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Dr. Roger Ray, Executive Vice President/Chief Medical Officer“The Experience of a Large IDN”
November 1, 2013
Today’s Agenda
Carolinas HealthCare System
Key Drivers
Imperatives
Interim Measures of Performance
2
Carolinas HealthCare System Overview
3
Carolinas HealthCare System (CHS)
• Second largest public, healthcare system in the nation
• Largest healthcare system in the Southeast
• 40 hospitals, 11 nursing homes and over 900 outpatient service locations
• Over 2,300 employed physicians and nearly 400 residents delivering care in over 500 sites
• Forecasted 2013 net operating revenue: $7.8 billion
• AA-rated since 1983
4
Breadth of CHS
Summary of System
•60,000 employees•>900 care locations•Nearly 7,500 licensed beds•11 long-term care facilities•12 home health agencies•9 hospice providers•8 freestanding EDs•One of 5 academic medical centers in the state of North Carolina
Summary of System
•60,000 employees•>900 care locations•Nearly 7,500 licensed beds•11 long-term care facilities•12 home health agencies•9 hospice providers•8 freestanding EDs•One of 5 academic medical centers in the state of North Carolina
Key Statistics – Projected 2012
•10.5 million patient encounters •Over 6.2 million physician visits•281,393 inpatient discharges•573,323 adjusted discharges•1,079,393 ED visits
Key Statistics – Projected 2012
•10.5 million patient encounters •Over 6.2 million physician visits•281,393 inpatient discharges•573,323 adjusted discharges•1,079,393 ED visits
Rehabilitation Hospitals
LiveWELL Carolinas
Primary Care Practices
Health Clinics
Urgent Care Centers
Hospitals
Behavioral Health
Nursing Homes
Home Health
Continuum of Care
Emergency Care Centers
Ambulatory Surgery Centers
Hospice & Palliative Care
Specialty Care Practices
5
Physician Services at CHS
• First practice in 1988 • Over 600 locations across North Carolina,
South Carolina and Northern Georgia
• Carolinas Physician Network• NorthEast Physician Network• Faculty Physicians• Levine Cancer Institute• Regional Physician Network (Scotland,
Columbus, New Hanover, Cleveland, Wilkes, St. Luke’s and Anson)
• Regional Hospital Groups (Roper, Cone Health, AnMed, Murphy, MedWest, Blue Ridge, Stanly)
Total CHS Employed Physicians: 2,317
• First practice in 1988 • Over 600 locations across North Carolina,
South Carolina and Northern Georgia
• Carolinas Physician Network• NorthEast Physician Network• Faculty Physicians• Levine Cancer Institute• Regional Physician Network (Scotland,
Columbus, New Hanover, Cleveland, Wilkes, St. Luke’s and Anson)
• Regional Hospital Groups (Roper, Cone Health, AnMed, Murphy, MedWest, Blue Ridge, Stanly)
Total CHS Employed Physicians: 2,317
6
Clinical Integration Outreach
Remote ICU monitoring center will enable consistent, high quality care across the System
Levine Cancer Institute is focused on delivering care at the community levelBranded Clinical Programs
• Levine Cancer Institute• Carolinas Hospitalist Group• Sanger Heart and Vascular Institute• Neurosciences Institute• Remote Critical Care Services• Carolinas Stroke Network• Carolinas Trauma Network
Branded Clinical Programs• Levine Cancer Institute• Carolinas Hospitalist Group• Sanger Heart and Vascular Institute• Neurosciences Institute• Remote Critical Care Services• Carolinas Stroke Network• Carolinas Trauma Network
7
Key Drivers
8
Prospering in a Changing Environment
Volume
Value
team accountability
standardization
engaged physicians
cost containment
improved qualitysafe
patient-centric
transparency
care coordination
innovation
team-based care
information technology
uncoordinated
facility based
variable
Silo work
volume-based
fee for service
reactive
Issue-focused
Individual patient focus
Individual responsibility & autonomy
Current
Strain
9
Imperatives
10
#1. What are we trying to accomplish?
Degree of Integration
Imp
act
on
Val
ue:
Qu
alit
y, S
ervi
ce, C
ost
Coordinated Operations
Shared Clinical Standards
Managing Care Across Continuum
Assembling Scale for Leverage
11
#2. Focus on Value in Three Dimensions
12
#3. Determine Budgetary Constraints
What
Short-Term
Outcomes
Can Be
Tolerated?
13
– Physician leadership and engagement
– Team approach to care and improvement
– Devotion to Evidence-Based Care (EBC)
– Culture of accountability
Providers that can develop innovative ways to meet demand, reduce cost and exceed quality requirements will prosper.
#4. Procure Physician Leadership
14
#5. Transform Primary CareAn integrated system of primary care that proactively identifies patients needs and provides appropriate level of coordinated continuum of care services leading to optimal patient outcomes, outstanding care experience, efficient utilization of resources.
15
#6. Reduce Readmissions and Overutilization
Variation in Imaging Utilization by Network Type
Hospital Outpatient Utilization Rates per 1000 Covered LivesMilliman MedInsight BenchmarksWell-managed networks using 45-60% less imaging than
those managed loosely
The Advisory Board, 2012
The Advisory Board, 2012
High cost drugs Unnecessary lab testing
Testing in higher cost settingsAvoidable ED visits
Readmissions
16
#7. Integrate with palliative care, home health, etc.
17
#8. Leverage Virtual Care
and…
Growth of existing servicesExpansion of new services
ConnectivityLegislation
18
#9. Organize, Prioritize & Align Care Management
19
Interim Measures
20
CHS Recognitions
Society for Thoracic Surgeons
American College of Cardiology
Project Impact
CHS has been recognized nationally for delivery of high quality medical care and exceptional customer service.
CHS has been recognized nationally for delivery of high quality medical care and exceptional customer service.
21
CHS Disease Specific Certifications
5555
22
CHS Is A Leading Health System
DATA POINTS1: OVERALL2: Mortality3: Complications4: Patient Safety5: Core Measures6: ALOS7: HCAHPS
QUINTILES 80 to 100 60 to 80 40 to 60 20 to 40 0 to 20
2006 - 2010 Comparison group: N = 85
©2012 Thomson Reuters. All rights reserved.
23
CMS National “HEN” Ratings
HEN Points HEN Points
Carolinas 34 Tennessee 22
Nevada 29 UHC 22
New York 28 Washington 22
NC-VA 28 Iowa 21
Ascension 27 Minnesota 21
LifePoint 27 Intermountain 18
Ohio 27 Michigan 17
Dignity 26 Premier 16
New Jersey 26 VHA 15
DFW 25 NPHHI 14
Georgia 24 AHA 13
Ohio Children’s 24 TJC-R 11
Pennsylvania 22 TCQPS 8
Quality UpdateAppropriate Care – Manual Audits Q2 QCC
Favorable
Diabetes Poor ControlHemoglobin A1c >9% HEDIS Definition
10.0%
15.0%
20.0%
25.0%
30.0%
HEDIS 90%ile**
Actual
Actual Favorable
**HEDIS 90%ile Commercial all LOB
(INCLUDES A1C UNTESTED RATE)
27
Questions/Discussion