1. Payment and Delivery Reform: Building a Bridge to the Future
Richard M. Hamrick III, MD, MBA HCA Capital Division, Chief Medical Officer June 6, 2013

2. HCA Virginia: Healthcare Provider

3. HCA Virginia: 5th Largest Private Employer
Our Employees
Over 30,000 covered lives enrolled in our medical benefit plans
$77.8 million in annual medical spend

4. HCA Virginia

5. Bloodstream infections are usually serious infections typically causing
Prolonged hospital
stay
Increased Cost and
Risk of mortality.
Targeted versus Universal Decolonization to Prevent ICU Infection
Edward Septimus, MD
Julia Moody, M.S., Jason Hickok, M.B.A., R.N.,
Jonathan B. Perlin, MD, PhD
Healthcare-Associated Infections are a leading cause of preventable illness and death
43 HCA hospitals participated in a cluster-randomized trial to determine the best protocol to decrease MRSA healthcare-associated infections in the ICU – over 73,000 patients
Trial resulted in identifying protocol that significantly reduces the rate of MRSA positive cultures by 37% and bloodstream infections by 44%.
Source: Centers for Disease Control, 2009 “The Direct Medical Costs of Healthcare Associated Infections in US Hospitals and the benefits of prevention”
-- Estimated attributed per patient cost for CLABSI is $25k

6. Employer Observations
Access
“Help us increase the % of our covered lives who have a primary care physician relationship”
Chronic
Disease
“The minority of our covered lives drive the majority of our employee benefit plan cost”
Costs
“A well managed covered life is less costly to our employee benefit plan”

7. A Clinically Integrated Network
Over 900 Physicians in Central VA
Holding Each Other Accountable to a Clinical Quality Program
Supported by IT Infrastructure
A Clinically Integrated Network

8. How HCA is Managing Their Own Covered Lives
16,000 covered lives Central VA
Economic incentives to utilize VQCP
Began
January 1, 2013
Embedded in all 3 HCA benefit plans

9. How HCA is Managing Their Own Covered Lives
CENTRAL VIRGINIA ONLY
GENERAL STATS
15,321 members
62% Female (Avg. 37 Yrs Old)
38% Male (Avg. 34 Yrs Old)
HEALTH STATUS
76% Healthy
10% Episodic
14% Chronic
HIGH COST MEMBERS
10% of Population
70% of Total Spend
747 Diabetics
116 Morbid Obesity
115 COPD
482 Asthma
85 CHF
Biometric Screenings
H2U
Health Coaching
Physician Led
RN Care Managers

10. Employer Solutions Better Quality, Lower Costs. Increased Productivity
Employer Claims Analysis
Tailored Care Management
Better Quality, Lower Costs. Increased Productivity

11. Building a Bridge Data transparency
New payment models based on quality and cost
Personal performance improvement