Bon Secours Virginia Medical Group’s Journey

Bon Secours Health System’s Foundation for ACOs

June 6, 2013Payment and Delivery Reform Panel

Virginia Chamber 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.

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• 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

• 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

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

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

Acute care is delivered in the next available appointment and walk-ins

Acute care is delivered by open access and non-visit contacts

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

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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 – 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

• US 32,976• NY 6,331• VA 671• PA 2,307• NC 2,364• TX 1,428 • WI 939• CO 747• IL 384• MD 457

Advanced PCMH Outcomes

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Inpatient Discharges

Readmissions

High-end Imaging

ED Visits

Quality/Clinical Outcomes

Facility Buffering Vectors

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Aging Population

Obesity

Hi-Tech

Market Share

Appropriate Admissions

Managed Care Contracting

One Of Our Experiences

• One Payer – One Year• 9000 attributed patients• $1.2 million in savings• $10 pmpm savings compared to market• 35% reduction in readmissions

Moderate Risk

High Risk

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

 

Same as low risk plusCommunication

• Quarterly tailored messages, email and home mailing on specific risks such as hypertension.

Incentive Program• Group Coaching (Healthy Weigh,

Compass to the Good Life)• Complete 1-2 coaching Sessions

either in person or telephonic • Complete 2 Healthstream/Webinars

based on wellness goals 

Same as low risk plusCommunication

• 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

Weight Management: Referral into weight loss program based on BMI

Physical Activity

If you are Diabetic and/or Hypertension, Group exercise classes made available

Physical ActivityIf you are Diabetic and/or Hypertension, Physical assessment and group training sessions available over a 3 month period then a reevaluation.

Physical Activity

Bon Secours Virginia Employee Wellness Model of Care

Tobacco Cessation: Quitline or Freshstart in person class

SeIf-Care/Health Care Consumerism

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Advanced Payment ModelsManaged Care Contracting:

• Cigna• Humana• Conventry• Aetna• Optima*• Anthem• United*• MSSP*Negotiations ongoing

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Medicare Shared Saving Program

• 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

Patient & Family• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement & Activation

Building an ACO Patient Activation

Advanced Primary Care

Patient & Family

Advanced Primary CareUnder Patient-Centered Medical Home

• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement &

Activation

•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

New Health System Coordination

Patient & Family

Advanced Primary CareUnder Patient-Centered Medical Home

Medical Group & Health Care SystemEnterprise 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

• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement &

Activation

• 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

• Care management (Acute, Chronic, Inpatient, SNF)

• Health Coaching (Shared Decision Making)

• Transition of Care• Provider Satisfaction• Behavioral & Mental

Health

Patient & Family

Advanced Primary CareUnder Patient-Centered Medical Home

Medical Group & Health Care SystemEnterprise Level Activities

Accountable Care OrganizationHospitals• Service Line Integration• Medical Staff Alignment• Incentives for Efficiency & Lean Six Sigma• Quality (SCIP, Leap Frog)• Safety

Medical Groups &Health Care System• Enterprise Level Activities• PC-MH FunctionsSkilled Nursing Facilities

• SNFists• On-site Case Management• Efficiency Rating Systems

“Preferred Facilities”

Ancillary Services• Free-Standing ASC &

Diagnostic Testing Centers

Home Care• Home Safety Visits• Post Discharge Visits• Home Health

Coordinator of Services

Hospice• Transitions

(CHF, COPD, Frailty Syndrome, Dementia)

• PCP/SCP Incentives & Clinical Guidelines• Pay for Performance Initiatives and Outcomes

Measurements• Hospitalists, Post Discharge Follow-Up Programs

DME• Integration &

Oversight with Care Management

• Outcomes & Evidence Based Medicine

• Call Coverage• Consult Services (Stroke,

STEMI)

• ER Avoidance Programs• Urgent Care• End of Life (Palliative Care)• Patient Satisfaction & Loyalty

• Personal Health Record• Patient Portal• Health Risk Assessment• Patient Engagement &

Activation

• 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

• Care management (Acute, Chronic, Inpatient, SNF)

• Health Coaching (Shared Decision Making)

• Transition of Care• Provider Satisfaction• Behavioral & Mental Health

Maturing ACOs Payment Mechanism