Presenter

1. Bon Secours Virginia Medical Group’s JourneyBon Secours Health System’s Foundation for ACOsJune 6, 2013Payment and Delivery Reform PanelVirginia Chamber Health Care Conference

2. Presenter • Tom Auer, MD, MHA • CEO, Bon Secours Virginia Medical Group • Contact Information: thomas_auer@bshsi.org • Cell Phone: 804-572-0557 • I have no real or apparent disclosures to report

3. Bon Secours means Good Help The Sisters of Bon Secours went to great lengths to meet the needs of their patients…among the first to go into patients’ homes to provide round the clock nursing care. The Sisters were innovators, guided by an unwavering commitment to their patients - a commitment we continue today.

4. Basic Delivery System is NOT WORKING • Physicians are not happy – particularly PCPs • Physician Workforce cannot keep up with Access • Patients are not happy and not insured or underinsured • Employers cannot continue to afford healthcare and compete in a global economy • Fee-for-Service incentivizing volume not value

5. Healthcare Reform Requires Change • We Know that We Have a Challenge • We Know that There are Some Success Stories • We Now Need to Push For the Changes That Work • Physician Leadership is Critical

6. It is a New World

7. Bon Secours Virginia Medical Group Transforming our care in order to transform the lives of our patients and the health of our communities.

8. BSVMG Journey • Electrify – Connect Care • Grow- Strategically • Re-engineer – PCMH • Connect – My Chart • Coordinate – Nurse Navigation, Geriatric MH • Proactive – Registries • Clinical Innovation – Hi Tech and Hi Touch • Medical Group Culture - Synchronization • Advanced Payment Models – ACOs • Healthcare Without Walls – Returning to our Roots

9. Bon Secours Medical Group Virginia • 460 Provider Multi-Specialty Group • 100+ locations • 45% PCP/55% Specialists • 65% Richmond/35% Hampton Roads • Experienced Medical Group Support Team • Dyad Leadership Model • Very Active Clinical Councils and Sub-Committees

11. TODAY’S CARE MEDICAL HOME CARE My patients are those who make appointments to see me Our patients are those who are registered in our medical home Patients’ chief complaints or reasons for visit determines care We systematically assess all our patients’ health needs to plan care Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it Acute care is delivered in the next available appointment and walk-ins Acute care is delivered by open access and non-visit contacts It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients 11 *Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

12. Patient-Centered Medical Home • PCMH – Proactive Approach to Care • PCMH – Building Blocks for an ACO • PCMH – Philosophy of Care – Team Based • PCMH – Grounded in Evidenced Based Medicine • PCMH – Requires Nurse Navigators focused on Population Health • PCMH – Expanded Capacity and Reduced Unnecessary Care • PCMH – The Right Care, at the Right Time, for the Right Reasons • This is VERY Different than what we do today

13. NCQA PCMH • US 32,976 • NY 6,331 • VA 671 • PA 2,307 • NC 2,364 • TX 1,428 • WI 939 • CO 747 • IL 384 • MD 457

14. Advanced PCMH Outcomes Inpatient Discharges Readmissions High-end Imaging ED Visits Quality/Clinical Outcomes

15. Facility Buffering Vectors Aging Population Obesity Hi-Tech Market Share Appropriate Admissions Managed Care Contracting

16. One Of Our Experiences • One Payer – One Year • 9000 attributed patients • $1.2 million in savings • $10 pmpm savings compared to market • 35% reduction in readmissions

17. Bon Secours Virginia Employee Wellness Model of Care 13 Physical Activity Tobacco Cessation: Quitline or Freshstart in person class  Weight Management: Referral into weight loss program based on BMI • Communication • Web-based information • Targeted messaging and emails reminders of prevention screenings and disease prevention • Weekly wellness tips and Bimonthly Good Life Newsletter • Incentive Program • Complete the PHA and Wellness plan • Complete all age related recommended screenings. Examples: Physical with PCP, Annual Mammogram (or baseline for women 35-40) and Pap for women or Prostate Exam and PSA for men • Complete Self-care workshop and complete personal health record for future visits to PCP Physical Activity If you are Diabetic and/or Hypertension, Physical assessment and group training sessions available over a 3 month period then a reevaluation. Physical Activity If you are Diabetic and/or Hypertension, Group exercise classes made available • Same as low risk plus • Communication • Invitational letter from EWS mailed to home with a follow up phone call from CENVANET to those who have not responded. • Incentive Program • If Diabetic, Hypertensive, Asthma or Back (Ortho) complete 6 coaching sessions with CENVAT for disease and medication management or enroll into disease management program such as DTC or Cardiac Wellness. • Other high risk employees not identified in the 4 groups above will work with the nurse navigator • Same as low risk plus • Communication • Quarterly tailored messages, email and home mailing on specific risks such as hypertension. • Incentive Program • Group Coaching (Healthy Weigh, Compass to the Good Life) • Complete 1-2 coaching Sessions either in person or telephonic • Complete 2 Healthstream/Webinars based on wellness goals SeIf-Care/Health Care Consumerism

18. Advanced Payment Models • Managed Care Contracting: • Cigna • Humana • Conventry • Aetna • Optima* • Anthem • United* • MSSP • *Negotiations ongoing

19. Medicare Shared Saving Program • 25,000 Medicare patients in Va. • Shared savings for CMS • 33 quality metrics • Create a new delivery platform • Partnering with Aetna

20. Our New Frontier and Mantra Healthcare Without Walls

21. Building an ACO Patient Activation Patient & Family • Personal Health Record • Patient Portal • Health Risk Assessment • Patient Engagement & Activation

22. Advanced Primary Care Advanced Primary Care Under Patient-Centered Medical Home • Prevention & Wellness • Point of Care Analytics & Clinical Decision Support • Gaps in Care • Population Management & Chronic Care Registries • Home Visiting Teams • Generic Prescribing • Program • Embedded Nurse Navigation • Cost Effective Medical Management & Utilization of Services (SCP, Ancillary) • Access, Same Day Appointments, e-Visits • Patient Satisfaction & Loyalty • Provider & Office Staff Satisfaction Patient & Family • Personal Health Record • Patient Portal • Health Risk Assessment • Patient Engagement & Activation

23. New Health System Coordination Medical Group & Health Care System Enterprise Level Activities • PCP/SCP Incentives & Clinical Guidelines • Pay for Performance Initiatives and Outcomes Measurements • Hospitalists, Post Discharge Follow-Up Programs • ER Avoidance Programs • Urgent Care • End of Life (Palliative Care) • Patient Satisfaction & Loyalty • Care management (Acute, Chronic, Inpatient, SNF) • Health Coaching (Shared Decision Making) • Transition of Care • Provider Satisfaction • Behavioral & Mental Health Advanced Primary Care Under Patient-Centered Medical Home • Prevention & Wellness • Point of Care Analytics & Clinical Decision Support • Gaps in Care • Population Management & Chronic Care Registries • Home Visiting Teams • Generic Prescribing • Program • Embedded Nurse Navigators • Cost Effective Medical Management & Utilization of Services (SCP, Ancillary) • Access, Same Day Appointments, e-Visits • Patient Satisfaction & Loyalty • Provider & Office Staff Satisfaction Patient & Family • Personal Health Record • Patient Portal • Health Risk Assessment • Patient Engagement & Activation

24. Payment Mechanism Maturing ACOs Accountable Care Organization • Medical Groups & • Health Care System • Enterprise Level Activities • PC-MH Functions • Hospitals • Service Line Integration • Medical Staff Alignment • Incentives for Efficiency & Lean Six Sigma • Quality (SCIP, Leap Frog) • Safety • Skilled Nursing Facilities • SNFists • On-site Case Management • Efficiency Rating Systems “Preferred Facilities” • Outcomes & Evidence Based Medicine • Call Coverage • Consult Services (Stroke, STEMI) Medical Group & Health Care System Enterprise Level Activities • Ancillary Services • Free-Standing ASC & Diagnostic Testing Centers • ER Avoidance Programs • Urgent Care • End of Life (Palliative Care) • Patient Satisfaction & Loyalty • PCP/SCP Incentives & Clinical Guidelines • Pay for Performance Initiatives and Outcomes Measurements • Hospitalists, Post Discharge Follow-Up Programs • Home Care • Home Safety Visits • Post Discharge Visits • Home Health Coordinator of Services • DME • Integration & Oversight with Care Management • Transition of Care • Provider Satisfaction • Behavioral & Mental Health • Care management (Acute, Chronic, Inpatient, SNF) • Health Coaching (Shared Decision Making) Advanced Primary Care Under Patient-Centered Medical Home • Hospice • Transitions (CHF, COPD, Frailty Syndrome, Dementia) • Prevention & Wellness • Point of Care Analytics & Clinical Decision Support • Gaps in Care • Population Management & Chronic Care Registries • Home Visiting Teams • Generic Prescribing • Program • Cost Effective Medical Management & Utilization of Services (SCP, Ancillary) • Access, Same Day Appointments, e-Visits • Patient Satisfaction & Loyalty • Provider & Office Staff Satisfaction Patient & Family • Personal Health Record • Patient Portal • Health Risk Assessment • Patient Engagement & Activation