1. 1 Virginia Chamber 3rd Annual Health Care Conference June 6, 2013 Sheldon M. Retchin, MD, MSPH CEO, VCU Health System

2. 2 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)

3. 3 Early Warning System –EWS Quickly identify changes in critically ill patients Pulls data from the patients electronic record to alert providers to potential changes in the patients condition Empowers the medical centers rapid response team (RRT) to effectively triage and visit the most critically ill patients before their conditions deteriorate

4. 4 Early Warning System Where is the patient? Who is the patient? Who is caring for this patient? What is their resuscitation status? What is their EWS Score? How are they trending?

5. 5 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

6. 6 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.www.theimsinstitute.org/healthspending *

7. 7 VCUHS Population Health Management Patient Stratification Process 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 5% of Patient Population

8. 8 (VCC) 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 VCUHS Complex Care Clinic Launched the VCUHS Complex Care Clinic program in November 2011 Medical home for patients with multiple chronic conditions

9. 9 SocialWorker Engagement with Care Team Care Team Interdisciplinary Care Coordination of Care Nurse Care Manager Physician Clinical Nurse Behavioral Health Provider Pharmacist Patient Experience With the Complex Care Clinic Improved Health Patient

10. 10 Complex Care Clinic Pre- and Post-Utilization Study 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% *Includes Hospital inpatient, outpatient and ED costs

11. 11 Find out more: www.vcuhealth.org/annualreport