1. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. Rewarding Provider Performance Aligning Incentives in Medicare Sam Ho, M.D. CMO, Pacific & Southwest Regions

2. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 2 Implications for Health Plans Standardized Measures Transparency Incentives / disincentives High-performance networks

3. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 3 Standardized Measures Evidence-based CMS AHRQ / NQF AQA HQA BTE ABIM MOC MDs, MG/IPAs, Hospitals

4. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 4 Transparency Quality National comparison, by specialty Preventive Health Chronic Diseases Primary Care (3) Specialty Care (18) Efficiency Local comparison, by specialty Episode groups Risk-adjustment Total costs of care Resource utilization Unit costs Coordination of Care?

5. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 5 Incentives / Disincentives Direct incentives Rational value = Q&E (budget neutrality) Market share P4P Performance-based contracting Indirect incentives Administrative simplicity

6. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 6 Performance-based Contracting Model Reimbursement Fee Schedule Increases

7. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 7 High-Performance Networks Premium (value) designation Differential benefits Preferential marketing

8. Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 8 Thank you.