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WelcomeMary Barker

Vice President, Publishing and Education

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Webinar 5 Issue BriefPowerPoint File

• An email with links to these documents was sent to all registered participants

• Check your inbox for an email from the “California Hospital Association”

• For assistance, call CHA Education at (916) 552-7637

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Anne McLeodSenior Vice President, Health Policy & InnovationCalifornia Hospital Association

Anne McLeod provides leadership in the development of CHA’s public policy objectives and develops innovative policy solutions for CHA’s members. Using her experience and extensive knowledge of federal and state health policies, Ms. McLeod represents hospitals’ interests and supports their future growth and success as they respond to the challenges they face going forward.

Staff

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Ken KaufmanChairKaufman Hall

Since 1976, Mr. Kaufman has provided healthcare organizations with expert counsel and guidance in areas including strategy, finance, financial and capital planning, and mergers, acquisitions and partnerships. Recognized as a leading authority and committed to industry education, Mr. Kaufman has given more than 400 presentations at meetings of leading industry groups. He has authored or coauthored six books, and his articles regularly appear in major healthcare publications. Mr. Kaufman has an MBA with a concentration in hospital administration from the University of Chicago Graduate School of Business..

Speakers

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Mark E. GrubeManaging DirectorKaufman Hall

Mark Grube leads Kaufman Hall’s Strategic Advisory practice. Mr. Grube has more than 25 years of experience in the healthcare industry as a consultant and as a planning executive with one of the nation’s largest healthcare systems. Mr. Grube is a frequent speaker and author, and he is a three-time winner of the Healthcare Financial Management Association Best Article Award. He has presented at meetings of the American College of Healthcare Executives, The Governance Institute, The Healthcare Roundtable, HFMA and many other organizations.

Speakers

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Dr. Lambert has more than 40 years of experience as a physician, healthcare executive and board member. As a member of Kaufman Hall’s Strategy practice, he assists hospitals and health systems with integrated strategic and financial planning, service line planning/distribution across systems and medical staff planning/physician alignment strategy. Previously, Dr. Lambert held senior executive positions at several Chicago area hospitals. He also has provided consultation in physician relations and continuity of care.

Matthew J. Lambert III, MDSenior Vice PresidentKaufman Hall

Speakers

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Today’s Topics

1. The Changing Healthcare Business Model2. Leadership Mindset3. Leadership Competencies4. Leadership Structure and Metrics5. Examples of Leadership for Population Health Management6. Concluding Comments

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The Changing Healthcare Business Model

Ken Kaufman

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B-School, DisruptedIn moving into online education, Harvard discovered that it wasn’t so easy to practice what it teaches.

MINH UONG/THE NEW YORK TIMES

SundayBusiness SUNDAY, JUNE 1, 2014

“A company must stay the course even in times of

upheaval while constantly improving and extending its

distinctive position.”

Michael Porter

“The only way that market leaders like Harvard Business School can survive “disruptive

innovation” is by disrupting their existing business

themselves.”

Clayton Christensen

10Source: Congressional Budget Office: Extended Alternative Fiscal Scenario. Extrapolated by Committee for a Responsible Federal Budget, as illustrated in Blinder, A.S.: After the Music Stopped: The Financial Crisis, the Response, and the Work Ahead. New York: The Penguin Press, 2013.

The Dominant Role of Healthcare Spending (Congressional Budget Office Long-Term Budget Projection)

The Driving Force Behind the Change to America’s Healthcare System

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The Numbers Send a Clear and Present Message

“The implication for budgeteers is clear: If we can somehow solve the health care cost problem, we will also solve the long-run deficit

problem. But if we can’t control health care costs, the long-run deficit problem is insoluble.”

Alan S. Blinder

Source: Blinder, A.S.: After the Music Stopped: The Financial Crisis, the Response, and the Work Ahead. New York: The Penguin Press, 2013.

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Since 2010, Hospitals Have Absorbed $144B in Payment Cuts

Source: American Hospital Association

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Hospitals

Doctors

Patients

Fee-for-Service Model

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Fee-for-Value Model

Patients

Healthcare Company

Hospital Outpatient ServicesDoctors Continuum

of Care

Content of Care

• Commodity • Make vs. buy • Low-cost provider• Contract to specifications

Select Contract(?)

Who is This?

Employers Medicare and Medicaid

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Leadership Mindset

Mark Grube

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Are you trying to make the old model work in the new

world?

Are you learning to use a new model based on the

new world?OR

A New View of Healthcare

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A New View of Patients

“For healthcare executives, the challenge is to think about their delivery networks and their healthcare services with

this new, multifaceted patient in mind — a patient who may be healthy or sick, who values nurturing but wants

independence, who craves information and flexibility, and who will make choices based on perceptions of value that

vary depending on each situation.”

—Ken Kaufman, “Patients as People”

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A New View of Scale

• Network strength• Physician/clinical alignment• Operational efficiency• Infrastructure• Expertise

Hospital systems with more than $1 billion in revenue have experienced higher revenue growth, better

balance sheet ratios, and higher operating and

operating cash flow margins than smaller health systems

Need Benefit

Source: Analysis by Kaufman, Hall & Associates, LLC, of proprietary medians data from Moody’s Investors Service, 2013

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A New View of Volume

• Non-strategic volume such as emergency department, cash customers and patient-preference decisions

• Fixed revenue per person or member (PMPM)• Organized under accountable care model • Organization receives portion of revenue depending on arrangement

• Contractual relationships with payers, employers and providers• Preferred-provider status for select tertiary/quaternary services

Managed/Attributed Lives

Influenced Lives

Incidental Volume

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• Partnerships focused on acquiring selected PHM/value-based capabilities

• Partnerships for broad collaboration on network and care management

• Partnerships for focused network development • Partnerships between large employers and provider

networks to manage defined populations• Partnerships designed to achieve full population health

manager capabilities

A New View of Partnerships

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Leadership Capabilities

Matt Lambert, MD

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New Leadership Expertise

• Fostering clinician leadership• Network development and management• PHM and associated risk• Clinical, business and consumer intelligence• Innovation and transformation• Technology

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Which leadership capabilities do you view as most important for success in a PHM environment? (Select all that apply)

1. Fostering clinical leadership

2. Network development and management

3. Population health management and associated risk

4. Clinical, business and consumer intelligence

5. Innovation and transformation

6. Technology

Polling Question #1

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Clinical leadership needed for care redesign:

Fostering Clinical Leadership

Population Segmentation & Stratification

Program/ Intervention

Development

Program Evaluation & Refinement

1 2 3

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Physician Leadership Competencies in a PHM World

• Systems theory and analysis• Use of information technology• Cross-disciplinary training

and multidisciplinary teams• Expanded knowledge areas• Interpersonal and

communication skills

Physician Core Competencies Next-Generation Core Competencies

• Medical knowledge• Patient care• Practice-based learning and

improvement• System-based practice• Professionalism• Interpersonal and

communication skills• Use of informatics

From Top Doctor to Physician

Leader

The competencies that make an individual a good physician are not the same competencies that make a physician a great leader. However, the heart of being a

good physician leader is being a good physician.

Source: Combes, J.R., Arespacochaga, E.: Lifelong Learning: Physician Competency Development. American Hospital Association’s Physician Leadership Forum, Chicago, IL, June 2012.

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Network Development and Management

• Familiarity with full continuum of care• Contract negotiation• Performance monitoring and management• Technology integration

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PHM and Associated Risk

Risk Expertise:1. Assessing, managing,

mitigating risk2. Actuarial services3. Predictive/risk modeling

PHM Expertise:

1. PHM strategic direction2. Development of PHM

services3. Coordination of PHM

initiatives

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Clinical, Business and Consumer Intelligence

Clinical Intelligence Business Intelligence Consumer Intelligence

• Identify, stratify and prioritize the patientpopulation

• Design and evaluate interventions

• Network performance

• Risk contracting• Operational

efficiency

• Demographic, socioeconomic,behavioral, attitudinal information

• Consumer engagement

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Innovation and Transformation

Transformation• Change management• Project/results

management

Innovation

• Linking strategy and innovation

• Creating structure for innovation

• Cultivating new ideas• Developing and testing

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Technology

Source: Arlotto, P.: “Technology for Population Health Management,” California Hospital Association and Kaufman Hall, Aug. 25, 2015.

• Understand consumer needs and preferences• Develop connected healthcare ecosystem

integrating medical, social and community services• Use advanced population analytics to help predict

care requirements for population segments and assess performance of individual providers, sites and entities

• Incorporate disruptive innovations that drive redesign of business and care-delivery models

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• Chief Transformation Officer

• Chief Medical Informatics Officer

• Chief Innovation Officer

• Senior Healthcare Economist

• SVP, Pharmaceutical Management

• SVP, Managed Care Pricing

• SVP, Health Plan and Managed Care

• SVP, Actuarial Services and Predictive/Risk Modeling

• SVP, Product and Benefit Design

• EVP, Consumer Solutions

• EVP, Advanced Analytics

• EVP, Network Partnerships and Management

• COO, Network Operations and Development

• Endless physician and clinical leadership and councils in key areas such as primary care, ED, hospitalist and post acute

• University, research institutes and other partnerships

New Roles

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Press *1 to enter the queuePress *2 to remove yourself from the queue

Phone questions:

Questions?

Online questions:

Type your question in the Q & A box, hit enter

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Leadership Structure and Metrics

Mark Grube

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PHM “NewCo”Ownership OwnershipEntity 1 Entity 2

Board of Managers

Entity 1 % Representation

Entity 2 % Representation

Care Coordination

Managed Care Contracting HIT/IT

Network Development and Provider Engagement

Proposed PHM Governance Structure

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PHM Division Leadership

Local PHM Network 1

Local PHM Network 2

Population 1

Local PHM Network 3

Care Model Coordination/ Integration

Value-Based and Risk Contracting/Products

PHM Analytics and Information Systems

Service Delivery and Network Operations

PHM Innovation, Training and Education

Financial Risk Management and Modeling

PHM Operations

Primary Care Physicians

Other Providers

PHM Division Governance and Executive Leadership

Population 2 Population 3

Primary CarePhysicians

Other Providers

Primary Care Physicians

Other Providers

New View of Organizational Structure

The PHM-centralized

operations and talent infrastructure

– build, buy and partner options

The PHM delivery hubs – physician orgs, employers,

purchasers, medical neighborhoods, etc.

Overall strategy; integration with

broader healthcare company

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KeyInitiative

AreaPotential Performance Metric

• Primary care base as % of total physicians• % employed physicians• # of physicians in leadership roles• Loss per physician• Commercial rates as a % of Medicare• PMPM cost for employees• % of revenue in non-fee-for-service relationships• Performance relative to target credit medians• # of patient-centered medical home sites• % well, % at risk, % chronically ill for employee population• Core measures, % readmissions, % mortality• # of innovation center projects and impact • Attributed primary care lives• Utilization rates• Market share• % of revenue inpatient vs. % of revenue outpatient• Successful initiative execution (on time, on budget)• Overall organization performance against metrics defined above

Physician Platform

Development

1

Pricing and Competitive

Cost Strategy

2

Care Coordination

and PHM

3

Efficient Service Delivery

4

Organizational Structure and

Goal Alignment

5

Leadership Accountability Metrics

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Clinical Outcomes/Patient Satisfaction Measures

Covered Lives in Value-Based Arrangements 50,000

18% 52% 30%

0% 50% 100%

Population by Risk Level

High risk Medium risk Low risk

100 125 148

350 300400

8501000

750

Hospital 1 Hospital 2 Hospital 3

Inpatient admits per thousandED visits per thousandPhysician office visits per thousand

Observed/expected risk-adjusted all-cause mortality rate 0.75

Risk-adjusted all-cause readmission 13.8%

Hospital-acquired conditions 6%

Core measures sets, composite 88%

HCAHPS composite 95%

Physician Measures

Midlevel provider wRVUs / total practice wRVUs 25%

PMPM cost efficiency score 0.90

Revenue from value-based contracts 35%

Physicians qualifying for EHR incentives 82%

Referral leakage rate 18%

Average wait time to PCP appointment 1 day

Utilization Rates

Positive/negative trends over previous year

Payer Mix

Commercial

Medicare Advantage

Medicaid

Sample Value-Based Dashboard

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Examples of Leadership for PHM

Matt Lambert, MD

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Cedars-Sinai Medical CenterMovement to Value-Based Care Arrangements

• Vivity Partnership • Three Medicare Advantage Plans• Three ACO Arrangements

• Proactively engage and educate network physicians about issues related to value-based care

• Use data to highlight the performance of each clinician • Use a dual-reporting structure in some instances; encourages a system-

centric approach

~70K lives for all of these arrangements

“… developing local clinician champions and leaders for PHM has been and will continue to be critical to our success with PHM.”

Dr. Scott Weingarten, MD, MPHSenior Vice President and Chief Clinical Transformation Officer

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Community Hospital of the Monterey Peninsula

• New leadership mindset

• PHM governance and leadership structure

• Partnerships to support PHM

• Leadership accountability

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Talent

Training

Technology

Trustees

Time

“It is really, really hard work. But it can be done through successfully involving your stakeholders in advancing the process.”

Elizabeth A. Lorenzi, Vice President and Chief Operating OfficerCommunity Health Innovations

Community Hospital of the Monterey Peninsula

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Concluding Comments

Mark Grube

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• How high a priority does your leadership place on preparing for PHM?

• What gaps in expertise for PHM are most pressing in your organization?

• What would be the key value proposition your organization can and should deliver in a PHM environment?

• How can you ensure that physicians and other clinicians play a leading role in preparing for and managing under PHM?

• What metrics will you use to evaluate your progress toward effective and efficient PHM?

• How might your leadership/organizational structure and decision-making process need to change to drive the major strategic shifts required for PHM?

Key Questions

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Financing/Distribution System Competencies

Delivery System Competencies

Care Management

Care Management

Technology/Infrastructure (Claims-focused)

Technology/Infrastructure(Medical records-focused)

Webinar 3

Webinar 4

Population Health Management Framework

Webinar 2

Webinar 1

Leadership and Talent for Population Health Management

Webinar 5

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PHM requires levels of leadership, and organizational sophistication and nimbleness

never before required in healthcare.

Bottom Line

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Phone questions:

Questions?

Online questions:

Type your question in the Q & A box, hit enter

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Thank youAnne McLeodamcleod@calhospital.org

Ken Kaufman kkaufman@kaufmanhall.com

Mark Grubemgrube@kaufmanhall.com

Matt Lambert, MDmlambert@kaufmanhall.com