WCHN PHO/ACO Annual Meeting

1. WCHN PHO/ACOAnnual Meeting Rowena Bergmans VP, Clinical Integration and Population Health 12/7/15

2. “Delivery models and payment systems are changing. The episodic approach to care, characterized by one physician directly caring for each individual care “event” will be replaced by a team-based longitudinal approach across multiple facilities, sites, practitioner type including the patients home…” Kaufman Hall

3. Overview • Healthcare environment • Response to environmental factors • Competencies to succeed • PHO/ACO • Foundation • 2015 Successes • Future

4. Healthcare Environment • Healthcare spend • 3 Trillion Dollars 2014/ 17.5% of GDP • $9,146 Per Capita • Healthcare quality • Hospital errors third leading cause of death (2013) • Rank 37th in the world • Physician satisfaction • 60% would retire if they had means • 22% of clinician time paper work

5. National/Local Response • Downward pressures on traditional delivery volumes • Downward pressures on volume-based reimbursement rates • Growing demands for clinical integration • Expansion of non-traditional competitors • More sophisticated purchasers of care government, payers, employers and consumers

6. CMS Payment Models

7. Skills Systems Will Need for Future Success 7

8. Formation of the WCHN PHO • The PHO/ACO is a vehicle for WCHN to develop a physician led clinically integrated infrastructure that will encompass both employed and aligned community providers that will result in increased quality of care, enhanced financial performance and improved patient satisfaction.

9. The WCHN PHO Board Structure

10. PHO/ACO Board PHYSICIAN REPRESENTATIVES  PCPs Specialists James Ahern, MD Neil Culligan, MD – Neurology Henry Allen, MD Adam Gorelick, MD – Gastroenterology Harold Kamm, MD Jeffery Gorelick, MD – Urology (Chair) Cornelius Ferreira, MD Sohel M. Islam, MD – Surgeon Martin Williams, MD (Secretary) David Kramer, MD – Surgeon HOSPITAL (WCHN) REPRESENTATIVES Rowena Bergmans Patrick Broderick, MD Mike Daglio (Vice Chair) Matt Miller, MD Steve Rosenberg (Treasurer)

11. WCHN PHO Functions • Develop/maintain a provider network • Contract with health plans w/ opt-ins for individual practices • Prepare our provider community for changes in the health care arena by: • Seeking ways to improve quality & efficiency of health care services provided under PHO/ACO agreements (e.g. clinical integration, collaboration, data analytics, care management.) • Offering member practices various optional administrative & technology solutions (e.g. EMR, PCMH, group purchasing, etc.) • Supporting practice managers w/ education and networking functions • Healthcare Reform Support!

12. 2015 PHO/ACO Membership • 871 Providers • 282 Community • 589 Employed • 186 Primary Care • 695 Specialists • Value Care Alliance (VCA) • St. Vincent's Hospital • Middlesex Hospital • Griffin Hospital • St. Vincent's Health Partners (PHO/ACO) • Griffin PHO

13. 2015 Contracts • Current • Aetna Commercial – Shared Savings • Aetna Medicare Advantage – Shared Savings • CMS MSSP – Shared Savings • Connecticare – Shared Savings • Harvard Pilgrim • Multiplan • US Family • Healthy CT • Other • Aetna Tiered Network • Future • Cigna – 2016 – Shared Savings • Anthem – PHO/ VCA - 2016 • United – PHO/ VCA - 2016

14. Highlights 2015Building the infrastructure to achieve clinical integration • Physician Leadership and Clinical Support • Dr. Bob Carr, Medical Director PHO/ACO • Care Managers (2) • PCMH Specialists • Technology and Business Intelligence • Highline data warehouse (claims) • Arcadia (EDW) • Process • CAHPS Survey Vendor (MSSP) • Finalized shared savings methodology • Trainings (ICD, CPT)

15. Where are we headed? • Utilization Review Accreditation Commission (URAC) accreditation as a clinically integrated network • Stronger partnerships with non-traditional providers • Continue to seek out shared savings relationships • Continue to move practices to PCMH level 3 • Introduction of behavioral health supports

16. Questions…