Advocate Good Shepherd Physician Partners

April 23, 2012

ANNUAL MEETING

Agenda

6:00 PM PHO President Remarks6:05 PM Hospital President Remarks6:10 PM Election6:15 PM AdvocateCare Update6:45 PM Check Distribution

PHO HighlightsDick McDonough, MD

President, AGSPP

3

APP Organizational Chart withAGSPP Representatives

4

PHO Board CompositionPhysician Directors

Dick McDonough, MD, PresidentJ. Dean Feldman, MD, SecretaryFred Locher, MDMichelle Roig, MD

Hospital Directors

Don CalcagnoKaren LambertBarry Rosen, MDGeorge Teufel, Treasurer

Non-Voting Representatives

Debra O’Connor, MD, Medical Director

Annual Election• 2 year Term expiring 2014

– J. Dean Feldman, MD

– Michelle Roig, MD

• 1 year Term expiring 2013– Mark Gross, MD

6

Good Shepherd Hospital UpdateKaren Lambert, President

Becoming a Population Health Management

EnterpriseScott Kent

VP, Field Operations, APP

Accountable CareIs Here to Stay

Costs By Age Categories

10

Heathcare Costs by Age

$-

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

0 10 20 30 40 50 60 70 80 90

Age

An

nu

al p

er c

apit

a h

ealt

hca

re c

ost

s

UK

Germany

Sweden

US

Spain

U.S. is spending much more for older population

Source: Fischbeck, Paul. “US-Eruope Comparisons of Health Risk for Specific Gender-Age Groups” Carnegie Mellon University; September, 2009.

Two Years Ago …• Blue Cross & Advocate/APP Faced 2 Choices:

– Lower Unit Cost Now– Partner Together/Reduce Waste

• Employers Demanding Change Even If Reform Overturned– “Unstoppable Market Force Unleashed”

• Prepares Us for ACOs in 2012• First Mover Advantage• Better Patient Care Fulfills 2020 Vision

11

What Results Have We Seen?• 4.2 % HMO Membership Growth in Last Year

– Added Blue Advantage HMO in 2011

• APP Physician Membership Growth– 208 Total; 37 PCPs

• Blue Cross PPO Shared Savings Trends Are 4.6% Positive Thru Q3 2011

• $13 M Shared Savings in 2011 Payout• $6.4 M HMO Full Risk Earned Funds in 2011

Payout

12

APP’s New Approaches to Medicare

Planned Participation in 2 Models

• Medicare Shared Savings Program (MSSP)– Program for Accountable Care Organizations

(ACOs) Established in Health Reform Act

– Start Date: July 1, 2012

• Medicare Advantage HMO– New Opportunity with Blue Cross

– Targeting “Age In” Population

– Start Date: January 1, 2013

14

What Is the Medicare Shared Savings Program?

What MSSP Isn’t . . .• MSSP Is Not a Bundled Payment Program

• MSSP Is Not a Capitated Payment Program

• All Physicians and Hospitals Continue To Submit Fee-for-Service Bills To Medicare

• All Physicians and Hospitals Continue To Be Paid by Medicare Using the Medicare Fee Schedule– None of the FFS Payments Are Sent To APP

16

APP’s MSSP Details• 3½ Year Contract Starting July 1, 2012

• No Downside (Repayment) Risk

• Up to 50% Share of Savings Based on Quality Score– 33 Quality Measures in 4 Domains

– Pay-for-Performance Phased in Over 3 Years

• 125,000 Medicare Beneficiaries

• $1.5 Billion Annual Medical Expenses

• Estimated 50% of Spend “In Network”

17

Why Participate in MSSP?• Better Overall Care for Patients

• Aligns with Advocate 2020 Strategy and Vision to Develop Lifelong Relationships with Patients

• Extension of Clinical Integration Program

• Helps Transition to One Model of Care– Gets Us to Critical Mass

– Prepares Us for Emerging Opportunities

18

What’s In It For Physicians?• Improved Coordination of Care Benefits Your

Patients• A Percentage Point Improvement In Total

Cost Will Increase APP Incentive Pool by About $6 Million– 1% of $1.5 Billion Annual Spend on 125,000

Medicare Beneficiaries Is $15 Million– APP Receives 50% of Savings Multiplied by

Quality Score– $6 Million If Quality Score Averages 80%

19

Blue CrossMedicare AdvantageContract

Medicare Advantage Opportunity• Blue Cross Planning Medicare Advantage• BC Has Large Share of Medicare Supplement

Market• Targeting Younger Medicare Population (~66)

– Interest In Capturing “Age In” Market• BC Application Submitted to CMS In February• Required Binding Commitment of Provider

Network• APP Would Be Central to Network, But Others

Necessary to Satisfy CMS’ Geo Access Requirements

21

APP Board Approved Blue Cross Medicare Advantage

• Start Date of January 1, 2013• Global Risk Arrangement• Responsibilities Delegated to APP

– Utilization Management– Credentialing– Part B Claims Payment

• Counties Included: Cook, DuPage, Kane & Will

• Counties Excluded: Lake, Kendall, McHenry, McLean

22

In-Network Care Coordination

Why Is “In-Network Care” Important?

Keeping Care in APP Network Is Good for

Patients, Good For Doctors & Good for Advocate

24

Good for Patients…

Care Managers Assist Patients

• Outpatient CM for Complex Patients

• Inpatient CM for All Hospitalized Patients

• Transition Coaches After Discharge to Assure Follow Up with Physicians & Avoid Readmissions

25

Good for Quality Improvement

• Internal Transparency of APP Allows Doctors to Share Performance with Colleagues

• Which Can Lead to:

– Mutual Efforts to Improve Performance

– Opportunities to Change Referral Patterns Based on Data, Not Hunch

• Clinical & Patient Experience Data Is Not Available from “Out-of-Network” Providers

26

Good for Financial Performance• Contracts Represent Over 60% of All Physician

Billings BCBS PPO, BCBS HMO, MSSP & MA

• Admissions and ER Visits Outside of Advocate Lead to Uncontrolled Care & Expenditures

• Physician Care Outside of APP Leads to Uncontrolled and, Often, Undocumented Care, Testing & Expenditures

• Out-of-Network Care Compromises Patient Care & Reduces Shared Savings

27

In-Network Care Incentives• Counseling Patients About In Network Care

Takes Physician Time

• 2 New Incentives and 1 Established Incentive Encourage In Network Care1. % of Hospital Days In-Network

2. SCIP Performance and Increase of In-Network Inpatient Surgical Cases

• Current: Inpatient Performance Incentive

28

Improvement from Baseline in the Percentage of In-Network Acute Care

• Includes All Non-Hospital Based Physicians

• Attributed APP PPO Patients Measured

• Weighted at 5% of the Total CI Score

• Tiered Points Allotted: 6% Improvement Over Baseline (Top Tier)

4% Improvement Over Baseline (Mid Tier)

2% Improvement Over Baseline (Lower Tier)

Increase in In-Network Inpatient Surgical Care If SCIP Achieved

• SCIP Performance Targets Must Be Achieved• Measures % Improvement Over Baseline in Inpatient

Surgical Cases• Eligible Specialties: Cardiovascular, Thoracic, Vascular,

Colorectal, General Surgery, Orthopedics, and OB/Gyn • Weighted at 5% of the Total CI Score• Tiered Point Allocation:

– 6% Improvement Over Baseline (Top Tier) – 4% Improvement Over Baseline (Mid-Tier) – 2% Improvement Over Baseline (Lower Tier)

Inpatient Performance Incentive Fund

• Applies to All Doctors with Admissions

• Performance Based on LOS and Readmissions

• Payment Based on Performance Level for Practice Group and Volume of Admissions for Individual Physician

• Earnings Up to $120 per Admission

• 3 Earnings Tiers for 2012

31

What Do You Need to Do?

What Should Physicians Do?• Sign New Physician Participation Agreement

• Sign New Business Associate Agreement

• Work with APP to Collect Names & Addresses of Medicare Beneficiaries

• Work with APP To Facilitate Medicare Claims Data Sharing:– APP Required To Send Patient Letter Allowing

Them Not To Share Medicare Claims Data

– APP Would Like Patients To Allow Data Sharing To Assist in Improving Patient Care

33

Focus on AdvocateCare

AdvocateCare Index

• ED Visits/1000

• Admits/1000

• Length of Stay

• 30-Day Readmissions

• % Days In-Network

34

SynAPPs Update

Specialists Live on SynAPPs as of 3/31/12(Excluding PCPs and Pediatricians)

n=188

Benefits of SynAPPs• Selected by APP Physician Task Force• SynAPPs Program Benefits Based on 4 Criteria:

– InterOperability:• Fully Integrated System (PM, EMR, Patient Portal, P2P, MAQ

Dashboard, Lab, CIRRIS, and CareConnection Interfaces)

– Cost:• Lowest Cost of Full Spectrum EMR’s

– Pace of Roll-Out:• Scalable Database to 3,000 Physicians

– Functionality:• Ease of Interfacing and Inclusion in CareNet Plus

• Ongoing Support from SynAPPs Team• Robust Physician and Non-Physician User Groups Across APP

• Proven Track Recording Helping APP Physicians Achieve MU

Meaningful Use– 94 APP SynAPPs Physicians Have Achieved

Medicare Meaningful Use• Anticipated Medicare MU Incentive Dollars

$1,692,000

– 7 APP SynAPPs Physicians Have Achieved Medicaid Meaningful Use

• Anticipated Medicaid MU Incentive Dollars $99,000

– Total Anticipated Meaningful Use Incentive Dollars to APP SynAPPs Physicians $1,791,000

39

Lake Cook Orthopedic Associates

40

• “The organization and support from the dedicated APP teams has made the transition to SynAPPs much more manageable than we had feared. People like Renee Witthoff have been invaluable in organizing our training, looking out for our best interests in dealing with any problems as they occurred. From initial introductions to the software, hardware upgrading, training and implementation, and now meaningful use, the experience and help of the various SynAPPs teams has been of great help during this process.”

~ Dr. Frederick Locher

New APP Membership Criteria• SynAPPs Required for PCPs Not Currently on an

EMR by January 1, 2014

• New Physicians Joining APP on an EMR NOT Meeting Highest Current Stage of Meaningful Use Criteria Must Adopt SynAPPs within 12 Months

• Once Stage 2 Meaningful Use Criteria Finalized, Any Physician NOT on EMR Certified for Stage 2 Will Need to Convert to SynAPPs within 12 Months

Incentive Distribution Model

New PCP Reimbursement • PCP Cap Changing to FFS on July 1st, 2012

• Paid at 110% of Medicare

• Services Rendered to HMOI, Blue Advantage and Humana HMO Patients

• Final Monthly Capitation Payments for Paid by July 15th, 2012

43

2011 CI Year-End Results

44 Final Results: Post Reconsideration Process

Single Fund, Single Distribution• “One Program, One Set of Measures, One

Set of Incentives”

• Integration of HMO Surpluses, CI Funds & Shared Savings Dollars Into One Fund

• Creation of Value Pool Concept

• Increased Weighting On, and Eligibility for, Work Pool

• Must Achieve Minimum Score of 65% for Payout

45

Single Incentive Fund Payout

46

Professional HMO

Surplus$28.4 M

Professional HMO

Surplus$28.4 M

Facility HMO

Surplus$6.4 M

Facility HMO

Surplus$6.4 M

CI Funding$65.2 M

CI Funding$65.2 M

AdvocateCare Shared Savings$13.0 M

AdvocateCare Shared Savings$13.0 M

Minus Infrastructure Costs, Deficits and 120% Fee Schedule

$19.5 M

Physician

Advocate Physician PartnersCombined Incentive Fund Distribution History

2007-2011($ in millions)

$56.0 $63.9 $80.0

$101.4 $91.6

$4.8 $4.0

$5.0

$5.2 $12.9

$0.0

$20.0

$40.0

$60.0

$80.0

$100.0

$120.0

2007 2008 2009 2010 2011

UnearnedEarned

47

Advocate Good Shepherd Physician PartnersPhysician Incentive Fund Distribution History

2007-2011($ in millions)

$5.3 $6.3 $8.8

$10.4 $10.5 $0.7 $0.9

$0.8

$1.0 $1.5

$0.0

$2.0

$4.0

$6.0

$8.0

$10.0

$12.0

$14.0

2007 2008 2009 2010 2011

UnearnedEarned

48

Questions & Answers

Check DistributionBirdie Chow, PHO Director

50

51

Amount Paid to 120% of MC

CI Earned & Unearned

Inpatient Incentive Earned

& Unearned

TOTAL Earned & Unearned

Value Pool - PCPs

Registry Work Incentive

Logistics for Check Distribution• PHO Member by July 1, 2011 to be Eligible for Clinical

Integration Distribution

• Meadow Room

• Checks Distributed by Name:– Last Name if You Are a Solo Practitioner– Group Name if You Are in a Group Practice

• Please Designate 1 Person per Group to Obtain Checks

52