Mercy Virtual. Transforming Medicine and Value Through Virtual Care. Randall S Moore, MD, MBA. Orlando, FL. September, 2017

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1 Mercy Virtual Transforming Medicine and Value Through Virtual Care Randall S Moore, MD, MBA Orlando, FL September, 2017 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

2 Reimagining health & sickness care What is your Why for your career and being here? How does the hospital to reverse life threatening complications of chronic disease in less than 5 days? What happened 2 days or 2 weeks earlier? What if the hospital expert interdisciplinary team was present 24/7/365, when and where optimal? What if we were redesigning sickness and health care from scratch? A few analogies: (1) Steel Industry, (2) Sisters of Mercy & Amazon?

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4 650+ Coworkers, supporting 15+ solutions, serving 40+ hospitals, across 10+ states We are the people of the Mercy Health Ministry. Together, we are pioneering a new model of care. We will relentlessly pursue our goal to get health care right. Everywhere and every way that Mercy serves, we will deliver a transformative health experience.

5 Value based sickness care 13 hospitalizations in preceding 2 years, with 33 active medical conditions, including incurable lung and colon cancers. Majority of hospitalizations required ICU care, intubation and ventilator support. Increasing impact of exacerbations and disease progression supporting recommendation for SNF Outcomes supported by tele- ICU/sepsis/other solutions $473,000 Mercy costs of care

6 Extending Value 24/7/365 Naomi desired outcomes Live in my home Tuesday evening Bingo games More time with my family First patient- enrolled about a year One short hospitalization Missed one Bingo night Quality family/community time Virtual supported home hospice in final 3 weeks Value drivers: Expert, interdisciplinary team Integrate/partner with system Single care plan and team Proactive vs. reactive care Engagement, activation, empowerment

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11 Integration Partnering - Continuum

12 Mercy s Virtual Care Center: A Hospital without Beds 24/7/365 Transformation Patient-centric Disruptive innovation leveraging Technology, AI and Teams Complete solutions

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14 Sepsis Mortality Pre/Post Process Reengineering Severe Sepsis Septic Shock Pre Sepsis Resuscitation Program Post Sepsis Program

15 Core Value Drivers Augment and extend person-centric care continuums Identify care intervention need earlier Intervene earlier, simpler, at lower expense Mitigate subsequent deterioration Partner, integrate within existing system Overcome delays, gaps, Activate, empower teams, communities, patients Improve system capacity and access Leverage expert, interdisciplinary team care targeting greater than 100% gains in efficiency, effectiveness and impact.

16 Virtual portfolio supporting intentional, informed transformation across the continuum Virtual s First Mover Advantage Provides Multi-Year Competitive Advantage In Triple Aim Performance TELEICU TELESEPSIS TELEHOSPITALIST CASE MGMT. PHARMACOTHERAPY WELLNESS Healthcare Lifecare SPARC TELESTROKE ESITTER UTILIZATION MGMT. NURSE ON CALL CONDITION MGMT. MERCY VIRTUAL SOLUTION PORTFOLIO INTEGRATED VIRTUAL CARE STRATEGY 40+ HOSPITALS, 10+ STATES, NATIONAL EXPANSION END-TO-END CLINICAL CARE CONTINUUM

17 Representative Value Analysis ASSUMPTIONS: 550 Licensed Beds, 30K Hospital Admissions, 67K ED Visits, 10K Covered Lives, 10% Member Enrollment in Care Management, 25% Participation in MV Wellness Note: Market Pulse defined as current market problem coupled with relative value of product / solution to key stakeholder(s) 1)TeleICU: Attract and Retain ICU Talent, Augment Intensivist Coverage, Increase ICU Patient Throughput, Reduce 2)Hospital-Acquired Conditions, Increase Nurse Productivity, Reduce Patient Mortality 3)SPARC: Decrease Patient Mortality, Augment Monitoring Tech Productivity, Reduce Hospital Acquired Conditions 4)Attract and Retain Telemetry Talent 5)TeleSepsis: Decrease Patient Mortality, Increase Patient Throughput, Improve appropriate coding, Decrease 6)Variable Expenditure 7)TeleStroke: Reduce Patient Mortality, Decrease Variable Expenditure, Improve Volume 8)TeleHospitalist: Increase Hospitalist Patient Throughput, On-Demand Hospitalist Coverage, Decrease Variable 9)Expenditure, Attract and Retain Hospitalist Talent 10)eSitter: Decrease Variable Expenditure, On-Demand esitters 11)Engagement@Home: Reduce Cost of High-Utilizers, Improve Employee Productivity 12)Nurse on Call: Divert ED Admissions, On-Demand PCP Visit 13)Case Mgmt: Decrease Member Expenditure, Improve Employee Productivity 14)Condition Mgmt: Decrease Member Expenditure, Improve Employee Productivity 15)Wellness: Decrease Member Expenditure, Improve Employee Productivity 16)Pharmacotherapy: Optimize Formulary, Improve Medication Adherence, Reduce Adverse Drug Events (ADE) 17)Utilization Mgmt.: Decrease Unnecessary Medical Spend, Reduce Administrative Overhead

18 Value Levers

19 80% of Healthcare Cost Comes from Sickest 20% of Population Healthies t Population % HealthCare Cost % 20% Tailored Solutions for each patient across the population Wellness Nurse on Call Teleconsults Pharmacotherapy Utilization Management Health Sickest 80% 15% 5% 30% 50% Health Care Cost TeleHospitalist TeleSepsis SPARC Condition Management Nurse on Call Teleconsults Pharmacotherapy Utilization Management Engagement@Home TeleICU TeleHospitalist TeleSepsis esitter SPARC Case Management Teleconsults Pharmacotherapy Utilization Management

20 Solution Development Competencies Analytics: Epidemiology, AI, Machine Learning Reengineering: Clinical, Operational, Financial, Systems Delivery Infrastructure Realignment IT: Clinical workflow management system Change/Transformation Management Education, Training, Talent Development Regulatory/Quality & Safety Marketing/PR/GR Business/Partnership Management

21 An Overview of Mercy Services & Locations Headquartered in St. Louis, Mercy is one of the largest Catholic health systems in the US, serving millions each year over a multi-state footprint through touchpoints including outreach ministries and virtual care. Hospitals & Ambulatory Sites As of June acute care hospitals 4 managed/affiliated hospitals 4 heart hospitals 3 rehab hospitals 2 children's hospitals 2 orthopedic hospitals 1 virtual care center 764 physician practices 302 clinic locations 8 outpatient surgery centers 17 urgent care sites 21 convenient care centers Medical Staff & Co-workers 40,000 co-workers including: 2,100+ integrated physicians 1,100+ integrated advanced practitioners Utilization FY16 3,945 staffed beds 24,217 births 171,183 surgeries 165,315 inpatient discharges 9,198,526 outpatient/office visits 664,551 ED visits Financial Information FY16 $5.3 billion total operating revenue $6.4 billion total assets $394 million community benefit/charity care Note: Virtual Care locations include Mercy Hospitals and other virtual care and care management customer locations. June 2017

22 National Consortium Virtual Care Center Virtual Care Center Virtual Care Center Virtual Care Center Virtual Care Center Virtual Care Center Virtual Care Center Virtual Care Center Virtual Care Center Virtual Care Center

23 Interdependent (Inter)National Virtual Network Creating patient centric care delivery right care, right time, right resource(s)

24 Aligning Strategic Partners Mercy Virtual Seeks Certain Attributes in Partners Based on the Strategic Relationship Cultural Congruence Differentiated Patient Outcomes Clinical Capacity Commitment to Quality Cultural Congruence Mission-based, committed to getting health care right, patient-centric, shared mission and vision, shared journey, collaborative Clinical Capacity MD group size, expertise, RN access Commitment to Quality Transparency, embrace continuous improvement Differentiated Patient Outcomes Reduction of lost work days, greater program participation, decreased readmission rates, reduced mortality and reduced length of stay, reduced overall cost of care REGIONAL / STRATEGIC PARTNERS Shared Common Values Nationally Respected Brand Focused Triple Aim Leader Committed Virtual Care Leadership Ability to Create Differentiated Outcomes Commitment to Care/Access Across the Consortium Demonstrated Bias for Innovation Financial Stability Agreeable Regulatory Environment

25 Roadmap Begin with the why and what is possible, evolving a transformative experience for our highest need patients. Scale and replicate in partnership aligned with community specific, actively managed, business plans. Actively management virtual solution/competency portfolio Align with and inform assumption of financial risk Design to support shared ecosystem across communities Leverage Systems approach System of Systems

26 Innovation is about change

27 Numbers Tell Us Only Part of the Story.. Mike (transformation began within 10 person pilot in 2015) 70 year old male Congestive heart failure, chronic kidney disease, coronary artery disease, atrial fibrillation, type 2 diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea, 18 meds Mark Twain Forest, 100 miles from MD/hospital; no internet or cell service 600+ Mikes, top 2-3%, representing 20% + of total spend Mike Question: Pre-Liberty Liberty (90-Days ) 5 admissions $224,000 2 yr cost 0 admits 3 potential admits avoided

28 Our Focus Mission Minded Operational Excellence Transformative Virtual Care

29 Questions? Randall Moore, MD Please be sure to complete the session evaluation on the mobile app! The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development