Dr. Roger Ray, Executive Vice President/Chief Medical Officer“The Experience of a Large IDN”

November 1, 2013

Today’s Agenda

Carolinas HealthCare System

Key Drivers

Imperatives

Interim Measures of Performance

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Carolinas HealthCare System Overview

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Carolinas HealthCare System (CHS)

• Second largest public, healthcare system in the nation

• Largest healthcare system in the Southeast

• 40 hospitals, 11 nursing homes and over 900 outpatient service locations

• Over 2,300 employed physicians and nearly 400 residents delivering care in over 500 sites

• Forecasted 2013 net operating revenue: $7.8 billion

• AA-rated since 1983

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Breadth of CHS

Summary of System

•60,000 employees•>900 care locations•Nearly 7,500 licensed beds•11 long-term care facilities•12 home health agencies•9 hospice providers•8 freestanding EDs•One of 5 academic medical centers in the state of North Carolina

Summary of System

•60,000 employees•>900 care locations•Nearly 7,500 licensed beds•11 long-term care facilities•12 home health agencies•9 hospice providers•8 freestanding EDs•One of 5 academic medical centers in the state of North Carolina

Key Statistics – Projected 2012

•10.5 million patient encounters •Over 6.2 million physician visits•281,393 inpatient discharges•573,323 adjusted discharges•1,079,393 ED visits

Key Statistics – Projected 2012

•10.5 million patient encounters •Over 6.2 million physician visits•281,393 inpatient discharges•573,323 adjusted discharges•1,079,393 ED visits

Rehabilitation Hospitals

LiveWELL Carolinas

Primary Care Practices

Health Clinics

Urgent Care Centers

Hospitals

Behavioral Health

Nursing Homes

Home Health

Continuum of Care

Emergency Care Centers

Ambulatory Surgery Centers

Hospice & Palliative Care

Specialty Care Practices

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Physician Services at CHS

• First practice in 1988 • Over 600 locations across North Carolina,

South Carolina and Northern Georgia

• Carolinas Physician Network• NorthEast Physician Network• Faculty Physicians• Levine Cancer Institute• Regional Physician Network (Scotland,

Columbus, New Hanover, Cleveland, Wilkes, St. Luke’s and Anson)

• Regional Hospital Groups (Roper, Cone Health, AnMed, Murphy, MedWest, Blue Ridge, Stanly)

Total CHS Employed Physicians: 2,317

• First practice in 1988 • Over 600 locations across North Carolina,

South Carolina and Northern Georgia

• Carolinas Physician Network• NorthEast Physician Network• Faculty Physicians• Levine Cancer Institute• Regional Physician Network (Scotland,

Columbus, New Hanover, Cleveland, Wilkes, St. Luke’s and Anson)

• Regional Hospital Groups (Roper, Cone Health, AnMed, Murphy, MedWest, Blue Ridge, Stanly)

Total CHS Employed Physicians: 2,317

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Clinical Integration Outreach

Remote ICU monitoring center will enable consistent, high quality care across the System

Levine Cancer Institute is focused on delivering care at the community levelBranded Clinical Programs

• Levine Cancer Institute• Carolinas Hospitalist Group• Sanger Heart and Vascular Institute• Neurosciences Institute• Remote Critical Care Services• Carolinas Stroke Network• Carolinas Trauma Network

Branded Clinical Programs• Levine Cancer Institute• Carolinas Hospitalist Group• Sanger Heart and Vascular Institute• Neurosciences Institute• Remote Critical Care Services• Carolinas Stroke Network• Carolinas Trauma Network

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Key Drivers

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Prospering in a Changing Environment

Volume

Value

team accountability

standardization

engaged physicians

cost containment

improved qualitysafe

patient-centric

transparency

care coordination

innovation

team-based care

information technology

uncoordinated

facility based

variable

Silo work

volume-based

fee for service

reactive

Issue-focused

Individual patient focus

Individual responsibility & autonomy

Current

Strain

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Imperatives

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#1. What are we trying to accomplish?

Degree of Integration

Imp

act

on

Val

ue:

Qu

alit

y, S

ervi

ce, C

ost

Coordinated Operations

Shared Clinical Standards

Managing Care Across Continuum

Assembling Scale for Leverage

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#2. Focus on Value in Three Dimensions

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#3. Determine Budgetary Constraints

What

Short-Term

Outcomes

Can Be

Tolerated?

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– Physician leadership and engagement

– Team approach to care and improvement

– Devotion to Evidence-Based Care (EBC)

– Culture of accountability

Providers that can develop innovative ways to meet demand, reduce cost and exceed quality requirements will prosper.

#4. Procure Physician Leadership

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#5. Transform Primary CareAn integrated system of primary care that proactively identifies patients needs and provides appropriate level of coordinated continuum of care services leading to optimal patient outcomes, outstanding care experience, efficient utilization of resources.

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#6. Reduce Readmissions and Overutilization

Variation in Imaging Utilization by Network Type

Hospital Outpatient Utilization Rates per 1000 Covered LivesMilliman MedInsight BenchmarksWell-managed networks using 45-60% less imaging than

those managed loosely

The Advisory Board, 2012

The Advisory Board, 2012

High cost drugs Unnecessary lab testing

Testing in higher cost settingsAvoidable ED visits

Readmissions

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#7. Integrate with palliative care, home health, etc.

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#8. Leverage Virtual Care

and…

Growth of existing servicesExpansion of new services

ConnectivityLegislation

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#9. Organize, Prioritize & Align Care Management

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Interim Measures

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CHS Recognitions

Society for Thoracic Surgeons

American College of Cardiology

Project Impact

CHS has been recognized nationally for delivery of high quality medical care and exceptional customer service.

CHS has been recognized nationally for delivery of high quality medical care and exceptional customer service.

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CHS Disease Specific Certifications

5555

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CHS Is A Leading Health System

DATA POINTS1: OVERALL2: Mortality3: Complications4: Patient Safety5: Core Measures6: ALOS7: HCAHPS

QUINTILES 80 to 100 60 to 80 40 to 60 20 to 40 0 to 20

2006 - 2010 Comparison group: N = 85

©2012 Thomson Reuters. All rights reserved.

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CMS National “HEN” Ratings

HEN Points HEN Points

Carolinas 34 Tennessee 22

Nevada 29 UHC 22

New York 28 Washington 22

NC-VA 28 Iowa 21

Ascension 27 Minnesota 21

LifePoint 27 Intermountain 18

Ohio 27 Michigan 17

Dignity 26 Premier 16

New Jersey 26 VHA 15

DFW 25 NPHHI 14

Georgia 24 AHA 13

Ohio Children’s 24 TJC-R 11

Pennsylvania 22 TCQPS 8

 

Quality UpdateAppropriate Care – Manual Audits Q2 QCC

Favorable

Diabetes Poor ControlHemoglobin A1c >9% HEDIS Definition

10.0%

15.0%

20.0%

25.0%

30.0%

HEDIS 90%ile**

Actual

Actual Favorable

**HEDIS 90%ile Commercial all LOB

(INCLUDES A1C UNTESTED RATE)

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Questions/Discussion