HFMA December 2012

1. HFMA December 2012

2. Change is Upon Us • Attacking Rising Costs • 23% of the Medicare population has a chronic condition with • 5 or more co-morbid conditions that compel them to see • 12 (different) physicians per year, to fill • 16 prescriptions and account for • 68% of total Medicare spending Source: Institute for Healthcare Improvement

3. Future Healthcare Model:Strategic Imperatives

4. Strategy #1: Physician IntegrationMercy Health Physician Base Continues To Expand Mercy Health employs physicians (primary care and specialists) in every planning area. * *includes MD extenders

5. Strategy #1: Physician Integration 4

6. Strategy #2: Cohesive Care Delivery Network

7. Strategy #3: Population Health Management 20,000 Patients Coming up in 2013 22,000 Patients 800 Patients

8. Strategy #4: Increasing Efficiency Good Target approximates top quartile Good Benchmark approximates top quartile

9. ACO Development

10. An Accountable Care Organization (ACO) is a group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. What is an ACO? • Core Components: • People Centered Foundation • Health Home • High-Value Network • Population Health Data Mgmt • ACO Leadership • Payor Partnerships • Payer Partners • Insurers • Employers • States • CMS 9

12. Mercy Health Select / ACO Vision • MHS is a virtual partnership between Mercy Health hospitals, Mercy Health Physicians, community PCPs, specialist groups contracted with MH hospitals, and potentially other health care professionals who accept responsibility for and are dedicated to improving the health status of residents in the Tri-State region through improved access, coordination of care and clinical performance management

13. Mercy Health Select - Building the ACO • Approved by Medicare to be an ACO in July 2012 • Mercy Health Physicians and Affiliated Physicians • 22,000 attributed lives • PCP determined by a plurality of visits • Developing population health management skills • Exploring commercial ACO opportunities

14. ACO Development Timeline

15. Cornerstones of ACO

16. There are two important goals the ACO must accomplish before it can get shared savings

17. 33 Quality MeasuresMeasure and Report • Patient experience • Care Coordination • Preventive Care • Management of Population Health for at-risk chronic populations • Diabetes • Hypertension • IVD • CAD

18. Key strategies to bend the cost curve • PCMH that is fully implemented in all of our practices • Care Coordination to proactively manage patients • Reduce re-admits by improving • communication among PCPs/ ED/ Hospitalists • Reduce ED utilization by expanding access • CarePATH Common IT Platform

19. My Mercy Health Medical Homea patient centered experience

20. Improving Patient Access

21. PCMH Care Coordination Pilot Results • Admission rate ↓ 51% • Readmission rate ↓ 35% • ER visit rate ↓ 37% • Diabetes A1C control improved: ↑ 33% • LDL (% Ideal) ↑ 6.45% • Goal of not smoking: ↑ 11.8%

22. Pulling it All Together: Comprehensive Population Health Management • Physician-led Governance Body and Committees • PCMH & Nurse Care Coordinator Program • Risk Stratification, Disease Mgmt., Wellness, High-Cost Claims, Data Warehousing/Reporting

23. QUESTIONS?DISCUSSION