keta|| C||n|c Leadersh|p &

Integranon "Sweet Spots"

Andy Sussman, M.u.

2
nauonal ShorLage Cf rlmary Care
Accesslble, Aordable, Plgh CuallLy Care
Lxpandlng SlLes And Cllnlcal Scope
Caremark CllenL Collaborauon
PealLh SysLem Amllauons
CuallLy
Access
CosL
MlnuLeCllnlc Cvervlew
3
rlmary Care ShorLage And 8lslng uemand
- LxpecL ShorLage Cf 43,000 rlmary Care
hyslclans (C) 8y 2020
- Cs Colng 1o Conclerge racuce And
8eurlng
- lncreased C Supply ?ears Away
- 30 CbeslLy, 30 8y 2030
- 73 Mllllon eople WlLh ulabeLes ln 10 ?ears
- Sllver 1sunaml"
- PealLh Care 8eform LxpecLed 1o Add 32
Mllllon newly-covered auenLs ln 2014
0
300
1,000
1,300
2,000
2,300
'97 '99 '00 '03 '03 '07 '09
Source: Amerlcan Academy of lamlly hyslclans, AAMC CenLer for Workforce SLudles, !une 2010
a|nfu| Ia||?
1he ercenLage Cf uS Medlcal School
CraduaLes Chooslng 8esldency SpoLs
ln lamlly Medlclne Pas uecllned 34
Slnce 1997
4
rlmary Care ShorLage Worsenlng
Source: AAMC CenLer for Workforce SLudles, !une 2010, 2009 5otvey of lbyslcloo Appolotmeot wolt 1lmes,
Mettlu nowklos & Assoclotes, ovolloble ot www.mettlubowklos.com/pJf/mbo2009wolmmesotvey.pJf
63
39
30
24
20.3 - nauonal Average
9,000
29,800
63,800
2010 2013 2023
5
rlmary Care ShorLage May
8ecome Severe ln Many SLaLes 8y 2016
noLe: uoes noL pro[ecL changes Lo C supply over nexL 3 years
Source: Amerlcan Medlcal Assoclauon, CenLers for ulsease ConLrol, CvS Caremark 8eform lnslghLs 1ool
C uemand: 2011 C uemand: 2016
6
MlnuLeCllnlc: 2011 Cvervlew
- LargesL 8eLall Cllnlc rovlder
- PealLh Care/8eLall Leadershlp
- 11 Mllllon vlslLs Slnce lncepuon
- Walk-ln Care, 7 uays er Week,
Lvenlngs/Polldays
- Lvldence-based Culdellnes
- 80 1hlrd arLy Coverage
- 30 8eporL no hyslclan
Source: ketoll cllolcs, ltlmoty cote lbyslcloos, ooJ metqeocy uepottmeots. A compotlsoo of loueots' vlslts,
PealLh Aalrs, 27, no. 3 (2008): 1272-1282.
7
1
CA 33
nv 8
AZ
20
kS 9
Mn
29
MC
12
ln
24
Ml
13
nC 38
SC 21
CA 37
lL
64
lL 41
CP 27
A 26
n? 7
vA 29
MA
31
8l 2
C1 14
n! 33
Mu 30
uC 3
Ck 4
1x
31
1n 23
100 new Cllnlcs Cpened ln 2011
400
300
600
700
800
900
1,000
2011 2012 2013 2014 2013 2016
lull-ume MlnuLeCllnlcs
More 1han 630 Cllnlcs ln 23 SLaLes
8
Cverall Sausfacuon 8aung: 94
Cverall racuuoner 8aung: 93
lelL LlsLened 1o And 8especLed": 96
Source: ress Caney survey, 2010
Sample Scores
uSAA (llnanclal) 87
1rader !oe's 82
M|nuteC||n|c 80
Apple 72
Amazon.com 70
hyslclan Cmces 69
urgenL Care 68
LxcellenL CuallLy And auenL Sausfacuon
MlnuLeCllnlc neL romoLer Score: 80
M|nuteC||n|c Is Iu||y
Accred|ted 8y 1he
Io|nt Comm|ss|on
9
MlnuLeCllnlc Cllnlcal CuallLy: PLulS Measure
0 10 20 30 40
Un|vers|ty of M|nnesota hys|c|ans
M|nuteC||n|c
Metropo||tan Intern|sts
Sanford C||n|c
Mayo C||n|c
A|||na nea|th System
Ia|rv|ew nea|th Serv|ces
St. Luke's C||n|cs
A|tru nea|th System
CentraCare nea|th System
nea|thartners C||n|cs
ue||o C||n|c
Integr|ty nea|th Network
Innov|s nea|th (Lssenna nea|th West)
k|dgev|ew C||n|cs
ark N|co||et nea|th Serv|ces
Avo|dance Cf Annb|onc 1reatment
In Adu|ts W|th Acute 8ronch|ns (2010)
Source: Mn PealLhScores.org , from MlnnesoLa CommunlLy MeasuremenL, accessed CcL 26, 2011

HEDIS = Healthcare Effectiveness Data and Information Set

10
6
7
81
MlnuLeCllnlc non-acuLe vlslLs:
lasLesL Crowlng SegmenL
Non-acute V|s|ts
2009 2010 2011
2011 1D Non-acute V|s|ts
hyslcals
PyperLenslon
And CLher
Pyperllpldemla
ulabeLes
1ype Cf V|s|t
8y 2013, non-acuLe Care lncludlng vlslLs And non-u
vacclnes Could AccounL lor 2S Cf All MlnuLeCllnlc vlslLs
11
2007 2008 2009 2010 2011
M|nuteC||n|c 8reak-even 8y Lnd Cf 2011 Cn Lnterpr|se 8as|s
MlnuLeCllnlc vlslL 8evenue Conunues 1o Crow
neL 8evenue
12
1,329
1,318
0
1,000
2,000
3,000
4,000
Rx
Medlcul
Spend
1ota| 53,909
1ota| 54,26S
opu|anon M|nuteC||n|c User: n = 12,376. Non-user: n=34,326
Source: CvS Caremark LnLerprlse Analyucs MlnuLeCllnlc CosLs and Servlces: Comparlson Lo CLher Medlcal rovlders, CcLober 2011

uullzer Spend 2010:
MlnuLeCllnlc versus non-MlnuLeCllnlc
Lower 1ota| nea|th Care Costs er erson Who Used M|nuteC||n|c
MlnuLeCllnlc user non-user

$

e
r

M
e
m
b
e
r
,

e
r

?
e
a
r

8.3
Less
13
Comparlng CosL And CuallLy Cf 1reaung
Common lllnesses Across Medlcal Semngs
ua||ty Ind|cators
noLes: n = 2,100 care eplsodes compared across venues. AggregaLe quallLy scores based on 14 ob[ecuve measures of quallLy.
Source: Comparlng CosLs and CuallLy of Care aL 8eLall Cllnlcs WlLh 1haL of CLher Medlcal Semngs for 3 Common lllnesses,"
Annals of lnLernal Medlclne, AugusL, 2009.
Lmergency
ueparLmenLs
hyslclan
Cmces
urgenL Care
MlnuLeCllnlc
Lmergency
ueparLmenLs
hyslclan
Cmces
urgenL Care
MlnuLeCllnlc
33
61
63
64
Cost er Lp|sode
non harmacy CosL
harmacy CosL
$26
$21
$22
$21
14
-CpporLunlLy: AcuLe And Chronlc Care lor Caremark Members
-Caremark Cerlng CllenLs CpporLunlLy 1o Change 1helr 8eneL SLrucLure 1o
SubsLanually 8educe Co-pay AL MlnuLeCllnlc 1o Lower Cverall PealLh Care CosLs
-llu vacclnauon rograms AL MlnuLeCllnlc
-8lomeLrlc Screenlng rograms lor CllenLs
-Wellness rograms lor CllenLs
-Cn SlLe Cllnlcs AL CorporaLe Locauons
Caremark Member Care AL MlnuLeCllnlc
Access
ua||ty
Cost
15
MlnuLeCllnlc SLraLeglc Amllauons:
Ma[or PealLh SysLems
CA
39
nv
8
AZ
21
kS 8
Mn
27
MC
11
ln
17
k? 1
nC 36
SC 11
CA 29
lL
A 26
vA 27
nv
AZ
lL

Mn
CP
vA
lL
Ml
ln

CA
9S nosp|ta|s
14,000 8eds
31,200 hys|c|ans
23.S M||||on V|s|ts
nC
16
!olnL Cllnlcal And harmacy Care rograms
PealLh SysLem hyslclan ulrecLors lor MlnuLeCllnlc
Chronlc ulsease rograms
lnLegraLe LlecLronlc Medlcal 8ecords
aruclpaLe ln luLure AccounLable Care Crganlzauons
PealLh SysLem Amllauons
17
lnLegrauon Cf LlecLronlc Medlcal 8ecords WlLh
AmllaLed PealLh SysLems
8ead 09/23/2010 LabLesL, Labfour 8eLall Cllnlc vlslL rovlder,LxLernal... Closed CCl ueparLmenL
Scanned uocumenLs
vlew 8eLall Cllnlc vlslL - CvS SLrongsvllle 09/23/2010 ]
18
MlnuLeCllnlc's LnLerprlse 8ole
Access
ua||ty
Cost
19
Lxpandlng 1o Cver 1,000 lull-ume Cllnlcs 8y 2016
8obusL volume And 8evenue CrowLh
Lowerlng PealLh Care CosLs
CpporLunlLy WlLh Caremark CllenLs 1o rovlde
CosL-eecuve, CoordlnaLed Care
Ma[or PealLh SysLem Amllauons And luLure ACC 8ole
8elnvenung harmacy lor 8euer Shareholder value