1. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Ohio Healthcare Efficiencies Study Committee Richard Shonk, MD, PhD Chief Medical Officer

2. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Who We Are Neutral forum for all stakeholders concerned with health and health care Those paying for health care Those providing health care Those receiving health care Those improving community health

3. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Our Mission To positively affect health status, experience, outcomes, and affordability by fostering a connected system of health care and community health through innovation, integration and informatics

4. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above What’s the Triple Aim? 3 12 BETTER CARE LOWER OVERALL COST BETTER HEALTH

5. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Collective Impact on Health

6. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Health Care Costs Continue to Rise And overall health is not improving 2013 State of American Well-Being; Gallup – Healthways Well-Being Index 42 nd 49 th KENTUCKY OHIO 142 of 189: Community Well-Being

7. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Where Did We Begin: Bold Goals For Our Region Today 52% Today 82%

8. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above The Story of Our Top Scenarios… Initiatives with Impact Income and Education improvement Healthy Behaviors Continued Improvement in Patient Centered Medical Home & Care Coordination Payment Reform

9. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Action Teams & Steering Committee 2.0 Proposed Action Teams: Action Team Structure Co-Chairs: to reflect diversity, ideally members of current Steering Committee or Leadership Forum Members: Additional Steering Comm. and Leadership Forum volunteers, subject experts, reps of current programs. Others to assure diversity of perspective, geography, race, and knowledge of current work in that area Accountable to the Steering Comm. 2.0 to research strategies and recommend action plans Healthy Behaviors Care Delivery Bundle Payment Reform and Financing Other (TBD) Steering Committee 2.0 Chair: Sue McPartlin Co-Chairs: Sr. Sally Duffy, Dr. Lynne Saddler Members: Existing Steering Committee members Action team co-chairs Accountable to the community to assure action plans are sound, aligned, leveraged, address equity and mental health, and match agreed-upon decision criteria

10. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above The Comprehensive Primary Care (CPC) Initiative

11. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Primary Care Payment Model Shared Savings (2014-2016) Care management pmpm; private health plans for commercial, MA, medicaid lines of business Care management pmpm; “fee for service” Medicare and Ohio Medicaid beneficiaries Fee for Service + PMPM + Shared Savings = Total Reimbursement

12. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above CPCi Markets

13. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Cincinnati/Dayton/Northern Kentucky Market 75 Practices 1/3 Independent 2/3 System 250 Physicians 220,000 lives 9 Payers Aetna Anthem Caresource Centene/Buckeye CMS Humana Medical Mutual Ohio Medicaid UnitedHealthcare

14. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above An Initiative of the Center for Medicare & Medicaid Innovation Project Timeline: 2013-2016 National Leaders in Primary Care Transformation Regional Data Transparency 84,000 Patients Received Care Management 42,000 Shared Decisions on Smoking Cessation Treatment 220,000 Beneficiaries 250 Providers 9 Health Plans Medicare Outcomes to Date: Measure % decrease Overall Hospital Admissions-8% Primary-Care-Treatable Admissions-10% Readmissions-3% Overall Expenditures-3.4%

15. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Patient-centered medical homesEpisode-based payments Goal 80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years Year 1 ▪ In 2015 focus on Comprehensive Primary Care Initiative (CPCi) ▪ Payers agree to participate in design for elements where standardization and/or alignment is critical ▪ Multi-payer group begins enrollment strategy for one additional market Year 3 Year 5 ▪ State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement ▪ Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year ▪ Model rolled out to all major markets ▪ 50% of patients are enrolled ▪ 20 episodes defined and launched across payers ▪ Scale achieved state-wide ▪ 80% of patients are enrolled ▪ 50+ episodes defined and launched across payers State’s Role ▪ Shift rapidly to PCMH and episode model in Medicaid fee-for-service ▪ Require Medicaid MCO partners to participate and implement ▪ Incorporate into contracts of MCOs for state employee benefit program 5-Year Goal for Payment Innovation

16. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above

17. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Already Local Support for Public Reporting & Transparency 17 Primary Care Providers Cardiovascular Health Colon Cancer Screening Rates Diabetes Management Patient Experience Hospital Effectiveness Patient Experience Emergency Department

18. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above PROMOTE TRANSPARENCY

19. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above

20. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above What gets measured, gets improved

21. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Collaborative Community Health Needs Assessment

22. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Collaborative CHNA: Community stakeholder meetings

23. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Regional Data Aggregation; A Comprehensive View to Support Comprehensive Care

24. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Why an Aggregated Claims Database? Need for a neutral, trusted, local source of truth- no one Payor or Provider has the whole picture Payment is proceeding to “payment for value” from “fee for service” Community-wide view of cost and utilization for decision support and benchmarking Consistent and Continuous methodology is needed to monitor progress year over year

25. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above CPC Data High Level

26. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above

27. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above SUMMARY Models like PCMH are changing the way care is delivered and paid for We have an opportunity to use data to guide and inform health care decision We offer tools for employers to drive high quality care Our region’s Collective Impact strategy on Health unites the community

28. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above RECOMMENDATIONS 1: Support health improvement organizations that meet the following criteria: a.) multi-stakeholder b.) neutral conveners c.) data capable 2: Recognize the importance of regional data utilities that ensure health care information is readily available and trusted. 3: Support efforts of State Innovation Model to transition to greater emphasis on Payment for Value and less emphasis on Fee For Service. 4: Seek to align goals, measures and incentives with those of CMS and the private sector to increase signal strength across Ohio.

29. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Thank you! Richard Shonk, MD, PhD Rshonk@Healthcollab.org

30. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Who are the members?

31. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Who are the members? 120+ Care Partners 100+ Business Partners

32. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above The ReThink Health Model Shared Understanding of Possible initiatives Outcomes over time Cost of effort

33. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above CPCi Overview The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients.

34. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above 34 Project Timeline OH-KY Health Collaborative Project Timeline (September 2015) 17 MAR9 MAY8 JUNE15 SEPT20 OCT 9 NOV19 NOV8 DEC

35. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above Data Strategy

36. ARIAL Use Arial as the Font. Use The Health Collaborative Colors Above HIE Evolution ConnectivityMessage DeliveryOnline RepositoryInformation/Insight “The goal is to turn data into information, and information into insight.” -Carly Fiorina Transactional Research