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I N T E G R A T E D C A R E O R G A N I Z A T I O N

Best Outcome for Every Patient, Every Time

Agenda

• Today’s changing healthcare environment• Positioning IHS for success• The ICO’s role in the IHS ACO• Organizational structure of the ICO• ICO strategy

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The Catalyst

• Patient Protection and Affordable Care Act (“health reform”)While important, health reform has acted as a

catalyst, bringing to the forefront issues we knew existed

With or without reform, the world as we know it will change

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Ty p i ca l Re l ati o n sh i p Between th e Govern ment an d P hys i c i an s

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The Real Issues

• What we can all agree onCosts for patients and employers increasingFederal and State Budget deficits immenseLack of affordable access to careIncreasing regulatory burdensDecreasing reimbursement for hospitals and

physicians

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The Real Issues

• Patients are frustratedHigh costFragmentationLack of coordination and collaborationQuality not commensurate with cost

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The Real Issues

• Physicians are frustratedDeclining reimbursementIncreasing regulatory burdensLack of coordinationVolume driven patient care“Being a physician isn’t what it used to be…”

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Insanity?

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A New Day

• Value will be rewarded over volume• Physicians and other clinicians will be able to

serve their patients • Hospitals, physicians and other providers will

be rewarded for managing the overall health of our communities

• Patients will receive coordinated and collaborative health care…not fragmentation

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Integrated Care Organizati on

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Positi oning for Success

• Physicians and hospitals are better off working togetherCollaborate on initiatives that make both clinical

and financial sensePreparation will require a well-organized, capable

provider network with supportive infrastructure for population management

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Potenti al Payment Arrangements

Increasing Risk

Value-Based PaymentFee for Service

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IHS Overview• Formed in December 1994• 15 hospitals and 800+ employed physicians practicing in more

than 76 Iowa and Illinois communities• 2,600+ affiliated physicians• $2.6 billion total operating revenue• 22,200+ employees• 4 Colleges of Nursing• 2.5 million patient visits annually• Mission: Improve the health of the people and communities

we serve• Vision: Best outcome for every patient every time

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Physician Alignment

Create Value

Demonstrate Value

Value-Based Contracting

IHS Road Map

ACO Model

Performance Incentives for Physicians &

Hospitals

Performance Incentives for Physicians &

HospitalsTota

l cos

t of c

are

for d

efine

d po

pula

tion

$MM

Projected cost based on medical inflation trends

Actual costs based on ACO and Medical Home

collaboration

Actual costs based on ACO and Medical Home

collaboration

2007 2008 2009 2010 2011 2012 2013 2014 2015

$ - SAVINGS FOR EMPLOYER/PAYOR$ - SAVINGS FOR

EMPLOYER/PAYOR

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Populati on Management

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ICO Vision and Identi tyIHS Integrated Care Organization

About Us

The Integrated Care Organization (ICO) is our clinical integration platform for employed and independent physicians to work together to improve quality of care, enhance the patient experience and create more value in health care

Vision Statement

Best Outcome for Every Patient, Every Time

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ICO Defi ned

• The ICO is a tax-exempt, nonprofit organization• Designed by independent and employed

physicians with multi-specialty group leaders from around the system

• Physicians intricately involved in governance and operations of the ICO

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ICO Regional Overview

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ICO LeadershipAlan Kaplan, MD

Network President

Nate ThompsonDir. of Physician Services

Dave Williams, MDICO Medical Director

Gina RossICO Director of Operations

Lisa KlobnakAdmin. Assistant

Angela RubinoNet. Dev. / Fin. Analyst

Tim McCulleyContracting

Amber LenhardtFinance

Ashley AthertonACO/ICO Communications

Ewa HumphreyClinical Integration Mgr.

IHS Legal Dept.Legal Counsel

Kathy CunninghamExec. Dir. ACO Strategies

Joe WaltersAnalytics Manager

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ICO Governance Structure

Operating Committee

Board of Directors

Quality Committee

Future ICO Committees

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ICO Governance• Majority of Board must be “non-insiders” • Delegated authority to Operating Committee

Board Member Background

Dan Allen, MD Employed; Internal Medicine; Des Moines

Steve Herwig, DO Independent; Otolaryngology; Des Moines

Jon Peacock, MD Independent; Cardiology; Sioux City

Mark Baldwin* CEO, Iowa Laser Technology; Cedar Falls

Pryce Boeye* Real Estate Executive; Quad Cities

Rose Mitchell* Sr. Vice President, Hy-Vee; Des Moines

John Perkins* Attorney; Fort Dodge*Community Board Member

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ICO Governance • Operating Committee

16 physician & 5 non-physician members Responsible for leading the operations of the ICO Gregory Johnson, MD, Chair (Peoria)

• Quality Committee 9 physician & 3 non-physician members Reports to the Operating Committee Responsible for development of the ICO Quality

Program Ron Iverson, MD, Chair (Dubuque)

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ICO Operati ng Committ eeExpandable as Required

PC-I = Primary care independent; PC-E = Primary care employedSpec-I = Specialist Independent; Spec-E = Specialist employed

Non-Phys = Medical group leaders, IHS Chief Medical Officer & IHS Chief Financial Officer

Region PC - I PC - E Spec - I Spec - E Non-Phys Total

Corporate Kaplan/Vermeer 2

Des Moines Dr. Chase Dr. Reece Ed Brown 3

Cedar Rapids Dr. Bell Dr. Langager 2

Quad Cities Dr. Kane Dr. Constantinou 2

Dubuque Dr. LiaboeDr. Nelson Mike Stoll 3

Waterloo Dr. Berstler Dr. Sundaram 2

Fort Dodge Dr. Wallace Dr. Adams 2

Sioux City Dr. Remer Dr. Stewart Shanin Harding 3

Peoria Dr. Jongerius Dr. Johnson 2

Total 5 4 3 4 5 21

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ICO Quality Committ eeExpandable as Required

PC-I = Primary care independent; PC-E = Primary care employedSpec-I = Specialist Independent; Spec-E = Specialist employed

Region PC - I PC - E Spec - I Spec - E Non-Physician Total

Corporate Dr. Williams Gina Ross 2

Des Moines Dr. Schulte Wendt, Sander 3

Cedar Rapids Dr. Hodge 1

Quad Cities Dr. Raman 1

Dubuque Dr. Iverson 1

Waterloo Dr. Sampat 1

Fort Dodge Dr. Smith 1

Sioux City Dr. Brenner 1

Peoria Dr. Johnson 1

Total 1 4 3 1 3 12

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ICO Strategy• Establish a clinically integrated network across IHS

Align independent and employed physicians on a common quality improvement platform

Pursue value-based contracts that reward performance on quality metrics which are meaningful to physicians, patients, families and our communities (i.e. shared savings)

Assist ICO physicians with the changing healthcare environment where quality, patient experience and value are recognized

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ICO Engine

• Chronic Disease AnalyticsCreate disease registryAid in the management of chronically ill patientsEnhance physician-to-physician communicationProvide outcome measuresProvide actionable information to support

management of patient populations

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ICO Engine

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ICO Initi ati ves• Build system-wide primary care network

aligned on common set of metrics for 2012• Reward achievement of quality targets with

incentive dollarsIHS Self Funded Health PlanACO Shared Savings agreement with WellmarkRestructured Wellmark Pay for Performance

programsMedicare Shared Savings Program

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Phases of Physician Engagement• Phase One: System wide network of primary

care physicians• Phase Two: Core specialty physicians required

for care of complex, chronically ill patientsCardiologyGastroenterologyEndocrinology

• Phase Three: Full spectrum of physicians

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2012 Proposed ICO Metrics• Quality Program Measures

Chronic Care Management (Claims Data) Office visits within 30 days of hospital discharge 3 or more annual office visits for chronically ill

Primary Prevention (Claims Data) Mammography Colonoscopy Pediatric well visits

• Thresholds based on historical performance

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Financial Drivers for Shared Savings

• Shared savings driven by:Avoidable ER visitsAvoidable admissionsReduction in pharmaceutical costsReduction in duplicative ancillary tests/proceduresEvidence based care guides

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Timeline• January 1, 2012

Engage primary care physicians

• April 1, 2012IHS Self Funded Health PlanWellmark ACO Shared SavingsModified QIS ProgramEngage core specialty physicians

• July 1, 2012Engage full spectrum of physiciansMedicare Shared Savings Program

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Ideal State

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Summary• The ICO is the physician-driven quality improvement

platform within the IHS ACO• The ICO will create and demonstrate value through

physician collaboration around the “triple aim”: Improve quality outcomes Enhance patient experience Decrease overall cost of care

• ICO physicians will be positioned for long-term stability and success, regardless of what happens with healthcare reform

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