Medical Directors & Pharmacy Directors

Fall 2011 Meeting

ACHP Mission

ACHP and its members improve the health of the communities we

serveand

actively lead the transformation of health care to

promote high quality, affordable care and superior consumer experience.

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ACHP Member Organization Attributes

Quadruple Aim: Focus on health of populations, optimal patient experience (outcomes, quality, satisfaction), affordability, and community benefit.

Community-Based: Build communities to better health. Loyal to our communities and inspiring loyalty in return.

Provider Partnerships: Partner closely with dedicated and contracted physician groups to improve health and health care delivery. Accept risk and share it with providers through payment strategies to achieve high performance and delivery system reforms.

Non-Profit Orientation: The community is the chief stakeholder in our plans’ success. Make decisions that keep consumers healthy for the long-term. Provide community benefit.

Who are ACHP Members?

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Capital District Physicians’ Health Plan

Albany, NY

Capital Health Plan Tallahassee, FL

CareOregon Portland, OR

Fallon Community Health Plan Worcester, MA

Geisinger Health Plan Danville, PA

Group Health Seattle, WA

Group Health Cooperative of Madison, WI

South Central Wisconsin

HealthPartners Minneapolis, MN

Independent Health Buffalo, NY

Kaiser Foundation Health Plans Oakland, CA

and the Permanente Federation

Martin’s Point Health Care Portland, ME

New West Health Services Helena, MT

Presbyterian Health Plan Albuquerque, NM

Priority Health Grand Rapids, MI

Rocky Mountain Health Plans Grand Junction,

CO

Scott & White Health Plan Temple, TX

Security Health Plan Marshfield, WI

SelectHealth Murray, UT

Tufts Health Plan Waltham, MA

UCare Minnesota Minneapolis, MN

UPMC Health Plan Pittsburgh, PA

Where are ACHP Members?

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ACHP’s Mixed Delivery Models

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* Source: Based on self-reported estimates from ACHP plans reflecting 2008 - 2011 data. * Information does not reflect the percent of members seen by owned/affiliated hospitals or specialists, which may vary considerably from the PCP figures.

ACHP Total Membership Distribution

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* Source: Based on self-reported estimates from ACHP plans reflecting 2009 - 2010 data. * Other Non-Medical enrollments reflect lives ACHP plans touch through other arrangements such as third-party administrators and dental coverage.

NCQA’s Health Plan Rankings – Proven Quality

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On the 2010-2011 Health Plan rankings, ACHP plans were:•16 of the top 25 Medicare plans•10 of the top 25 private plans•5 of the top 25 Medicaid plans

Plan NameMedicare

Commercial

Medicaid

CDPHP 15 6

Capital Health Plan 1 4

Fallon Community Health Plan

3 8 1

Geisinger Health Plan 10 5

Group Health Cooperative - SCW

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Group Health – Seattle 11

HealthPartners 19

Independent Health 18 16 14

Kaiser Permanente 2,4,5,8,12, 14,18,19

9, 21 2

Priority Health 13

Security Health Plan 6

Tuft’s Health Plan 7 2

UPMC Health Plan 10

ACHP Medical Directors: How We Work

Sharing Innovation

Collaborative,outcomes oriented

initiatives

Enhance ACHP

visibility by demonstrating differentiation

We aim to strike a balance between these three areas – and enhanced patient care

at affordable cost remains our end game.

Medical Directors Goals for 2011

• Delivering high value patient-centered care and telling a compelling story to policy makers– We will document and publish results

for our primary care innovation work: medical home and transitions of care

─ We will create templates of value-based reimbursement pilots for plan adoption as part of our ACO-focused work

─ We will define the role of the integrator in ACO’s and identify options for ACHP members, including functions to “migrate”

─ We will share best practices in leading community initiatives to achieve the triple aim

─ We will define the pharmaceutical opportunity for ACHP and launch this work

Experience

HealthCost

(projection)

Healthcare Costs for American Families – Projection to 2021

Source: 2011 Milliman Medical Index

RFI on VBID• Describe in general terms• Specifically what value based benefits do members receive for what

– Pharmacy– Visits– DME– Other

• What, if any, differential benefits exist for overutilized conditions, e.g. higher coinsurance if conservative route not done prior to surgery

• What incentives are being offered to members (e.g. premium relief)• What requirements are placed upon members (PHA, PCP

identification, etc.)