Patient Centered Medical Home: Bon Secours Health System’s Foundation for ACOs June 7, 2012 Aligned 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.

Volume 2011 Vitals 2011 Financials 2011 Acute Care 9 hospitals Inpatient Beds 1,500 licensed Employed Physicians 400 Providers Total Medical Staff 3,000 Total Employees 12,200 Emergency 380,000 visits Discharges 77,000 Surgeries 92,000 Vitals 2011 HCAHPS Inpatient 68th percentile CMS Appropriateness 94 %compliance Employee Engagement 89th percentile Turnover 13% employee Financials 2011 Net Patient Revenue $1.9 billion Operating Income $95.0 million Margin from Operations 5.1% EBIDTA 10.0% 4

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

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 Inpatient Discharges Readmissions High-end Imaging ED Visits Quality/Clinical Outcomes

Facility Buffering Vectors 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

Our New Frontier and Mantra Healthcare Without Walls

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

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

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

Maturing ACOs Payment Mechanism 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) Ancillary Services Free-Standing ASC & Diagnostic Testing Centers 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 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