Embracing Transformation: How alliances drive Innovation and create opportunities

1. Embracing Transformation: How alliances drive Innovation and create opportunities Robin Richardson, Senior Vice President, Moda

2. Moda Transformational Initiatives • Medical Homes • Coordinated Care Network (CCN) • Comprehensive Coordinated Care (C3) • NEW The Coordinated Care Model -Eastern Oregon Coordinated Care Organization (EOCCO) -The Summit and Synergy Partnerships

3. Opportunity for Coordination/Partnership Synergy and Summit Partners Moda Assembly of Appropriate PCP Based Care Model Distribution Channel Shared Claims Processing Plan Design Consumer Education Enhancement of Evidence-Based Protocols Provider Payment Model Prioritizing Target Savings opportunities Performance Measures Disease Management Wellness Services Develop Physician Leadership Actuarial Expertise Change Physician Behavior Data Analytics, Predictive Modeling Define and Assemble Appropriate Provider Mix Utilization Management Capability EHR Implementation/Integration Accounting Validation Financial Models Clinical Collaboration Sales and Marketing Legal Compliance

4. The Coordinated Care Models A new approach to transformation and innovation

5. The Coordinated Care Model (CCM)Oregon’s Vision “Governor Kitzhaber’s ambition is to adopt this model for: -Medicaid -Large State Controlled Insurance pools (OEBB & PEBB) -The Exchange -Eventually, the private market” Interview with The Nation, May 21, 2013

6. The Coordinated Care Model(CCM) Components • Global Budget • Metrics and Accountability for Quality (17 CCO Metrics) • Payment Transformation (Provider Performance Risk Models, Medical Home payments) • Medical Homes (A patient centered healthcare experience) • Care Transformation and Efficiency (Reduced ED visits, integration of mental health, oral health and physical health)

7. The Coordinated Care Model (CCM): Benefits to Members and Employer Groups • Best Practices to manage and coordinate care • Shared responsibility for health • Measured performance (accountability for quality) • Pay for outcomes and health (value) • Information and transparency • Sustainable rate of growth (global budget)

8. The Coordinated Care Model (CCM) Gobal Budget + The Triple Aim

9. The Coordinated Care Model: Eastern Oregon Coordinated Care Organization (EOCCO)-Medicaid

10. EOCCO Service Area

11. Quick Facts About Eastern Oregon CCO • Land Area: 49,929.75 sq. miles • 52% of Land Area of State of Oregon • Larger than Land Area of 19 states • MS, PA, OH, VA, TN, KY, IN, ME, SC, WV, MD, HI, MA, VT, NH, NJ, CT, DE, RI • Population: 194,592 • 4.99% of Oregon’s population • 1/3 the population of WY (least populous state) • Equivalent to the combined populations of Salem, Lake Oswego and Lebanon, Oregon

12. EOCCO • Six Counties previously had Medicaid managed care organizations (ODS, Family Care, CareOregon) • Ten Critical Access Hospitals • Federally Qualified Clinics (i.e. Mirasol) • Rural Health Clinics • Large IPA—Pendleton IPA • Umatilla County

13. EOCCO • County Governments received mental health funds • Care going out of state—Idaho, Washington, Northern California • Care going out of the service area within Oregon----Bend, The Dalles, Portland • Eastern Oregon politics/culture • Oregon Health Authority had to approve in each county

14. EOCCO • Readiness Review • Global Budget process • Network Adequacy

15. The Rest of the Requirements • Community Meetings • Community Advisory Councils • Board of Directors

16. EOCCO • Board of Directors -Dennis Burke, CEO, Good Shepherd Hospital-Union County -Kevin Campbell-GOBHI -Bruce Carlson, MD, Umatilla, Gilliam Counties -Russ Demianew, CEO Pendleton IPA-Umatilla County -Ray Gibbons, CEO, St. Alphonsus, Baker & Malheur Counties -Renee Grande, MD, Winding Waters Cliinic, Wallowa County -Sandy Hata -Bob Houser, CEO, Blue Mountain Hospital, Grant County -Ken Kestner, County Commissioner, Lake County

17. EOCCO Board of Directors -Diane Kilkenny, Public Health Nurse, Morrow County -Carlos Olivera, Mirasol, Clinic, Umatilla County -Jim Mattis, CEO, Grande Ronde Hospital, Union County -Robin Richardson, ODS -Jim Schlenker-CEO, St. Anthony’s Hospital, Umatilla County -Chris Siegner, Director, Symmetry Health, Harney County -Mike Smith, County Commissioner, Sherman County

18. Getting the Providers as Partners • Hospitals • The Pendleton IPA • Mirasol • Legal (Memorandum of Understanding and the operating agreement)

19. Shared Savings and Shared Risks • Investors Moda (25%) Greater Oregon Behavioral Health (25%) Good Shepherd Hospital (10%) Grande Ronde Hospital (10%) St. Alphonsus Hospitals (Ontario and Baker City) (10%) St. Anthony’s Hospital (10%) Pendleton IPA (1%) Mirasol Clinic (1%) Future---(8 % held in reserve for Counties, Dental, other providers

20. EOCCO • Transformation Plan • Transformation Summits • Non-Emergent Transportation • Clinical Advisory Council • Dental • Dual eligible application to CMS • Long Term Care

21. EOCCO Goals/Opportunities/Challenges • Profitable operations within the global budget • Care Transformation • Meeting all of the OHA/CMS requirements/metrics

22. The Coordinated Care Model: The Synergy and Summit Partnerships-Commercial

23. The Synergy and Summit Networks: Two Sentinel Events • OEBB’s Strategies, Evidence and Outcomes Workgroup (SEOW) requests a revised and updated CCN alternative. • PEBB’s Bid-Fall of 2013 for an effective date of January 1, 2015 -Required either a Regional Coordinated Care Model (CCM) or a statewide PPO bid

24. The Synergy and Summit Networks • The Synergy and Summit Concept -A Commercial Coordinated Care Model patterned after the Eastern Oregon Coordinated Care Organization (EOCCO) developed by Moda *Global Budget *Accountability for quality *Payment Transformation *Medical Homes *Care Coordination/transformation -Regional integrated delivery systems capable of addressing the Coordinated Care Model requirements of the PEBB bid and capable of being considered by OEBB for October 1, 2014

25. The Summit Network • Original Model was the Eastern Oregon Coordinated Care network and concept • Network already formed with ODS Plus Network to fill in gaps • Selected as a new regional option for OEBB, effective 10/1/14 • Selected as a new option for PEBB for the Eastern Oregon Region, effective 1/1/15 • Additional work: -Commercial provider performance risk arrangements with individual Hospitals and Providers -Tertiary Hospitals---none in the geography---getting provider performance risk arrangements with them -Addressing the Boise and Eastern Washington provider networks for OEBB and PEBB

26. The Synergy Network • Initial/Original Partner---OHSU -Insurance Risk -Provider Performance Risk -Employees in the network • Other Health Systems added for network footprint and adequacy -Peace Health (Vancouver and Eugene) -Portland Adventist (East Metro) -Legacy (Metro Primary Care footprint) -Salem Health (Marion and Polk Counties) -Salem Clinic • Selected as a new regional OEBB option effective 10/1/14 • Selected as a new regional PEBB optioneffective 1/1/15

27. The Synergy and Summit Networks

28. The Coordinated Care Model: Payment Transformation

29. Primary Care Providers • All Primary Care Providers are included in the Synergy and Summit networks except thoseprimary care providers owned by health systems not currently participating in the Synergy or Summit Networks • Payment for Medical Home Status -EOCCO-over 65% of membership in a medical home -OEBB-over 80% of OEBB members in a medical home • Payment for C3 Patients • Risk Pool Sharing -Hospital -Specialist -Pharmacy

30. The Coordinated Care Model: Benefit Design/Patient Engagement

31. Program cornerstones Relationship-based care and social determinants of health

32. Moda Passport to Health • Healthy Foundations (HF) & Comprehensive Coordinated Care (C3) • Developed Spring 2011, 2nd full year of implementation • C3 designed to accommodate larger scaled populations • High intensity patient centered coordinated care & advocacy • Target population 3-5% • Distributed model versus central model • Scalable for 5000 to 100,000 +

33. Analytics and Attribution • Top 5% of utilization • Diagnostic profile • Risk scores • Prospective • Pharmacy data • Medication adherence • Geo mapping • Focus groups & value stream Identify members ♦ design incentives ♦ outreach/engage ♦ build trust ♦ measure outcomes

34. Preliminary results • Members are better self-managers, and are seeking more preventive care • Reflected as more appropriate pharmacy and outpatient use • Members are utilizing outpatient visits rather than the ER • 50% decrease in annual ER visit rate after active engagement • 37% decrease in annual ER cost per member per month • Average length of stay shortened after active engagement compared to pre-program episodes of care • Improvement in patient activation and quality of life indicators including PHQ9 depression scores and overall function • 100% of members rated their experience with Healthy Foundations as positive and would refer others to the program

35. The Coordinated Care Model: The 4th Partner: Supporting Transformation

36. Grant Submissions per County Letters of intent / Submitted grant applications 4/1 6/6 2/3 3/2 52 letters of intent received/ 48 grant applications received 5/3 5/3 2/1 1/1 7/3 Multiple counties: 4/5 6/4 2/1 5/5

37. Grant Proposals

38. OEBB/Moda Health Grant Program • $3 M grant fund provided by Moda Health on behalf of OEBB • Investing in improving the health and healthcare of OEBB members and the communities where they live • Guided by the fundamental premise that funding can incentivize sustained commitment • Committed to identifying and supporting evidence-based, measurable, and equitable initiatives

39. OEBB/Moda Health Grant Program *In thousands