Robert Margolis, M.D.Chairman & CEOHealthCare Partners

ACO’s – Getting from Here to ACO’s – Getting from Here to ThereThereBenefits / Risks / Opportunities Benefits / Risks / Opportunities

National Delivery System

• California– HealthCare Partners

LLC

– HealthCare Partners Medical Group

– HealthCare Partners IPA

• Florida– JSA

• Nevada– Pinnacle Health Care

Systems

– Summit Medical Group

– Fremont Medical Group

– Rainbow Medical Group

– In Patient Physician Network (IPN)

HealthCare Partners •HealthCare Partners and its physician networks nationally serve over 1,000,000 patients including over 168,000 Medicare Advantage and over 500,000 commercially insured members primarily through global capitation.• •The pre-eminent physician-owned, professionally managed, patient-centered coordinated care system in the nation and an important delivery system in the many communities we serve.

Proactive Population Management

The continuous ‘Virtuous Cycle’ of Improved care and outcomes is at the heart of HCP’s proactive population management.

•Better Care•Better Quality•Better Efficiency•Better Patient Experience

Continuous improvement to drive:

Target Patient PopulationTarget Patient PopulationRiskStrat PMPM

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

Predicted Cost Percentile

80%

81%

82%

83%

84%

85%

86%

87%

88%

89%

90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

Risk Stratification PMPM Costs

Stratifying Patients into the Appropriate Program

Level 4Home Care Management

Level 2Complex Care and Disease

Management

Level 1Self-Management & Health Education

Programs

Home Care ManagementProvides in-home medical and palliative care management by Specialized Physicians, Nurse Care Managers and Social Workers for chronically frail seniors that have physical, mental, social and financial limitations that limits access to outpatient care, forcing unnecessary utilization of hospitals

Complex Care and Disease ManagementProvides long-term whole person care enhancement for the population using a multidisciplinary team approach.Diabetes, COPD, CHF, CKD, Depression, Dementia

Self Management, PCPProvides self-management for people with chronic disease.

Level 3 High Risk

Clinics

High Risk Clinics and Care Managementintensive one-on-one physician /nurse patient care and case management for the highest risk, most complex of the population. As the risk for hospitalization is reduced, patient is transferred to Level 2. Physicians and Care Managers are highly trained and closely Integrated into community resources and Physician offices or clinics.

High PMPM

LowPMPM

ESR

D M

edical

Hom

eHospice/Palliative Care

$130 - $

140

$250 - $260

$ 50 - $100

$220 - $200

The HCP Care Team Approach

Interactive and collaborative teams of clinicians support HCP clinical programs.

High Risk Programs: •Home Care•ESRD•Comprehensive Care Center•Post-Acute Comprehensive Care

Disease Management Programs: •Diabetes•CAD•CHF•COPD•Dementia

Clinical Data, Clinical Tools

Disease Registries for every HCP physician to better understand the make up of his or her patient panel

Web-based, Self-Serve, Disease Registries: • Diabetes• COPD• CHF• CKD• Dementia• CAD• Asthma• Depression

9

Outreach / Compliance OpportunitiesCustom Registries Based on Specific Interventions

Results – Medicare Patients

• Acute Bed Days ~ 1/3 national average @ 800 days 1K

• Readmission – all cause 30 days ~ ½ national average @ 12% (including elective readmissions)

• Terminal in hospital care ~ ½ national average @ < 20%

• Quality / HEDIS metrics ≥ national statistics

• Patient Satisfaction (“very” and “completely satisfied”) > 90%

CMMI Opportunity

• Embrace Medicare FFS ACO’s

• The Quality Improvement and Savings Opportunities are Enormous

• Population Based Payment Incentives Work!

Clinica Family Health Services

Pete Leibig, CEO WWW.CLINICA.ORG

Underserved population

ContinuityIf one thing…

TEAM BasedWay to be evidenced based

Care SpaceDesign

Patient Centered Population Health Management

Group Care Space Design

AlternativeVisits• Lower A1c• Lower LBW• Higher

Satisfaction

Advanced Access

Patient Centered Population Health Management

Information SystemsPartnerin

g

Community Health Record

EHRTemplates Evidence

based

Registries

Outcome Reports

Self Management - Patient Activation

Pregnancy Outcomes

0.0%

10.0%

20.0%

30.0%

40.0%

C Section Rates Low Birth Weight Preterm

USA

Colorado

Clinica

Centering

CMMI Help! www.clinica.org

• Colorado cutting Clinica’s FQHC payments as a way to reduce Medicaid expenses. DRAT!!! – Quality up – outcomes improving– Compensation down $3 million (23%)– HRSA wants more users at same cost to

them – 22% of total

• Need demonstration of FQHC QI Investment payoff to 3rd parties

• Share FQHC savings impact with Governors and Medicaid Directors in a meaningful way –they are trying to save money by cutting what we’re paid.