Cynthia Napier Rosenberg, M.D. Senior Medical Director Network Management and Provider Relations

1. UPMC Health PlanPartners in Excellence™Patient-Centered Medical Home: An Integrated Approach with Results Cynthia Napier Rosenberg, M.D. Senior Medical Director Network Management and Provider Relations UPMC Health Plan

2. Three Things • Who we are • UPMC Health Plan • Patient-Centered Medical Home Initiative: Overview • Results • Quality • Cost • Satisfaction • How we got there • What Matters • Access Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

3. Where We Are Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

4. Who We Are Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

5. Network Map Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

6. UPMC Health Plan Overview • More than 1.4 million members • Integrated products, including: • Group Health • Commercial • Medicare (including SNP) • Medicaid • CHIP • Wellness only • Community Care • Employee Assistance Program (EAP) • Claims Management Services • Workers’ Compensation • Short-term Disability Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

7. UPMC Insurance Services Division Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

8. UPMC Health PlanPatient-Centered Medical Home Overview • Made a strategic decision to organize entire network operations and approach around principles of Patient-Centered Medical Home (PCMH) • Met with over 450 primary care practices serving adult members to assess each practice based on PCMH principles • Engaged a pilot group of four practices (approximately 8,300 members and 20 physicians) to work on an intensive, integrated PCMH approach. Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

9. Spring, 2008 - Present • Phase I PCMH • Six practice sites with 8300 members • Phase II PCMH • Six additional practice sites with 14,600 members • Phase III PCMH • 105 additional practice sites with 62,000 members Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

10. Spring, 2008 - Present Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

11. Results: Quality ** NOTE: Baseline date is 6/2008. Year One date is 6/2009 Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

12. Results: Cost Pre-Post Comparison (Baseline Year to Year One) Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

13. Results: Efficiencies (Cost meets Quality) • Middle-aged male with multiple chronic medical conditions, including Diabetes, CAD, CHF, HTN, Peptic Ulcer Disease, Stroke, BPH, Urinary Retention, Neurogenic Bladder, Liver Disease, Hyperlipidemia, Sleep Apnea • Seven admissions in seven months ($30,000.00) • PCMH Care Manager met with member, facilitated appointments for durable medical equipment and home health services, engages mobile outreach representative, maintained frequent telephone contact with home health services and with member • No hospitalizations or ED visits in following two months • Member compliant with outpatient office visits and medications

14. Results: Satisfaction • Physician • Independent and employed physicians, University of Pittsburgh School of Medicine faculty, residents • Over 80% would personally recommend program to another physician • Member Testimonials • Member with newly-diagnosed symptomatic hypertension. Placed on medication by PCMH physician. • Educational materials, contacted by PCMH office-based care manager. Follow-up both by phone and in-person over next several months. • “I would encourage anyone with health concerns to take advantage of the programs the Health Plan offers. The services are priceless.”

15. How We Got There • Culture Change within and without organization: An Integrated Systemic Payer-Provider Team Approach • Clear Mission: Work in an Integrated Fashion to put the tools and services of the Health Plan in the hands of the PCMH Provider • Expectation: Payer-Provider Team (two-way street) • Clear Goals: To Improve Health care, enhance patient and provider satisfaction, and control cost • Leadership • Engagement of Everyone Involved in the Program • Engagement of Physician Community Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

16. ACCESS Role of UPMC Health Plan: Supportive Services, Data, Infrastructure

17. Infrastructure 17 Lining up Health Plan Functions and Services with the Practice Placing the Tools and Services of the Health Plan in the Hands of the Provider Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

18. Process Improvement Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

19. Process Improvement Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

20. Process Improvement Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

21. Process Improvement Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

22. Access E-visits Acute Chronic Remote Monitoring Interdisciplinary Team Meeting Supportive Services Transition Services Mobile Community-based Care Managers Pharmacy Consultation Behavioral Health Consultation Physician Rx for Lifestyle Health Coaching

23. Results: Admissions and ED Utilization Per Month Before and After Monitor Placement Admissions/Visits Per Month * Denote a statistically significant difference Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.

24. Conclusions: What Matters • Culture • Strategy • Leadership • Team • Management • Delivery • Results Copying, citing, quoting, or distributing without written permission of UPMC Health Plan is prohibited.