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Positioning forPopulation Health

Management.

Through:

Accountable care networks

Clinical integration & care coordination

Value-based reimbursement

Value-based health insurance benefit desig

Enabling infrastructure

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Our Health Agenda

A CALL TO ACTION:

Risks of Delay and AvoidancePlace revenue streams at risk

Need to demonstrate value of services to payers:

Evidence based

Outcome measured

Better price with operational improvement through coordination of care across the continuum

Revenue impact as payors limit cost shift from government programs

Shift in revenue from fee for-service to value-based reimbursement

Changes in market share

Aging population

Shifts in care delivery to lower cost providers

Programs to support early intervention, diagnosis and treatment

Physician and community programs to reduce admissions, ER visits, and certain procedures

Changes in Physician network and referrals

New Physician / Hospital alignments

Emerging provider networks across the continuum of care

New Health System, Physician, and Payor alignments

Health reform is occurring

Accountable care: improve quality

Positive experience: provider and patient

Consumer demands

Transparency: quality and cost

Affordable care: bend the cost trend

Transforming fromvolume to value

Value =Cost and quality

Value-based reimbursement

Pay for performance Care management

Bundled payment

Global budget / shared savings

Value-based benefit design

Service

Disease management

Clinical condition

Value-basedreimbursementis happening.

Health insuranceexchanges in 2014.

New Benefit Designsare occurring.

BETTER HEALTH, BETTER HEALTHCARE, LOWER CO STS

Are you prepared to act,

and ultimately achieve competitive advantage

in delivering value - Quality, cost, and experience?

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Education (Health Reform Agenda and Implementation)

ReadinessAssessments

(External, internal)

Driving forces, influencers& key issues

EXTERNAL Economic policy Regulatory Market Financial

Competition

INTERNAL Financial Quality Operations

Infrastructure

Progress on existing strategy

Financial Performance

SWOT analysis

Critical success factors

Risk considerations

Where to compete? Market niche Key processes Customer value Human capital Technology Data

Refine strategic themes(3-5) and areas of focus

Requirements: Integrated provider

networks / strategicrelationships

Patient centered medical home

Clinical care coordination and engagement

Physician / hospitalalignment

Value-based revenue

Information technology

Business intelligence /data analysis

Value opportunitydefined by initiative:

Measures Resources Dependencies Investment Budget ROI

Organizational alignmentand change management

Program / projectmanagement

Performance monitoring

Benchmarking

Evaluation

Learning

Business InitiativePlanning

(Initiative portfolio)

Strategy Development

(Strategic themesand areas of focus)

Strategic Roadmap

(Key performanceindicators)

Execution /Performance Monitorin

(Balanced Scorecard)

Organizational and leadership sponsorship

Approach to Building an Accountable Care Network

Requirements and Capabilities

Market

Value-basedrevenue

Capitalmanagement

FFSrevenue

Expensemanagement

Businessintelligence /data analysis

Informationtechnology

Workforcedevelopment

Organization /leadershipdevelopment

Physician /

hospital alignment

Engagementof consumer

Clinical

improvement

Operationalimprovement

Revenue

management

Carecoordination

Quality

Transformation required through:

Financial

The catalysts include:

Access

Quality

Experience

VALUE

Who is drivingyour market?

Providers Competitors Payors Federal / State

Financial

&Quality

What are yourfinancial drivers?

Where willyou increasecustomer value?

Proce

ss

Are youdelivering

clinical andoperationalexcellence toachieve value?

Infrastructure

What are thefoundationalbuilding blocksto achieve value?

STRATEGY STRATEGIC ROADMAP PERFORMANCEMEASUREMENT

Optimize

margins withoperational

efficiency and

effectiveness

Populationhealthmanagement

Strategicrelationships

Value-basedpurchasing &benefit design

Informationtechnology

Optimizevalue Better health for

the population

Better healthcare for the individual

Lower percapita cost

COMMUNICATION - COMMUNICATION - COMMUNICATION

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Our Leadership Team

Our Experience in Accountable CareCarol Cassell and Bradley Truax M.D., have worked together in the same organizationfor 4 years in hospitals and 10 years in a health plan with the following experience:

VALUE-BASED HEALTH: Developed and managed health plan and provider

relationships transforming data into information supportingmedical management, patient centered medical home(PCMH) and reimbursement models.

Introduced the Institute for Healthcare ImprovementTriple AimTMapproach to improve population health,

enhance patient experience and bend the cost trend.

Participated in the development and management ofMedicare Advantage, Medicare Special Needs Plan(Institutional), Medicaid Managed Care, andConsumer Drive Health Insurance Products.

Supported a health systems managed care organization.

PAYMENT / REIMBURSEMENT: Developed, negotiated, andmanaged pay for performance, capitation and global budgets withrisk sharing for primary care physicians, specialists and hospitals.

CARE COORDINATION & ENGAGEMENT: Provided leadership indevelopment and implementation of care coordination, PCMH, and patient engment initiatives supported by information management and reimbursement m

INFORMATION TECHNOLOGY: Initiated Western New YorkCommunity EMR program for primary care physicians; supported

planning and implementation of WNY health information exchange.

BUSINESS INTELLIGENCE & PERFORMANCE MEASUREMENT:Implemented Key Performance Indicators and Dashboards forPerformance Management, including Care Management,Insurance Products, PCMH practices and community health.

LEADERSHIP: Led and coordinated collaborative relationships amongstand between hospitals, physicians, health plan and key stakeholders.

25+ years experience,including 15 years with Big 4 firm

5+ years experience as a hospital CFO

Lloyd Arakelian, CPA, FHFMA

Alan Gracie, CPA

20+ years experience, including8 years with Big 4 firm

2+ years experience in hospital finance organization

HEALTH SYSTEMS & HOSPITALS

Carol Cassell

Bradley Truax M.D.

Jack Sieber, CPA

Strategy & Performance Improvement Leader

30+ years experience, including 20 years with Big 4 firm

5 years experience in hospital finance

3 years experience in senior managementposition with large payor

3 years experience with proprietary long-term care cha

Strategy & Performance Improvement Leader

32+ years experience, including community-based planning, innovation, health informationtechnology, and 3 years with Big 4 firm

17 years executive leadership in community, tertiary an government Health Systems including hospital, long-te care, home care, ambulatory surgery, physician practic

2 years executive leadership of aHealth Plan and related Foundation

Board certified in Neurology and Internal Medicine

Clinician and educator with 20+ years in MedicalAdministration including hospitals and a health plan

20+ years in quality and patient safety

Ryan Grady, CPA

Process and internal control enhancement

12 years experience, including 6+ with Big 4 firm

PHYSICIAN PRACTICES

Shawn Frier, CPA, CFE, CMPE

Physician Practices Leader

20+ years experience, including 2 years with Big 4 firm and 15 years providing strategic direction for physician practices

President New York State Medical Group Mgmt.Association (Past President of Buffalo Chapter)