1. CSI CLAIMS DATA COLLECTION AND ANALYSES UPDATE CSI Steering Committee April 11, 2014 1

2. CSI Multi-payer, Multi-year Dataset RI covered lives (residents and nonresidents) Three health plans (Tufts not included) Receiving quarterly data from the health plans 2009 through June, 2013 Non-residents excluded (by RTI) if they receive primary care services out of state Adults only (claims for kids received but not in any analyses) 2

3. CSI Cohort 1: 15 practice sites Blackstone Valley Community Health Care, Inc. Coastal Medical, Inc. - Greenville Coastal Medical, Inc. - Hillside Coastal Medical, Inc. - Narragansett Coastal Medical, Inc. - Wakefield Family Health and Sports Medicine Kristine Cuniff Memorial Hospital Family Care Center South County Hospital Family Medicine South County Internal Medicine Stuart Demirs Thundermist CHC - Wakefield Thundermist CHC - Woonsocket University Family Medicine University Medicine - Governor Street Primary Care 3

4. CSI Cohort 2: 21 practice sites Anchor Medical Associates - Lincoln Anchor Medical Associates - Providence Anchor Medical Associates - Warwick Aquidneck Medical Associates - Newport Aquidneck Medical Associates - Portsmouth Associates in Primary Care Medicine East Bay Community Action Program - East Providence East Bay Community Action Program - Newport Medical Associates of RI - Bristol Medical Associates of RI - East Providence Ocean State Medical, LLC Tri Town Community Action Program University Internal Medicine University Medicine - 909 North Main Street University Medicine - Barrington University Medicine - East Ave University Medicine - Plain Street University Medicine - Warwick Family Medicine WellOne Primary Medicine - Foster WellOne Primary Medicine - North Kingstown WellOne Primary Medicine - Pascoag 4

5. Metrics For Today Inpatient admissions (all-cause and ambulatory care sensitive) ED (all cause and preventable) Available Observation stays 30-day readmissions Stratifications payer type (Medicaid, Medicare, Commercial) Medical versus surgical procedures 5

6. Default: Rate for Rolling Years (Trailing Four Quarters) Numerator Number of measure-specified events (e.g., ED visits) in the trailing four quarters. Denominator Sum of all time with coverage (in monthly chunks) in the trailing year across the covered population, expressed as 1000 member-months. 6

7. CSI Cohort 1 and Comparison Changes 7 Changes 2012 - 2013 Group July '11 – June '12 July '12 – June '13 Difference% Difference (A)(B)(B-A)(B-A)/A All-cause inpatient admissions per 1000 member months: (1) CSI Cohort 17.727.35-0.37-4.8% (2) Comparison9.8110.050.242.4% Difference (1-2) -0.61-7.2% All-cause ED visits per 1000 member months: (1) CSI Cohort 125.1528.743.5914.3% (2) Comparison22.1124.312.2010.0% Difference (1-2) 1.394.3%

8. Inpatient Stays (per 1,000 member-months)

9. ED Visits (per 1,000 member-months)

10. CSI Cohort 2 and Comparison Changes 10 Changes 2012 - 2013 Group July '11 – June '12 July '12 – June '13 Difference% Difference (A)(B)(B-A)(B-A)/A All-cause inpatient admissions per 1000 member months: (1) CSI Cohort 28.659.070.424.9% (2) Comparison9.8110.050.242.4% Difference (1-2) 0.182.4% All-cause ED visits per 1000 member months: (1) CSI Cohort 217.7521.233.4819.6% (2) Comparison22.1124.312.2010.0% Difference (1-2)1.289.7%

11. CSI Cohort 2: Inpatient Stays (per 1,000 member-months)

12. Cohort 2: ED Visits (per 1,000 member-months)

13. Limitations Attributing people to practice sites is imperfect Results are sensitive to sample sizes Changes in rates are relatively small Differential case-mix over time Secular trends affect the rates 13

14. Current Status and Next Steps Includes standardized rates (adjusted for age, gender, and payer type) Adding Medicare and Medicaid FFS claims now Working on risk adjustment methodology Program Evaluation Committee focusing on developing a more robust evaluation plan for CSI Comparison groups Risk adjustment Meaningful subgroups 14