Patient Centered Medical Home:

Bon Secours Health System’s Foundation for ACOs

June 7, 2012Aligned Incentives Panel

Virginia Health Care conference

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

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.

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Volume 2011 Acute Care 9 hospitalsInpatient Beds 1,500 licensedEmployed Physicians 400 ProvidersTotal Medical Staff 3,000 Total Employees 12,200 Emergency 380,000 visitsDischarges 77,000Surgeries 92,000

Vitals 2011HCAHPS Inpatient 68th percentileCMS Appropriateness 94 %complianceEmployee Engagement 89th percentileTurnover 13% employee

Financials 2011Net Patient Revenue $1.9 billionOperating Income $95.0 millionMargin from Operations 5.1%EBIDTA 10.0%

It is a New World

Bon Secours Virginia Medical Group

Transforming our care in order to transform the lives of our patients and the health of our communities.

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

Bon Secours Medical Group Virginia

• 400 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

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

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

Acute care is delivered in the next available appointment and walk-ins

Acute care is delivered by open access and non-visit contacts

*Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

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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 – 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

NCQA PCMH

• US 21,183• NY 5,497• VA 240• PA 1867• NC 1615• TX 950• WI 939• CO 747• IL 384• MD 457

Advanced PCMH Outcomes

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Inpatient Discharges

Readmissions

High-end Imaging

ED Visits

Quality/Clinical Outcomes

Facility Buffering Vectors

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Aging Population

Obesity

Hi-Tech

Market Share

Appropriate Admissions

Managed Care Contracting

Advanced Payment Models

Managed Care Contracting:• Cigna• Humana• Conventry• Aetna*• Optima*• Anthem*• United**Negotiations ongoing

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Our New Frontier and Mantra

Healthcare Without Walls

Patient & Family• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement & Activation

Building an ACO Patient Activation

Advanced Primary Care

Patient & Family

Advanced Primary CareUnder Patient-Centered Medical Home

• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement &

Activation

•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

New Health System Coordination

Patient & Family

Advanced Primary CareUnder Patient-Centered Medical Home

Medical Group & Health Care SystemEnterprise 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

• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement &

Activation

• 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

• Care management (Acute, Chronic, Inpatient, SNF)

• Health Coaching (Shared Decision Making)

• Transition of Care• Provider Satisfaction• Behavioral & Mental

Health

Patient & Family

Advanced Primary CareUnder Patient-Centered Medical Home

Medical Group & Health Care SystemEnterprise Level Activities

Accountable Care OrganizationHospitals• Service Line Integration• Medical Staff Alignment• Incentives for Efficiency & Lean Six Sigma• Quality (SCIP, Leap Frog)• Safety

Medical Groups &Health Care System• Enterprise Level Activities• PC-MH FunctionsSkilled Nursing Facilities

• SNFists• On-site Case Management• Efficiency Rating Systems

“Preferred Facilities”

Ancillary Services• Free-Standing ASC &

Diagnostic Testing Centers

Home Care• Home Safety Visits• Post Discharge Visits• Home Health

Coordinator of Services

Hospice• Transitions

(CHF, COPD, Frailty Syndrome, Dementia)

• PCP/SCP Incentives & Clinical Guidelines• Pay for Performance Initiatives and Outcomes

Measurements• Hospitalists, Post Discharge Follow-Up Programs

DME• Integration &

Oversight with Care Management

• Outcomes & Evidence Based Medicine

• Call Coverage• Consult Services (Stroke,

STEMI)

• ER Avoidance Programs• Urgent Care• End of Life (Palliative Care)• Patient Satisfaction & Loyalty

• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement &

Activation

• 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

• Care management (Acute, Chronic, Inpatient, SNF)

• Health Coaching (Shared Decision Making)

• Transition of Care• Provider Satisfaction• Behavioral & Mental Health

Maturing ACOs Payment Mechanism