C O N F I D E N T I A L PLEASE DO NOT DISTRIBUTE

2014 NECoMG ANNUAL MEETING

AGENDA

WELCOME – Dr. Ezzi

Nominating Committee Report – Dr. DiLillo

Northeast PHO Overview– Nicole DeVita

Strategic Vision – Dr. Ezzi

Election Results – Dr. DiLillo

Nominating Committee Report: Dr. DiLillo

Nominating Committee members: Louis DiLillo, M.D. (Chairperson), Daniel McCullough M.D., Curtis Ersing, M.D.

Nominees

• Class P/PCPs: Two Open Seats

• Pierre Ezzi, M.D. (Incumbent)

• John Malolepszy, M.D. (Incumbent)

• Class S/SCPs: One Open Seat

• Steven Hollis, M.D. (Incumbent)

• Robert Cipolle, M.D.

Physician Hospital Organization

PHO

Organizations

NEPHO (Northeast Physician Hospital Organization)

Northeast Health System

50% Owner

NECoMG

(New England Community

Medical Group)

50% Owner

Northeast PHO Board of Directors

Pierre Ezzi, M.D., President

Gary Marlow, Treasurer

Louis Di Lillo, M.D., Secretary

Suzanne F. Graves, M.D. , Director

Steven C. Hollis, M.D., Director

Francis X. Cleary, M.D., Director

Peter Short, M.D., Director

Denis Conroy, Director

Phil Cormier, Director

William Medwid, M.D., Director

New England Community Medical Group, Inc. Board of Directors

Pierre A. Ezzi, M.D., President

Steven C. Hollis, M.D., Treasurer

Suzanne F. Graves, M.D., Secretary

Stephen A. Barrand, M.D.

Louis Di Lillo, M.D

Erin Heiskell, M.D.

John Malolepszy, M.D.

William Medwid, M.D.

NEPHO BOARD OF DIRECTORS

ORGANIZATION CHART

Executive Director, Nicole DeVita

Director,Transitional & Ambulatory Care Management

(Pat Noonan, RN, MBA, CCM, CH-GCN)

Administrative Assistant

(Cheryl Clocher)

Care Manager

(Ken King, RN)

Care Manager

(Diane Hannify Broughton, RN, BS, CCM, CH-GCN)

Geriatric Social Worker

(Jessica Webb, MSW, LCSW)

Care Manager

(Amy Gibbs, RN, BSN, CH-GCN)

Care Manager

(Karen Richard, RN, BSN, CCM)

Care Manager

(Audrey Fraser, RN. BSN, CCM, CH-GCN)

Care Manager

(Patty Drozdowicz, RN, BSN, CCM, CH-GCN)

Managed Care Pharmacy Coordinator

(Carol Freedman, RPh)

Quality Analyst

(Jennifer Andersen)

Director, Clinical Director, Ambulatory Performance Improvement (Liz Isaac, PharmD)

Medical Director, Leslie J. Sebba, MD

Director of Contracting & Operations

(Stacey Keough)

Manager, Provider Relations

(Ann Cabral)

Executive Assistant

(Lisa Driscoll)

Office Clerk

(Krista Jones)

Referral Coordinator

(Michelle Costanza)

Provider Relations/Credentials

(Lisa Enderle)

Referral Coordinator

(Jean Servizio)

Data Entry Specialist

(Open)

Financial Analyst

(Maureen Von Zweck)

Sr. Business Analyst

(Brian Doucette)

Healthcare Analyst

(John Manyiel)

Administrative Secretary II

(Judith O’Leary)

Project Manager

(Ellen Kenyon)

Care Manager

(Susan Wambolt, RN, CDE)

Funding Sources

36%

32%

32%

Health Plans

NECoMG

Hospital

Shareholders and Service Fees

All physicians are credentialed as Shareholders

Shareholders must purchase 1 share • ($2,000: NECoMG will buy back share when

the physician leaves the organization)

NECoMG Service Fee for 2014: $900

Physician Membership: May 2014

Total: 307

• PCPs:63

• SCPs:244

5 IM PCPs expected to join by August

1 Pediatrician will be joining in July

2 Pediatricians will be joining in January

5-6K additional covered lives expected

Contracting Medical Management

Administration/ Provider Relations

Data/Analytics Program Development

• Health Plans • Providers • Reinsurance • Vendors

• Case Management

• Quality Improvement • HPHC

Honor Roll

• Clinical Pharmacist

• Performance Improvement Projects – DVT, Breast MRI

• Referral Management

• Appeals • Audits • Surplus

Distribution • Accounting • HPHC Grant • NP/PA Meetings • Office Staff

Meetings

• Data Warehouse

• Opportunity Reporting

• MD Score Cards • EMR Extracts

• Patient Centered Medical Home

• Accountable Care Organization

PHO Services

Negotiated Contracts

COMMERCIAL

• TAHP

• HPHC

• Fallon

• HMO Blue

MEDICARE

• Tufts Medicare Preferred

• ACO

OTHER

• NETWORK HEALTH

• BOSTON MED CTR/HEATLH NET

• CELTICARE

PHO Risk Contracting Performance

WH

Return

Budgeted Efficiency

Quality

Total Return

PMPM Savings

2010 100% $2,080,051 $5,887,407 $7,967,458 $15.55

2011 100% $2,597,141 $6,273,163 $8,870,304 $18.72

2012 100% $5,787,793 $6,410,815 $12,198,608 $28.38

2013 Projected

100% $4,269,409 $4,927,267 $9,196,676 $21.99

TOTAL $14,734,394 $23,498,652 $38,233,046

PHO Investment 2010 – 2013 :$3,848,166 PLEASE NOTE THIS DOES NOT INCLUDE INCREASED FEE SCHEDULES

Rates “ Big 3”

BCBS

• 125% of Statewide/158% of Medicare

HPHC

• 146% of Statewide/175% of Medicare

Tufts

• 170% of Statewide/190% of Medicare

Please note these rates do not include Surplus Dollars

AQC Quality Performance

2010 = 3.5

2011 = 4.0

2012 = 4.2*

Projected 2013 = 4.4

* Highest Gate Score of AQC Groups in 2012

Management Service Organization (MSO)

MSO

Lahey Medical Center & Community Group Practices

NHC NECoMG

LAHEY HEALTH SYSTEMS

NEPHO LAHEY Accountable Care Unit

NEW RISK UNIT MSO / ACO

LAHEY CLINICAL PERFORMANCE LCPN

Confidential Do Not Distribute

Contracting Medical Management

Administration/ Provider Relations

Data/Analytics Program Development

• Health Plans • Providers • Reinsurance • Vendors

• Case Management

• Quality Improvement • HPHC

Honor Roll

• Clinical Pharmacist

• Performance Improvement Projects – DVT, Breast MRI

• Operations & Oversight

• Referral Management

• Appeals • Audits • Surplus

Distribution • Accounting • HPHC Grant • NP/PA Meetings • Office Staff

Meetings

• Data Warehouse

• Opportunity Reporting

• MD Score Cards • EMR Extracts

• Patient Centered Medical Home

• Accountable Care Organization

PHO/LCPN Services

Collaboration Offers:

MSO PHO

• Economies of Scale

• Increased Covered Lives

• Protection from downside risk

• Stronger Negotiations

• Clinical Integration

Tufts Health Plan 2013

NEPHO projecting a $542K deficit

Lahey ACU projecting a $916K surplus

LCPN projecting a $364K surplus

Tufts Share is 50%

LCPN projected surplus is$182K

Based on LCPN Funds Flow NEPHO would receive 100% WH return and an $ 88K surplus

Lahey ACU would receive a $75K surplus

NEPHO Strategic Planning

Overview

Health Care Market Landscape is Changing

The merger with Lahey was a by-product of the economic climate in health care

Consolidation of hospitals/systems continues to occur across Massachusetts and the Country

There is also a shift from private practice to employment by physicians

Success of the NEPHO will be dependent upon developing a strategic plan that will allow us to be “steady at the helm” and

respond to the above changes.

Role of the PHO

“Back to Basics” Best in Class Performance

• Make sure all PHO participants are performing at the highest level possible

• Refined data/analytics opportunity reporting

• Targeted performance improvement program

• Redefine physician incentive program for CY 2015

• Work with LACU leadership to implement physician incentives

Contracting

• Strong Representation on LCPN Board & Committees to help drive contract strategy

• Strategy includes:

• Determining minimum reimbursement required for financial success of our practices

• Select contracts that are consistent in terms/measures/risk

• Expansion of contracts to include PPO and other Exchange insurers

Role of the PHO Maintain/Grow Covered Lives

• Meet with Lahey Health leadership to agree upon a geographic strategy for all ACUs

• Move to include the Beverly, Danvers, Hamilton and Ipswich CGP practices to the PHO

• Guarantees for NMP to remain in the PHO

• Expand the number of contracts the PHO currently takes to include more exchange insurers and PPO where appropriate

• Attract new PCPs

• Improvement to the PHO website

Leadership Development

• Specialty Council

• “PHO” course development/training

• Increased exposure and participation of Board Members

• Potential Term Limits for Board of Directors

Role of the PHO Mixed Medical Management/Performance Improvement Model

• Potential for slightly different approach models for private and employed physician practices

• Private Practice • More hands on from the PHO

• Employed Practice

• Work more closely with practice leadership and “hand off” some medical management/performance improvement activities

Results