Randeep Kahlon, MD, MSD Timothy Constantine, President, BCBSD Delaware Health Care Commission

1. Randeep Kahlon, MD, MSD Timothy Constantine, President, BCBSD Delaware Health Care Commission March 1, 2012

2. Rationale The “Triple Aim” • Lower Costs • Improve Quality • Better Health Outcomes

3. Fundamentals for PCMH Transformation Care Mgmt, Coordination & Communication Practice Viability & Efficiency Medical Homes & Medical Neighborhoods Patient Engagement & Access Leadership & Team-Based Care Outcomes Reporting

4. PCMH Gets Results Integrated Delivery System: Group Health Cooperative of Puget Sound • $10 PMPM reduction in total costs Private Payer Sponsored: Blue Cross Blue Shield of North Dakota • Hospital admissions decreased by 6% and emergency department visits decreased by 24% in the PCMH group from 2003 to 2005, while increasing by 45% and 3%, respectively, in the control group.

5. PCMH Gets Results continued Medicaid-sponsored: Community Care of North Carolina • Cumulative savings of $974.5 million over 6 years (2003-2008) • 40% decrease in hospitalizations for asthma • 16% lower emergency department visit rate These results, and more, are available in the report “The Outcomes of Implementing Patient-Centered Medical Home Interventions”Prepared by Kevin Grumbach, MD, Thomas Bodenheimer, MD MPH, and Paul Grundy MD, MPHAugust 2009. http://www.pcpcc.net/files/pcmh_evidence_outcomes_2009.pdf

6. A Forum for Statewide PCMH Efforts Patients First in the First Statewas created as a partnership between Blue Cross Blue Shield of Delaware (BCBSD) and Medical Society of Delaware (MSD). Objectives: • Design and launch an operational statewide PCMH program. • Provide a policy and program design framework for analysis and adoption of standardized criteria. • Provide an information-sharing infrastructure for multiple stakeholders for best practices.

7. Patients First in the First State Multi-Stakeholder Leadership Team -MSD -BCBSD -QID -Physician Specialty Societies -Hospitals* -State of DE* -DSCC/DPPI* -Others TBD* Operational Workgroup Representatives of partner organizations who plan technical design and processes *A multi-stakeholder structure has been assembled but has not been fully activated due to the rigors of the early design period. Full team concept is anticipated with launch of the program May 2012. Physician Advisory Workgroup Physician leaders from Primary Care Specialty Societies and MSD. Other Health Plans whose PCMH conforms to Patients First Criteria BCBSD Incentivized Quality-Focused, Programs Other Plans/Initiatives Whose PCMH does/does not conform but who seek dialogue P4P “PCMH Light” PCMH Education & Disease Management (HealthWays) MSD Practice Support (15 practices) TBD Practice Support

8. MULTI-STAKEHOLDERLEADERSHIP TEAM- INVITEES Conveners Blue Cross Blue Shield of Delaware & Medical Society of Delaware Physician Specialty Societies Delaware Chapter of the American Academy of Pediatrics Delaware State Osteopathic Medical Society Delaware Chapter of the American College of Physicians IPAs MedNet of Delaware

9. MULTI-STAKEHOLDERLEADERSHIP TEAM- INVITEES, continued Hospitals A.I. duPont Hospital for Children Bayhealth Medical Center Beebe Medical Center Christiana Care Health System Nanticoke Memorial Hospital St. Francis Hospital VA Health Care System Employers/Purchasers AstraZeneca Delaware State Chamber of Commerce

10. MULTI-STAKEHOLDERLEADERSHIP TEAM- INVITEES, continued Payers Blue Cross Blue Shield of Delaware Aetna Delaware Health and Social Services, Division of Medicaid & Medical Assistance Others Delaware Health and Social Services, Division of Public Health Delaware Health Care Commission Delaware Health Sciences Alliance QID Others TBD

11. Principles • Adheres to the Joint Principles of the PCMH as approved by the American Academy of Family Physicians, American Academy of Pediatricians, American College of Physicians and American Osteopathic Association • Utilizes the National Committee for Quality Assurance’s (NCQA) Physician Practice Connections® PCMH Recognition Process as a framework • Serves patients from all age groups and medical conditions • Targets Primary Care Providers (PCPs) as participants, including family medicine, internal medicine and pediatrics • Stimulates multi-payer environment ® Registered trademark of the National Committee for Quality Assurance

12. Program Structure Three-phases (3 years) Targeted to: • BCBSD contracted physicians • Primary Care Physicians (FP, IM, and PEDS) • Members of MSD and MedNet • Practices with a minimum number of BCBSD members

13. An Alignment of Effort

14. Payment Structure Year 1: Educational/Transformation • Enhanced Fee for Service Rates Year 2: Care Coordination/Clinical Metrics • Additional per-member-per-month (PMPM) reimbursement for care coordination (ideally adjusted for intensity of care needed – e.g., burden of illness or case- mix) Year 3: Outcomes and Performance Incentives

15. Program Components

16. Program Components-1 Administrative Requirements • Indicators of whether a participating physician’s technological infrastructure/capacity will facilitate the exchange of information required for successful performance as a PCMH (e.g., EMR/DHIN participation)

17. Program Components - 2 Clinical Quality Metrics • Based on HEDIS • Focus on Preventive Care including pediatric immunization, cancer screenings and well visits • Regular visits for patients with chronic conditions • Scorecards will provide performance measures to participants • Targets established for phases of the program for continued participation and bonus eligibility

18. Program Components - 3 Value & Utilization Benchmarks in place to: • Improve health care utilization patterns specific to laboratory, radiology, and ambulatory surgery services • Prevent unnecessary emergency department utilization

19. Program Components - 4 NCQA Accreditation Participants must earn a minimum of Level 1 NCQA PCMH Recognition by the end of the 3 years

20. MSD Practice Support Program Practice Transformation Enhanced in-office support and “Learning Collaborative” education for up to 15 participating sites. A “Practice Coach”will provide support with: • Use of data to guide the delivery of clinical care, • Training on the NCQA PCMH requirements, • Practice re-engineering. MSD is partnering with A nationally recognized company in Colorado to plan and administer the practice support program. Clinical Care Coordination

21. Leveraging Expertise The Wall Street Journal, The Denver Post, and The Northern Colorado Business Reportall recently spotlighted patient-centered care, compensation to primary care physicians and HealthTeamWorks. In the Colorado PCMH initiative with Anthem BCBS, PCMH practices being coached by HealthTeamsWorks; • Reduced hospital admissions by 18% • Reduced ED use by 15% • Reduced total cost of care by 14.5% (compared to non-PCMH practices • Experienced Return on Investment ranging from 250 to 450%

22. Vision Multi-Payer PCMH Environment Remains Optimal • Not practical to treat patients within the same practice differently based upon their insurance carriers • A PCMH program including attribution, metrics, practices support, and payment structure has been created • An infrastructure for sharing lessons learned/best practices for the State and other payers has been created

23. Vision Opportunity for Multiple Stakeholders to Participate With formal launch of program in May 2012, additional opportunities for participation will include: • Committees • Information Sharing Conference Calls • Educational Sessions & Expert Speakers (w/ CME) • “Consortium” meetings

24. Thank you for your support and participation. Randeep Kahlon, MD, MSD Timothy Constantine, President, BCBSD Delaware Health Care Commission March 1, 2012