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: [email protected]
• 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