Bon Secours Virginia
Medical Group’s Journey
Bon Secours Health System’s
Foundation for ACOs
June 6, 2013
Payment and Delivery Reform Panel
Virginia Chamber Health Care Conference
Presenter
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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.
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
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
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
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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
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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 SubCommittees
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 followup after ED & hospital
Clinic operations center on meeting the
doctor’s needs
A multidisciplinary team works at the top
11
of our licenses to serve patients
*Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
Patient-Centered Medical Home
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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
NCQA PCMH
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US
NY
VA
PA
NC
TX
WI
CO
IL
MD
32,976
6,331
671
2,307
2,364
1,428
939
747
384
457
Advanced PCMH Outcomes
Inpatient Discharges
Readmissions
High-end Imaging
ED Visits
Quality/Clinical Outcomes
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Facility Buffering Vectors
Aging Population
Obesity
Hi-Tech
Market Share
Appropriate Admissions
Managed Care Contracting
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One Of Our Experiences
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One Payer – One Year
9000 attributed patients
$1.2 million in savings
$10 pmpm savings compared to market
35% reduction in readmissions
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Bon Secours Virginia Employee Wellness Model of Care
Low Risk
Awareness
High Risk
Moderate Risk
Targeted Intervention
High-Risk Intervention
Physical Activity
Tobacco Cessation: Quitline or Freshstart in person class
Weight Management: Referral into weight loss program based on BMI
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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
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Quarterly tailored messages, email
and home mailing on specific risks
such as hypertension.
Incentive Program
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Group Coaching (Healthy Weigh,
Compass to the Good Life)
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Complete 1-2 coaching Sessions
either in person or telephonic
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Complete 2 Healthstream/Webinars
based on wellness goals
SeIf-Care/Health Care Consumerism
Same as low risk plus
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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
Advanced Payment Models
Managed Care Contracting:
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Cigna
Humana
Conventry
Aetna
Optima*
Anthem
United*
MSSP
*Negotiations ongoing
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Medicare Shared Saving Program
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25,000 Medicare patients in Va.
Shared savings for CMS
33 quality metrics
Create a new delivery platform
Partnering with Aetna
Our New Frontier and Mantra
Healthcare
Without Walls
Building an ACO
Patient Activation
Patient & Family
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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
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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
•ER Avoidance Programs
Guidelines
•Urgent Care
•Pay for Performance Initiatives
•End of Life (Palliative Care)
and Outcomes Measurements
•Patient Satisfaction & Loyalty
•Hospitalists, Post Discharge
•Care management Follow-Up Programs
•Transition of Care
(Acute, Chronic,
•Provider Satisfaction
Inpatient, SNF)
•Behavioral & Mental
•Health Coaching
Advanced Primary Care
Health
(Shared Decision
Under Patient-Centered Medical Home
Making)
• Prevention & Wellness
• Embedded Nurse Navigators
• 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, eVisits
• Patient Satisfaction & Loyalty
• Provider & Office Staff Satisfaction
Patient & Family
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Personal Health Record
Patient Portal
Health Risk Assessment
Patient Engagement &
Activation
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
Skilled Nursing Facilities
• Quality (SCIP, Leap Frog)
• SNFists
• Safety
• On-site Case Management
• Outcomes & Evidence Based
• Efficiency Rating Systems
Medicine
“Preferred Facilities”
• Call Coverage
Ancillary Services
• Consult Services (Stroke,
Medical Group & Health Care System
• Free-Standing ASC &
STEMI)
Enterprise Level Activities
Diagnostic Testing
Centers
• ER Avoidance Programs
• PCP/SCP Incentives & Clinical Guidelines
• Urgent Care
• Pay for Performance Initiatives and Outcomes
Home Care
DME
• End of Life (Palliative Care)
Measurements
• Home Safety Visits
• Integration &
• Hospitalists, Post Discharge Follow-Up Programs • Patient Satisfaction & Loyalty
• Post Discharge Visits
Oversight with Care
• Home Health
Management
• Transition of Care
Coordinator of Services
• Provider Satisfaction
• Care management (Acute,
• Behavioral & Mental Health
Advanced Primary Care
Chronic, Inpatient, SNF)
Hospice
(Shared Under Patient-Centered Medical Home
• Transitions• Health Coaching
Making)
(CHF, COPD, Decision
• Prevention & Wellness
• Cost Effective Medical
Frailty
• Point of Care Analytics & Clinical
Management & Utilization
of
Syndrome,
Decision Support
Services (SCP, Ancillary)
Dementia)
• Gaps in Care
• Access, Same Day Appointments, e• Population Management & Chronic
Visits
Care Registries
• Patient Satisfaction & Loyalty
• Home Visiting Teams
• Provider & Office Staff Satisfaction
• Generic Prescribing
Program
Patient & Family
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Personal Health Record
Patient Portal
Health Risk Assessment
Patient Engagement &
Activation