“The Integrator” Optimal Care for All our Members and Patients BRENDA BRUNS, MD EXECUTIVE MEDICAL DIRECTOR, HEALTH PLAN

Who We Are Founded 1947 Financing & Delivery System Consumer Governed, Not for Profit 675,000 Members/patients Group Practice GH Physicians – 2/3 Contracted Network - 1/3 1,281 Providers (27 Different Specialties) in Group Practice 26 Primary Care sites/4 Multispecialty sites Contracts with 6,000 physicians & 44 hospitals $23.4M Research Grants (2008)

The Integrator’s Role Responsible for the Triple Aim Engage Individuals and Families in Their Own Health Redesign of Primary Care Population Health Management Financial Management Macro System Integration Proprietary - do not duplicate

Our vision is two-fold To have the Best Group Practice in the Country To Have the Best Overall Network for our Members and Purchasers GPD performance boosts overall network performance GHP providers influence coordination & content of care with selected network partners Our Contracted Network should be at least as good, if not better than other health plans’ Members and Purchasers should have access to a consistent experience and to similar resources

Group Health Affordability Goals A major component of Group Health’s 2007-2015 strategic plan has been to achieve a significant (~10%) cost advantage over leading competitor networks Tactics to “bend trend” have included: Primary care medical home deployment across entire GPD System-wide implementation of Emergency department/hospital inpatient (EDHI) initiative Shared decision making/preference sensitive conditions in GPD and CN Appropriate reductions in High End Imaging Contracting strategies to keep “P” at <4% YOY increase Development of Network Design and Clinical Integration Strategy 5

Group Health ACO Strategy Form key provider partnerships in major markets to control clinical cost trends, improve quality of care and expand Group Health medicine more broadly into the communities we serve Deploy and build in our best clinical practices; primary and specialty care; information technology; care management; premium, contracts, membership and claims administration; marketing and sales capability as infrastructure to support the partnership network Build a financial model which yields profitable growth in every market through best medicine at the lowest per capita cost

Care Model for Clinical Integration Patients supported to manage their own care, driven by proactive outbound treatment Patient centered Collaborative organizations that are under clinical leadership with aligned management systems and cultures Practice structure A single, coordinated, transparent, and evidence-based approach to patient care that supports continuous improvement Common care approach Information systems Entire care team has real-time transparency about patients, with effective coordination In evaluating integration we have 6 elements: patient centered care, common care approach, payment reform, aligned management systems, IT systems and community partners. To achieve the vision of integration you need to move on all of these components. Payment structures The right payment structures in place to drive alignment on a common care approach Community partners A broad set of community stakeholders that are fully aligned on a common care model 7

Strategy and Goals Grow the Group Practice by expanding our footprint in markets and through clinical integration with strategic partners Engage in markets through a continuum of clinical integration models that control financing and delivery of care Growth in market share through a coherent network that is attractive and affordable to our members Improve per capita cost through selective and enhanced strategic partnerships Improve quality of care through reduction of clinical variation throughout the delivery system Increase Group Health’s influence on the member experience and how care is delivered 8

Group Practice and Community Network Trends IP days/1,000 are trending down faster in Community Networks (CN) than Group Practice (GP). GP have Medicare days included so overall levels are higher than CN.

Consistent Care Experience On the outside, the member or purchaser views a gift box that has a distinct, recognizable look (differentiated from other health plans) The inside of the package (caliber of patient experience) differs based on where and how the model is deployed. The Health plan provides varying levels of support or intervention, based on the type of delivery system ACO Integrator Care Gap Report Disease and Care Management Programs Predictive Modeling and CMIS Member Care 1o Care Spec Care 0% 100%