Continuum Provider Partners IPA Formation and Clinical Integration

1. Continuum Provider Partners IPA Formation and Clinical Integration July 2012

2. Continuum Provider Partners IPA Purpose Continuum Health Partners, Inc. (“CHP”), - Beth Israel Medical Center, St. Luke’s Hospital, Roosevelt Hospital, and New York Eye and Ear Infirmary – in collaboration with its voluntary and employed providers, is establishing a clinically integrated network to address the future of health care delivery. Through the establishment of this network by means of an independent practice association, the IPA will improve the quality and efficiency of care provided to our communities and offer meaningful value to payers.

3. Continuum Health Partners Goals for IPA Formation Goal • To achieve a high-performing, seamless system of care across the IPA network in partnership with payers and other providers. Why? • To improve performance on the key dimensions of quality, cost and patient and provider satisfaction. • To prepare for the emerging healthcare environment: • Value-based purchasing (pay for performance, shared savings) • Bundled payments • Financial penalties for avoidable care • Formation of accountable care organizations (“ACOs”). • To strengthen our ability to attract patients.

4. Steering Committee Members

5. Clinical Integration Definition “An active and ongoing program to evaluate and modify the clinical practice patterns of the physician participants so as to create a high degree of interdependence and collaboration among the physicians to control costs and ensure quality.”* • Components of Clinical Integration • Mechanisms to monitor utilization, control costs, and assure quality of care. • Population health management across the continuum of care. • Use of common IT to ensure exchange of all relevant patient data. • Development and adoption of clinical protocols. • Care review based on and adherence to implemented protocols. • *FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, #8.B.1 (1996)

6. What the FTC looks for (No Cookie-cutter Approach) • Components of CI • Mechanisms to monitor utilization, control costs, and assure quality of care. • Selectivity of physician participants. • Significant investment of monetary and human capital.* • Use of common IT to ensure exchange of all relevant patient data. • Development and adoption of clinical protocols. • Care review based on the implementation of protocols. • Mechanisms to ensure adherence to protocols.** • FTC Tests for CI • Is the CI “real”: authentic initiatives actually undertaken? • Are the initiatives of the program designed to achieve improvements in healthcare quality and efficiency? • Is joint contracting with fee-for-service plans “reasonably necessary” to achieve the efficiencies of the CI program?** • *FTC/DOJ Statements of Antitrust Enforcement Policy in Health Care, #8.B.1 (1996) • **FTC/DOJ, Improving Health Care: A Dose of Competition Ch. 2, p.37 (July 2004)

7. Messenger Model For Managed Care Organizations Participation Overview • While clinical integration is under development, IPA may serve as messenger for voluntary physicians. • As messenger, IPA may coordinate and analyze information and communicate with payers on behalf of individual voluntary physicians, but it cannot negotiate on behalf of them or make recommendations about participation. • IPA must communicate with each voluntary physician individually about acceptable contract terms, including fees.

8. Messenger Model For Managed Care Organizations Participation Overview • Each voluntary physician must make his or her own independent and unilateral decision whether to accept a contract. • Competitively sensitive information, which includes but is not limited to rates, obtained by IPA as messenger is confidential and cannot be shared with other physicians, even with those acting in their capacity as IPA officers and directors. • IPA’s directors, officers, and members cannot query IPA’s staff, officially or unofficially, about IPA’s contracting activities as messenger, except whether the activity has commenced, is in progress, or has concluded. • Each voluntary physician and payer retains the right to contract with one another without IPA participating as a messenger.

9. Provider Participation Eligible Providers Physicians, podiatrists, dentists, behavioral health professionals, hospitals, ambulatory surgery centers, diagnostic and treatment centers, FQHCs, and other ancillary providers. Qualifications • Licensed/Certified/Registered providers or accredited facilities. • Member of the medical staff (in any capacity) of at least one CHP member hospital. • Board certified in declared primary specialty (unless waived by IPA’s credentialing committee). Process • Complete and sign IPA application. • Review and sign Provider Participation Agreement. • Pay annual membership dues. • Be credentialed by the IPA.

10. How to Join • Beginning in July, CHP will send electronic and hard copy mailings of an introduction package to potential provider participants. • The application and provider participation agreement will be included. • A central communication line will be staffed to provide additional information and to answer any questions providers have. • A website is being established to facilitate online enrollment in the IPA; additional details and links to the website will be announced in July. • Providers will complete the documentation either online (preferred) or in hard copy and mail it back to the IPA. https://sharepoint.thecamdengroup.com/Clients/Continuum_Health_Partners/Steering_Committee_Materials/Camden_CHP_IPA_CI_LongFormPresentation_6_19_2012.pptx

11. IPA Key Facts and Milestones IPA established as an LLC and approved by NYS: August 2012. Initial provider enrollment period: July to September 2012. IPA operable for messenger model contracting: September 2012. IPA operable for clinical integration contracting: 2013. Initial membership dues: $250 per year. Continuum Health Partners Hospitals provide initial capitalization. Balance of physician and hospital leadership on Board of Managers.