A Washington Perspective on Payment Reform

2. A Washington Perspective on Payment Reform October 13, 2011 Karen Ignagni President and Chief Executive Officer America�s Health Insurance Plans

3. Overview New Landscape Achieving the Triple Aim Strategies Driving Change What�s Next? 3

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5. The New Landscape of HealthCare: It�s Not the 90s Anymore Partnerships Quality and Cost Goals Improved Performance Standards Population Focused Patient Centered Leveraging Technology 5

6. Triple Aim: Better Health, Better Care, Lower Cost Health Plans are Working on Three Fronts to Achieve This Aim: 1. Redesigning care delivery 2. Engaging patients to be more active participants 3. Restructuring payment models to incentivize redesign 6

7. Partnerships to Incentivize Redesign Move from Encounters ? Continuum of Care Accountability for Care & Gaps in Care Demonstrate Better Value Experience Better Individual and Population Health 7

8. Health Plan Payment Models Driving Change Data drives approach Population-based /primary care approaches PCMHs/advanced primary care practices ACOs Procedure/episode-based approaches Bundled payments 8

9. Health Plan Payment Reform & Cancer Care -- Approaches Approaches include bundled payments, shared savings Build on traditional FFS Incorporate care management fees, performance-based payments Different approaches to achieving similar goals Reduce variation Promote best practices Improve patient outcomes 9

10. Health Plan Payment Reform & Cancer Care � Identifying Targets Use of clinical pathways Flexibility to account for clinician choice, patient characteristics Evaluation of data targets priority areas Avoidable hospitalizations Avoidable emergency department visits Wide variation in treatment patterns Redundant imaging and testing Lack of improved outcomes

11. Health Plan Payment Reform & Cancer Care � Evaluation Quality metrics used measure effectiveness of model Complications and side effects Care plan development Provision of counseling Adherence to pathways Identify best practices Feedback to clinicians Comparison to peers, benchmarks 11

12. What�s Next: Maximizing Opportunity Identify Best Practices, Advance High-Quality Care and Facilitate Rapid Learning by: Investing in Research on What Works Developing a Strategy for Clinical Registries Migrating from Per Procedure Payment in Public Programs to Coordinated, Integrated Care Learn from Private Sector Experience to Drive Public Program Change 12