1. HFMA December 2012

2. Attacking Rising Costs 23% of the Medicare population has a chronic condition with 5 or more co-morbid conditions that compel them to see 12 (different) physicians per year, to fill 16 prescriptions and account for 68% of total Medicare spending Source: Institute for Healthcare Improvement Change is Upon Us

3. Future Healthcare Model: Strategic Imperatives

4. Strategy #1: Physician Integration Mercy Health Physician Base Continues To Expand Mercy Health employs physicians (primary care and specialists) in every planning area. * *includes MD extenders

5. 4 Strategy #1: Physician Integration

6. Strategy #2: Cohesive Care Delivery Network

7. Clinical Integration Mercy Health Employees Commercial Payors Medicare Advantage (MediGold) Medicare Patients (ACO) 20,000 Patients 22,000 Patients 800 Patients Coming up in 2013 Strategy #3: Population Health Management

8. Strategy #4: Increasing Efficiency GoodGood GoodGood GoodGood GoodGood Benchmark approximates top quartile Target approximates top quartile

9. ACO Development

10. What is an ACO? 9 An Accountable Care Organization (ACO) is a group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. Payer Partners ► Insurers ► Employers ► States ► CMS Core Components: People Centered Foundation Health Home High-Value Network Population Health Data Mgmt ACO Leadership Payor Partnerships

12. Mercy Health Select / ACO Vision  MHS is a virtual partnership between Mercy Health hospitals, Mercy Health Physicians, community PCPs, specialist groups contracted with MH hospitals, and potentially other health care professionals who accept responsibility for and are dedicated to improving the health status of residents in the Tri-State region through improved access, coordination of care and clinical performance management

13. Mercy Health Select - Building the ACO

14. ACO Development Timeline Oct 2011 Mercy Health Select LLC was formed April 2012 Physician Led board of managers and committee operational July 2012 Medicare ACO application approved Oct 2012 Medicare Advantage Offering

15. Clinical Integration Care Coordination Information Technology Financial Management ACO Cornerstones of ACO

16. There are two important goals the ACO must accomplish before it can get shared savings Create Sufficient Savings (>2.5%) Meet or exceed the minimum quality score Shared Savings

17. 33 Quality Measures Measure and Report  Patient experience  Care Coordination  Preventive Care  Management of Population Health for at-risk chronic populations  Diabetes  Hypertension  IVD  CAD

18. PCMH that is fully implemented in all of our practices Care Coordination to proactively manage patients Reduce re-admits by improving communication among PCPs/ ED/ Hospitalists Reduce ED utilization by expanding access CarePATH Common IT Platform Key strategies to bend the cost curve

19. My Mercy Health Medical Home a patient centered experience

20. Improving Patient Access

21. PCMH Care Coordination Pilot Results  Admission rate ↓ 51%  Readmission rate ↓ 35%  ER visit rate ↓ 37%  Diabetes A1C control improved: ↑ 33%  LDL (% Ideal) ↑ 6.45%  Goal of not smoking: ↑ 11.8%

22. Pulling it All Together: Comprehensive Population Health Management  Physician-led Governance Body and Committees  PCMH & Nurse Care Coordinator Program  Risk Stratification, Disease Mgmt., Wellness, High-Cost Claims, Data Warehousing/Reporting Healthier Population Lower Costs Healthier Patients

23. QUESTIONS? DISCUSSION