Charting the Changes in the Physician-Patient Relationship Austin Regional Clinics Accountable Care and Patient Centered Medical Home Navigating the Future of Healthcare Round Rock, Texas October 14, 2011

1,000,000 patient visits 380,000 active patients 1,400 employees 290 physicians 18 locations 15 specialties 6 cities 3 counties 1 medical group 1,000 square miles Austin Regional Clinic

4 Fee-for-Service Pay-for- Performance Episodic Bundling Global Payment Full Risk / % of Premium Episodic Cost Total Cost Provider Accountability Continuum of Payment Models Patient Centered Medical Home Accountable Care Organization Enter Reform

Patient Centered Medical Home Trusted personal physician Physician who provides, manages and facilitates care Care is coordinated or integrated across healthcare system More accessible practice with increased hours and easier scheduling

1% of the population accounts for more than 25% of health costs. 10% of the population account for 70% of health care expenditures. 78% of national health care expenditures can be attributed to chronic illness. On order of $2 trillion. The Chronically Ill Drive Cost

Advanced Care Coordination Clinic Data analytics to identify highest-risk members. Outreach process to engage and enroll these members. Comprehensive multi-disciplinary care team. 24/7 access by patient to care team. Goal is reducing unnecessary ER and Inpatient services, referrals, medications, and testing in highest utilizing patients.

Personal Health Guides are the primary point of contact with members. They assist physicians in coordinating care, educate members about their illnesses, and use motivational interviewing to inspire members improve their health. Nurse Navigators help manage the care process and coordinate clinical care. Extensivist Physicians, with assistance of Advanced Practice Nurses, take responsibility for the whole patient, providing hour long initial visits and frequent and extended follow-up appointments. Behavior Health support to identify co-morbid illness and address barriers to lifestyle change ACCC Care Team

More emphasis on proactive and comprehensive care More emphasis on preventative care More emphasis on access to care More emphasis on coordination of care More emphasis on primary care What Does It Mean for You?

Contacts Greg Sheff, MD Medial Director, ARC Care Management Austin Regional Clinic (o) (m)