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James Dougherty, M.D.

Being Accountable for Healthcare Delivery in Central Ohio. James Dougherty, M.D. Thomas D. Thompson, M.B.A. Chief Medical Officer. Vice President, Business Development and CFO. The Medical Group of Ohio (MGO). Demographics. Physicians by County. Physicians 2,036

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James Dougherty, M.D.

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  1. Being Accountable for Healthcare Delivery in Central Ohio James Dougherty, M.D. Thomas D. Thompson, M.B.A. Chief Medical Officer Vice President, Business Development and CFO

  2. The Medical Group of Ohio (MGO) Demographics Physicians by County • Physicians2,036 • Groups 631 • 56% Solo Practitioners • 22% Group of 2-3 Physicians • 16% Group of 4-9 Physicians • 6% Group of 10 or more Physicians • Primary Care 693 (34%) • Specialists 1,343 (66%) Growth 2003-2010

  3. The Medical Group of Ohio (MGO) Structure • Independent, Physician Owned and Governed Company • Mission “Improve the Process of Delivering Health Care and Enhance the Professional Satisfaction of its Members” • > 150 Physicians Engaged in Leadership Roles Services • MGO Contracting, NCQA Certified Credentialing • MGO PR Billing, Group Purchasing, Practice Support Services • PLPP Professional Liability Insurance

  4. OhioHealth Hospitals Not-for-Profit, Faith Based Health System Mission – “Improve the health of those we serve” Eight Hospitals Riverside Methodist Hospital Grant Medical Center Doctors Hospital Dublin Methodist Hospital Grady Memorial Hospital Marion General Hospital Hardin Memorial Hospital Doctors Hospital-Nelsonville 20+ Ambulatory Sites including home care and long-term care $ 2.1 billion Operating Revenue 15,000 Associates Cleveland Columbus Cincinnati Core Region Referral 4

  5. Our Market Population and Growth Patterns 5

  6. Physicians Physicians by Specialty, Central Ohio Source: State Medical Board of Ohio; Note that physician location can be defined by physician’s county of residence, not necessarily their practice location.

  7. Health Plans Major Health Insurers, Central Ohio Source: Columbus Business Journal; OhioHealth

  8. Physician Hospital Organization The Health4 (Clinically Integrated) Network + = OhioHealth Group-Products and Services

  9. The Journey

  10. The OhioHealth Pilot… Goals and Process Collected Data 2008 - Implemented a pilot pay for quality (P4Q) program with OhioHealth’s health plan Developed Attribution Logic Developed Clinical Guidelines and Metrics Established Baseline Performance Created / Distributed Actionable Reports to Physicians

  11. OhioHealth Pilot Results 2008

  12. OhioHealth Pilot Results 2008

  13. OhioHealth Medical Plan – Financial Impact Claims Cost Per Associate $450 $16M Reduction $375 Total Cost Per Associate Initiation of OhioHealthy Program Cost Per Member / Per Month

  14. The Journey

  15. Health4 Directions Group Health4 Directions Group Work Groups MANAGED CARE CONTRACTING LEGAL OHIOHEALTH PILOT PROGRAM OPERATIONS & TACTICS ACCOUNTABLE CARE ORGANIZATION INFORMATION TECHNOLOGY PERFORMANCE AND OUTCOMES COMMUNICATIONS

  16. Health4 – The New Requirements A committed, stable, comprehensive network Required engagement of physicians Requiredin-network coordinated care Required use of point-of-care technology Infrastructure to provide performance feedback

  17. Covered Lives More Payer Contracts and Lives 150,000 OhioHealthy Aetna Cigna MMO 100,000 OhioHealthy Aetna Cigna 80,000 OhioHealthy Aetna 20,000 OhioHealthy 2008 2009 2010 2011 Future

  18. Health4 – Aetna and Medical Mutual of Ohio • Fee Schedule • P4Q • Gain Share • Vs. Payer Trend • Vs. Cost of Other Networks • Discussions with major employers underway

  19. Financial Rewards More Payer Contracts and Rewards $8M OhioHealthy Aetna Cigna MMO Actual Potential $5M OhioHealthy Aetna Cigna $4.2M OhioHealthy Aetna $220,000 OhioHealthy

  20. Clinical Integration Summary

  21. Proper infrastructure is important • Provides equal representation between the “P” and the “H” • Engages wider spectrum of key resources • Enhances stakeholder involvement and interest • CI is complex and stakes are too high to overlook issues • No single way of provider communication is optimal. A variety of ways need to be used • Reliance on payer data is a short term strategy for information • Success (P4Q) breeds more interest, less patience • Not every group will want to join immediately What We Learned

  22. The pace and priorities of the partners vary and can be a challenge to manage The sooner you can get physicians to talk about value (cost) in the same sentence, the better “Best Practice Model” resonates with physicians “ACO” and “bundled payments” get physician’s attention but clinical integration provides the flexibility to pursue Learning to manage as if you are under risk is not a bad thing because you probably will be soon What We Learned. . . Continued

  23. Health4 Strategic Priorities 2011-2013 Network serves needs of both owners and purchasers Measurable cost efficiencies Valence implementation/ usage/ expansion Health4 achieves commercial success Majority of commercial patients cared for by Health4 network Population and disease management programs ACO Status Implement comprehensive communication and education plans

  24. Measurably Improving the Quality and Value of Healthcare, and Being Accountable for Our Results The NETWORK OF EXCELLENCE and

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