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Using the CDPHP Health Value

Strategy to Achieve Reform

John Bennett, MD

Capital District Physicians Health Plan, Inc.President & Chief Executive Officer

March 12, 2011

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Creating Value in the Community

Bruce Nash, MD, MBA

Capital District Physicians Health Plan, Inc.

Senior VP / Chief Medical Officer

March 12, 2011

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Practice Reform

Payment Reform

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Strategic Intent

Pilot

Develop a unique model of payment

Test our hypothesis

Phase II

Support Practice Transformation

Develop a critical mass of practices prepared toaccept new payment model in 2012 (contingent uponevaluation and Board approval)

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PCMH Statistics

Membership Physician FTE Mid Level FTE

Pilot 11,500 15.4 8

Phase II 38,980 87.75 46.75

Total 50,480 103.15 54.75

Total Providers =158

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Enhanced Primary Care Practices Cohort

Pilot Practices

CapitalCare Family Practice Clifton Park*

Community Care Latham Medical Group*

Community Care Schodack*

* Achieved NCQA Level III Designation

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Enhanced Primary Care Practices Cohort

Albany Family Practice Group*

BravermanPanza Medical Group

Brunswick Family Practice

CapitalCare Family Medicine

Averill Park CapitalCare Family Practice Charlton

CapitalCare Family PracticeGuilderland

CapitalCare Family PracticeRavena

CapitalCare Internal MedicineNott Street

Clifton Park Family Medicine*

CapitalCare Family MedicineSlingerlands

Cohoes Family Care

Community Care Family Medicine*

Ellis Family Health Center

Four Seasons Pediatrics*

Internal Medicine Group (AMC)

Irongate Family Practice Associates

Saratoga Family Practice

Scotia-Glenville Family Medicine Shaker Pediatrics

Troy Family Physicians

Whitney M. Young Health Centers*

Phase II Practices

* Achieved NCQA Level III Designation

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Practice Reform

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Practice Transformation

TransforMED Consulting (subsidiary of AAFP)

Retooling the operations of the primary carepractice

Focus on: care coordination, leadershipdevelopment, team care, improved access,population management

Goal: NCQA Level III Medical Home certification

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Strategic coordinators integrated with Enhanced Primary Care (EPC)practice teams

Integration of case management resources

CDPHP case managers embedded in nine EPC sites serving 20,000

members

Pharmacy reporting and consulting to the practices-

Improve patient safety and health outcomes via care andmanagement of high-risk, high-cost, complex patients

Hospital discharge notification

EPC pilot practices receive daily discharge reports

Health Plan Integration

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Accomplishments to Date

Pilot practices have received Level III NCQA Certification

Phase II practices working toward submission in fall of 2011

15 EPC practices partnered with CDPHP/ HIXNY/MAeHC to achieve meaningful use in2011

Physicians and administrators stepping into leadership roles, with focused efforts to improve:

Pre-visit planning

Access

Coordination of care Use of HIT

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Payment Reform

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Payment Reform CDPHP Pilot

63% Risk-Adjusted

ComprehensivePayment*

10%

FFS - RBRVS

27% Bonus**Payment

* Designed to increase base payment by $35,000**Targeted at creating a $50,000 performance-based bonus opportunity

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Pilot Practice Opportunity

Per physician $35,000 base payment increase $50,000 bonus potential

Year One (2009) Pilot Practices earned 27% of thebonus opportunity ($13,500 avg)

$10,000 - $30,000

All measurements and payments were made at thepractice level.

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Pilot Hypothesis

Are the aggregate savings associated withbetter health outcomes and lower utilization

sufficient to fund the enhanced compensationto a primary care physician?

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Preliminary Findings

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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

CervicalCan

cerScre

ening

BreastCanc

erScreening

ColorectalCan

cerScre

ening

Chlamy

diaScre

ening

Glauco

maScre

ening

AdolescentW

ellcareVisits

EyeE

xam

HgBA1cTe

sting

LDLCTe

sting

Nephrop

athyA

ttention

PersistentMe

dicationManageme

ntAC

E/AR

B

PersistentMe

dicationMonitro

ringD

iuretics

AppropriateAntibioticUseforAc

uteBron

chitis

AppropriateAsthma

Medications

AppropriateTxforChildrenw

ithPharyn

gitis

AppropriateTxforChi

ldrenwithURI

ImagingStud

iesforL

owBackP

ain

Pilot 2009

Pilot 2010

2009-2010 Pilot Practice

Quality Performance (HEDIS)

Perform

ance

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Commercial members only/ Pharmacy, Behavioral Health, Lab costs carved out/ catastrophic casesexcluded (>25K)

2008-2009 Pilot Practice - Total Cost of Care

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External Analyses: Results after one year

Risk adjustedED visit

reduction

9%

Risk adjusted

PMPM savings

$32Risk adjusted

advancedimaging

reduction

18%

Risk adjustedadmissions

reduction

24

%

Source: Verisk Health- Arlene Ash, PhD, University of Massachusetts Medical School;Randy Ellis, PhD, Boston University

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Medical and inpatient spending comprise the bulk

of total savings on a risk-adjusted basis

Pharmacy

$43%

Total

$32***9%

Medical

$27***11%

Other$34%

ER$03%

Inpatient$21***30%

Primary

Care$13%

Specialty

Care$12%

Treatment Practices Risk AdjustedSavings PMPM by Sub-category

*** P-value

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EPC Timeline- Future Direction

Pilot to Spread

2008

Pilot

launch

2010

Phase II

launch

Jan 2012

Go Live

2011

Planning

Model revision and

organizational preparation

June 2011

Evaluation

Report

Commonwealth Fund evaluation

Board to make decision- move forward / sunset

July-Dec

Model

finalization

Final upgrades to the model

Re-contract with providers

2012 go live

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Phase III - 2012 Expansion

CDPHP is planning to launch third EPC cohort

Notify your CDPHP strategic coordinator of your interest in the nextsix weeks

Selection criteria will include:

Stable practice culture and strong leadership

Commitment to: achieving NCQA Level III Medical Home

enhanced access

establishing contracts with hospitalists, urgent carefacilities, and specialty groups

collaborating with CDPHP

The formal application process will begin May 1, 2011

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Thank you