Measuring Progress Toward Accountable Care

1. Measuring Progress Toward Accountable Care Aurora Health Care Readiness to Implementation Patrick Falvey, PhD Executive Vice President/ Chief Integration Officer Aurora Health Care Milwaukee, Wisconsin The Commonwealth Fund Webinar March 14, 2013

2. Aurora at a Glance • Private, not-for-profit integrated health care provider • 31 counties, 90 communities • 15 hospitals • 172 clinics sites • More than 1,500 employed physicians • Largest homecare organization in the state • More than 70 retail pharmacies • 30,000 caregivers • 94,000 inpatient discharges • 2 million outpatient visits • 4.1 million ambulatory care visits • Revenues greater than $4.2 billion

3. Focused Populations Aurora Caregivers and Beneficiaries • 50,000 Lives • 15 years of better-than-market performance • Top-tier quality performance Shared Savings ACO • CMS Model 1 Demonstration • About 10,000 Beneficiaries • Improved Quality and Efficiency Aurora Accountable Care Network • Commercial market ACO • Partnership with Aetna • Partnership with Anthem Medicaid Program • Medicaid OB pilot Care Redesign Pilots • Behavioral Health • Orthopedics • Nursing Home • Kenosha ACO

4. Transforming Towards Accountable Care Accountable care infrastructure Patient-centered continuum of care Care redesign tactics Communication & EHR Payer partnerships Network Interconnectivity Patient Populations Operational Efficiency Patient/Family engagement Health home Legal Clinical knowledge management Risk Assessment minimization Public policy Measurement Population benefits & data management

5. Factors That Differentiate Organizations with High ACO Readiness • Full or partial ownership of a health plan with population health management capabilities • Existing collaboration with other health systems in the community • Existing risk-based contracts with payers including bundled payments • A sophisticated EHR and HIE implementation strategy across the continuum of care • Clinical integration across the continuum of care • Patient-centered medical home with employed or community providers • Positive relationships with primary care and specialty care providers in the market • Active governance structures that include physician leadership (e.g. PHOs)

6. Positive Physician Relationships • Accountable Care/Care Redesign Medical Group Leadership • Care Redesign Around Primary Care, Clinical Integration, Smart Chart, Clinical Programs, and Redesign Pilots • Patient-Centered Medical Home • Physician Compensation Collaborative

7. Factors Likely to Become Differentiators in More Mature Models • Active governance structures that include physician leadership (e.g. PHOs) • An EHR and HIE implementation strategy across the continuum of care • Physician leadership development programs or culture barriers • Payers that are initiating innovative risk-based relationships

8. Organizational Relationships • Smart Chart Implementation to Transformation • ACO Governance • Administrators and Physician Leadership Development • Medical Group Leadership Council • Payer–Provider Role Definition

9. Population Health Analytics • Quality and Efficiency Metrics • Registries—Leverage EHR • Clinical and Financial Analytics • Patient Risk Models, ETGs

10. Moving Forward • Accountable Care Infrastructure • Care Redesign Tactics • Network Development • Payer Partnership • Analytics