Payment and Delivery Reform

Steve Arner

Senior Vice President / Chief Operating Officer

June 6, 2013

Carilion ClinicWho we are

(FY 2012)

• Physicians 592

• Hospitals 8

• Employees 11,300

• Admissions 50,300

• Revenue $1.3 B

Vision 2017

We are committed to a Common Purpose of Better Patient Care, Better

Community Health and Lower Cost

Challenges with Today’s Care Model

• High prevalence of chronic disease and mental illness

• Health care cost growing; burden to business• Shortage of healthcare professionals• Overuse; volume “treadmill”• Inconsistent care; fragmentation• Lack of coordination• Payment models at odds with countering rising

costs

Affordable Care Act

2700 pages and virtually nothing about payment

reform

OutcomesCost

Value =

HealthEpisodes

PerPerson

ProcessesPer

HealthEpisode

CostPer

Processx x

Transformational Management

Operational ExcellenceIncreased Productivity and Quality & Lower Unit Cost

Cost in Health Care

Changing the Value Proposition

• Reducing the number of “Health Episodes per person”

• Case Study: Congestive Heart Failure

Action Team 5/08:

• Cardiologists• Nursing leaders• Hospitalist• Palliative Medicine• Case Management• Home Health• Primary Care• IT

Action Timeline

• EPIC order sets, CPGs & best practice alerts (late ’07- early ‘09)• Medical Director (Steve Phillips MD) 2/09• Program Co-ordinator (Mary Davis RN) 2/09• Outpatient CHF clinic 8/09• Dedicated inpatient unit 11/09• “Transitions of Care” program (late ’09 – present)• Home health – use of Telemedicine link 1/08• Began JCAHO DSC for Heart Failure process 10/10• JCAHO DSC for CHF Accreditation 8/11• Broad Education Initiatives ’09-present

Steady improvement has placed us in the top 10 percentCarilion Medical Center – Heart Failure Readmission Rate

Jul-09 July 2005 - June 2008

Jul-10 July 2006 - June 2009

Jul-11 July 2007 - June 2010

Jul-12 July 2008 - June 2011 (FY2013 Pay-

ment Period)

Jul-13 July 2009 - June 2012 (FY2014 Pay-

ment Period)

Carilion Medi-cal Center HF - RSRR

0.24 0.238 0.233 0.222 0.212

US HF - Aver-age

0.245 0.247 0.248 0.247 0.23

US Top 10% Rate

0.221 0.224 0.225 0.225 NaN

19.5%20.5%21.5%22.5%23.5%24.5%25.5%

Carilion Medical Center HF - RSRR US HF - Average US Top 10% Rate

Heart

Fail

ure

Read

mis

sio

n R

ate

CMC 30 Day Readmission Rate (All Cause) for Medicare Patients with Heart Failure Diagnosis

Changing the Value Proposition

• Reducing the number of “Health Episodes per person”

• Case Study: Congestive Heart Failure• Other focus areas:

– Reduce Waste– Prevention– Patient Involvement

Risk Sharing in the Future is a Must

• Partnerships between providers and payers is critical

Accountable Care

Key Facts:

ACO product with Aetna, start date 1/1/2012 (in addition to collaboration on Medicaid, Medicare Advantage, and Employee programs)

Participating in other payers’ shared savings initiatives (Anthem PC2 for example)

Key Facts:

MSSP Participant, start date 1/1/2013

Shared savings based upon achievement of quality benchmarks and cost reduction

46,400 beneficiaries

Qualitative application process; Carilion medical home strategies very helpful for questions regarding quality, care coordination, beneficiary engagement, evidence-based medicine, and reporting.

Key Facts:

Dedication of senior leadership to ACO strategy and development.

Recruitment of a Chief Strategy Officer

Development of a comprehensive enterprise data warehouse (EDW) for integration of EMR data and healthcare claims.

Creation of a Transformation Oversight Committee of senior leadership to develop care delivery strategies for key disease states (CHF, COPD, Diabetes).

Commercial StrategyMedicare Strategy Carilion Clinic Support

575 employed Carilion physicians are Doctors Connected ACO participants.

What is Population Health Management?

• Goal is optimal patient health• Healthcare, not sick care

– Proactive, not reactive

• Align care team resources to meet the needs of different patient segments and personalized to the patient.

• Reduce the need for higher cost services (ED, hospitalizations, imaging tests, etc)

Medicaid Expansion

• Why it is important to business