1. CONFIDENTIAL Terry McGeeney MD, MBA

2.  2010 TransforMED Confidential TransforMED is a non-profit, independent subsidiary of the American Academy of Family Physicians.

3.  2009 TransforMED TransforMED Mission and Objectives Mission Our mission is the transformation of healthcare delivery to achieve optimal patient care, professional satisfaction and success of primary care practices. Objectives Develop high-performance primary care practices through a transformative process of practice redesign focused on patient care and practice team satisfaction Generate transportable new knowledge about the practice transformation process Generate means to allow for the continued financial viability of the organization

4.  2010 TransforMED Confidential  Virtual pre-work/assessment—change readiness, leadership, MHIQ (Medical Home Implementation Quotient)  On-site assessment with MH gap analysis  Practice-specific project list and timeline  Individual reports to practices and cumulative report to Leadership  Highly skilled, dedicated facilitators throughout the project with on-site visits, phone and video conferencing, Delta Exchange  Periodic collaborative meetings – 1 or 2 day strategy  Practice recognition---NCQA?  Quarterly reports and conferencing with leadership

5.  2010 TransforMED Confidential  PCMH Assessment Identify expectations, define process and understand objectives Online assessment, practice metrics, financial assessment and change readiness assessment  Gap Analysis Identify current state and PCMH opportunities  Comprehensive Practice Transformation Plan Prioritized roadmaps and timelines

6.  2010 TransforMED Confidential  Assigned a Dedicated Facilitator/Coach  Delta-Exchange Unlimited access to online primary care learning community  Enrollment in TransforMED’s National Learning Collaborative  Access to TransforMED Web Site Resources Whitepapers, models of care, MHIQ, leadership videos and success stories  TransforMED PCMH Recognition

7.  2010 TransforMED Confidential  Includes Components of Virtual Engagement +  Onsite Consultation with TransforMED Staff Review assessments, gap analysis, project timelines and develop PCMH transformation plan $10,000 Per Practice/Per Year 2 Year Project

8.  2010 TransforMED Confidential  Regularly Scheduled Educational Forums  Designed to Accelerate PCMH Adoption  Peer to Peer Interactive Learning Community  Eligible CME and CEU Credits  Learn from PCMH Experts SM

9.  2010 TransforMED Confidential  Patient Experience Assessment Tool (PEAT)  TransforMED Workbook Series  NCQA Recognition  Culture Assessment  Practice Retreats  EHR Prep-Select Tool

10.  2010 TransforMED Confidential

11.  2009 TransforMED

12.  2010 TransforMED Confidential The healthcare world is changing in ways that many of us have never seen in our lifetime with the possible exception of Medicare.

13.  2010 TransforMED Confidential Improved Outcomes! a. Quality b. Chronic Disease c. Transitions in care d. Satisfaction e. Efficiency (cost savings) f. Practice Financials

14.  2010 TransforMED Confidential

15.  2010 TransforMED Confidential  Enhanced fee for service  Care management fees  Capitated, no risk models  Shared savings  Targeted incentives for quality and efficiency  Global or Bundled payments  Accountable Care Organizations  HIT Stimulus Incentives

16.  2010 TransforMED Confidential

17.  2010 TransforMED Confidential  A medical home is an enhanced model of primary care in which care teams attend to the multi-faceted needs of patients, providing whole person comprehensive and coordinated patient- centered care.

18.  2010 TransforMED Confidential  Patient-Centered : Each patient has access to care based on an ongoing relationship with a licensed clinician who provides continuous and comprehensive primary care;  Team-Based Approach: The model employs a multidisciplinary team of individuals, including the patient, who is the center of the care team, who collectively take responsibility for the ongoing needs and care of a patient. Patients actively participate in decision-making and feedback to ensure expectations are met;  Whole Person Orientation : The licensed clinician provides for each patient’s comprehensive health care needs or appropriately arranges care with other qualified professionals. This includes care for all stages of life, including acute, chronic, preventative and end of life care;  Care Coordination and Integration : Care is coordinated and/or integrated across all elements of the complex health care system and the patient’s community (family, public, and private [for-profit and non-profit] community- based services). Care is facilitated by the use of office practice systems such as registries, information technology, health information exchange, and other systems to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner;

19.  2010 TransforMED Confidential  Quality and Safety : Quality and safety are hallmarks, including clinician advocacy for patient-centered outcomes driven by a compassionate, robust partnership among licensed clinicians, patients, and the patient’s family. Evidence based care and clinical decision-support tools guide decision making, and clinicians accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement. Information technology is utilized to support optimal patient care, performance measurement, patient education, and enhanced communication. Practices go through a voluntary recognition process by a nationally recognized entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model;  Enhanced Access : Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication among patients, licensed clinicians, and staff.  Payment : Payment appropriately recognizes the added value provided by care coordination, care that falls outside of the face to face visit, health information technology for quality improvement, enhanced communication access, work associated with remote monitoring of clinical data, and case mix differences. 

20.  2010 TransforMED Confidential

21. CONFIDENTIAL

22.  2010 TransforMED Confidential  Impacted 9,601 providers.  TransforMED has worked to improve care for up approximately 20 million patients (assuming 2000-2200 patient panel size per primary care provider).  857 fully facilitated providers.  ~1,200 Delta-Exchange members (not counted in the 9,601 figure).  Total of 168 practices that received TMED facilitation across all projects in past 3 years.  MHIQ has had a total of 4,890 individual registered users.  Of which 1,449 users have completed the MHIQ and 604 have completed NCQA cross-scoring.

23.  2010 TransforMED Confidential  13 Primary Care Practices ( FM, IM, Peds)  Project Objectives ◦ Improve Quality of Care ◦ Reduce Costs associated with PCMH care ◦ Increase market share ◦ Develop a strong primary care base within market  Improve physician satisfaction  Improve practice revenue ◦ Full Facilitation Methodology with 4 Collaborative Meetings

24.  2010 TransforMED Confidential  20 Primary Care Practices (FM, IM, Peds)  Project Objectives ◦ Deliver an “distinctive” patient experience ◦ Achieve upper decimal of performance ◦ Standardization of best practices across 160 primary care sites ◦ Positioning for an ACO ◦ Grow / Protect market share  Full Facilitation Methodology with 4 Collaborative Meetings  Develop Internal Resources to support Dissemination.

25.  2010 TransforMED Confidential  Multi Payer Pilot in Cincinnati  11 Primary Care Practices (Virtual Facilitation)  20 Primary Care Practices (Co-Pilots)  Pilot Objectives ◦ Strengthen Primary Care within community ◦ Align Healthcare forces in community ◦ Improve Quality and Equity of Care within Community ◦ NCQA Recognition  Virtual Facilitation with 5 Collaborative Meetings over 1 year  Next Steps: 25 New Practices for 2011

26.  2010 TransforMED Confidential  11 Primary Care Practices (FM, IM, Peds)  Pilot Objectives ◦ Improve quality outcomes ◦ Development of new reimbursement methodology ◦ Technology integration with data  Virtual Facilitation with 4 Collaborative Meetings Next Step: Scalability to 2,000 Primary Care Providers in market.

27.  2010 TransforMED Confidential  1 Family Medicine Practice  Project Objectives ◦ Design of PCMH prior to clinic opening ◦ Work with internal teams as PCMH experts ◦ NCQA Recognition Level 1 upon start up ◦ NCQA Recognition Level 3 within 6 months of start up  Virtual Participation in Design Team Meetings  On Site Assessment and PTP to Level 3 Next Step: Model for future clinics in development

28.  2010 TransforMED Confidential  Open Engagement  System Standardization leveraging technology (Epic) and process (PCMH)  Project Objectives ◦ Standardization across 70 primary care sites in 4 states ◦ Improve EMR adoption ◦ Develop team base care model to improve efficiencies  Collaborative Build with CHP, Epic and TransforMED  Assessment of 70 sites to determine needs  Full, Virtual, and Targeted Methodologies

29.  2010 TransforMED Confidential  Statewide PCMH Initiative  5 to 6 Primary Care Practices (FM, IM)  Pilot Objectives ◦ Improve Quality of Care ◦ Reduce Costs ◦ Develop internal payer resources to support primary care ◦ Payment Methodology Reform  Full Facilitation with 4 Collaborative Meetings  Train the Trainer Methodology

30.  2010 TransforMED Confidential  Internal Medicine Residency Program  Affiliated with Yale School of Medicine  Objectives ◦ To develop, implement, and evaluate a new curriculum in PCMH to prepare residents to serve the role of Personal Physician – P4 ◦ To transform health care delivery in the resident ambulatory care clinic and ambulatory rotation sites to align it with the principles of PCMH ◦ Utilizing principles of PCMH to develop new enthusiasm for primary care

31.  2010 TransforMED Confidential  2009 Nebraska Legislature passed LB 396 to adopt the Medical Home Pilot Program Act ◦ Selection of TransforMED as project facilitators  Develop PCMH within a select number of practices to support Nebraska Medicaid ◦ General Practice, Family Practice, Internal Medicine, Peds  Work with key stakeholders across the state to leverage PCMH concepts to improve care and reduce costs

32.  2010 TransforMED Confidential  Create an integrated, comprehensive plan for ongoing medical care in partnership with patients, their families, and Clinical staff.  Easily allow providers to use evidence-based medicine and clinical decision support tools to guide decision making at the point of care  Develop Leadership to support a team base care approach

33.  2010 TransforMED Confidential

34.  2010 TransforMED Confidential  ER Utilization: -9.46% as compared to a 5.74% increase in the non-pilot primary care group;  Inpatient admissions at one site were reduced by 12.49% as compared to a 4.02% reduction in the non-pilot primary care group  Quality improvement in 14 of 18 HEDIS Measures  Total payer cost of care for the PCMH practices was 2.02% lower than the non PCMH primary care group Project Focus – Team Base Care, Care Management, Care Coordination

35.  2010 TransforMED Confidential  25.8% reduction in diabetic admissions  6.1% reduction in overall population admissions  20.3% reduction in ER utilization for diabetic members  9.5% reduction in overall ER utilization  4.7% increase in generic utilization  4.1% decrease in average diabetic patient costs PMPY  3.6% decrease in average medical costs PMPY Pilot Objectives: Lower Costs, Improve Patient Satisfaction, Payment Reform

36.  2010 TransforMED Confidential  TMED SitesNon TMED SitesPlan Level Analysis Active Members18,90014,100375,000 Admits per 1000496356 ED Visits per 1000159202191 Average Patient Medical Costs PMPY $2,852$3,635$2,922 Pilot Savings$14,798,700 Plan Savings$1,323,000 Project PCMH Savings $26,250,000

37.  2010 TransforMED Confidential  4.5% Reduction in Necessary ER Visits  22 % Reduction in Unnecessary ER Visits Pilot Objectives: Reduce ER Visits, Increase Primary Care Access and Improved Communications http://www.azcentral.com/arizonarepublic/business/articles/2010/08/22/20100822unitedhealthcare-medical-home- program.html

38.  2010 TransforMED Confidential  Improved Practice Revenue: The analysis of financial outcome data released indicates that average annual growth in revenue for practices that participated in the transformation to a medical home pilot increased 11% on average  Improved Physician Salaries: 14% increase in salaries with no new money from outside sources.  Improved Efficiencies/Quality: Average reduction in cycle time of 12 minutes over the course of being transformed to a medical home.  Improved Provider / Staff Satisfaction: Overall provider satisfaction increased 58%. During the same period, staff satisfaction increased 66% with 82% indicated that they prefer the patient centered medical home.

39.  2010 TransforMED Confidential One year data from payer pilots has demonstrated that individual practices can provide the same higher quality at lower cost as published data from large integrated systems.

40. CONFIDENTIAL

41.  2010 TransforMED Confidential  Cost of Care Metrics ◦ Number of Admissions ◦ Emergency Room Visits ◦ Prescription trends / costs  Quality Metrics ◦ Number of Patient Encounters ◦ Quality Health Indicators (Hedis and others) serving as surrogate outcome metrics

42.  2010 TransforMED Confidential  Clinical Outcomes  Breast Cancer Screening  Tobacco Use  Pneumococcal Vaccine  HbA1c Control  LDL Control  BP Control  BMI

43.  2010 TransforMED Confidential  Clinical Efficiency ◦ Same Day Availability % ◦ Average Visits per Day per Provider ◦ Panel Size ◦ EMR Use ◦ E-Prescribing Use

44.  2010 TransforMED Confidential  Financial Outcomes ◦ Average Net Medical Revenue (ANMR) per Physician ◦ Overhead as a % of ANMR ◦ Employee Salary and Benefits as a % of ANMR ◦ Physician Compensation

45.  2010 TransforMED Confidential  Clinical Satisfaction ◦ Patient Satisfaction with Practice ◦ Provider Satisfaction ◦ Employee Satisfaction

46. CONFIDENTIAL ….Because everyone deserves a Medical Home! Terry McGeeney MD, MBA