1. 1 Key Activities Establishing patient attribution and financial benchmarking standards Developing performance measurement guidelines Identifying data sharing requirements This group is identifying the most important elements of population-based payment models for which alignment across public and private payers could accelerate their adoption nationally, with a focus on data sharing, financial benchmarking, quality measurements, and patient attribution. Glenn Steele, Jr. Chairman, xG Health System, Immediate Past President and CEO of Geisinger Dana Gelb Safran, ScD Chief Performance Measurement & Improvement Officer, Senior Vice President Enterprise Analytics, Blue Cross Blue Shield of Massachusetts Chairs 16 Members Population-Based Payment (PBP) PBP Work Group

2. 2 Hoangmai Pham, MD, MPH Chief Innovation Officer, Center for Medicare & Medicaid Innovation Thomas Raskauskas, MD, MMM, CHCQM Consultant, Population health and Practice Transformation Andrew Sperling, JD Director of Federal Legislative Advocacy, National Alliance on Mental Illness Jeff White, MBA/MS Director, Health Care Strategy and Policy, The Boing Company Steve Hamman, MBA Senior Vice President, Provider Engagement and Enterprise Network Solutions, Health Care Service Corporation Amy Nguyen Howell, MD, MBA Chief Medical Officer, CAPG Kathleen Kinslow, CRNA, EdD, MBA President and Chief Executive Officer, Aria Health System Sanne Magnan, MD, PhD Former President and Chief Executive Officer, Institute for Clinical Systems Improvement Elizabeth Mitchell President and CEO, Network for Regional Healthcare Improvement David Muhlestein, PhD, JD Senior Director of Research and Development, Leavitt Partners, LLC Andrew Baskin, MD National Medical Director Clinical Professor of Health Care Policy, Aetna Michael Chernew, PhD Leonard D. Schaeffer Professor of Health Care Policy, Harvard Medical School Gretchen Hammer Director, Medicaid for Colorado Glenn Steele, Jr., MD, PhD Chairman, xG Health System, Immediate Past President and CEO of Geisinger Dana Gelb Safran, ScD Chief Performance Measurement & Improvement Officer, Senior Vice President Enterprise Analytics, Blue Cross Blue Shield of Massachusetts Member Roster PBP MEMBERS

3. 3 Final Release May 13, 2016 Revise March 7 – May 16, 2016 Public Comment February 8 – March 7, 2016 Draft Release February 8, 2016 Development November 2015 – February 2016 The draft white paper titled Accelerating and Aligning Population-Based Payment Models: Patient Attribution describes the method by which patient populations are assigned to providers who are accountable for total cost of care and quality outcomes for their designated populations in a PBP model. The paper recommends that active, intentional identification or self-reporting by patients should be considered first. The paper also outlines nine additional recommendations that payers and providers can use when making decisions on attribution in their PBP models. Key Components Recommendations Flowchart Comparison Table with CMS models For population-based payment models PATIENT ATTRIBUTION

4. 4 for PBP models Patient Attribution Patient Self- Report Gold standard when it is available Primary Care Providers E&M codes for wellness and preventive care Primary Care Providers Other E&M codes Primary Care Providers Prescription data Specialty Care E&M codes for specialty care (selected specialists) 12345 Key Steps in Patient Attribution FLOW CHART Verify attribution results with patient and provider

5. 5 PBP Work Group Recommendations Medicare Shared Savings Program Tracks 1 and 2 Medicare Shared Savings Program Track 3 Pioneer ACOs Next Generation ACOs Patient Self-Report Gold standard when it is available None Patient Selection Tested 2015 onward Patient Selection Beginning 2016 Primary Care Providers E&M codes for wellness and preventive care Primary Care Providers Plurality of primary care services Primary Care Providers Plurality of primary care services Primary Care Providers Plurality of primary care services Primary Care Providers Plurality of primary care services Primary Care Providers Other E&M codes Primary Care Providers Prescription N/A Specialty Care E&M codes for specialty care (selected specialists) Non-Primary Care Providers Primary care services Non-Primary Care Providers Primary care services Non-Primary Care Providers Primary care services Non-Primary Care Providers Primary care services Prospective or Concurrent Attribution Either is Acceptable As long as provider has timely, actionable data on the attributed patients Concurrent AttributionProspective Attribution Limited exclusions occur throughout the performance year and at the end Prospective Attribution Limited exclusions occur throughout the performance year and at the end Prospective Attribution Limited exclusions occur throughout the performance year and at the end 3 3 225 2 2 1 1 4 3 2 1 1 1 Comparison of the PBP Work Group recommendations with CMS program approaches to attribution COMPARISON TABLE

6. 6 Final Release May 13, 2016 Revise March 7 – May 16, 2016 Public Comment February 8 – March 7, 2016 Draft Release February 8, 2016 Development November 2015 – February 2016 The draft white paper titled Accelerating and Aligning Population-Based Payment Models: Financial Benchmarking describes approaches for setting an initial benchmark and updates over time and also addresses risk adjustment considerations. The white paper discusses the need to balance voluntary participation with the movement toward convergence in a market with providers at different starting points. Key Components Principles Recommendations For population-based payment models FINANCIAL BENCHMARKING

7. 7 Final Release Early August 2016 Revise Early May – August 2016 Public Comment April 22 – May 23, 2016 Draft Release April 22, 2016 Development December 2015 – April 2016 The PBP Work Group’s draft White Paper, Accelerating and Aligning Population-Based Payment Models: Performance Measurement is grounded in the notion that payers, providers, purchasers, and patients should be collectively accountable for ensuring that the health care system delivers the highest possible value. The paper offers a way forward that could change how performance is measured across the board in order to enable effective population-based payments. The paper makes recommendations for immediate action steps, describing four key performance measurement principles and seven recommendations for building and sustaining a performance measurement system that supports and encourages collaboration among stakeholders. For Population-Based Payment Models PERFORMANCE MEASUREMENT

8. 8 COMPONENTS OF MEASUREMENT SYSTEMS Calculate Overall Performance Scores Connect Payment Levels to Performance Scores Specify Measures

9. 9 MEASURES BY PURPOSE AREA

10. 10 Final Release Early August 2016 Revise July – August 2016 Public Comment June 10 – July 1, 2016 Draft Release June 3, 2016 Development April – June 2016 The PBP Work Group’s draft White Paper, Accelerating and Aligning Population-Based Payment Models: Data Sharing outlines a vision for data sharing in PBP models. Sharing data is critical to supporting clinicians and health care stakeholder groups in providing care, responding effectively to patient needs, and enabling the transition to alternative payment models (APMs). The paper offers several guiding principles, recommendations, and outlines case studies for data sharing. The goal is to create an environment where data follows the patient and is available to stakeholders (patients, providers, purchasers, and payers) in a timely manner. For Population-Based Payment Models DATA SHARING