Virginia Chamber 3rd Annual
Health Care Conference
June 6, 2013
Sheldon M. Retchin, MD, MSPH
CEO, VCU Health System
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Innovation is a vital competency for
successful health care organizations
 Value is the evolving currency in health care
today
 Value rests at the nexus of quality and cost,
and is fleeting given a dynamic and
competitive market
 Two VCU programs represent innovations
creating value
• Electronic Early Warning System (quality &
safety)
• Management of complex care patients (quality &
cost)
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Early Warning System –EWS
 Quickly identify changes in critically ill
patients
 Pulls data from the patient’s electronic
record to alert providers to potential
changes in the patient’s condition
 Empowers the medical center’s rapid
response team (RRT) to effectively triage
and visit the most critically ill patients
before their conditions deteriorate
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Early
Warning
System
How are
they
What is their
trending?
EWSisScore?
Where
the
patient?
Who is the
patient?
What is their
resuscitation
Who is caring forstatus?
this patient?
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Population Health Management
…Programs targeted to a defined population
that use a variety of individual,
organizational, and societal interventions
to improve health outcomes…
Felt-Lisk, S. and Higgins, T., Exploring the Promise of Population Health Management Programs to Improve Health, Mathematica
Policy Research, August 2011
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VCUHS “80/20” Scenario
• $960 million
Total Costs
• 164,000 Unique
Patients
*
*Understanding High-Cost Patients, IMS Institute for Healthcare Informatics, www.theimsinstitute.org/healthspending. Accessed April 2013.
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VCUHS Population Health Management
Patient Stratification Process
5% of
Patient Population
LEVEL 3
Complex Care
High risk for significant disease
progression/high cost/high use
LEVEL 2
Chronic Care
Stable, with moderate risk of disease
progression or stable with risk of
advancing to Level 3
LEVEL 1
Episodic Care
Accesses health care services “as needed” or episodically
Low risk of increased healthcare needs
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Virginia Coordinated Care (VCC) Program
Complex Care Program
 VCC program established in 2000 to coordinate
care for uninsured patients
 Provides “medical homes” through partnerships
with 50 community-based physicians
• Care coordinators and outreach workers assist patients
with case management and navigation support
 Approximately 27,000 patients enrolled in FY12
 Published studies demonstrated the merits of
managing care for uninsured patients
 Launched the VCUHS Complex Care Clinic
program in November 2011
• Medical home for patients with multiple chronic
conditions
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Patient Experience With the Complex Care Clinic
Engagement with
Care Team
Coordination of Care
Interdisciplinary Care
Improved Health
Pharmacist
Physician
Clinical
Nurse
Patient
Social
Worker
Nurse Care
Manager
Behavioral
Health
Provider
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Complex Care Clinic
Pre- and Post-Utilization Study
Pre- and Post-Complex Care Clinic
Enrollment (n=365)
$8.0
$8.0
$7.0
$6.0
$4.1
$5.0
Millions
■ Evaluated patients with at
least one clinic visit between
Nov. 2011 and Oct. 2012
■ Cost of care for the population
was reduced by
approximately 49%
■ Inpatient utilization dropped
44%
■ Emergency Department use
fell 38%
VCC Patient Costs*
$4.0
$3.0
$2.0
$1.0
$Pre-Clinic
Post-Clinic
*Includes Hospital inpatient, outpatient and ED costs
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Find out more: www.vcuhealth.org/annualreport
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