240 PCPs
Expanded Network from 603 Providers to 922 Providers
Network Platform
Negotiated 7 Payer Partnership Vale Contracts
Launched collaborative health plan product with IUHP
ISUI: Analysis of trends demonstrating impact to systems
Financial Platform
Deployed Clinical Programs across 3 States, 2 time zones, & over 13 EMRs
Physician Alignment: PAC, Pods, Specialist Council & Summit, Incentives
Clinical Initiatives: PCP/Specialist Co-Management Agreement, CHF Protocol
Clinical Platform
Transitioned teams & organization from PCMH model to EVH model of care
Developed & matured collaborative, trusting relationships
Change Management Process

11. Financial Platform Results: Payer Partnerships & Next Generation ACO Highlights
Anthem Commercial
Top Performer for Quality
First year shared savings
Anthem Medicare
Anthem Medicaid
Anticipated 2017 effective date
Clinical Programs Deployed
Specialty/PCP Initiatives
3-Day SNF Waiver
RAF Results: Favorable trend
Financial Projections:
Based on claims through October anticipate significant shared savings .

12. Deaconess Health System ACO Utilization Commercial Payer Partner Utilization Impact
+10%
+15%
55%
55%
50%
48%
2014
2015
2014
2015
Inpatient
Outpatient

13. Results: People We Serve
Lives Growth (000s)
Start of Evolent Partnership
119
113 8
106 8 4 8 4 2 2 4 2 65 62 56 35 1 1
<1 8 1 2 35 36 38 9 9 24 7 8 1 2
2013
2014
2015
2016
2017
2018
IUHP/Deac
Anthem MA
IUH Cobranded MA
Humana MA
Anthem Commercial
Next Generation ACO

14. Results: Building & Deploying the Clinical Platform
Optimize existing programs & deploy best-of-breed population health management capabilities to drive improved quality and outcomes.
Clinical platform
Clinical Programs
Physician Engagement
Key Optimizations
Complex Care
Condition Care
Transition Care
Emergent Care
Proactive Care
Roster Reviews
PATH Visits
EMR Access
Physician Advisory Council
Incentive Alignment
RAF Education
OneCare Collaborative Newsletter
PHMs – Practice Assessments
Clinical Integration Programs
LEAP
Specialist Involvement
Targeting managed populations
Ability to identify patients across the network
OneCare Collaborative Banner
Integrated Epic RAF Solution
Infrastructure to support coordinated care across network & multidisciplinary team
“I wish all of my visits were like this. I had the information I needed for the visit and my patient stated he has a much better understanding of his condition and he loved the extra attention!” -DC PAC Physician
“The stratification is much better than our previous tool. These are the right patients for Complex Care.”
-DC Physician
“I was very impressed with the initial education, practice evaluation, and IT assessment.”
-Network Physician

15. Results: Improved Experiences for the People We Serve
“I wish all of my visits were like this. I had the information I needed for the visit and my patient stated he has a much better understanding of his condition and he loved the extra attention!” -DC PAC Physician
Each of you contribute to improved experiences for the people we serve
“I was very impressed with the initial education, practice evaluation, and IT assessment.”
-Network Physician

16. Discussion Guide Deaconess Health System:
Market Overview & Catalyst for Change
Early Innovation & Testing
Creating the Infrastructure: Approach & Results
Network: Creating & Maturing the Network
Lessons Learned

17. Network Growth & Development: Critical to Achieving the Business Case
Value Business P&L
Revenues and expenses to the Payer Partnership focused Value-Based Business from improved care and outcomes
Payer Revenue: Provider portion of the value created from the DHS Employee Plan and lives under Payer Partnerships based on terms governing capture
Pop Health Investment: Initial investments and ongoing operating costs, including physician engagement spend to deliver and run the Value- Based Business
Physician Engagement Expense: Quality bonus pool distributed to physicians
Facility Impact Summary
Gains / Losses related to market consequences of operating a Value-Based Business on the traditional facility business
Pop Health Impact: Reductions in facility utilization from population health
In-System Utilization Impact (covered lives): Estimated value from referral shift impact from lives under Payer Partnerships
In-System Utilization Impact (non-covered lives): Estimated value from “rest of panel” lives being referred into the system from physicians participating in the network

18. Successful Network Expansion & Growing!!
Network Platform: Objectives Achieved
Successful Network Expansion & Growing!!
Expanded ACO PCPs from 69 PCPs to over 240 PCPs
Expanded Network from 603 Providers to 922 Providers

19. Physician Advisory Council (PAC)
Physician Leadership & Governance: Critical Component of High Performing Network
Commercial ACO / Medicare ACO
VBSO:
People, Processes, & Tools
Physician Advisory Council (PAC)
Subcommittees: Specialist Council, RAF/Physician Incentives, Initiatives
Pod Team Lead
Pod Team Lead
Pod Team Lead
Practice A
Practice B
Practice C
Practice D
Practice E
Practice F
Practice Physicians

20. Strengthening the Network: Optimize Workflows & Efficiency

21. Strengthening the Network: Communicate, Communicate, Communicate!
Epic OneCare Patient Identification Banner
OneCare Collaborative Provider Newsletter
OneCare Collaborative Website

22. Discussion Guide Deaconess Health System:
Market Overview & Catalyst for Change
Early Innovation & Testing
Creating the Infrastructure: Approach & Results
Network: Creating & Maturing the Network
Lessons Learned

23. Lessons Learned Commit to transformation Quality is not Savings
Ease into risk
Be realistic about where your organization is and what are your limitations
Not every move will be successful—Learn and move on
Look at the whole package
Physician leadership is key
Timed & strategic deployment of clinical, network & financial platform initiatives is essential
Quality is not Savings
In system utilization
Value network can drive growth
Understand metrics
Quality and Financial
Understand risk adjustment!
If you don’t have it, get it
Transformation takes time
CMS is a great partner!

24. Move to become an APM Next Generation ACO Prospective alignment
Risk Adjusted
Benefit enhancements
Regional Benchmarking
APM status with financial benefits
Avoid MIPS reporting
DCI NGACO
Limited participants to Primary Care
Initial Preferred Providers—SNFs
Constant analysis of cost drivers
Constant innovation
CMS is a great partner

25. Next Steps
Continue to mature the provider network through pods, reporting, and initiatives
Optimize Post-Acute Care network
Define 1-3 year strategy for payer partnerships
Optimize Clinical Platform to achieve greater results and patient outcomes

26. Thank you