Sheryl L. Garland, M.H.A. Vice President, Community Outreach VCU Health System June 23, 2010

1. Sheryl L. Garland, M.H.A. Vice President, Community Outreach VCU Health System June 23, 2010

2. VCU Health System Overview VCU Health System - the clinical delivery component of the VCU Medical Center Only academic medical center in Central Virginia Referral center for the state and Mid-Atlantic 32,500 admissions and 500,000 outpatient visits MCV Hospitals Teaching hospital of the VCU Health System 779 licensed beds 20% share of the Richmond inpatient market 80,000 patients are treated annually in the hospital�s emergency department, which is the region's only Level I Trauma Center MCV Physicians 566-physician, faculty group practice University Health Services Virginia Premier Health Plan 140,000 member Medicaid Health Plan

4. Virginia�s Indigent Care Program Established in the late 1970�s to provide coverage to the uninsured and underinsured Virginia�s Medicaid program only covers those who are pregnant, under 18, aged, blind or disabled Indigent Care Program marries federal Disproportionate Share Hospital (DSH) dollars and State General funds Eligibility criteria: - Reside in the Commonwealth - U.S. Citizen - At or below 200% FPL - Meet asset test criteria

5. VCU Health System�s Payer Mix - FY09

6. VCU Health System Indigent Care Distribution

7. VCUHS PCP Partnership Journey

8. Virginia Coordinated Care for the Uninsured (VCC) Fall of 2000, the Virginia Coordinated Care for the Uninsured (VCC) program was launched Program applied managed care principles to the Commonwealth�s Indigent Care program Primary objective is to coordinate health care services for a subset of the patients who qualify for the Commonwealth�s Indigent Care program Target population is uninsured in the Greater Richmond and Tri-Cities areas who qualify for the Indigent Care program

9. VCC Program Goals Establish access to a community-based medical home Utilize managed care principles to effectively manage the care of a population Educate patients regarding how to access health care services Improve the quality and reduce costs of care for a defined population

10. VCC Program Highlights Utilize existing Indigent Care program financial screening process to initiate enrollment Virginia Premier Health Plan - serves as third party administrator for the program (TPA) Patients assigned to �medical homes� provided by community PCP�s (including FQHC�s and Free Clinics) 50 community physicians (33 practices) participate in the program Providers receive fee-for-service payment + a monthly management fee Outreach Workers in the VCUHS Emergency Department assist with patient navigation and RN Case Managers assist PCP�s with chronic disease management

15. VCC Today Anticipate enrollment will be close to 24,000 by the end of FY10 Continue to expand partnership with Community Physician Practices and Safety Net Providers Provide access to VCUHS electronic records in practice sites Developing quality indicators to monitor Community partnerships are driving costs down (primary care visits dropped from $180 to $90/visit) Program is reducing utilization of services �Bridge� to Health Care Reform; Model for population who will transition into Medicaid and Health Insurance Exchanges in 2014

16. Sustainability Issues Since 2000, VCUHS has provided over $22 million to fund services for Indigent/VCC patients cared for in community settings Due to federal regulations, Indigent Care dollars received by VCUHS cannot be applied towards reimbursement to community partners Funding for the VCC program comes from reimbursement VCUHS receives from commercial payers Increasing costs of the program and growth in number of uninsured have prompted VCUHS to apply for an 1115 waiver to utilize Medicaid DSH funds to cover reimbursement for community provider services

17. Lessons Learned Outline goals at the beginning to build trust Utilize evidence-based models whenever possible Develop ongoing communications with PCP�s Clearly establish evaluation criteria Understand the politics in your community Find community partners who are willing to grow with you Identify mutually beneficial quality initiatives that will improve outcomes and reduce costs for the patients

18. Questions to Consider Does your leadership embrace the concept? Do you have a champion(s)? Is your culture ready? What are the institutional barriers? Are the systems in place to support the partnerships? Are the resources available to effectively implement the initiative?