1. The Primary Care Crisis: Prospects for Reinvention Kavita K. Patel M.D., M.S. Daniel Fields Elizabeth Leshen The Primary Care Crisis May 4, 2010, Page 1

2. The Promise of Health Reform Payment for Value Incentives for Coordination of Care Improved Measurement and Reporting Investments in a High Quality, Community-Based Workforce Private Insurance Market Regulations and Enhanced Primary Care Access The Primary Care Crisis, Page 2

3. VermontColoradoInter mountain North Dakota North Carolina Group Health Geisinger Embedded care coordinator Community teams* 24/7 access Performance evaluations Health IT Pay for performance PMPM payment Shared savings Note: characteristics as reported * With care coordinator ** % reduction from baseline Comparison of Successful Medical Homes Dedicated Care Coordinator Access Data-driven tools Payment reform Key common features are: Dedicated care coordinators Expanded access to care givers Data-driven analytical tools Incentives for providers

4. 4 Group Health 7 Vermont 4 Geisinger Intermountain North Dakota Colorado North Carolina ED visit reduction Total savings / patient 11% 15% 18% 40% 2 29% 24% 16% $71 $215 $640 $169-530 3 $516 6 North Dakota6% 1 Not all metrics reported; unless indicated otherwise, data is based on as reported outcomes, reduction from baseline 2 Only for Asthma patients 3 $169 for all patients; $530 for patients with chronic conditions 4 Expected 5 4.8% for all patients; 19.2% for patients with complex illnesses 6 Based on AFDC savings from FY2007 ($135m) and ABD savings from FY2008 ($400m). 7 Change relative to control group. See Reid et al, 2009 for more detail. 8 No change for overall population, 7.3% for patients with complex illnesses. $530 Hospitalization Reduction 4.8-19.2% 5 11%12% 0-7.3% 8 Sources: Colorado Department of Health Care Policy and Financing, Geisinger Health Plan, Paulus et al., Group Health Cooperative, Reid et al (2009), Dorr et al (2006), Care Management Plus, Community Care of North Carolina, McCarthy et al (2008), Vermont Blueprint for Health Overview of Outcomes Pilots showed significant improvements: Hospitalization reduction ED visit reduction Per-patient savings 1 Not all metrics reported; unless indicated otherwise, data is based on as reported outcomes, reduction from baseline 2 Only for Asthma patients 3 $169 for all patients; $530 for patients with chronic conditions 4 Expected 5 4.8% for all patients; 19.2% for patients with complex illnesses 6 Based on AFDC savings from FY2007 ($135m) and ABD savings from FY2008 ($400m). 7 Change relative to control group. See Reid et al, 2009 for more detail. 8 No change for overall population, 7.3% for patients with complex illnesses. Geisinger Intermountain4.8-19.2% 5 0-7.3% 8 $640 North Dakota6%24%$531 15%

5. Challenges for the Future Determining which features are essential and which can vary Mastering the complexity of scalable implementation Aggregating program data to learn from mistakes and successes Consideration of systemic reforms? Primary Care Pipeline- is it what we needed/wanted?