QuadMedInnovations in Population Health Management – Delivered On-site

Raymond Zastrow, M.D.Chief Medical OfficerQuadMed LLCWest Allis, Wisconsin

We provide innovative, high-value health care solutions to companies, improving the overall

health and productivity of their people.

QuadMed Clinic Locations

MillerCoors Brewing• Primary Care

• Fitness Center

• Occupational Med

• Rehab

Briggs & StrattonHealth Center• Primary Care• Fitness Center• Occupational Med• Rehab

Northwestern MutualHealth Centers (2)•Primary Care•Occupational Med

Briggs & StrattonHealth CenterPoplar Bluff, MO• Primary Care• Rehab

QG Lomira, WI• Primary Care• EAP, AODA• Rehab • Fitness Center• Dental• Vision

QGWest Allis, WI• Primary Care• ENT

• Orthopedics

• Cardiology

• Occupational Medicine• EAP, AODA

• Rehab • Fitness Center

• Dental

• Vision Care

QG Sussex, WI• Primary Care• Surgery• EAP, AODA• Rehab • Fitness Center

QG Saratoga Springs, NY• Primary Care• EAP, AODA• Rehab • Fitness Center

QG Martinsburg, WV• Occupational Med• Primary Care• EAP / AODA• Fitness• Rehab

QuadMed Model• Onsite Employer-directed Primary

Care• Organized as PCMH• Self-funded / Self-administered• Value-based Benefit Design• Our Strategic Directives: Triple Aim /

Lean• Not Presently Serving Medicare /

Medicaid Populations

Care Improvement• Population Health Management

– From a Primary Care Platform

• Proactive – Across the Care Continuum– Incentivized Wellness– Coaching / Behavior Modification– Chronic Condition Management– Complex Case Management

Communications and Change Management

Integration across the Continuum

Inte

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Population Health Management delivered from a Primary Care Platform

Population Care Continuum

Preventative Care

Short Term Acute

ChronicGood Health

Complex Catastrophic

Fitness Centers

HRA

Wellness Programming

Chronic Condition Management

High Performance Network

Case Management

Patient Centered Primary Care (platform for managing population health )

Lifestyle Coaching

Cost Reduction• Specialty Care• Hospital Inpatient• Pharmaceutical • Emergency Department• Diagnostic Imaging

QuadMed Track Record

Average healthcare cost per employee

0123456789101112

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

$ Thousands

Midwest Quad/Graphics

Average Cost Trend 1999-2008: 5.6%

Regional Collaboration• WI Collaborative HC Quality• WI Health Information

Organization• WI Health Information Exchange

– ED Linking Project

• PCMH (WAFP, Jackson Clinic)• IHI Triple Aim (Bellin)• Lean (Theda)

Accountable Community Partnerships• Value-based Contracting

– Terrific Whitepaper at CHVI site– http://www.vbhealth.org/wp-content/uploads/CHV_OBC-Cover_Text_REV8-30-10c.pdf

• Narrow, High-Performance Networks– Service Level Agreements

• QuadMed External to QG– Cost-Plus Contracting– Performance Guarantees

• Future: Risk-adjusted PMPM?

Payer

Providers

Risk-Adjusted PMPM Fee-For-Service

Pay for Performance

ACO RVUs Coding Accuracy Chart Completion

Schedule Efficiency EBM Patient SatisfactionSalary +

Current Challenges• Integration of Worldcolor into Quad

– Fighting for Transparency• e.g. Pharmacy Benefit Design

– Extending the QuadMed Model to multiple smaller legacy WC sites

• Consumer Health IT• Telemedicine

• Paying More for Care Under ACA– Understanding Ramifications of

Exchanges heading into 2014

Collaboration With CMMI• QuadMed has developed a healthcare

enterprise that has been successful in controlling cost and improving quality of care for Quad/Graphics and other employers with a focus on:– Accountable / Empowered Primary Care– Wellness and Prevention– Practice of Evidence Based Medicine– Outcomes-based Contracting

• QuadMed features are applicable to healthcare systems in general and can be successfully implemented at other large organizations with similar results.

Contact Information

Raymond J. Zastrow, M.D.

Chief Medical Officer / QuadMed

raymond.zastrow@quad-med.com

414-566-8057

Innovations in Health Care Delivery

Bruce Nash, M.D., M.B.A.Capital District Physicians’ Health Plan Senior VP, Chief Medical OfficerAlbany, NY

Who We Are•Not-for-profit network model health plan

•Physician-founded and guided for 27 years

•350,000+ members in 29 counties in upstate New York

•Top-ranked plan nationally for Commercial, Medicare Advantage and Managed Medicaid products

Practice Reform

Payment Reform

CDPHP Pilot

Patient Centered Medical Home Practices - Total Cost of Care Commercial Product Performance in Pilot and Core-4 CountiesYTD Third Quarter 2009 Compared to YTD Third Quarter 2008

n = member-months

$199.13 $202.59

$223.16 $219.04

$0.00

$50.00

$100.00

$150.00

$200.00

$250.00

$300.00

Core 4 Pilot

Co

st o

f C

are

Allo

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Do

llars

PM

PM

3Q YTD 2008 3Q YTD 2009

n = 1,220,189n = 1,286,065 n = 80,955 n = 77,726

Trend = + 12.07% Trend = + 8.12%