1. Monarch HealthCare Inc. Efficiency Collaborative Focus Group: “Exploring Variation in the Frequency of Emergency Department Visits Among PCP Panels” Tuesday, May 13 – Pediatricians

2. California Quality Collaborative The California Quality Collaborative (CQC) is a healthcare improvement organization dedicated to advancing the quality and efficiency of patient care in California. The California Quality Collaborative (CQC) is a healthcare improvement organization dedicated to advancing the quality and efficiency of patient care in California. The CQC is supported by a state-wide leadership alliance of healthcare purchasers, providers and health plans, all working toward a shared goal of accelerating quality improvement in California. The CQC is supported by a state-wide leadership alliance of healthcare purchasers, providers and health plans, all working toward a shared goal of accelerating quality improvement in California.

3. Efficiency Collaborative Goals Increase health care affordability through the reduction of unnecessary variations in care. Increase health care affordability through the reduction of unnecessary variations in care. Promote reduction in the underuse, misuse and overuse of medical services, ensuring patients get the care they need, when they need it, and in the correct setting. Promote reduction in the underuse, misuse and overuse of medical services, ensuring patients get the care they need, when they need it, and in the correct setting.

4. Participants Six (6) Medical Groups across California Six (6) Medical Groups across California Monarch HeatlhCare Monarch HeatlhCare Hill Physicians (Northern CA) Hill Physicians (Northern CA) Mills Peninsula Medical Group (Northern CA) Mills Peninsula Medical Group (Northern CA) Physicians Medical Group, Santa Cruz Physicians Medical Group, Santa Cruz Torrance IPA (Southern CA) Torrance IPA (Southern CA) Physicians Associates of San Gabriel Valley Physicians Associates of San Gabriel Valley

5. Efficiency Collaborative Goal “Reduce Emergency Department Utilization for Non-emergent Conditions” “Reduce Emergency Department Utilization for Non-emergent Conditions” Monarch consistently performs poorly on this measure Monarch consistently performs poorly on this measure Not the quality of care we expect for our patients Not the quality of care we expect for our patients Profound financial implications Profound financial implications Improvement directly affects practicing physician reimbursement Improvement directly affects practicing physician reimbursement

6. Objectives of the Focus Group 1. Understand variation in ED Utilization among PCP panels 2. Determine what is working and what is not 3. Learn preferred methods of communication and define IPA/ PCP partnership 4. Share what Monarch is currently doing to help reduce inappropriate ED utilization

7. ER Utilization Variance Among MHC PCPs * Larger spread between actual vs. expected utilization indicates higher ER utilization; Ranked among PCP invitees to this focus group (individual PCP or group) Actual=Expected

8. YOUR THOUGHTS? What causes High Utilization of the ED for Non-emergent conditions? What causes High Utilization of the ED for Non-emergent conditions? What can “low utilizing” PCPs do to keep the utilization appropriate? What can “low utilizing” PCPs do to keep the utilization appropriate? What are the “high utilizing” PCPs doing or not doing that can contribute to higher rates? What are the “high utilizing” PCPs doing or not doing that can contribute to higher rates?

9. Sample Practitioner ER Utilization Report * Higher percentile ranks indicate higher ER utilization; Ranked among vendors (PCP or PCP Office) with at least 1,000 participating member months in 2006 Calendar Year

10. YOUR THOUGHTS? Is this a useful report? Is this a useful report? What can be done to make it more useful? What can be done to make it more useful?

11. What Monarch is Doing Ambulatory Case Management Ambulatory Case Management Disease Management Disease Management ED Frequent Flyer Lists ED Frequent Flyer Lists Outreach to Patients and PCP’s Outreach to Patients and PCP’s Information to Patients Information to Patients Urgent Care Locations Urgent Care Locations Defining “Emergent Care” Defining “Emergent Care”

12. THANK YOU What we will do with the information from tonight: What we will do with the information from tonight: Create a user-friendly template to present variance data to Monarch’s PCPs Create a user-friendly template to present variance data to Monarch’s PCPs Formulate interventions and create support tools to reduce inappropriate ED utilization - revising systems where necessary to improve the quality of care our patients receive Formulate interventions and create support tools to reduce inappropriate ED utilization - revising systems where necessary to improve the quality of care our patients receive