WCHN PHOACO Annual Meeting Rowena Bergmans VP Clinical

WCHN PHO/ACO Annual Meeting Rowena Bergmans VP, Clinical Integration and Population Health 12/7/15

“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 2

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

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 37 th in the world • Physician satisfaction – 60% would retire if they had means – 22% of clinician time paper work 4

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 5

CMS Payment Models 6

Skills Systems Will Need for Future Success 7

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. 8

The WCHN PHO Board Structure WCHN PHO Board 10 Physician Board Members One Vote 5 PCP Representatives on PHO Board 9 5 Hospital (WCHN) Board Members One Vote 5 Specialist Representatives on PHO Board 5 WCHN Representatives on PHO Board

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

WCHN PHO Functions 1. 2. 3. 4. 11 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!

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

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

Highlights 2015 Building 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) 14

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 15

Questions… 16