WCHN PHO/ACO Annual Meeting Rowena Bergmans VP, Clinical Integration and Population Health 12/7/15

“Delivery models and payment systems are changing “Delivery models and payment systems are changing. The episodic approach to care, characterized by one physician directly caring for each individual care “event” will be replaced by a team-based longitudinal approach across multiple facilities, sites, practitioner type including the patients home…” Kaufman Hall

Overview Healthcare environment Response to environmental factors Competencies to succeed PHO/ACO Foundation 2015 Successes Future

Healthcare Environment Healthcare spend 3 Trillion Dollars 2014/ 17.5% of GDP $9,146 Per Capita Healthcare quality Hospital errors third leading cause of death (2013) Rank 37th in the world Physician satisfaction 60% would retire if they had means 22% of clinician time paper work Healthcare spend 2014 1.2% faster than the economy/ 200-2009 6.9% faster than economy The study also highlights IM docs in their practice manage 370 unique diagnosis, 600 unique meds and 150 unique lab tests Another study found that in a single year in fee-for-service Medicare, the typical primary care physician had to coordinate with 229 other physicians in 117 different practices (Pham et al., 2009).

National/Local Response Downward pressures on traditional delivery volumes Downward pressures on volume-based reimbursement rates Growing demands for clinical integration Expansion of non-traditional competitors More sophisticated purchasers of care government, payers, employers and consumers

CMS Payment Models

Skills Systems Will Need for Future Success 7

Formation of the WCHN PHO The PHO/ACO is a vehicle for WCHN to develop a physician led clinically integrated infrastructure that will encompass both employed and aligned community providers that will result in increased quality of care, enhanced financial performance and improved patient satisfaction.

The WCHN PHO Board Structure 10 Physician Board Members One Vote 5 PCP Representatives on PHO Board 5 Specialist Representatives 5 Hospital (WCHN) Board Members 5 WCHN Representatives

PHYSICIAN REPRESENTATIVES PHO/ACO Board PHYSICIAN REPRESENTATIVES  PCPs Specialists James Ahern, MD Neil Culligan, MD – Neurology Henry Allen, MD Adam Gorelick, MD – Gastroenterology Harold Kamm, MD Jeffery Gorelick, MD – Urology (Chair) Cornelius Ferreira, MD Sohel M. Islam, MD – Surgeon Martin Williams, MD (Secretary) David Kramer, MD – Surgeon HOSPITAL (WCHN) REPRESENTATIVES Rowena Bergmans Patrick Broderick, MD Mike Daglio (Vice Chair) Matt Miller, MD Steve Rosenberg (Treasurer)

WCHN PHO Functions Develop/maintain a provider network Contract with health plans w/ opt-ins for individual practices Prepare our provider community for changes in the health care arena by: Seeking ways to improve quality & efficiency of health care services provided under PHO/ACO agreements (e.g. clinical integration, collaboration, data analytics, care management.) Offering member practices various optional administrative & technology solutions (e.g. EMR, PCMH, group purchasing, etc.) Supporting practice managers w/ education and networking functions Healthcare Reform Support!

2015 PHO/ACO Membership 871 Providers Value Care Alliance (VCA) 282 Community 589 Employed 186 Primary Care 695 Specialists Value Care Alliance (VCA) St. Vincent's Hospital Middlesex Hospital Griffin Hospital St. Vincent's Health Partners (PHO/ACO) Griffin PHO

2015 Contracts Current Other Future Aetna Commercial – Shared Savings Aetna Medicare Advantage – Shared Savings CMS MSSP – Shared Savings Connecticare – Shared Savings Harvard Pilgrim Multiplan US Family Healthy CT Other Aetna Tiered Network Future Cigna – 2016 – Shared Savings Anthem – PHO/ VCA - 2016 United – PHO/ VCA - 2016

Highlights 2015 Building the infrastructure to achieve clinical integration Physician Leadership and Clinical Support Dr. Bob Carr, Medical Director PHO/ACO Care Managers (2) PCMH Specialists Technology and Business Intelligence Highline data warehouse (claims) Arcadia (EDW) Process CAHPS Survey Vendor (MSSP) Finalized shared savings methodology Trainings (ICD, CPT)

Where are we headed? Utilization Review Accreditation Commission (URAC) accreditation as a clinically integrated network Stronger partnerships with non-traditional providers Continue to seek out shared savings relationships Continue to move practices to PCMH level 3 Introduction of behavioral health supports Primary care providers 79% antidepressants, 60% Treating Depression

Questions…