1. Prospects for New Delivery Systems and Reimbursement Models
AHLA Practice Group Luncheon
June 28, 2010 | Rick Woods
Executive Vice President & General Counsel
Group Health Cooperative | Seattle, Washington

2. What is the benefit? Improved patient experience Lower costs
Higher quality
Increased use of evidenced based medicine

3. Integrated Delivery Systems
Several characteristics are essential for all integrated delivery systems (ACOs)
Financial incentives to create the system of care
Provide or manage the continuum of care as a system
Sufficient size to support comprehensive performance measurement and expenditure measurements
Capable of internally delivering shared savings and prospectively planning budget and resource needs
Group Health has operated as an integrated delivery system for 60+ years and our experience tells us it works and it is worth it

4. Group Health Corporate Structure

5. 26 Group Health Medical Centers
640,000 covered lives
1,200 doctors
10,000 employees

6. Better results through integrated care

7. A system of care at Group Health
24/7 Access
Patient Web Portal
Virtual Visits
Secured Messaging
Urgent Care
Primary Care
Specialty Care
Consulting Nurse Service
Quality
Disease Predictive Modeling, Registries and Protocols
Patient Population Research
Patient Safety Monitoring
Electronic Medical Record
Content of Care
Shared Decision-making
Evidence-Based Tools & Practice Guidelines
Continuity
of Care
Medical Home Model
Seamless Care Transitions
Case Management and Outreach
On-site Care Managers
These 4 quadrants represent some of the key areas where our ACO needs to excel
Our information systems have helped us accelerate our delivery system transformation. And we have aggressively adopted lean thinking as it applies to our clinical and business efforts.
To manage a patient population you need to enhance access, enable continuity of care, and engage patients in their health. We use disease predictive modeling, outreach to patients, and study of our outcomes. Our system is great for patient care, but it is also sustainable business model which we believe it is replicable.
Next we will drill down into these quadrants to show how we are using an ACO approach to coordination care for our patients. We believe all of these are essential pieces in managing quality and costs. 7

8. Group Health’s Medical Home Model

9. Prospects: What it takes to create performance focused care
1. Focus on engaging patients to meet their health care goals
Patients must be an active part of an effective system of care
Future “retail” orientation of health reform exchanges will make this more important
Need to capitalize on the role of employers in promoting patient engagement
2. Financing structure that reimburses clinical providers for achieving better outcomes (cost, utilization, quality, service) for a common population of patients
All parts of the system are focused on health outcomes
All parts of the system are aligned and have reason to look broadly at how to achieve the goals
3. A strong, integrated, multi-specialty group practice
Compensation based on salaries with focus on quality and service
Transparent comparative reporting of performance
Advanced primary care model serves as foundation for accessing and organizing care & coordinates with other aspects of delivery system

10. Prospects: What it takes to create performance focused care
4. Integrating systems that support care coordination
Electronic health record, full-featured patient web portal, consulting nurse service, transparent performance reporting and more
Operational & management excellence derived from Lean principles
5. Strong clinical leadership that translates scientific evidence into clinical practice
Active use of comparative effectiveness data & processes
Clear decisions about clinical guidelines & a conviction to use them to measure & improve performance
Evidence-driven drug formulary
6. Effective partnerships with other care providers & resources with common goals that support a coordinated, cost-effective system
Endorse principles of chronic care model
Hospitals, clinicians, hospices, churches, fitness centers, grocery stores, families all contribute to outcomes

11. Reduced health care costs through Integrated Systems
Appropriate care teams
Improved care coordination
Reduced waste
Internal process improvement
Informed patient choices
Chronic disease management
Point of care reminders and best-practices
Actionable, timely data