IBM Healthcare and Life Sciences PatientCentered Medical Home

IBM Healthcare and Life Sciences Patient-Centered Medical Home Pilots Landscape as of 06/19/2008

IBM Healthcare and Life Sciences PCMH Pilots Map Note: this chart is from Carol Flamm, who leads the PCPCC Center for Multistakeholder Demonstrations. It doesn’t bear any one-to-one relationship to the PCMH pilot details included in this deck, but is offered as an example of how the state and local activities might be summarized. RI Multi-Payer pilot discussions/activity Identified pilot activity No identified pilot activity 2 © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Summary (multi-payer and significant single payer projects) 3 State Region Convening Authority Slide New York Mid-Hudson Valley THINC RHIO 5 Colorado Statewide Colorado Clinical Guidelines Collaborative 6 New York City Group Health & Health Plan of NY 7 Rhode Island Statewide RI Office of Health Insurance Commissioner 8 Washington Statewide Wash. State Dept. of Health 9 Pennsylvania Southeast Governor’s Office of Health Reform 10 New York Albany CDPHP 11 Tennessee Memphis Business Group on Health 12 New Hampshire Dartmouth-Hitchcock patients CIGNA and Dartmouth. Hitchcock 13 Texas Dallas, Houston, San Antonio, Austin Texas Academy of Internal Medicine 14 Michigan Statewide Michigan Primary Care Initiative 15 Ohio Southwest Greater Cincinnati Health Improvement Collaborative 16 Notes © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Summary (multi-payer and significant single payer projects) 4 State Region Convening Authority Slide North Carolina Statewide North Carolina Division of Medical Assistance (Medicaid) 17 Washington Seattle – Everett – Renton Area Boeing Company 18 Vermont Statewide BCBS of Vermont 19 Michigan Statewide BCBS of Michigan 20 Notes © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: New York Mid-Hudson Valley THINC RHIO Payer(s): Overview: Aetna, CDPHP, United Health. Care, MVP, Wellpoint, Hudson Health 2 -5 year pilot to demonstrate improved cost and quality of care. P 4 P / Medical Home project funded by $1. 5 M grant from NYDOH. Providers and covered lives: PCMH components: 500 providers; 1 M lives EHR (e. Clinical Works); e. Prescribing (Rx. Hub and Sure. Scripts); provider portals (Health. Vision); data aggregation & analytics (IPRO and VIPS); Continuity of Care Document for interoperable data elements between ambulatory care practices & other health entities (e. g. , hospitals); Masspro support for practice assessment and redesign; multi-disciplinary approach Project contact(s): John Blair jblair@taconicipa. com (845) 897 -6359 Asha Upadhyay asha@thincrhio. org (845) 896 -4726, Ext. 3205 5 Link to press release: Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Colorado Statewide, but primarily Front Range and Denver centered Colorado Clinical Guidelines Collaborative (CCGC) Payer(s): Overview: Aetna, Anthem-Well. Point, Cigna, Humana, Rocky Mtn Health Plan, United, and Medicaid 2 -year pilot to reduce fragmentation and implement systems and processes, using evidence-based clinical guidelines and improve healthcare in Colorado. Providers and covered lives: PCMH components: Guiding Principles: Joint Principles, NCQA PPC-PCMH, 3 -Tiered Reimbursement (FFS, Care Management Fee and P 4 P) Project contact(s): Marjie Harbrecht mharbrecht@coloradoguidelines. org (720) 297 -1681 Julie Schilz jschilz@coloradoguidelines. org (720) 297 -1681 6 Use of disease registries; Reach My Doctor; Technical support for Practice Transformation and achievement of NCQA PPC-PCMH. Measurement on Cost, Quality (Chronic Disease and Prevention) and Provider Office/Patient Satisfaction. Evaluation Methodology-Matched Comparison Group Link to press release: XXXXXXXX Notes: 6/17/08: Seeking Funding for Technical Assistance and Evaluation. The Commonwealth Fund will choose Pilot Evaluator. © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: New York City Group Health Inc. and Health Plan of New York Payer(s): Overview: Group Health Inc. and Health Plan of New York 2 -year demo of PCMH model by Group Health Inc. (GHI), a New York State health insurer, and Health Plan (HP) of New York, a large HMO. Providers and covered lives: PCMH components: 50 practices; 100 providers; 20 k covered lives Project contact(s): "advanced health information technology" to direct services to patients and coordinate services from other physician; care coordination services and technical support to redesign physician offices and management systems Judith Fifeld fifield@nso 1. uchc. edu (860) 679 -3815 Link to press release: XXXXXXXXXXXXXXXX 7 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Rhode Island Statewide RI Office of Health Insurance Commissioner Payer(s): Overview: BCBSRI, United, Neighborhood Health Plan, Medicaid 2 -year pilot to demonstrate that PCMH model is sustainable, i. e. provides better care, provides more cost-effective care, enhances patient satisfaction with medical care received and provides improved professional satisfaction for primary care physicians Providers and covered lives: Project contact(s): Deidre Gifford dgifford 1@riqio. dspd. org Lynn Pezzullo lpezzullo@riqio. sdps. org (401) 528 -3222 8 PCMH components: Practices must satisfy nine NCQA PPC standards for a PCMH (access and communication, patient tracking and registry, care management, patient selfmanagement support, electronic prescribing, test tracking, referral tracking, performance reporting and improvement and advanced electronic communications). Insurers providing or funding dedicated nurse for practice support. $3 PMPM funding for practices NCQA PPC-PCMH recognized (Level 1 in 6 mos, Level 2 in 18 mos) Link to press release: XXXXXXXXXXXXXXXX Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Washington Statewide Wash. State Dept. of Health, Children with Special Health Care Needs Program Payer(s): Overview: Public sector project Coalition to promote and provide practical support for medical homes -- family-centered, comprehensive coordinated primary health care -- for children and youth with special health care needs. Provide medical home for every WA State CSHCN by 2010 Providers and covered lives: PCMH components: All WA state children age birth to 17 years Developing performance indicators to identify whether children have an effective medical home. Identifying stakeholder representatives who can formulate performance measures to be used starting in 2009 to link quality improvement measures with provider rate increases. Project contact(s): Mary. Anne Lindeblad lindem@dshs. wa. gov (360) 725 -1786 Link to press release: XXXXXXXX 9 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Pennsylvania Southeast Governor’s Office of Health Reform Payer(s): Overview: Aetna, Ameri. Choice (Medicaid), Health Partners (Medicaid), Independence Blue Cross, Keystone Mercy Health Plan (Medicaid) Statewide implementation of the Chronic Care Model (a PCMH-like model) involving learning collaboratives, practice coaches, an incentive alignment strategies for providers and consumers. Providers and covered lives: 33 practices; 165 clinician FTE’s; 176 k patients Project contact(s): PCMH components: Practice coaches, consumer self-management training, patient registries, statewide pooled claims database, practice certification process, performance measures, evaluation plan and public reporting, communication plan Phil Magistro pmagistro@state. pa. gov (717) 214 -8174 Michael Bailit mbailit@bailit-health. com (781) 453 -1166 10 Link to press release: XXXXXXXX Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: New York Albany Capital District Physicians’ Health Plan, Inc. (CDPHP) Payer(s): Overview: CDPHP Pilot supported with a 1 million grant from CDPHP. Will look at the Allen Goroll payment reform model. Three practices will all have support with an on the ground transformation model. Facilitators are being provided by Transfor. MED and paid for by CDPHP. Providers and covered lives: PCMH components: Project contact(s): The practices will be paid for PCMH services whether or not the patient is a CDPHP member. So, 100% of the patients are in the pilot. The breakout is 40% CDPHP members, a mixture of ASO and commercial. About 17 % are Medicare, 30 % Blues, 8% MVP. Brian J. Morrissey bmorriss@cdphp. com (518) 641 -5220 Link to press release: XXXXXXXX 11 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Tennessee Memphis Business Group on Health Payer(s): Overview: BCBSTN, Humana Several phone discussions and two face-to-face meetings with potential stakeholders in a multipayer pilot of PCMH; led primarily by ACP and Memphis Business Group on Health. Agreement on 5/7/08 to form Steering Committee of interested stakeholders. Providers and covered lives: PCMH components: to be determined Project contact(s): Cristie Travis (MBGH) ctravis 493@aol. com (901) 767 -9585 Shari Erickson (ACP) serickson@mail. acponline. org (202) 261 -4551 12 Link to press release: XXXXXXXX Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: New Hampshire Statewide CIGNA and Dartmouth-Hitchcock Payer(s): Overview: CIGNA Providers and covered lives: 17 k CIGNA members receiving primary care from Dartmouth-Hitchcock providers Project contact(s): Dick Salmon (CIGNA) dick. salmon@cigna. com (901) 767 -9585 Primary care providers affiliated with Dartmouth-Hitchcock will be paid for the medical services they provide, reimbursed an additional amount for enhanced services such as care management they provide and be rewarded through a “pay for performance” structure for improving quality and appropriate health care. PCMH components: In the pilot, patients, especially those with chronic illness or ongoing medical needs, will have access to enhanced care coordination, communications, appointment availability and education to help them navigate their health care system, while physicians will receive additional reimbursement for providing these enhanced services and supportive infrastructure. Dartmouth-Hitchcock has a tradition of pursuing these objectives; both organizations say the new pilot program will help to accelerate existing efforts. Barbara Walters (Dartmouth-Hitchcock) Link to press release: XXXXXXXX 13 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Texas Dallas, San Antonio, Houstin, Austin Texas Academy of Internal Medicine Payer(s): Overview: Meeting on 6/27/2008 in Austin to inform and assess local stakeholder interest. The Texas Academy of Internal Medicine is also seeking business groups that may be interested in participating in the effort. Providers and covered lives: PCMH components: to be determined Project contact(s): Neil Kirschner (ACP) nkirschner@mail. acponline. org (202) 261 -4535 Link to press release: XXXXXXXX 14 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Michigan Statewide Michigan Primary Care Consortium Payer(s): Overview: BCBSMI, United, Humana, Aetna Providers and covered lives: Project contact(s): Through collaboration between public health and primary care, by 2010, key system level barriers will be resolved; by 2015, every consumer of primary care services in Michigan will consistently receive evidence-based preventive and chronic disease care, and changes to assure quality care will have been embedded in primary care practices across the state PCMH components: Initial focus areas will be: prevention(aligned with RX for Healthier MI and MI Steps Up), Physical Inactivity, Poor Nutrition, Tobacco Use and Exposure; Chronic Disease Care & Management: Asthma & Diabetes Janet Olzekski, MD - chair mccullochs@michigan. gov (517) 373 -3740 Donald Nease, MD – vice chair (734) 936 -4660 15 Link to press release: Notes: http: //michigan. gov/som/0, 1607, 7 -19226847 -184896 --, 00. html © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Ohio Southwest Greater Cincinnati Health Improvement Collaborative Payer(s): Overview: Anthem, United (Managed Medicare and Commercial), Humana Initial stages of discussion. $1. 7 M grant from R. W. Johnson Foundation under Aligning Forces for Quality initiative to focus on improved healthcare messaging for patients with diabetes. Providers and covered lives: PCMH components: Medical Home forum held at Univ. of Cincinnati on March 17; presenters included Michael Sherman, Corp. Medical Director of Physician Strategies at Humana. Project contact(s): PCMH pilot kick-off meeting may be held sometime in summer 2008. Paul Grundy has been contacted as a potential speaker. Craig Brammer, MD craig. brammer@uc. edu (202) 261 -4535 Link to press release: XXXXXXXX 16 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: North Carolina Statewide N. Carolina Division of Medical Assistance (Medicaid) Payer(s): Overview: Medicaid Providers and covered lives: PCMH components: Project contact(s): Started 1998 -1999 as way to manage Medicaid patients in rural area—medical home model –particularly targeted at small practices that did not have a lot of resources—goal was to link them with a local hospital and other safety net providers – gave payment to providers and to networks for them to put resources into the community (e. g. case managers, recently added a clinical pharmacist) goal is organizing MDs Allen Dobson MD adobson@cabarrusfamily. com (704) 721 -2073 Jeffrey Simms jeffrey. simms@ncmail. net (919) 855 -4100 17 Link to press release: XXXXXXXX Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Washington Seattle – Everett – Renton areas Boeing Company Payer(s): Overview: Medicaid Ambulatory Intensive Caring Unit model, similar to that being employed by UNITE HERE. In 2 nd year of pilot targeted to serving the top 20% of employees and dependents projected to be greatest need of future health care. Providers and covered lives: PCMH components: A dedicated core primary care team of 1 -2 physicians and a nurse case manager sees enrolled patients. Project contact(s): Theresa Helle theresa. m. helle@boeing. com (704) 721 -2073 Boeing is actively involved in the pilot’s day-to-day management and is paying a PMPM payment to each MD in addition to the providers’ regular FFS reimbursement. The practice-embedded nurse case manager is thought to be the key to the model’s success. Link to press release: XXXXXXXX 18 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Vermont Statewide BCBS of Vermont Payer(s): Overview: BCBSVT Pilot Pay for Quality Program is aligned with The Chronic Care Model and the VT Blueprint for Health. P 4 Q pilot program started in 2005 with diabetes and was roughly built off of the structure of the NCQA Diabetes Physician Recognition Program Providers and covered lives: PCMH components: MD participation in the P 4 Q program requires the proactive adoption of the following practice infrastructure changes, derived from the Health System component of The Chronic Care Model. Project contact(s): Sharon Winn winns@bcbsvt. com (802) 371 -3230 Increased reimbursement is available for office-based E & M, consultations, preventive medicine and counseling codes. The enhanced reimbursement applies to all of the practices patients, not just those with select chronic conditions. Practices may utilize some BCBSVT tools and services to satisfy program entry requirements, or use enhanced funding to support development of their own infrastructure and systems. Link to press release: XXXXXXXX 19 Notes: © 2007 IBM Corporation

IBM Healthcare and Life Sciences PCMH Pilots Detail State: Region: Convening Authority: Michigan Statewide Blue Cross Blue Shield of Michigan Payer(s): Overview: BCBSM Initial stages of discussion, Providers and covered lives: Project contact(s): PCMH components: BCBSM Physician Group Incentives will embody elements of chronic care model and PC-MH. 2008 initiatives will focus on: individual care management, extended access, test tracking, patient registry, performance reporting and patient-provider agreement. Implementation of differential reimbursement for PGIP physicians who meet criteria for BCBSM designation as a PC-MH will begin mid-2009 Thomas Simmer (BCBSM CMO) tsimmer@bcbsm. com Margaret Mason MMason@bcbsm. com 20 Link to press release: XXXXXXXX Notes: © 2007 IBM Corporation