1. BHCAG TCOC Discussion March 28, 2012 Meg Hasbrouck Vice President, Contracting and Reimbursement
Mission
We serve our communities by providing exceptional care, as we prevent illness, restore health and provide comfort to all who entrust us with their care.

2. Objectives for Today How TCOC and Shared Savings work together
Key steps in transitioning to accountable care and TCOC payment methodology
Lessons learned so far with ACO pilots
How employers can help advance the triple aim

3. How do FFS and TCOC work together?
Health Plan Payment Methodology
FFS
FFS
FFS
PMPM
PMPM
Interim
Payment
Methodology
Other
Drugs
Ancillaries
Hospital
Services
Clinic
Services
Admin fee
Care
Management
Annual retrospective
calculation on attributed patients
TCOC

4. Shared Savings and TCOC: the target matters
Savings achieved are shared between the payer and Allina at pre-negotiated levels

5. TCOC Metrics – short version
Membership
Attributed Membership
Illness Burden
Affordability Key Indicators
TCOC Index
Price Index
Use Index
ER Visits PMPM
Rx PMPM
Generic Use
High Tech Radiology Use
Shared Savings Gain / Loss
TCOC Gain Potential (1,000’s)
TCOC Loss Potential (1,000’s)
Shared Savings & of Revenue
Risk Adjusted Allina PMPM
Estimated PMPM Target
Actual Trend Compared to Baseline
Market Average PMPM
Market Average Trend

6. What are we doing to bend the trend?
Integrate population data, disseminate and track
Focus on waste
Use Outcome improvement approach
Strengthen the patient/primary care relationship
Keep the patient at the center of all decisions

7. Map to accomplish our aim Tool Template: Driver Diagrams
Aim and Outcome
Primary Drivers
Secondary Drivers
Expand Team Care model to increase capacity
Expand urgent care access points
Expand non-visit based care options (evisit)
Patient Care Model Redesign
Implement Advance Care Team model for chronic disease/high risk patients
Expand care navigators and deploy care guides
Care Management & Coordination
Better Health, Affordable Care
Identify & prioritize top areas of care variation
Expand clinical service line infrastructure
Clinical Excellence & Consistency
Increase percentage of contract revenue based on Value and evolve shared savings model
Pilot bundled payment model(s)
Payment Reform / Contracting
Build clinically integrated network with independent physician groups
Outcomes:
Deliver Optimal Care for Allina’s core measures
Improve patient & caregiver experience
Improve affordability
Network Development
Establish a focused Value Analytics area and produce Pioneer patient profile & dashboard
Enhance predictive modeling & risk stratification capabilities at the point of care
Measurement & Reporting
Promote self-care education in MyChart, After Visit Summary & Allina.com
Expand patient advisory committees
Implement shared decision making & advance care planning
Patient Engagement 7

8. Focus on Waste Now Future Preventable Complications Waste
Unnecessary Treatments
Inefficiency
All Services
Add
Value
Errors
Services
That
Add
Value
100%
Value
Value

9. Lessons Learned - Challenges
Investing in resources while building the program and planning for sustainability
Engaging independent physicians in care improvement initiatives without well-aligned incentives
Consistent and reliable care management, patient engagement and shared decision making
A difficult hiring environment for case management and analytic staff
Size and complexity make it difficult to implement change quickly and we have more ideas than resources. Purposeful planning, prioritization, communication and focus is needed
Data Issues
Overload, Analysis paralysis, Imperfect, Timeliness?
Distribution within care system and Sharing/Consent with collaborators external to care system

10. Challenges – Aligned incentives?
In Millions
Target
Actual
FFS Revenue Change
Shared Savings
(Loss)
Variable Cost
(Increase) Decrease
Net Change
Before
Investment
Invest-ment Cost
Net Impact
Trend Favorable to Target
by 5%
Payer Participation
$135
$128
$(7)
$3.5 $4
$0.5
$(2)
$(1.5)
Payer Non- Participation $0
$(3)
$(5.0)
Trend Unfavorable to Target
Payer
Participation
$142 $7
$(4)
$1.5
$(0.5) $3 $1
For illustration only

11. Employers can help advance better, more affordable care
Align Benefit design
Some designs create barriers to care with high deductibles and coinsurance preventing good follow-up care and at times preventive care
Some designs emphasize open access versus developing a relationship with a care system
Ensure there are motivators and incentives for patient accountability
Support incentives tied to triple aim outcomes, and explore ways to disconnect payment from utilization (separate from FFS)

12. Employers can help advance better, more affordable care
Keep focus on outcomes and let us continue to innovate on best ways to achieve results
Beware of adding administrative burden
Help with community engagement, educating the healthcare consumer regarding healthcare choices and the appropriate and most beneficial way to access healthcare  
Don’t Support the Race to the bottom
If all care systems are improving cost, all savings should be shared