Frederick Integrated Healthcare Network All Provider Meeting

1. Frederick Integrated Healthcare NetworkAll Provider Meeting January 13, 2016

2. Agenda • Call to Order Dr. Gough • Laboratory Utilization and Cost Dr. Gough • MSSP & FMH Contract Dashboards Jennifer Teeter • 2016 FMH Contract Quality Measures Jennifer Teeter • Shared Savings Methodology Jennifer Teeter • ACO Reporting to Medicare Phil Stiff • Annual Wellness Visit Dr. Koilpillai • Care Management update Heather Kirby • Specialist Follow-up Visits Dr. Gough • Palliative Care/Advanced Directives Dr. Gough • DVT Protocol Dr. Gough

3. Board of Managers

4. Frederick Integrated Healthcare Network Board of Managers Chair: Richard Gough Johnson Koilpillai Neil Waravdekar Kevin Hohl Wayne Crowder Sibte Kazmi Gaffar Syed Saeed Zaidi William Johnson Mark Soberman Michelle Mahan Jennifer Teeter Richard Holz Credentials Committee Clinical Integration and IT Committee • Neil Waravdekar - Chair • Wayne Crowder • Manny Casiano • Gaffar Syed • Leonard Kinland • Michael Costello • Johnson Koilpillai • Jennifer Teeter • Richard Gough - Chair • Dawei Yang • Lakhvinder Wadhwa • Johnson Koilpillai • Gerard Delgrippo • Paul Feinberg • Mark Glass-Royal • Vipul Kela • Jim Trumble • Manny Casiano • Phil Stiff • Heather Kirby • Jennifer Teeter Finance Committee • Saeed Zaidi – Chair • Mark Soberman • Kevin Hohl • Amy Jones • Dave Bromberg • Richard Gough • Michelle Mahan • Jennifer Teeter Governance and Membership Committee • Johnson Koilpillai - Chair • Sibte Kazmi • Vincent DiFabio • Jennifer Teeter

5. Network Participation Report 20% increase since 11/2014 Non par Future provider contracting strategy – Preferred SNFs, HH Agencies

6. Welcome New FIHN Members! Comprehensive Neurology Services Comprehensive Neurology and Sleep Medicine Critical Care Associates Tracy Culbertson Diane Ford Mann and Henry Podiatry Stephen McKenna Medical Emergency Professionals Mid-Maryland Ear Nose and Throat Mohammed Mohiuddin Progressive Podiatry, Julie Jurd Radiology Associates of Frederick Sound Physicians Yalamanchili Brain and Spine Network Gaps: Allergy OBGYN Opthalmology Outpt Psych

7. Laboratory Cost Data

8. Lab Orders • Electrolyte Panel • Glucose • BUN • Creatinine • SGPT (ALT)

9. Lab Orders Cost • Electrolyte Panel 9.55 • Glucose 5.12 • BUN 5.37 • Creatinine 6.33 • SGPT (ALT) 6.32 $32.69

10. Lab Orders Cost • Electrolyte Panel 9.55 • Glucose 5.12 • BUN 5.37 • Creatinine 6.33 • SGPT (ALT) 6.32 $32.69 Comprehensive Metabolic Panel $14.37

12. Year in Review – What did FIHN Accomplish?

13. 2015 Accomplishments • Network Growth -20% • Attributed lives under contract – 10,838 and 1,425 • Financial – as of 3Q 2015 • Medicare achieving 4% savings (MUST REPORT) • FMH Employee Health Plan achieving 11% savings • Utilization – Detailed reports – next set of slides • What have we done to contribute to these results? • PCP Dashboards and actionable patient level data • Tools to educate patients, ER use, High Tech Imaging • Provider best practice education CMEs, Premier data • Embedded Care Managers – Sept. start, not in data yet • FMH Transition in Care follow-up • Palliative Care and hospice criteria for referral

14. 2016 Priorities • Provide IT data integration to report/perform on measures! • Engage select Specialists with patient level detail on high utilizing patients • Help PCPs with Annual Wellness Visits – best practice • Continue work on readmissions, transitions of care • Improve communication between sites of care • Engage beneficiaries – disease management, embedded care managers, frail/home bound with home visiting PCP • Reduce Skilled Nursing Facility Length of Stay – preferred facilities, transparent dashboard , SNF-ists • Provide End of Life care in the most appropriate setting • Reduce overutilization of office based imaging, procedures

15. Other payor contracts for shared savings continue to be negotiated • AETNA • United

16. Medicare Shared Savings Contract Dashboard Q3 2015

20. MSSP - PCP Report Card

21. Comparison to other ACO Network Performance Premier benchmarking data

25. Trend is toward higher cost • FIHN is achieving savings over the 3-year benchmark, however comparing 2014 to 2015 costs have risen 1.3%per beneficiary • Highest areas of utilization opportunity in comparison to Milliman Standards for loosely managed populations: Inpatient Laboratory, Outpatient Imaging, Office Procedures • Inpt Admission areas of focus: COPD, Pneumonia • Preference sensitive admissions – PTCA/Angioplasty • Skilled Nursing Facility Length of Stay, specifically admissions over 21 days, FIHN ALOS 27 days. • Part B drug costs – injectables, oral anti-cancer, infused

26. FMH Employee Health Plan

27. 3rd Quarter 2015 Performance

28. Employee Health Plan MeasuresNew for 2016

29. Philosophy Keep measures consistent with MSSP where quality measures/employee health issues overlap Use measures that are not difficult to capture due to issues abstracting from multiple EMRs Do not make the goals so challenging that they are unachievable, keep providers engaged through incentives Help the Employee Health Plan make a difference for our most important resource, our employees/colleagues

30. Employee Health/Utilization Priorities Advanced Imaging Costs Diabetes Depression Coronary Artery Disease Emergency Room Utilization

31. Goals for 2016 High Tech imaging - reduce CT/MRI/PET utilization by 5% ER Visits/1000 - reduce another 5%, still very high compared to Milliman loosely managed standards PQRS/ACO-27, A1c poor control – improve this measure by 5% PQRS/ACO- 28, Controlling high blood pressure – improve this measure by 5% ACO 27 and 28 measured by the employee and spouse completing biometric screening lab testing annually. Patient specific information on each measure would be provided to the PCP at the start of the year.

32. Shared Savings Methodology Work

34. GPRO Reporting to MedicareJanuary – March 2016 Please open your door Work with our abstractors And we’ll complete PQRS together!

35. Abstractors / Reporting Team • Della Benford • Sandy Bair • Doris Baisey • Joseph McKinney • Premaris – 3rd party vendor • Sean Shillinger, Information Services • Aron Fejes, Information Services • Phil Stiff, Information Services • Jean Havrilla, Information Services • Jennifer Teeter, ACO Executive Director Nurse and/or Abstraction / Coding Backgrounds

36. Draft High Level Workflow CMS sends patient names FIHN looks for provider affiliation EcW or NextGen? Other EMR No EMR Paper Assigned to FIHN EcW Team Assigned to Primaris Assigned to RN Manual Abstractors No No Reporting data found? Data audited and put into xml file for reporting Yes

37. GPRO Reporting - Process Group Practice Reporting Option • ~3,000 patient records in our sample file • Jan – Feb: FIHN to come to your practice to ask: • Review charts for measures • OR, to establish remote access to your EHR • Including Premaris • 75% of answers = NextGen and eClinicalWorks • Early-March - Final GPRO upload due to CMS • Successful reporting triggers CMS payment of savings if savings are achieved and avoids PQRS penalty for all FIHN MSSP participants! Your support (expedient access to EMR data) is required!

38. Primary Distribution of Samples

39. Primary Distribution of Samples (cont’d)

40. Progress to date capturing ACO Quality Measures from Electronic Medical RecordsUpdate

41. Electronic Data • Estimate of electronic opt-in charts found • NextGen: 6,500 • eClinicalWorks EHR: 1,300 • TOTAL 7,800 Attributed 10,800 Other potential sources for charts: • Paper charts & other practices • Meditech • SNF • MMI/CAO 75%

42. What does data show? 2016 Performance efforts may want to focus on: Documenting past results and immunizations And focusing on Diabetic , pre-hypertensive, and Cardiac risk population -- need follow-up -- high number bad Involves both practice and IS resources

43. Important follow-up • Collect the measures • Put information in the correct/discrete field in your EHR • Collaborate with FIHN IT Analyst Sean Shillinger - free assistance to improve reporting from your EHR FIHN can help your practice improve reporting to PQRS for Medicare and other payors under performance based contracts

44. Medicare Annual Wellness Visits

45. 91% of FIHN patients have not had their Annual Wellness VisitIncreasing Annual Wellness Visits is an ACO best practice for achieving savings and improving care

46. Annual Wellness Visit Benefits • Catch medical problems early • Collect Quality Measures – improve our PQRS reporting score for next year • ACO Attribution of patients • Revenue for practice • Improve ACO population risk score which increases our benchmark cost, greater savings potential Keep open appointments weekly for scheduling a set number of AWVs, use data collection tools, midlevels

47. PCP meeting planned • February 25, 6:00-8:00 p.m. FMH Crestwood Conference Center • Catered Dinner • Work on Annual Wellness Visit best practice

48. Care Management Update

49. Care Management Patient Engagement

50. Care Management Team: • 5 FIHN Care Managers: • Onboarding additional CM to support Internal Medicine Associates • Care Management Coordinator – support funtions • Pharmacist pilot – Parkview Mt. Airy • Engaging beneficiaries: • Provider referrals – visibility makes a difference • Daily hospital activity reports • Handoffs from hospital / ED care management