1. Mesa County Physicians IPA Accountable Care for Mesa County Physicians Cooperating to Deliver High Quality Health Care to Our Community 2/10/2014 Gregory Reicks, D.O., FAAFP President Mesa County Physician's IPA

2. Mesa County Physicians IPA One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicares highest quality-of- care scores Grand Junctions medical community was not following anyone elses recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

3. Price adjusted Medicare Payments/Enrollee 2008 Mesa County Physicians IPA

4. Mesa County Independent Physicians Association 35 Year History Risk contracting Clinical Integration 295 Members –40% Primary Care

5. Mesa County Physicians IPA Lines of business: HMO Private Pay (Commercial) Medicaid (ASO Contract) Medicare (Cost Contract) Dual Eligible (Medi/Medi) CHP+ HCO PPO Self-funded Initial claims paid net of a withhold: 15% of allowed for HMO, Medicare, HCO-PPO plans 15% of allowed RMHP Medicaid fee schedule 0% of allowed for HCO-self funded plans Withholds released on a profit-sharing formula: MCPIPA/RMHP share 55 / 45 in first ~$9 million Balance shared at 80 / 20 until full W/H returned

6. Mesa County Physicians IPA

7. Historical Withhold Return

8. Mesa County Physicians IPA + 53%

9. What the Evidence Shows Delivery System Reform Without Payment Reform Does Not Work Investing in Primary Care Works Cost Accountability Works

10. What Do We Mean by Payment Reform?

12. Isnt This Capitation? No.

13. Mesa County Physicians IPA Thank you