Pennsylvania Public Transportation Association 2017 Winter Meeting

Pennsylvania Public Transportation Association 2017 Winter Meeting Membership Breakfast January 13, 2017 State College, PA

Who We Are Highly integrated health plan and delivery system with an academic hub 20 hospitals More than 400 outpatient locations 35 cancer centers 3,400 employed physicians 450 million in NIH funding per year with University of Pittsburgh 2.9 million lives enrolled in a portfolio of insurance products 22% membership growth in past year 10,000 local employer groups International clinical operations and advisory services Ireland: hospital, cancer centers; Italy: hospital, research 2

Our Vision UPMC will lead the transformation of health care. The UPMC model will be nationally recognized for redefining health care by: Putting our patients, health plan members, employees, and community at the center of everything we do and creating a model that ensures that every patient gets the right care, in the right way, at the right time, every time. Harnessing our integrated capabilities to deliver both superb stateof-the-art care to our patients and high value to our stakeholders. Serving the underserved and disadvantaged, and advancing excellence and innovation throughout health care. 3

UPMC is Committed to Achieving Commonwealth's Goals Innovative community relationships GOAL 1: Enhance opportunities for communitybased living Track record of quality, including D-SNP GOAL 3: Enhance GOAL 2: quality and Strengthen coordination accountability of LTSS and other types GOAL 5: Increase efficiency and effectiveness of health care, including all Medicare and GOAL 4: Medicaid services for Advance program innovation dual eligibles History of integrated physical and behavioral health care and large, innovative D-SNP 4 Experience in value-based care Nationally recognized analytics and clinical innovator

UPMC Value Proposition Tenets of the UPMC Value Proposition: 1. 2. 3. 4. Transformation Integration Partnership Intelligence Integrated Delivery & Financing System D-SNP Platform Analytics Participant Community Collaboration Informatics Clinical Excellence 5

Integrated Delivery & Financing System – Principles central to approach, implementations far beyond UPMC UPMC’s Integrated Delivery and Finance System (IDFS) brings together payer-provider incentives to manage premiums and achieve value UPMC has rich experience across the LTSS continuum IDFS foundation for network capabilities and approach – Integrated provider and health plan partnerships – Partnerships with non-UPMC providers – Experience in coordinated care and Practice-Based Care Managers 6

Care Model Differentiators Leverage Expertise Coordinate Service Address Social Needs With Determinants Partners & UPMC Housing partnerships Unpaid caregiver support Core Team As a PA-based plan, we see DHS existing service coordination networks & experiences are assets & Integrated care model & opportunities Informatics SNP breath and depth of expertise enables integration Partners: Performance & value of long-term support Represent diversity of Integrated delivery & participants financing offers innovation in value-based care 7 Connect participants with existing community resources

UPMC Embraces the Elements of Person-Centered Care Care for the whole person Active listening Honoring choice Person-centered care focuses not just on treatment for the person’s illness or condition, but on: Person-centered care can mean slowing down enough to be present with the person for a few minutes Person-centered care takes into account and honors a person’s preferences for such things as: The person’s strengths, rather than their limitations The person’s interests— what’s important to them Activities that are truly meaningful to them Close and continuous contact with others (real relationships) The rewards of being interdependent, not dependent. Active listening means being attentive to what someone else is saying The goal of active listening is to understand the feelings and views of the person. When and what they eat When they want to sleep and bathe What they want to wear What they want to do with their time Their end of life (for example, to be hospitalized or not, or to receive treatment such as CPR, intubation, or a feeding tube) 8

CHC Brings New Challenges and Opportunities Many providers will be new to managed care - 9 UPMC is dedicated to working with providers to ensure a smooth transition Cultural shift at UPMC Better communication and data sharing will allow for effective and integrated services - Daily updates from direct care workers - Transitions between care settings - Cut through red tape! Keep what’s working and fix what isn’t - Strong community roots - Share best practices and lessons learned - Get back to Real Service Coordination

UPMC is a Leader in Technology and Innovation UPMC IT organization is an industry and technology leader UPMC Enterprises partners with UPMC Health Plan to incubate innovative commercial health care solutions IT Payer Applications team offers full suite of development, integration, and support solutions Intelligent analytics powers our population health solutions and care management teams 10 Most Wired list 18 consecutive years and “Most Wired Advanced” in 2016 Ranked in 2016 InformationWeek Elite 100 and won the Decade Award

What’s Next? Next Steps Looking Forward Prepare for CHC go-live Contract and build out HCBS network Streamline assessment, service plan creation, and service delivery processes Discover and scale best practices across the entire system Better integration of disparate care management platforms and participant data Daily care notes from direct care workers Risk-sharing or shared savings models that incentivize the use of HCBS to prevent inpatient and ER admissions, and maintain participants in the community 11

Conclusion – Success Through Transformation, Integration, & Partnership UPMC’s model brings: Transformation of how LTSS are delivered – Value-based incentives are new to LTSS and provider action and payment are not yet connected to medical outcomes Integration of social supports with medical care – Vision of IT accessible to every participant or direct care worker Partnership with providers and community organizations to address social barriers – Achieving integrated community living for our members will require wholeperson support and broadened access to housing, employment, and socialization All of which will supports participants in leading engaged lives fully integrated in their communities 12