Strengthening Primary Care for Patients

April 9, 2013Kaiser Permanente Center for Total Health

Washington, D.C.

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The Primary Connection

Michael W. Cropp, M.D., M.B.A

President & CEO, Independent Health

Buffalo, New York

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The Primary Connection Patient Experience

2009 2010 2011 201265%

70%

75%

80%

85%

90%

PCMH/The Primary ConnectionPatient Experience of Care

Patient Experience

PCMH Baseline

7/1/2012 The Pri-mary Connection

Program Starts

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The Primary Connection Quality

4

2009 2010 Q3 2011 Q3201275.0%

76.0%

77.0%

78.0%

79.0%

80.0%

PCMH/The Primary ConnectionComposite Quality Score

Quality Sc...

PCMH Baseline

7/1/2012 The Pri-mary Connection

Program Starts

Restricted

The Primary Connection Efficiency

5

2008 2009 2010 Q3 2011 Q320120.97

0.98

0.99

1.00

1.01

1.02

1.03

1.04

1.05

PCMH/Primary ConnectionEfficiency Index

Efficiency Index

PCMH Baseline

7/1/2012 The Pri-mary Connection

Program Starts

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The Primary Connection Efficiency Comparison

6

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The Primary Connection Quality Comparison

7

Alliance of Community Health Plans (ACHP)Making Health Care Better

April 9, 2013

Scott Smith, MDAssociate Medical Director of OperationsKaiser Permanente Colorado

Confidential to Kaiser Permanente

Continuity

2006 2007 2008 2009 2010 2011 201240%

50%

60%

70%

80%

90%

100%

54%

80%82%

84% 84% 83% 83%

Confidential to Kaiser Permanente

Access

2006 2007 2008 2009 2010 2011 20120

2

4

6

8

10

12

14

16 15

12

9

3 3 34

YEAR

DA

YS

Confidential to Kaiser Permanente

Quality

2007 2008 2009 2010 2011 201240%

50%

60%

70%

80%

90%

100%

Mammography HypertensionColon Cancer Screening

Confidential to Kaiser Permanente

Patient Centered

Care Works!

Marci Nielsen, PhD, MPHChief Executive Officer, PCPCC

The Patient-Centered Medical Home and Health System

Transformation:Texas Health Home Summit

A Change in ParadigmToday Future

Treating Sickness / Episodic Managing Population

Fragmented Care Collaborative Care

Specialty Driven Primary Care Driven

Isolated Patient Files Integrated Electronic Record

Utilization Management Evidence-Based Medicine

Fee for Service Shared Risk/Reward

Payment for Volume Payment for Value

Adversarial Payer-Provider Relations

Cooperative Payer-Provider Relations

“Everyone For Themselves” Joint Contracting14

Health IT Infrastructure

PCMH and Accountable Care:Two Sides of the Same Coin

Accountable Care

PCMH

PCMH

PCMH

PCMH

PCMHHospitals

Public Health

Shared ServicesCare Coordination

Care Managers

Specialists

15

HIT Infrastructure: EHRs and Connectivity

Primary Care Capacity: Patient Centered Medical Home

Operational Care Coordination: Embedded RN Coordinator and Health Plan Care Coordination $

Value/ Outcome Measurement: Reporting of Quality, Utilization and Patient Satisfaction Measures

Value-Based Purchasing: Reimbursement Tied to Performance on Value

Supportive Base for ACOs, PCMH Networks, and Bundled Payments

Trajectory to Value-Based PurchasingIt is a journey, not a fixed model of care

16 Source: THINC - Taconic Health Information Network and Community

Role of The Collaborative (PCPCC)

17

Lead from the front Challenge the status quo Drive the marketplace Disseminate timely

information Provide networking &

educational opportunities

Delivery Reform

Payment

Reform

Public Engagem

ent

Benefit Redesig

n

Transformation requires…

Questions & Answers