1. ACO’s Al Kurose, M.D. President & CEO Coastal Medical

2. Coastal Medical: A Snapshot 70 doctors, 25 NP’s/PA’s; 18 offices across RI. Predominantly primary care. 100,000 patients. Founded in 1995. Physician owned and governed. Ancillaries: lab, imaging, billing, and CME. First Medicare Shared Savings ACO in RI: July, 2012. 9,400 beneficiaries First BCBSRI Shared Savings contract: January, 2012 37,000 commercial and Medicare Advantage members

3. What is an ACO? An ACO is an Accountable Care Organization. Accountable for what? Accountable for delivering on the Triple Aim goals: BETTER POPULATION HEALTH BETTER EXPERIENCE OF CARE LOWER PER CAPITA COST

4. Will ACO’s Make a Difference? YES – because of the opportunity to deliver an unprecedented level of service to patients. How? Accountability for quality of care and patient/caregiver experience. Alignment of financial incentives.

5. Medicare Shared Savings: How it works Based on total cost of care for a population (~$109.4 M ) Costs are compared to prior 3 years Costs are adjusted for risk scores and CPI If you save at least 3%, you earn up to 50% of that savings. ($1.6 M)

6. What does this have to do with patient care? 1. Medicare requires performance on 33 quality measures across 4 domains: Patient/caregiver experience Care coordination and patient safety Preventive Health Care of at-risk populations (disease management) 2.. The best path to financial success in shared savings: outstanding care, enhanced access and improved services.

7. (Some of) What We’re Doing Coastal 365 Patient Portal NCM in every office Pharm D’s ER Communication Pilot Utilization Analytics

8. Early Results Coastal/BCBSRI Trend by Category Q1 of 2011 vs. Q1 of 2012 Hospital admits: Commercial down 9%; Medicare flat Readmits down: Commercial -31%; Medicare -14% Urgent care down: Comm. – 31%; Medicare -18%

9. Implications of ACO’s for Long Term Care: ACO’s will be interested in cost efficiency of care. Possible impact on utilization of SNF’s Example: total joint replacement

10. Implications of ACO’s for Long Term Care ACO providers may become more active in long term care settings. ACO’s will want preferred relationships with SNF’s ACO’s will be incented toward: Better communication, and better coordination of care Better management of transitions of care Better end of life care