Aetna and PCMH

1. Aetna and PCMH Aetna’s experience with Patient-Centered Medical Home pilots in the Northeast Improving Employee Health through Patient-Centered Medical Homes Morristown, New Jersey October 12, 2010

2. New York Business Group on Health PCMH Characteristics • Personal Physician leading a dedicated team that includes a care coordinator • Care is coordinated across the spectrum of care from wellness and primary care to specialist and hospital care • Expanded Access – office hours as well as non face to face • Real-time patient-centered data management and performance tracking • Meaningful Practice Incentives [Example of text in right block: Arial, 18pt size.]

3. New York Business Group on Health PCMH Criteria • Aetna uses the NCQA certification for recognition • Pilots need a consistent measure set to track performance • Aetna’s compensation models generally align with the other national payers [Example of text in right block: Arial, 18pt size.]

4. New York Business Group on Health Common Features of Aetna Pilots • Multi-health plan state or market collaboratives • PCP offices should be or become NCQA recognized • Monthly payment PMPM • Commercial and Medicaid membership • Outcome and efficiency measures reported by data aggregator • Significant time before results are reported [Example of text in right block: Arial, 18pt size.]

5. New York Business Group on Health Measures of Success From Health Plan Perspective: • PCMH recognition • Outcome measures improvement: • HbA1c within goal, Diabetic BP and Lipid levels within goal • Population vs. disease cohort cost trend compared to market • UM improvement – ER visit rate, inpatient days, admissions, other medical cost category improvement [Example of text in right block: Arial, 18pt size.]

6. New York Business Group on Health Professional Society Views • Transformation takes place at the office level not the payer level – multi-payer configurations logical extension • Incentives for transformation, outcomes will follow • HIT a prerequisite [Example of text in right block: Arial, 18pt size.]

7. New York Business Group on Health Southeastern Pennsylvania – Medicaid Multi-Payer Results • July 2010 – All 33 practices PCMH certified • Preliminary UM results are based on one payer results (Medicaid – 37k members) • Inpatient admissions dropped 26% • ER visits dropped 18.4% • Total costs dropped 15.9% • Clinical metrics: • 33% improvement in HbA1c control • 71% increase in diabetic eye exams • 25% improvement in diabetic BP control

8. New York Business Group on Health Aetna and other Multi-Payer Collaboratives • Maine • Pennsylvania – commercial members • Hudson Valley • Maryland • Colorado • Washington state • CMS MAPCP pilot applications for most

9. New York Business Group on Health Aetna New Jersey Pilot 2008 Aetna-IPA Agreement • Commercial HMO FI population - 7,000 • FFS for care coordination either by IPA or offices • PCMH certifications expected for PCPs • Focus on Diabetes and Hypertension • Coordination of care alerts enabled by Aetna data feed. • Process and outcome metrics • Cost tracked for population - no outlier exclusion

10. New York Business Group on Health 2010 Aetna NJ PCMH Pilot Results • Total medical cost improvement of 15.9% first Quarter 2010 • Incremental quarter over quarter trend improvement most pronounced at 18 to 24 months • 34 MDs PCMH certified, 23 pending - still a majority of the PCPs are not certified • PCP HIT adoption still less than 50% - IPA administration supplies the clinical decision support/registry function

11. New York Business Group on Health Bending the Medical Trend: Evidence Comparison of 11/09-4/10 and 2007 • ER visit rate down - 8% • IP days down - 25% • Admissions down - 16% • Medical cost trend impact on: IP, Specialist, BH, Lab, Imaging, Injectables

12. New York Business Group on Health Distribution of Medical Cost Savings Highlight:Inpatient services are significantly lower PMPM than HMO FI NJ market compared to 2007

13. New York Business Group on Health Diabetes Care Improvements HbA1c tests and outcomes Highlights: HbA1c test compliance from 63% to 94% HbA1c control <7 from 36% to 58% %

14. New York Business Group on Health Additional ImprovementsLDL and BP tests and outcomes Highlight: Blood Pressure population’s outcome compliance improvement from 22% to 48% % *<=140/80 for non-diabetics

15. New York Business Group on Health PCP Office Performance Variability • Care coordination FFS payment enables direct measurement of office engagement • Engaged offices show the greatest clinical impact and cost savings • PCMH certified offices are not necessarily engaged or most cost effective

16. New York Business Group on Health PCMH/Care Coordination - ROIWhere are we going? • What is most scalable and affordable from purchaser point of view? • Multi-payer, low risk for payer, potential significant savings for purchasers, steep PCP adoption threshold, long report cycle • Care Coordination pushed from a central clinical support generator - impressive results on target population. Significant maturation time: 18-24 months • Challenge to increase the target population • Transition to partial or full risk and shared savings incentives to manage whole population - When to make the leap? For whom?