Richard M. Hamrick III, MD, MBAHCA Capital Division, Chief Medical Officer

June 6, 2013

Payment and Delivery Reform:Building a Bridge to the Future

HCA Virginia:Healthcare Provider

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

HCA Virginia

• 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%.

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

Jonathan B. Perlin, MD, PhD

Edward Septimus, MDJulia Moody, M.S., Jason Hickok, M.B.A., R.N.,

Employer Observations

Access“Help us increase the % of our

covered lives who have a primary care physician relationship”

ChronicDisease

“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”

Over 900 Physicians in Central VA

Holding Each Other Accountable

to a Clinical Quality Program

Supported by IT Infrastructure

A Clinically Integrated Network

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

How HCA is Managing Their Own Covered Lives

GENERAL STATS

15,321 members62% Female (Avg. 37 Yrs Old)38% Male (Avg. 34 Yrs Old)

HEALTH STATUS

76% Healthy10% Episodic14% Chronic

HIGH COST MEMBERS

10% of Population70% of Total Spend

747 Diabetics115 COPD

85 CHF116 Morbid Obesity

482 Asthma

CENTRAL VIRGINIA

ONLY

Biometric Screenings

H2UHealth

Coaching

Physician Led

RN Care Managers

Employer Solutions

Employer Claims

Analysis

Tailored Care Management

Better Quality, Lower Costs.

Increased Productivity

Building a Bridge

Data transparency

New payment models based on quality and cost

Personal performance improvement