1. 1 Johns Hopkins Community Physicians Presentation to MCMS October 25, 2012 Presented by: Matt Poffenroth, MD, MBA Director of Clinical Integration, JHCP

2. JHM Organizational Structure ……… focusing on strategic interfaces 2 The Johns Hopkins Health System Corporation (JHHSC) The Johns Hopkins University (JHU) The Johns Hopkins Hospital Johns Hopkins Bayview Medical Center, Inc. Howard County General Hospital Johns Hopkins Community Physicians School Of Medicine Johns Hopkins HealthCare LLC JH Ventures, LLC Johns Hopkins Medicine (JHM) Johns Hopkins Medicine International, LLC Johns Hopkins Home Care Group Suburban Hospital, Inc. Suburban Hospital Healthcare System, Inc. = Unincorporated board or division = Legal entity Sibley Memorial Hospital

3. JHCP Sections FY 12 3 Each section with clinical chiefs and administrators

4. JHCP FY 2012 36 outpatient sites 11 counties, Baltimore City 400+ providers 1000 staff 800 K encounters 230 K patients 4 ** Bayview Internal Medicine, practice managed by JHCP

5. JHM Clinical Enterprise

6. TRENDED VOLUME

7. Provider Growth Summary 7

8. JHCP Challenges In many ways, similar to private practice: Insure access to growing volume of patients Coordinate care for patients in a fragmented delivery system Meet demands of payers to measure and report data How to position ourselves for payment reform Physician work:life balance 8

9. How is JHCP meeting these challenges? Strategically adding capacity, based on access needs Partnering with other private practice physicians in the community New models of care – PCMH, extended hours, etc. Participating with various P4P programs Implementing EPIC in April, 2013 Evaluating physician compensation model 9

10. Pay for Performance Programs at JHCP Value Based Purchasing (JHHC) Meaningful Use of EHR’s Patient Centered Medical Home (PCMH) –Maryland Multi-Payer Pilot (MMPP)- 5 sites –CareFirst –USFHP ACO-prepared PQRS ePrescribing Maryland State-Regulated Payer EHR Adoption Incentive Program 10

11. Future of healthcare in Maryland Payment reform is happening – providers increasingly will be asked to take risk Quality and transparency is be demanded by payers and patients Shift towards population health management Uncertainty about HSCRC waiver and how this could affect providers 11

12. How will the system respond? Continued and accelerated consolidation –Physicians increasingly seeking “safe haven” of employment –Hospitals increasingly reliant on physicians to meet access and quality needs –Bundled payments, shared savings programs, etc. Alignment of incentives between providers, patients, payers and purchasers (is this a dream?) 12

13. JHM Strategic Response Developing an integrated delivery system is one of JHM’s Mission Imperatives Alignment with private physicians is a JHM priority to achieve clinical integration Strategies include: 1.Employment 2.Shared EHR 3.Accountable Care Organizations 4.Other 13

14. Employment Typically not “purchasing” practices Not always an appealing option for either side –Financial risk –Culture Requires a shared Mission and Vision 14

15. Shared EHR JHM begins transitioning to EPIC in April 2013, beginning with our ambulatory practices JH Community Division to offer EPIC Community Connect to private practices Full EHR and practice management system, without billing module Marketing to begin late fall 2012, implementation fall 2013 15

16. ACOs CMMI grant approval for J-CHiP in June 2012 – “academic ACO” Exploring community ACO model with intent to file letter of intent by June 2013 with implementation January 2014 Success (i.e. improved quality at lower cost) will require: –Infrastructure –Resources –Expertise in population health management Not all “ACOs” will succeed 16

17. Other methods to enhance alignment Improved access to JH clinics Part-time faculty appointments CME Shared purchasing agreements Networking with JH health plans MSO services “True” clinical integration model with shared contracting 17

18. Questions? Matt Poffenroth, MD, MBA mpoffen1@jhmi.edu 240-235-9130 18