1. Total Cost of Care Reporting Jim Chase Health Care Financing Task Force October 2, 2015

2. MN Community Measurement Accelerating the Improvement of Health Through Public Reporting The trusted source of information to improve health, patient experience, cost and equity Used by patients and providers to improve care Our community works together on measurement 2 MN Community Measurement

3. MNCM by the Numbers 3 MNCM all rights reserved

4. Current Environment for Cost of Care Measures Many medical groups have contracts with total cost targets Health plans are using different cost of care measures MnSure, other new insurance products will highlight cost differences to public Recent Medicare release of physician payment data State and federal health care programs likely to adopt cost measures in near future National Quality Forum (NQF) endorsed HealthPartners Total Cost of Care and Resource Use measures 4 MN Community Measurement

5. MNCM Cost of Care Measure In 2012, MNCM Board of Directors set goal to create a cost of care measure for public reporting Measure had to: Support improvement in the Triple Aim Align with local and national initiatives Aim at recognition of variation in cost and utilization, as well as opportunity to improve 5 MN Community Measurement

6. NQF Evaluation Criteria Importance to measure and report Scientific acceptability of measure Feasibility Usability and use Related and competing measures 6 MN Community Measurement

7. Purpose of Total Cost Measure Public awareness of cost variation and opportunity to increase value Alignment across payers so they compete on results, not information Actionable information for medical groups Transparent, nationally-endorsed method Timely data Verifiable results MN Community Measurement 7

8. What is Total Cost Of Care Measure of All Risk Adjusted Costs for All Patients compared to Overall State Average Patients are attributed to one and only one medical group Primary Care activity All of the patient’s costs are assigned to that group Insurance payment + patient responsibility Adjusted for patient risk and outlier costs removed Medical group level reporting MN Community Measurement – All Rights Reserved 8

9. Key Public Comment Concerns Attribution of total costs to primary care Reporting only on primary care and multi-specialty groups Comparison groups Impact on referral centers 9 MN Community Measurement

10. Range of Results 2013 Based on 1,500,000 commercially insured patients and $8,000,000,000 in costs MN Community Measurement – All Rights Reserved 10

11. Impact of the range 11 MN Community Measurement – All Rights Reserved

12. 2015 Total Cost of Care Report Reports data on 132 medical groups with 954 clinics Stability over two years, similar range and distribution Paired with average paid per procedure (201 medical groups) Average paid up 6%, average cost up 3% 12

13. Next Steps Review measure specifications for enhancements Include Relative Resource Use measure Expand to Medicare and Public Programs Align use with payers Provide medical groups with additional analysis 13 MN Community Measurement

14. Questions or Comments? Jim Chase President, MN Community Measurement info@mncm.org Connect with us! MN Community Measurement website MN HealthScores Website MN HealthScores on Facebook Twitter: @mnhealthscores 14 MNCM all rights reserved