1. Aetna and PCMH Improving Employee Health through Patient- Centered Medical Homes Morristown, New Jersey October 12, 2010 Aetna’s experience with Patient-Centered Medical Home pilots in the Northeast

2. 2 PCMH Characteristics  Personal Physician leading a dedicated team that includes a care coordinator  Care is coordinated across the spectrum of care from wellness and primary care to specialist and hospital care  Expanded Access – office hours as well as non face to face  Real-time patient-centered data management and performance tracking  Meaningful Practice Incentives [Example of text in right block: Arial, 18pt size.] New York Business Group on Health

3. 3 PCMH Criteria  Aetna uses the NCQA certification for recognition  Pilots need a consistent measure set to track performance  Aetna’s compensation models generally align with the other national payers [Example of text in right block: Arial, 18pt size.] New York Business Group on Health

4. 4 Common Features of Aetna Pilots  Multi-health plan state or market collaboratives  PCP offices should be or become NCQA recognized  Monthly payment PMPM  Commercial and Medicaid membership  Outcome and efficiency measures reported by data aggregator  Significant time before results are reported [Example of text in right block: Arial, 18pt size.] New York Business Group on Health

5. 5 Measures of Success From Health Plan Perspective:  PCMH recognition  Outcome measures improvement:  HbA1c within goal, Diabetic BP and Lipid levels within goal  Population vs. disease cohort cost trend compared to market  UM improvement – ER visit rate, inpatient days, admissions, other medical cost category improvement [Example of text in right block: Arial, 18pt size.] New York Business Group on Health

6. 6 Professional Society Views  Transformation takes place at the office level not the payer level – multi-payer configurations logical extension  Incentives for transformation, outcomes will follow  HIT a prerequisite [Example of text in right block: Arial, 18pt size.] New York Business Group on Health

7. 7 Southeastern Pennsylvania – Medicaid Multi-Payer Results  July 2010 – All 33 practices PCMH certified  Preliminary UM results are based on one payer results (Medicaid – 37k members)  Inpatient admissions dropped 26%  ER visits dropped 18.4%  Total costs dropped 15.9%  Clinical metrics:  33% improvement in HbA1c control  71% increase in diabetic eye exams  25% improvement in diabetic BP control New York Business Group on Health

8. 8 Aetna and other Multi-Payer Collaboratives  Maine  Pennsylvania – commercial members  Hudson Valley  Maryland  Colorado  Washington state  CMS MAPCP pilot applications for most New York Business Group on Health

9. 9 Aetna New Jersey Pilot 2008 Aetna-IPA Agreement  Commercial HMO FI population - 7,000  FFS for care coordination either by IPA or offices  PCMH certifications expected for PCPs  Focus on Diabetes and Hypertension  Coordination of care alerts enabled by Aetna data feed.  Process and outcome metrics  Cost tracked for population - no outlier exclusion New York Business Group on Health

10. 10 2010 Aetna NJ PCMH Pilot Results  Total medical cost improvement of 15.9% first Quarter 2010  Incremental quarter over quarter trend improvement most pronounced at 18 to 24 months  34 MDs PCMH certified, 23 pending - still a majority of the PCPs are not certified  PCP HIT adoption still less than 50% - IPA administration supplies the clinical decision support/registry function New York Business Group on Health

11. 11 Bending the Medical Trend: Evidence Comparison of 11/09-4/10 and 2007  ER visit rate down - 8%  IP days down - 25%  Admissions down - 16%  Medical cost trend impact on: IP, Specialist, BH, Lab, Imaging, Injectables New York Business Group on Health

12. 12 Distribution of Medical Cost Savings Highlight: Inpatient services are significantly lower PMPM than HMO FI NJ market compared to 2007 New York Business Group on Health

13. 13 Diabetes Care Improvements HbA1c tests and outcomes New York Business Group on Health Highlights: HbA1c test compliance from 63% to 94% HbA1c control <7 from 36% to 58% %

14. 14 Additional Improvements LDL and BP tests and outcomes New York Business Group on Health Highlight: Blood Pressure population’s outcome compliance improvement from 22% to 48% % * <=140/80 for non-diabetics

15. 15 PCP Office Performance Variability  Care coordination FFS payment enables direct measurement of office engagement  Engaged offices show the greatest clinical impact and cost savings  PCMH certified offices are not necessarily engaged or most cost effective New York Business Group on Health

16. 16 PCMH/Care Coordination - ROI Where are we going?  What is most scalable and affordable from purchaser point of view?  Multi-payer, low risk for payer, potential significant savings for purchasers, steep PCP adoption threshold, long report cycle  Care Coordination pushed from a central clinical support generator - impressive results on target population. Significant maturation time: 18-24 months  Challenge to increase the target population  Transition to partial or full risk and shared savings incentives to manage whole population - When to make the leap? For whom? New York Business Group on Health