2018 Annual Report

Introduction

Denis McDonald, Executive Director

Mary Anderson MD, Medical Director

2018 Summary

2018 was a very good year for PCA. We performed well on our health plan contracts in

terms of both quality and cost. This enabled us to distribute health plan incentives to

participating groups. We added Physicians of Southwest Washington and two health plan

contracts – United (10/1/18) and Regence (1/1/19). We also expanded the IBM platform to

include more data and increased its capabilities by adding the Watson Care Manager

module. We used our improved data and analytics capabilities to provide supplemental

data and prove that our quality performance was higher than initial health plan reports.

However, the year was not without challenges. We unfortunately lost Edmonds Family

Medicine at the end of 2018 due to their acquisition by Virginia Mason. We also struggled

with delayed contracting and prolonged settlement processes with health plans.

2019 is an important year for PCA. We need to grow in terms of participating groups and

covered lives. We recently completed an analysis of opportunities to expand (new groups,

provider types, regions and services) and we’ll aggressively pursue opportunities

throughout 2019. We must also continue to demonstrate our ability to improve quality,

control costs and take care of patients.

Thank you for your continued participation in and outside PCA committees and we look

forward to building on our success in 2019.

- Denis and Mary

Quality Performance Summary

Improved in 5 of 10 measures:

Achieved the goal for three measures

Came within 5% of achieving five additional measures

Realized improvements across all practice organizations

Measure Description 2018 Goal

2018Performance

BMI Determination - Adult 95% 96%

Breast Cancer Screening 75% 70%

Cervical Cancer Screening 68% 57%

Colorectal Cancer Screening 65% 70%

Childhood Immunization Status 40% 18%

Blood Pressure Control 69% 67%

DM: Eye Exam 35% 28%

DM: HbA1c Control 65% 62%

DM: Medical Attention for Nephropathy 88% 88%

DM: Statin Therapy 75% 79%

Appropriate Testing for Children w/Pharyngitis 82% Not Available

BMI Determination - Pediatrics 90% Not Available

Financial Performance Summary

Solid performance across all payers

High performance in Aetna across all programs

Cigna missed market trend as new groups were added

• PCA identified and escalated data discrepancies yielding additional shared savings

Financial Distributions

Distributed almost $600k to provider organizations to-date

Distributions in 2018 were based on organization size; 2019 distributions will be based on quality

Health Plan DistributionAetna $194kCigna $183kPremera $203kTotal $580k

Budget Review

Phased-in functionality of IBM resulted in a positive variance

Aggressive plans to hire and continue to implement IBM in 2019 to support substantial revenue growth targets

Final capital contribution completed

On track to achieve profitability in 2020

The PCA Network

Gained a strong new partner with PSW

Realized significant impacts due to market consolidation

Physicians of Southwest Washington joined PCA at the beginning of 2018, bringing in three family medicine practices

NPN was purchased by DaVita and is no longer participating

Edmonds Family Medicine was purchased by Virginia Mason and is no longer participating

Woodcreek Healthcare was purchased by Mary Bridge Childrens and is no longer participating

The Polyclinic entered into a strategic partnership with OptumCare, who supports the clinic’s continued participation in PCA

With the support of Physicians Insurance, PCA began building out a menu of services to provide to non-participating groups such as rural hospitals

Health Plan Contracting

Achieved major milestones with the addition of United and Regence value-based contracts

Successfully renegotiated contracts with Aetna and Premera

Signed a revised contract with Premera effective 7/1/2018 which expanded our patient population to include self-insured groups

Signed a revised contract with Aetna effective 1/1/2019 with favorable terms

Signed a new contract with United HealthCare effective 10/1/2018

Signed a new contract with Regence effective 1/1/2019

The addition of the United and Regence contracts and expansion of the Premera covered lives has potential to greatly expand the shared savings pool beginning in 2019

Premera Aetna Cigna United Regence

14,119 14,092 5,106 9,330 6,912

Covered Lives:

Population Health Platform – IBM Watson Health

IBM Watson Health EPM • Clinical & Claims Data• Utilization Measures• Foundation Measures

Watson Care Manager• Transition of Care • Complex and Chronic

Care Management

Next Steps• 2019 HEDIS Measures• Provider Dashboards• Tableau Dashboards

Population Health Platform Reporting and Dashboards

New provider dashboards

Network leakage reports and visualizations

Other reports under development

Practice TransformationCase Study #1:

Patient Focused Campaign:Diabetes Mellitus

August 2018

Why WWMG chose this project: Opportunity to extend recalls to contact a specific patient population to get

recommended follow-up care Improve patient outcomes

Goal of campaign: Improve the care of diabetic patients (population health) Improve performance of practices in closing diabetes related care gaps

Methodology: Email campaign to patients with outstanding care gaps related to

preventative diabetes care as identified in the population health platform

Results: 1,298 emails sent via Phytel Population Health Platform 73% of the sent emails were received by patients 65% of those patients seen or have a future appointment

Next steps: Monitoring response to campaign and diabetic care gap reports

Practice TransformationCase Study #2:

BMI, diabetic measures, and medication management

Why PSW chose this project: It supports two strategic initiatives: 1) create an opportunity for independent

providers to collaborate on new models of care and 2) leverage current quality reporting efforts across a commercial population

Goal of campaign: Improve preventive care and management of chronic disease

Methodology: Working with Physician Care Alliance to understand required quality measures,

supporting algorithms and evidence-based data, PSW’s team created alignment with its own provider and patient goals

Created a campaign to highlight and improve performance on three main measures: BMI, diabetic measures and medication management to include medication reconciliation

Created materials to support provider education on how to effectively engage patients, such as intensive behavioral therapy for obesity, and to ensure provider visits met the coding and billing requirements

Results: All providers now better understand how to document and engage their patients

in meaningful preventive care Standout example was a provider who improved their BMI quality measure from

9.4% in 2017 to 57.1% in the third quarter

Next steps: Continue to monitor for additional improvement opportunities

Practice TransformationCase Study #3:

DiabeticRetinopathy Screening

Why SFM chose this project: Team noted the need for a referral or second appointment was a barrier to

patients completing the diabetic retinopathy screening

Goal of campaign: Decrease the barriers to identifying and preventing retinopathy in SFM

patients with DM

Methodology: Implemented retinal image camera in primary care clinics Trained care team staff to capture image prior to patient leaving the clinic Image transmitted to and read by local ophthalmologist Results updated in EMR and provided to provider and patient

Results: 6% increase in percent of SFM DM patients with Retinopathy screening in

calendar year 2018 11% increase for SFM provider champion 12% increase for pilot clinic

Next steps: Spreading engagement to additional SFM providers and clinics

Practice TransformationCase Study #4:

Diabetic Retinopathy Screening

Q4 2018

Why TPC chose this project: Annual Diabetic Retinopathy screening is a significant performance opportunity

for Polyclinic with current performance of 28% based on clinical data

Goal of campaign: Increase numbers of Polyclinic patients with diabetes with completed annual

retinopathy screening Develop a standard workflow for referrals and documenting annual retinopathy

screenings

Methodology: Capture best practice from high performing clinics and teams Create new workflow using best practice PDSA workflow in primary care and endocrinology clinics

Results: Project in process

Next steps: Assess results related to number of diabetic eye exams captured in the

Polyclinic electronic health record Assess results related to in-house referrals to ophthalmology Identify additional diabetes best practice workflows to implement organization

wide

Closing

Thank you again for your participation in PCA. Please let us know if you have any questions about this report, PCA’s goals for 2019 or your participation. We value your input and engagement and want to keep the lines of communication open.

Here’s to a great 2019!

Denis McDonald Kim ClementsSenior Vice President for The Polyclinic Manager Population HealthDenis.McDonald@polyclinic.com Kim.Clements@polyclinic.com

Mary Anderson, MD David JohanssonChief Clinical Integration and Quality Officer Manager Analytics and Decision SupportMary.Anderson@polyclinic.com David.Johansson@polyclinic.com

Gena Tadych Sarah MiltonDirector of Quality and Practice Transformation Provider and Payer Relations ManagerGena.Tadych@polyclinic.com Sarah.Milton@polyclinic.com

Jeff Wright Michelle KarlssonDirector of Care Management Project CoordinatorJeff.Wright@polyclinic.om Michelle.Karlsson@polyclinic.com