Anatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization

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1 Anatomy of an ACO Through the Eyes of a Physician-owned IPA

2 Genesis: IPA by the Numbers 1,400 Physicians PCPs SCPs 700 Practices 400 Square miles in North Texas

3 Genesis: Challenges for Change Pressure from hospitals, health systems and payers Threatened and disengaged physicians Mediocre patient quality and cost management Excessive IT expense and inefficiency Falling Fee For Service Payments & Consolidating markets

4 Genesis: ACO by the Numbers 3 Contracts MSSP, 1.0 MA & 1.0 Commercial 22,000 Patient Lives 395 Physicians in ACO 215 PCPs 400 Square miles in North Texas A Joint Venture Management Services Organization

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11 Genesis: Initial ACO Contracting , FIRST contract - CMS Medicare Shared Savings Program (MSSP) 12,000 patients , Next contracts - Commercial Payers 2015, 2 Commercial ACO contracts 10,000 additional patients Care Coordination Fees (PMPM) Shared Savings Full Risk Contract

12 Genesis: Initial ACO Focus 1. Improving Preventive Services Delivery/Documentation 2. Coordinating Care across the continuum Transitional Care Chronic Disease Management with High-Risk Patients Evidence-based care delivery 3. Improving Physician-Patient Engagement

13 Genesis: Physician Shared Savings Distribution Principles 1. Physicians with Attributed Lives receive higher proportion of Shared Savings payments Should not have a physician w/o lives getting a higher payment than physician with lives 2. Physician Shared Savings payments should be based on some combination of: Patient volume Quality score Engagement/Participation in clinical integration

14 Genesis: Initial Physician Distribution Plan for Shared Savings GAPN Generated Savings CMS Shared Savings Retained Funds (50%) GAPN Shared Savings Payment (50%)* * Adjusted by quality score if <90% GAPN Pool (66%) Physician Payment Pool (34%) Base Payments (20%) ALL MSSP Physicians Bonus Payments (80%) Only Physicians with Attributed Lives

15 MSSP Contract - GAPN 2014/2015 Cost & Utilization Trend* Benchmark = $11,164 $12,000 Total Expenditures 2014/2015 $10,000 $8,000 $6,000 $4,000 $2,000 $0 Q1 Q2 Q3 Q4 Q GAPN $11,332 $10,773 $10,511 $10,373 $10,713 All MSSP ACO'S $9,863 $9,830 $9,840 $9,929 $10,035 National FFS $9,332 $9,273 $9,278 $9,339 $9,527 GAPN All MSSP ACO'S National FFS *Data Reported by CMS for GAPN s 2014 Performance Trend for 16,000 Medicare patients *Data Reported by CMS for GAPN s 2015 Performance Trend for 12,000 Medicare patients

16 MSSP Contract - GAPN 2014/2015 Cost & Utilization Trend* Emergency Department visits/1000 person - years 2014/ Q1 Q2 Q3 Q4 Q GAPN All MSSP ACO'S National FFS GAPN All MSSP ACO'S National FFS *Data Reported by CMS for GAPN s 2014 Performance Trend for 16,000 Medicare patients *Data Reported by CMS for GAPN s 2015 Performance Trend for 12,000 Medicare patients

17 MSSP Contract - GAPN 2014/2015 Inpatient Utilization Trend* Inpatient, Total/ Assigned Beneficiary $4,000 $3,500 $3,000 $2,500 $2,000 Q1 Q2 Q3 Q4 Q GAPN $3,615 $3,223 $3,112 $3,136 3,193 All MSSP ACO'S $3,208 $3,151 $3,116 $3,167 3,244 National FFS $3,075 $3,021 $2,990 $3,055 3,128 GAPN All MSSP ACO'S National FFS *Data Reported by CMS for GAPN s 2014 Performance Trend for 16,000 Medicare patients *Data Reported by CMS for GAPN s 2015 Performance Trend for 12,000 Medicare patients

18 MSSP Contract - GAPN 2014/2015 Inpatient Utilization Trend* 30 - Day All- Cause Readmissions/1000 discharges Q1 Q2 Q3 Q4 Q GAPN All MSSP ACO'S National FFS GAPN All MSSP ACO'S National FFS *Data Reported by CMS for GAPN s 2014 Performance Trend for 16,000 Medicare patients *Data Reported by CMS for GAPN s 2015 Performance Trend for 12,000 Medicare patients

19 $1,500 MSSP Contract - GAPN 2014/2015 Post-Acute Utilization Trend* Home Health/Assigned Beneficiary $1,300 $1,100 $900 $700 $500 $300 Q1 Q2 Q3 Q4 Q GAPN $1,313 $1,224 $1,154 $1,096 $1,193 All MSSP ACO'S $523 $505 $511 $499 $501 National FFS $574 $566 $563 $553 $563 GAPN All MSSP ACO'S National FFS *Data Reported by CMS for GAPN s 2014 Performance Trend for 16,000 Medicare patients *Data Reported by CMS for GAPN s 2015 Performance Trend for 12,000 Medicare patients

20 MSSP Contract- GAPN 2014/2015 Post-Acute Utilization Trend* Skilled Nursing Facility/Assigned Beneficiary $1,200 $1,000 $800 $600 $400 $200 $0 Q1 Q2 Q3 Q4 Q GAPN $1,004 $916 $856 $751 $750 All MSSP ACO'S $708 $723 $721 $706 $743 National FFS $813 $817 $820 $816 $832 GAPN All MSSP ACO'S National FFS *Data Reported by CMS for GAPN s 2014 Performance Trend for 16,000 Medicare patients *Data Reported by CMS for GAPN s 2015 Performance Trend for 12,000 Medicare patients

21 GAPN Quality Score Comparison COLORECTAL CANCER SCREENING 100% 80% 60% 50% 65% 65% 60% 73.62% 78.13% 40% 20% 0% MA Plan # 1 MA Plan # 2 MSSP GPG SCORE TARGET 56

22 GAPN Quality Score Comparison DIABETES: HbA1C < 8% 100% 80% 60% 62% 84% 86% 46% 78.53% 63.50% 40% 20% 0% MA Plan # 1 MA Plan # 2 MSSP GPG SCORE TARGET 57

23 Summary 1. IPAs are moving into the ACO business to provide physicians with choices 2. Independent Physicians must lean in to transformation of practices - CMORE 3. Clinical integration will enable physicians to be more successful in future contracting 4. Finding partners to assist with Data Analytics and Reporting is a key first step 5. Distribution of Financial Rewards must easy to explain and understand

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