1. HSCRC Call for Papers Patrick Redmon, Ph.D. Director Berkeley Research Group, LLC January 31, 2014

2. Demonstration Model 2 3.58% per capita growth in hospital revenue $330 million Medicare savings over 5 years Reduce readmissions to national average Reduce MHACs by 30%

3. Public Engagement 3 Advisory Council Guiding principles for implementationGuiding principles for implementation Final report in preparationFinal report in preparation Work Groups Convene on February 6, 2014Convene on February 6, 2014 Provide recommendations on technical implementation issuesProvide recommendations on technical implementation issues

4. Purpose of Call for Papers “The purpose of the papers is to encourage individuals and organizations to actively participate in policy discussions in a well developed and fact-based manner. The goal is to have an informed dialogue in which the technical approaches and findings from different papers are discussed, refined and ultimately contribute to technical analyses that will support HSCRC policy decisions.” 4

5. Topics for Discussion First Group (due January 10, 2014) –Potentially Avoidable Volume –Methods for Monitoring Total Costs of Care –Service Area / Market Share –Gain Sharing and Other Physician Alignment Programs 5

6. Topics for Discussion Second group (due date to be determined) –Attribution –Variable Cost Factor –Efficiency and Value Measurement –Payment Incentives for Quality-Based Reimbursement –Predictive Models for Uncompensated Care –Payment Models for Population Based Approaches –Financing Major Capital Projects 6

7. Themes 7 Incentives for Volume Quality of Care Measurement Uncompensated care

8. Incentives for Volume Per capita versus per case incentives Variable Cost Factor Global Budgets Per capita measurement and population attribution Potentially avoidable utilization –Readmissions –Prevention quality indicators –MHACs –Avoidable ER visits Future capacity and innovation -- capital 8

9. Quality of Care Be at the national average for readmissions by the end of the demonstration period Reduce MHACs by 30% Improve QBR performance –Includes patient satisfaction and mortality measures Strengthen incentives begun in existing programs 9

10. Measurement 10 Demonstration Compliance System Revenue Management Data

11. Measurement Demonstration Compliance –Total cost of care –Medicare per beneficiary performance for hospital services –Per capita hospital spending for Maryland residents 11

12. Measurement Managing System Revenue –Market share definitions –Patient attribution for direct measurement of hospital per capita revenue growth by hospital –Efficiency 12

13. Measurement Data –Medicare –Enhanced HSCRC Collection of Hospital Data –All Payer Data Base –CRISP 13

14. Uncompensated Care Policy Response to Insurance Expansion –Exchanges Expanded coverage Higher deductibles and copays –Medicaid Expansion 14

15. Conclusion Rapid development necessary to achieve demonstration goals over the five year time frame Process will require resources to develop Policies are likely to require revision over time 15

16. Questions? 16

17. Patrick Redmon, Ph.D. Director Berkeley Research Group, LLC predmon@brg-expert.com (484) 554-9654 17