Dr. Anne Docimo, Chief Medical Officer, UPMC Health Plan. Presentation at 2011 National Healthcare Conference in Dublin

1. Improving Healthcare: Payer-Provider Collaboration Anne Boland Docimo, MD, MBA

3. 5th in NIH funding, affiliated University of Pittsburgh

4. $8.0 billion in Annual Revenue

5. 50,000Employees

6. 2,700 employed physicians and 2,500 affiliated physicians

7. 21 hospitals and 43 regional cancer centers

8. 400+ service locations; home care; rehab, urgent care

9. 1.5million members in Insurance Division programs

10. 20,000+ contracted network providers

11. Global and Commercial Enterprise (UK; Italy)

12. $1 billion+/five years investment in technology 2

13. Vision of UPMC UPMC will create a new economic future for western Pennsylvania — a future built on new ways of thinking about health care and sparked by leveraging the uniqueness of the integrated health enterprise. By exporting excellence nationally and internationally, and fueling the development of new businesses that emerge from UPMC’s intellectual capital, core capabilities, and management expertise, UPMC will catalyze a regional economic renaissance. At the same time, UPMC will remain steadfastly committed to providing premier health care services to our region and contributing to this community. 3

14. UPMC Organizational Structure International and Commercial Services Hospital and Community Services Insurance Services Physician Services 4

15. UPMC named to 2010 U.S. News & World Report Honor Roll as one of “America’s Best Hospitals” for the 11th time Ranked in 15 of 16 clinical specialties; in the top 10 in seven of them UPMC Insurance Companies highly ranked with NCQA “Excellence” status Our Record of Success 5

16. Goal of Accountable Care: Improve Value Population Health Patient Centered Care Per Capita Costs Experience of Care Good Science Public Health Orientation Meaningful Information The Right Incentives Seamless Systems of Care Outcomes Based Care Healthy Communities Payment Aligned With Value Smart Systems Patient Centered Best in Class Administrative Infrastructure 6

17. Standard Claims Mapping: Clinical/Financial Integration Financial and clinical integration Financial and quality modeling Standard reporting Governmental Employer Provider contracting Intervention design Member benefit design 7

18. Identifying Health Conditions by Data Source 8

19. 75% of Healthcare Costs Driven by Chronic Disease 9 Medicare Key Chronic Conditions Prevalence and PMPM Hypertension CAD Arthritis Diabetes Neoplasm CHF

20. Escalating Costs Population Health 10

21. Medicare HMO CY 2009 Distribution of Healthcare Expenses by Membership 11 5% members = 40% costs

22. Approaches Coordinated care teams Population Management Supportive care Patient-Centered Medical Home Readmission/transitionprograms Inpatient manager/Hospitalist 12

23. Evidenced Based Guidelines Inpatient Manager Transitional Approach Traditional UM Accountable Care Discharge Advocate + Ongoing Coordination with Care Team 13

24. Payer-Provider Collaboration Create Value: Accountable Care Organization Evidence-based Clinical Pathways Right care, Right time, Right setting, Right price Common outcome metrics define value Process measures: Following pathway Clinical outcomes: Quality and Safety Utilization of Resources Admissions, Length of stay, Readmissions Diagnostics, Specialty Care, Pharmaceuticals Financial Outcomes 14

25. Partners in Excellence – Patient Centered Medical Home Transitional approach to utilization management Project RED – transitions program Wound Care – Telemedicine Anticoagulation – multidisciplinary Heart Failure – multidisciplinary Doula Maternity Connected Care Going Home Program Pharmacy quality initiatives Member engagement strategy Payer-Provider Collaboration: Seamless Systems of Care 15

27. Provided Disease Registries; Predictive Modeling and Patient Risk Profiles

29. Rate of Rehospitalization within 30 Days Source: NEJM, April 2009, S. Jencks. 18

30. Shared Goals Improve quality of care Decrease readmission rates Decrease adverse events after discharge Increase follow-up activity with the PCPs and specialists Elements of Complete Transition Home Medication reconciliation Compare discharge plan against national guidelines and clinical pathways Schedule follow-up appointments Review post discharge instructions Provider written discharge plan After Hospital Care Plan Symptom Response Plan Patient Education Discharge Summary to the PCP 19 Improving Care Transitions

34. vital sign trends

35. major tests and procedures

36. safety risks

37. vaccines and immunizations

38. tests results not available at time of DC (for follow-up)

39. communication process to access the hospital/unit and provider UPMC Safe Hand-Off 21 My UPMC Safe Discharge Reports include:

40. UPMC Safe Discharge Hand-Off Skilled Facilities Sharing the clinical information with downstream providers Rehabilitation Creating tools for safe hand-off communication during care transitions Engaging the patient in the process with enhancements for self-management Home Health Post-DC Office Visit 22

41. UPMC Safe Discharge Hand-Off Outcomes Implemented October 2010 % of physicians who agreed or strongly agreed 80 Report was timely to follow-up on DC needs % of Safe Hand-Off Reports Transmitted to PCPs Content assisted with transition of care 55 33,715 Delivery method was suitable for work flow 75 The # of Safe Discharge Reports Transmitted 23

42. MC: 30 Day Any DRG Readmission Rate Trend 24

43. All LOB: 30 Day Any DRG Readmission Rate Trend 25

45. Is this a related readmission?

47. No PCP or specialist visit since last hospitalization

48. Complication related to original stay

49. Unrelated causes

50. Discharge planning

51. Care giver support

52. Unable to determine

53. Could this admission have been avoided with alternate care plan?

54. Did patient receive discharge instructions?26

55. Collaborative Care Plans 27 Patients with complex needs require comprehensive, coordination of care: Frequent use of ED services Frequent hospital admissions Use of multiple hospitals Seeing multiple physicians Non-compliance with care in outpatient setting Patients with known narcotic seeking behavior Complex psychosocial issues Patients in top 5% use 40% of resources

56. Care Plan Committee 28 Identify key individuals to participate: Patient’s Clinical Care Team Primary Care Provider Key Specialists relevant to patient’s clinical needs Hospital Care Management (RN and SW) Behavioral Health Liaison Chronic Pain Service UPMC Health Plan Care Management Team

57. Creation of Care Plans 29 Template for Care Plans Emergency Department: Text-page/ email alerts to clinical and CM team on registration Worklist alert in HealthPlaNET Care Management system Clinical care plan, discharge care plan, follow-up instructions Hospital Care Establish criteria for admission Admission team: Consistent Care givers: hospitalist team, key specialists Compliance to clinical treatment plan, medications, behavior Transition to Community Caregivers /Outpatient Care Management Communication: Care Plan in e-record, CM system updated on each admission and as needed

58. Collaborative Care Plan Results of FY2010 compared to FY2009 for patients in Collaborative Care Plan Pilot: Number of ED visits  7% Number of hospital admissions 40% Number of outpatient visits  17% 30 Total Cost of Care  24%

59. Complex Care Plan Case Study:Chronic Pain Patient 31

60. Pharmacy Programs Drug therapy optimization Intelligent Formulary Design Promote safe, appropriate drug use Evidence-based algorithms Promote generic utilization Medication therapy management Provider partnerships Pharmacist as virtual team member Combine algorithms with real life clinical practice Pharmacy Initiatives 32

61. Provider Partnership Strategy: Rx for Success 33

62. Generic Fill Rates 34 66.2% 74% 68.7% 62.8% 79.3% 72.9% 68.4% 76.7% 73.8% 63.9% 67.7%

63. Clinical Management of Oxycontin Improving Quality and Cost - Oxycontin vs. Opana Medicaid Utilization 2008 Total Prescriptions OXYCONTIN OPANA IR OPANA ER Nearly $1 million in annual savings and 16% walk aways 1000 900 800 700 600 500 400 300 200 100 0 JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC 2008 35

64. Clinical Management of Designer Narcotics Improving Quality and Cost A narcotic painkiller that looks like a lollipop -- designed for quick pain relief to cancer patients. Narcotic painkiller Actiq, is ONLY FDA-approved for use in treating cancer pain. The Wall Street Journal published these findings in 2006: Oncologists accounted for only 1 percent of the 187,076 Actiq prescriptions in the first 6 months of 2006. More than 80% of patients receiving Actiq had no cancer diagnosis. Two children died after confusing the drug for candy. UPMC Health Plan has always required clinical approval of Actiq based on FDA label in order to ensure safe, on-label use and mitigate abuse potential. 2010 UPMC HP: 18 members out of 535,000 lives = 0.0034% of total population. Other designer narcotics with potential for abuse are also clinically managed include: Avinza, Kadian and Magnacet

65. Specialty Drug Cost Drivers - More Drugs, More Uses, More Patients Exploding pipeline - Oncology dominates Currently half of all new drug approvals are specialty drugs Expanding uses for existing products Orals changing the landscape – becoming maintenance therapy Management requires Evidence Based Guidelines developed with Clinical Experts. Over 633 Biologics In Development 37

66. Move to Accountable Care Create Value Defined by common metrics across payer-provider tracking clinical and financial outcomes Position of strength moving forward: Build sustainable programs that will deliver quality and use resources efficiently. What next? 38

67. “Prediction is very hard” “Especially about the future.” Yogi Berra Source: Susan Dentzer, Editor-in-Chief, Health Affairs at theGrand Rounds, Department of Orthopedics, University of Pittsburgh Medical Center, October 21, 2009. 39

68. Thank You 40