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Virginia Chamber 3rd Annual Health Care Conference

June 6, 2013

Sheldon M. Retchin, MD, MSPH

CEO, VCU Health System

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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)

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Early Warning System –EWS

Quickly identify changes in critically ill patients

Pulls data from the patient’s electronic record to alert providers to potential changes in the patient’s condition

Empowers the medical center’s rapid response team (RRT) to effectively triage and visit the most critically ill patients before their conditions deteriorate

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Early Warning SystemWhere 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?

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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

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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.

*

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VCUHS Population Health Management Patient Stratification Process

5% of Patient Population

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Virginia Coordinated Care (VCC) ProgramComplex 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 Launched the VCUHS Complex Care Clinic

program in November 2011• Medical home for patients with multiple chronic

conditions

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SocialWorker

Engagement with Care Team

Interdisciplinary Care

Coordination of Care

Nurse Care Manager

Physician

ClinicalNurse

Behavioral Health Provider

Pharmacist

Patient Experience With the Complex Care Clinic

Improved Health

Patient

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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%

Pre-Clinic Post-Clinic $-

$1.0

$2.0

$3.0

$4.0

$5.0

$6.0

$7.0

$8.0

$8.0

$4.1

VCC Patient Costs*Pre- and Post-Complex Care

Clinic Enrollment (n=365)

Mill

ions

*Includes Hospital inpatient, outpatient and ED costs

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Find out more: www.vcuhealth.org/annualreport