Renaissance Medical Management CompanyOverview

A Pioneer Accountable Care Organization

Agenda• Brief History of Renaissance• Overview of RMMC programs • Provider Collaboration Model• Question

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• Renaissance exists to support the practice of medicine in an economically sustainable way

• Renaissance works in conjunction with physicians

and payers to build new compensation models designed to properly align incentives for delivering efficacious care

• Founded in 1999– Created to align goals and objectives of providers and payers– Originally a specialist-owned organization– Recapitalized into a primary care – owned company

• Chairman of the Board – Dr. Barry Green– Practicing Physician

• Chief Medical Officer – Dr. Kenneth Goldblum– Practicing Physician

• Remains privately held by doctors

History of Renaissance

Compensation should be driven by Quality

• Less event-driven care means lower costs and higher quality

• HEDIS and CAHPS becoming ever more important in purchasing decision

• Improved outcomes drive lower costs for– the Patient– the Payer– the Employer/Purchaser

• Lower costs can fund incentives

Essential Components for Effective P4P

• Clinical Staff to manage the process– Coordinate with the practices– Outreach to the patients– Establish treatment goals

• Effective web based connectivity with the practices– Registry of patients needing preventive care

• A meaningful incentive program– Clear– Specific– Measurable

People, Processes and Technology

• Improved HEDIS Scores – RMMC managed program has consistently produced

HEDIS scores in 90th percentile nationally

• Demonstrated cost reductions for payer– Validated by third party actuarial firm

• Lower Readmissions• Less Event Driven Care• Better Outcomes• Slowing the progression of risk scores

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In the right combination…produces

Patient Centric Quality Incentive Model

Phy

sici

ans

Pay

ers

Patient

Lower Costs, Higher Quality

Pay for Performance

•Physician Coordination

•Quality Improvement Committee

•Regional Medical Directors

•Health Services teams

•Web-based tools

•Quality Program

•Developed by physicians and Plan

•Updated annually

•Clinical Nurse Outreach

•Follows physician’s plan of treatment

•Coordinates with patient and caregivers

•Web-based tools to manage plan

•Chronic Care Management

• Care modules to improve outcomes

• Reduce event-drive episodes

• Reduce readmissions

• Educate patients for self-management

•Incentive Program

• Clear

• Transparent

• Actionable

• Effective

Role of the Organization

• Education• Physician Leadership• Technology development• Patient Services: nursing support team• Physician office support• Program development and administration• Data management• Contracting

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Education

• Pay for Participation• 2-3 Learning Sessions per year• 3 Regional Physician Group meetings each year• Result sharing and feedback from peers• Chronic Care Model: teamwork and tools• QI processes• Leadership development

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Physician Leadership

• CMO and four regional Medical Directors• Physician Quality Improvement Committee• Developmental process• Physician led board• Quality Improvement doctor in each office

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Patient Services

• Telephonic nursing support for high risk patients and patients with chronic illnesses

• Home visit program in past• Transitional Care program to decrease

readmissions• Tied closely to enhancement program• “Inside” operation

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RMMC Enhancement Program

• Continues to evolve over time• Physician designed and administered• Goals are quality improvement, cost reduction,

and physician income enhancement• Incents both processes and outcomes• Uses single and composite measures

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RMMC Enhancement Program

• Includes HMO members that are formally associated with a PCP office

• Also includes PPO members that are identified by a validated algorithm we developed

• Penetration of over 20% in most of our offices• Earnings represent about a 10% increase in

overall compensation

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Diabetes Measures

• Began with just an enhancement for measuring glycohemoglobin

• Now includes a composite measure of glycohemoglobin under 7, LDL under 100, and urinary micro albumin measured and treated if abnormal

• Separate measure for blood pressure under 130/80

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Other Measures

• CAD: LDL <100, on BB and ACEI/ARB’s where appropriate

• CHF: BP <130/80, on BB and ACEI/ARB’s• Colorectal Cancer Screening• Breast Cancer Screening

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Program Supports

• Patient Services nurses working with a Diabetes specific module

• Regular physician meetings with Patient Services with patient identification

• Active use of reports available through the PMT to identify patients missing data and patients not at goal

• Learning Sessions on starting insulin and on treating statin intolerant patients

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Program Supports

• Learning Sessions on talking to patients about changing their health behaviors

• Referral to community resources including hospital based CDE programs

• Regular regional doctor meetings with result sharing

• Review of specific patient’s treatment with regional medical directors

• Team meetings in offices to discuss progress amongst doctors and staff

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Renaissance Operations

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Our Clinical Staff

• RMMC RNs collaborate with PCPs on chronic population• Care Modules:

– Transitional Care– Diabetes– CHF– CAD– Respiratory– Falls Risk Assessment– Hypertension

• Telephonic and home visit care models• Patient Discharge Partners Program for transitional care

post hospitalization• Coordination of community resources

Our Proprietary Technology Tools

• Population Management Tool (PMT)– Web-based, secure and compliant– Used by 100% of network practices to identify patients not at goal– Interfaces with Quest

TM & LabCorp

TM

– Interfaces with EMR

• Coordinated Care Tool– Provides clinical care management capabilities

• Risk Assessment• Goal setting• Patient monitoring• Nursing documentation• Outcomes reporting

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Impact on Compensation

• PCP’s earn incentives for quality metrics– Via incentive payment, enhancement to fee schedule or

capitation payments

– Paid regularly

• Gain share– Upside arrangement where payer and provider share in total cost

savings

– Paid annually based on total costs saved and allocated based on quality performance and membership

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CLINICAL QUALITY PERFORMANCE

Dr. Ken Goldblum CMO and Practicing Physician

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Results from Diabetes Program

HMO Commercial Diabetes

96%

57%

7%

95%

69%

87%93%

72%

93%

19%

89%

52%

72%

40%

88%

42%

0%

20%

40%

60%

80%

100%

120%

RMMC 95.7% 57.0% 7.5% 94.8% 69.3% 87.3% 92.8% 72.1%

National 90th HEDIS 93.2% 41.8% 19.0% 88.8% 52.3% 87.8% 72.3% 39.7%

Annual HbA1c Testing

HbA1c < 7.0% HbA1c > 9.0%Annual

Cholesterol Testing

LDL Cholesterol <

100

Annual Nephropathy Monitoring

BP< 140/90 BP< 130/80

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RMMC is an IPA in SE PA, using the tools and processes and pay for results model, the IPA has consistently delivered superior HEDIS results

…and Lower Disease Burden Progression-Diabetic Patients

3.05

3.96

3.33

3.66

4.12

3.65

2.73

3.30

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

RMMC 3.05 3.33 3.66 3.96

Cohort 2.73 3.30 3.65 4.12

2005 2006 2007 2008

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Well managed patients can lower the disease burden over time. In this case the population of the IPA had a higher disease burden in 2005 than the cohort group, while the progression of the risk scores would be expected with increasing age, the rate can be slowed by effective management reducing the event driven care, complications and intensity of the disease.

HMO DM CommercialHMO Commercial Diabetes

97%

51%

13%

96%

68%

93% 90%

51%

94%

19%

90%

54%

74%

42%

89%

54%

0%

20%

40%

60%

80%

100%

120%

An

nu

al

Hb

A1

cT

estin

g

Hb

A1

c <7

.0%

Hb

A1

c >9

.0%

An

nu

al

Ch

ole

stero

lT

estin

g

LD

LC

ho

leste

rol <

10

0

An

nu

al

Ne

ph

rop

ath

yM

on

itorin

g

BP

< 1

40

/90

BP

< 1

30

/80

RMMC National 90th HEDIS

HMO DM Medicare

HMO Medicare Diabetes

99%

63%

5%

99%

77%

95%88%

52%

92%

53%

18%

90%

58%

90%

65%

35%

0%

20%

40%

60%

80%

100%

120%

Ann

ua

lH

bA1

cT

estin

g

HbA

1c <

7.0

%

HbA

1c >

9.0

%

Ann

ua

lC

hole

stero

lT

estin

g

LD

LC

hole

stero

l<

10

0

Ann

ua

lN

eph

ropa

thy

Mo

nito

ring

BP

< 14

0/9

0

BP

< 13

0/8

0

RMMC National 90th HEDIS

Disease PopulationCommercial Total PMPM

Normalized to RMMC for 2005

0.99

0.95 0.980.87

1.001.00

0.88 0.90 0.79 0.89

y = -0.0072x + 0.9795 y = -0.0316x + 0.9888

0.00

0.20

0.40

0.60

0.80

1.00

1.20

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Disease PopulationMedicare Total PMPM

Normalized to RMMC for 2005

1.05

0.99 1.00 0.90

0.981.00

0.99 0.95 0.84 0.90

y = -0.0226x + 1.0511 y = -0.0354x + 1.0406

0.00

0.20

0.40

0.60

0.80

1.00

1.20

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Disease Population Commercial Acute Re-admission Rate

Normalized to Plan for 2005

0.73

0.700.77

0.64

0.71

1.00

0.88

0.71 0.63

0.72

y = -0.0104x + 0.7405 y = -0.0803x + 1.0282

0.00

0.20

0.40

0.60

0.80

1.00

1.20

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Disease Population Medicare Acute Re-admission Rate

Normalized to RMMC for 2005

1.04

1.010.97

0.97 0.88

1.00

0.98 0.97 0.88 0.86

y = -0.036x + 1.0831 y = -0.0383x + 1.0521

0.00

0.20

0.40

0.60

0.80

1.00

1.20

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Diabetes: Disease Population Commercial PMPM

Normalized to RMMC for 2005

1.02

0.97

1.01

0.94

1.03

1.00

0.90 0.90

0.86

0.93

y = 0.0013x + 0.9899 y = -0.0168x + 0.9701

0.75

0.80

0.85

0.90

0.95

1.00

1.05

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Diabetes: Disease Population Medicare PMPM

Normalized to RMMC for 2005

1.06

0.99

1.03

1.04

1.10

1.00

0.99 0.97 0.95

0.99

y = 0.0129x + 1.004 y = -0.0051x + 0.9952

0.85

0.90

0.95

1.00

1.05

1.10

1.15

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Diabetes: Disease Population Commercial Acute Re-admission Rate

39Normalized to RMMC for 2005

0.78

0.730.82

0.70

0.73

1.00

0.80 0.74 0.64

0.73

y = -0.0127x + 0.7896 y = -0.0698x + 0.992

0.00

0.20

0.40

0.60

0.80

1.00

1.20

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Diabetes: Disease Population Medicare Acute Re-admission Rate

40Normalized to RMMC for 2005

1.06

1.021.01

1.11

1.011.00

1.00

1.03 1.00

0.94

y = -0.0007x + 1.0423 y = -0.0125x + 1.0294

0.85

0.90

0.95

1.00

1.05

1.10

1.15

2005 2006 2007 2008 2009

Plan vs. RMMC

Plan RMMC Linear (Plan) Linear (RMMC)

Plan RMMC

Current Risk Scores: Medicare 5 years Continuously Diabetic & Under 80

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Source of SavingsMedicare

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Source of SavingsCommercial

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What Doctors Learn

• Population Management• QI processes• Working in teams and using tools• Result sharing• Helping patients change their health behaviors

RMMC Conclusions

• It is possible to change PCP behavior but it takes about a 10% reimbursement bump

• Multiple avenues of support improve results• The greater the degree of practice penetration

the better • Improved care of patients with chronic illness

lowers costs

Questions?