Agenda

2. Agenda Accountable Care Organization (ACO) details—who are we? Key strategies you believe are responsible for ACO success Challenges that arose during implementation of the strategies, and how your ACO is overcoming them Changes to existing strategies or new strategies your ACO is implementing to build on your success Advice you would give to new Medicare Shared Savings Program (MSSP) ACOs or organizations thinking of becoming MSSP ACOs Q&A and group discussion

3. Chinese Community ACO

4. Chinese Community Accountable Care Organization Inc. April 1, 2012 start date as a Track 1 ACO State(s): New York Advanced Payment? No Are any of the ACO participants hospitals? No Number of practitioners: 230 50% PCPs to 50% Specialists Cardiology, Oncology/Radiation-Oncology, OB/GYN, Ophthalmology, GI, Endocrinology, Rheumatology, ENT, Surgery, Podiatry, etc.

5. ACO Formation, Culture, and Background Number of assigned beneficiaries: 12,000 Percent EHR penetration, and number of EHR platforms used: 80% EHR penetration, primarily two major platforms Led by private practice physician-based ACO with collaboration with local hospitals Physician practices located in urban areas of NYC

6. Key Strategies Used to Improve Quality and Address Costs Unique nature of patient population and culture Close-knit nature of the family unit and close relationship with physician to coordinate the overall care of the patient Open access and extended business hours to reduce hospital care Leadership with extensive experience in operating an independent practice association (IPA) with full-risk contracts with health maintenance organizations (HMOs)

7. Key Strategies Used to Improve Quality and Address Costs Commitment to Quality Initiatives Diabetes Recognition Program: • Nearly 70 physicians achieved National Committee for Quality Assurance (NCQA) Diabetes Recognition Program via a grant funded by the New York State Health Foundation Patient Centered Medical Home (PCMH) Certification: • 30 practices are PCMH certified, Level 1 - Level 3

8. Key Strategies Used to Improve Quality and Address Costs Emphasis on Patient and Physician Education: • Co-sponsorship with community stakeholders of Annual Health Fairs and patient education seminars • Routine Physician Education Meetings to disperse information: • Large physician meetings—quarterly • Small group roundtables—monthly

9. Addressing Challenges Diverse use of electronic medical record (EMR) platforms and utilization of paper medical records, lack of centralized data warehouse Collaboration with ACO information technology vendor to analyze data and quality metrics from data provided by the Centers for Medicare & Medicaid Services

10. Future Directions Strengthen relationship with hospitals—early notification for ER visit and admissions, exchange data including discharge summary, shorten length of stay Exploring opportunity for bundled payment and global payment including Medicaid population with CMS Exploring commercial ACO with HMOs, particularly Medicaid HMOs

11. ACO “Pearls of Wisdom” • Strong leadership and educationis key to communicate information to members and patients • Understanding data—expenditures, benchmarks, quality metrics, health informatics, etc. throughout ACO process • Our advice to newcomers: start small with dedicated leadership, led and managed by physicians, lean operation, considering partnering with existing successful ACOs to reduce start up costs

12. Summa Health

13. New Health Collaborative Vision NewHealth Collaborative (NHC) is a clinician-led collaborativethat partners with communities to compassionately care for and serve our populations in an accountable, value and evidence-basedmanner.

14. The Change Process: 2010

15. What is the Summa ACO

16. Strategic Priorities 2013-2014 Eliminate silos and improve care coordination, quality, and satisfaction for community Equip patients and providers with the knowledge and tools to effectively manage care Develop a culture of leadership with strategic provider partners that are committed to the transformation of the delivery of health care Align payment with patient-centered, value-based care delivery Grow the population base served by NHC

17. NHC Governance Structure

18. Populations Managed SummaCare Medicare Advantage • Go-live date of January 1, 2011 • Approximately 13,000 members • Medical spend approximately $102 million SHS Employee Health Plan • Go-live date of January 1, 2012 • Approximately 7,000 members • Medical spend approximately $35 million MSSP • Go-live date of July 1, 2012 • Approximately 30,000 beneficiaries • Medical spend approximately $220 million Commercial Population (MMO) • Approximately 25,000 members

19. Delivery Network

20. PCMH: Status Update

21. Clinical Communications Center (CCC) CCC created to provide enhanced call management to NHC providers and increase satisfaction of their patients Nurse triage with connectivity to EMR Goals: • Care coordination • Access to clinical information • Support of the Delivery Network • Limit leakage out of network ClinicalProtocols CCC Patient Provider EMR

22. Integrated Care Manager Routine Care Management Activities • Facilitate specialist services • Referral tracking • Information coordination and sharing • Promotion of smooth care transitions: • Assisting patients and families moving from one care setting to another • Helping to ensure patients receive appropriate follow up care • Helping patients understand results and treatment recommendations • Developing systems to help prevent errors: • Medication reconciliation • Communications

23. Summa ACO Lessons Learned To truly achieve Care Delivery redesign, ACO needs to be Physician-led Need to navigate carefully the balance between PCPs/Specialists and their respective contributions to the ACO Design achievable Conditions of Participation and enforce these requirements in order to ensure behavior modification To ensure compliance with metrics, need to create dashboards or other measures to keep Physicians informed of progress