1. 1 Marjie Harbrecht, MD Chief Executive Officer It Takes a Region Working Together to Transform Healthcare 400-526707 HealthLINC Conference February 17, 2012

2. Abbott Sponsorship Disclosure “This presentation is sponsored by, and on behalf of, Abbott, and the presentation contents are consistent with all applicable FDA requirements. The Speaker for this program has been selected by Abbott and is presenting the program material on Abbott’s behalf.” 2 400-546705

3. Health Care Expenses in an International Context

5. For All the Money We Spend, How Well Does Our System Perform?

6. THE CURRENT SYSTEM IS UNSUSTAINABLE!!!

7. We need a NEW way of thinking and NEW systems and payment models to support the care we want delivered. Trying harder will not work! Changing systems of care will…

8. A nonprofit collaborative working to redesign healthcare and promote integrated communities of care, using evidence based medicine and innovative systems to optimize health, improve quality and safety, reduce costs, and improve the care experience for patients and their healthcare teams. Have trained over 250 practices, 1500 providers impacting over 2 million patients! 8

9. © MacColl Institute at Group Health 9

10. Triple Aim by Institute of Healthcare Improvement Population Health Experience of Care Per Capita Cost

11. Patient-Centered Medical Home (PCMH) An approach to providing high-quality, safe, continuous, coordinated, comprehensive care, with a partnership between patients and their personal health care team… “The kind of care you’d want your Mom to have!” 11

12. PROMISING TRENDS 12

13. The world is changing 13

14. The Colorado Multi-Payer PCMH Pilot

15. Multi-Payer Pilot Stakeholders 15

16. Three-year pilot Planning Year - 2008 May 2009 – April 2012 16 Family & Internal Medicine Practice sites 83 providers; 258 staff Various sizes across the Front Range NCQA PCMH Recognition 14 at Level III; 2 at Level II 7 Health Plans – public/private Fee for service (FFS); Care management fee (PMPM); P4P 20,000 patients covered (100,000 affected) Pilot Parameters

17. Making a House a Home! Making a House a Home! 17

18. What Do People Really Want? Trusting Relationship with Care Team “I can reach someone who knows me, knows my history, can advise me and cares about my issues” Service “I can get care or contact with someone when I feel I need to, without having to always come in” “Less waiting in general” – during visits, for test results, for referrals, for refills, etc. Reliable, Coordinated Care “My care is coordinated” – between providers, hospital/ER, home health, behavioral health, etc 18

19. What Do We Want? Trusting Relationship with Our Patients and Staff Work-Life Balance Job Satisfaction “Providing the best, most efficient care possible 19

20. So what does it take? So what does it take? 20

21. Building a Solid Infrastructure Fundamentals for Transforming 21 Technology & Outcomes Reporting Leadership & Team Based Care Practice Viability & Efficiency Care Mgmt, Coordination & Communication Patient Engagement & Access Medical Homes & Medical Neighborhoods

22. 22 Tactical Technology Registry/EMR Health Information Exchange (HIE) Systems Redesign Increased Access Guidelines/Protocols Workflow Redesign Care Coordination/Care Management Test/Referral Tracking Cultural Leadership Team Based Care Patient Activation Shared Decision Making Communication & Building Relationships Continuous Quality Improvement Tactics vs Culture

23. “Culture eats strategy for lunch …over and over again.” – Anonymous

24. 24 Technical Assistance On-site Coaching Learning Collaboratives Share lessons learned Data to Achieve Triple Aim Meaningful Use, HIE and Beyond…

25. You can’t manage what you can’t measure Data is CRUCIAL…

26. To Guide Your Team & Assess Gaps

27. To Engage Your Patients

28. To Outreach To Those Needing Care

29. PROVIDER_IDPROVIDER_NAME COST TOTAL_MED TOTAL_RXAGESEXPRIM_DXT_DESC 000095431770414832KATHERINE FLARE MD $ 65.15 $ 705,353.84 $ 19,828.8462MACUTE OSTEOMYELITIS ANKLE 000095485770414832ADRIANA PANDER MD $ 130.27 $ 423,103.62 $ 2,587.3746FSEPTICEMIA UNSPEC 000095412770414832SHARON L BREECE MD $ 300.36 $ 214,217.60 $ 6,654.8156MATHEROSCLER NATIVE COR ART 000092486770414832AL FARE MD $ 182.46 $ 209,287.22 $ 365.7954MLUMB/SAC DISC DEGENERATN 000405537770414832ED RAMOS MD $ 64.52 $ 146,996.08 $ 3,450.8152FRADIOTHERAPY 000442566770414832AMY CARD MD $ 353.24 $ 113,608.34 $ 4,339.8271FCHR INFLAM DEMYEL POLYNEURIT 000087963770414832MARY SEK MD $ 207.21 $ 101,326.63 $ 5,285.1847MEND STAGE RENAL DISEASE 000511092770414832MICHAEL GAYLE MD $ 139.62 $ 91,490.92 $ 382.8756FMALIG NEO BREAST UP OUTER 000334824770414832KEVIN W LONG MD $ 2,786.30 $ 91,033.04 $ 0.350MTWIN BIRTH MATE LB IN HOSP 000262829770414832ALICE G KELT MD $ 130.30 $ 88,755.67 $ 2,041.1858MSEPTICEMIA UNSPEC 000060005770414832RICHARD BRACK MD $ 495.21 $ 82,053.13 $ 4,227.4358MIDIOPATHIC SCOLIOSIS 000095412770414832SHARON L BREECE MD $ 99.04 $ 73,923.77 $ 17,177.8963FEND STAGE RENAL DISEASE 000095478770414832KEVIN J WHITE MD $ 335.79 $ 69,478.83 $ 12.6518FANOREXIA NERVOSA 000095485770414832ADRIANA PASH MD $ 545.50 $ 66,043.47 $ 376.9736FCHR INFLAM DEMYEL POLYNEURIT 000405537770414832ED RAMOS MD $ 49.52 $ 54,782.70 $ 5,278.7744FFITTING OTHER DEVICE 000095485770414832ADINA PALVIA MD $ 449.76 $ 53,393.74 $ 382.4736MACUTE VASC INSUFF INTESTINE 000060005770414832RICH BLAKE MD $ 324.44 $ 49,676.46 $ 2,218.7657MCHRONIC LIVER DIS UNSPEC 000060005770414832RICH BLAKE MD $ 465.38 $ 48,638.97 $ 1,224.5749MMORBID OBESITY 29 To Identify/Manage High Risk, High Need Patients

30. To Monitor Progress, Drive Improvement

31. To Connect With Others - HealthLINC Get ALL data on patient when needed Know when patients have been in ER/Hospital – prevent re-admissions Coordinate Care – “conversation” 31

32. To Compare With & Learn From Others

33. BUT BEWARE… GIGO….it’s important where and how you enter data All that can be measured is not important and all that is important cannot be measured Data is a guide, it’s NOT the end all be all… 33

34. Remember Why We’re Doing This… 34

35. 35 New payment models Allow a new way of thinking! Transition from FFS “Treadmill Medicine” to coordinated planned management of entire panel, with extra care for those who need it Redefine “VISITS” Secure email and/or phone Save appointments for those needing it most (Outreach) Care Coordination - Care Management

37. 37 Patient Centered Planned Care Before, During, and After Visit Develop Customized Care Plan Shared-decision making Prevention, Chronic Conditions, Acute Care Issues Warm Handover to Care Coordinator/Care Manager Track tests/referrals, coordinate with medical neighborhood, monitor registry (outreach and quality reports) Engage patients, help them overcome barriers Concentrate on high risk/high need patients

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39. Prioritizing Care Plan Management & Care Coordination 39 Multiple Chronic Conditions & Complex Patients

40. COLORADO MULTI-PAYER PILOT RESULTS TO DATE 40

41. 41 Goals/Measures Improve quality Diabetes Cardiovascular disease Tobacco Depression Prevention Reduce cost trends Emergency room (ER) visits Hospital admissions Generic pharmacy Improve experience/satisfaction Patients/families Healthcare Team Internal External Matched comparison design Meredith Rosenthal Harvard

42. Team Approach Information System Support Self­ management Support Use of Guidelines Quality Improvement Population Management Coordination of Care Patient- centered Care Mental Health Issues Survey Group TAISSSMSUGQIPMCCPCCMH Pilot Average - Baseline (n=60)70%73%77%81%75%74%70%73%71% Pilot Average - Yr 2 (n=63)78%81%79%85%80%82%74%80%86%

43. Pilot Diabetes Data 43

44. Pilot Cardiovascular Data 44

45. Pilot Prevention Data 45

46. Patient Satisfaction 46 98% Feel they get care when they need it 97% Would recommend their practice to friends and family 90% Find it easy to speak to a physician 95% Find their clinics well-organized, efficient and respectful of their time

47. Provider/Staff Satisfaction* 44% less difficult to provide quality care 90% less difficult to communicate with outside specialists 94% increase in calling patients overdue for visit Equivocal – job satisfaction 90% very busy/chaotic *Meredith Rosenthal, PhD - Harvard School of Public Health Job Satisfaction and Work life Survey - Minimizing Errors/Maximizing Outcomes (MEMO) Survey 47

48. Cost/Utilization Data Still early but... 48

49. HOT OFF THE PRESS! “In a pilot program with other insurers and reform groups, Anthem found that paying primary-care doctors more to coordinate patient care cut hospital admissions by 18 percent and emergency room use by 15 percent.” “Anthem has found spending money on the primary- care incentives creates a return on investment of 2.5 times to more than four times, Kraft said.” Denver Post February 2, 2012 49

50. HOT OFF THE PRESS !! “WellPoint officials said they think the company's upfront investment in primary care could reduce its projected medical costs by as much as 20% by 2015 by improving overall patient health and reducing the need for costlier medical services” “The impact could be amplified by another new effort, by health insurer Aetna Inc., which will start paying the 55,000 primary-care doctors across its network an extra fee if their practices are certified as meeting certain standards for providing access for patients and coordinating their care.” Wall Street Journal, January 27, 2012 “Efforts to change how Americans pay for health care are gathering momentum on a national scale as UnitedHealth Group Inc., the largest U.S. health insurer, becomes the latest carrier to say it is overhauling its fees for medical providers.” Wall Street Journal, February 9, 2012 50

51. “The current system will implode if we don’t fix it. … And the only way to achieve that is by crossing tribal boundaries.” — Michael Soman, President and Chief Medical Executive of Group Health Permanente A Medical Home Without An Integrated Medical Neighborhood Is Just An Island 51 Integrated Community Care (Accountable Care Organizations)

52. Building The Medical Neighborhood 52 Shared Services Model -Complex Care Managers, Clinical Pharmacists, Social Workers, Educators, Mental Health Providers, etc Specialists –Compacts Hospitals –Identification, Notification, Communication Mental/Behavioral Health –Overcoming HIPAA, Carve Outs Community Resources –Awareness and Connections

53. Ultimately, working together to assist patients in achieving the highest level of health they can, preventing problems BEFORE they occur! 53

54. Key Elements to Consider for Payment Reform Multi-payer or high penetrance - (ASOs!!) Attribution x PMPM = Redesign Budget Reduce FFS Treadmill – “think panel” Build “new” solid infrastructure (PMPM) Maintain “new” infrastructure (PMPM) Performance incentives (P4P/Shared Savings) Incentivize “neighborhood” to work together (PACs/Shared Savings) Incentives for patients – (Value-based benefit designs) 54

55. Employers--Health Plans--Providers Reduce Fragmentation – Increase Impact Common approaches for: PCMH program Quality measures Aggregated Data Payment structures Build on positive attributes already in place 55

56. IN SUMMARY 56

57. NOW IS THE TIME!!! NOW IS THE TIME!!!

58. Our Healthcare System Needs to be Rebuilt! WE ARE IN THE BEST POSITION TO LEAD THIS CHANGE BUT…

59. THIS WILL TAKE A COMPREHENSIVE TRANSFORMATION AT ALL LEVELS 59

60. Medical Groups Willing to redesign and coordinate care Hospitals Coordinate care - different business models Health Plans Payment reform - data to practices/aggregators Employers Participation in pilots - incent employees Patients/Consumers Engage in their care and healthy outcomes - value based choices 60 CULTURE CHANGE FOR ALL!!

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62. Investment Required to Reduce CHAOS and Build Solid Infrastructure 62 IT’S ALL ABOUT RELATIONSHIPS!!

63. 63 With Our TEAM Building Accountability to Each Other and Our Communities With Our NEIGHBORS With Our PATIENTS!

64. For stepping up to the plate and having the courage to build a better health care system! SO…CONGRATULATIONS!! SO… CONGRATULATIONS!!

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