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

1. Patient Centered Medical Home:Bon Secours Health System’s Foundation for ACOsJune 7, 2012Aligned Incentives PanelVirginia 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. Volume 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 68thpercentile CMS Appropriateness 94 %compliance Employee Engagement 89thpercentile Turnover 13% employee Financials 2011 Net Patient Revenue $1.9 billion Operating Income $95.0 million Margin from Operations 5.1% EBIDTA 10.0%

5. It is a New World

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

7. 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

8. 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

9. 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

10. 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

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

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

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

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

15. Our New Frontier and Mantra Healthcare Without Walls

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

17. 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

18. 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

19. 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