Brigham and Women’s Physicians Organization Overview

Center for Expertise in Healthcare ManagementAllen Smith, MD, MS

January 20, 2010

• Introductions

• BWPO Introduction– Overall corporate structure– Mission– Senior Management– Role– Physician statistics

• BWPO Areas of Focus– Patient Experience– Pay for Performance– Physician Experience: Volunteerism– Network Development

• Challenges and Opportunities

Agenda

Partners HealthCare System, Inc. (PHS)

Partners HealthCare System, Inc.

Partners HealthCare System, Inc.

Brigham and

Women’s/ Faulkner Hospitals

Brigham and

Women’s/ Faulkner Hospitals

Partners CommunityHealthCare,

Inc.

Partners CommunityHealthCare,

Inc.

North Shore Medical

Center, Inc.

North Shore Medical

Center, Inc.

AtlantiCare Medical

Center, Inc.

AtlantiCare Medical

Center, Inc.

Newton- Wellesley Hospital,

Inc.

Newton- Wellesley Hospital,

Inc.

Newton- Wellesley

Health Care System, Inc.

Newton- Wellesley

Health Care System, Inc.

The Brigham

and Women’s Hospital,

Inc.

The Brigham

and Women’s Hospital,

Inc. The General Hospital

Corporation

The General Hospital

Corporation

The Massachusetts

General Hospital

The Massachusetts

General Hospital

Faulkner Hospital,

Inc.

Faulkner Hospital,

Inc.

Brigham and Women’s

Physicians Organization

Brigham and Women’s

Physicians Organization

The Salem

Hospital

The Salem

Hospital

BWPO is a faculty practice plan which supports its physicians and departments in their aspirations to:

Provide the highest quality patient care

Develop the next generation of physician leaders

Be world leaders in translational research

PresidentAllen Smith, MD, MS

Chief Medical OfficerJessica Dudley, MD

Chief Financial OfficerWilliam Johnston

Vice President of Ambulatory and Women’s HealthSharon Vitti

Director of AdministrationSharon Cohen

Management Team

Role of BWPO

Streamline operations where possible– Organize and manage billing, administration and

financial components of its 17 business units– Foster departmental autonomy while supporting the

overall mission and goals of the organization

Support physicians in contracting and providing “medical management” support for high quality, efficient care

– Includes efforts in ambulatory experience

Focus on physician work life– Leadership, Volunteerism, IT systems

Employed Physicians

875950

10321144 1205

1273

801

605542

0

200

400

600

800

1000

1200

1400

2001 2002 2003 2004 2005 2006 2007 2008 2009

BWPO MDs

BWPO Physician Total

Corporate, 13

Emergency Medicine, 37

Anesthesiology, 119

Medicine, 306

Surgery, 113

Dermatology, 22

Neurpsurgery, 14

Neurology, 62

Psychiatry, 45

Rheum/Allerg/Imm, 38

Radiation Oncology, 27

Radiology, 152

Primary Care, 135

Pathology, 72Orthopedics, 25

Newborn Medicine, 26

OB/GYN, 67

Patient Experience

PhysicianExperience

FinancialHealth

Our

Staff

Our

Systems

BWPO Areas of Focus

Patient Experience

Patient First Launched by the Ambulatory Council

Helped focus attention on improving patient satisfaction

Staff TrainingLean Practitioner Training

Ambulatory operations improvement

Ambulatory patient satisfaction scores surpass 75th percentile mark

BW/F Ambulatory Services in top tier of UHC facilities that use Press Ganey

BWH/BWPO Overall Percentile Rank Trend Against UHC

44%

54%

69%73%

78%

64%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Q1 2008 Q2 2008 Q3 2008 Q4 2008 Q1 2009 Q2 2009

Survey Period

Per

cen

tile

Ran

k

Percentile Rank

Ambulatory Patient Satisfaction Scores:

Overall Trend of Percentile Rank

Target: 75th Percentile

Pay-for-Performance Contracts

• Ability to negotiate collaboratively as a physician network

• Pay-for-performance contracts with the 3 major commercial insurers for shared financial responsibility (risk) and interdependent clinical programs

• Withhold of an annual amount of revenue

• Withhold returned when network achieves certain efficiency and quality measures

2009 BWPO MD Withholds at Risk by Category

12%

Radiology

9%

Pharmacy11%

Inpatient

Process

15%EMR

25%

Quality

27%

$7,885Total

$745Radiology

$902Pharmacy

$978Inpatient

$1,157Process

$1,947EMR

$2,156Quality

2009 WH @ Risk ($1,000)Measure

$7,885Total

$745Radiology

$902Pharmacy

$978Inpatient

$1,157Process

$1,947EMR

$2,156Quality

2009 WH @ Risk ($1,000)Measure

• BWPO TEAM program focuses on improving patient

care outcomes and preventing unnecessary hospital admissions

• A team of nurses, doctors, pharmacist, social work, and administrative staff identify high risk patients and provide the following:

–High risk patient mgmt – face to face counseling and coaching

–Immediate access to necessary MD visits

–Programs for getting patients to LDL, BP, A1c targets + getting right meds prescribed

Pay for Performance: Training, Education, and Management

(TEAM)

Goal: Provide opportunities for teaching and clinical care in an impoverished setting

Indian Health Service (IHS): Compelling health care needs of Navajo population

Relatively easy for physicians to volunteer there

IHS Sites: Gallup, NMShiprock, NM

Progress: Assessment of needs (both IHS and BWH) and initial visits completed

Next Steps: Regular site visits and additional fundraising for program

Volunteerism: Indian Health Service

Christian Arbelaez, MD, MPH and staff at Gallup Indian Medical Center

Rhode Island1. Memorial Hospital

(Pawtucket) affiliation2. Emergency Medicine

management & Cardiology consulting services

Foxboro MACC1. Primary Care2. Dx. Imaging3. Surg Specialties4. Med Specialties5. Amb Surgery6. Pathology, etc

South Shore Hospital1. DFBWCC with SSH2. Expanded Surgery,

Cardiology, Neurology and OB/Gyn affiliations

South Coast1. PrimaCare,

Hawthorne (PCHI) relationship mgmt.

2. BWPO Rad Onc services at St.Anne’s Hospital

Compass Medical1.BWH MRI service2.BWPO surgery3.BWH Vein center, Center for Repr. Medicine

4. BWPO Cardiology

Near West1. OB/Gyn, CIRS

practice @ NWH

Map of BW/F Relationships in Southeastern Mass

Metrowest Area1. BWPO

Rheumatology2. BWPO

Cardiology

Plymouth1. Relationship Mgmt

with new PCHI groups

Cape Cod Hospital1. BWH cardiac

surgery and anesthesia services

2. BWPO radiology services

3. BWPO cardiology services

Milford1. DFBWCC at

Milford2. New PCHI group

(Tri-County)3. OB-Gyn (MIGS)

services

Quincy Medical Ctr1. Providing

Cardiology dept chair

2. Tertiary trauma services

*Map represents primarily “major” external relationships where we have on-the-ground presence or provide key on-site leadership

**MACC is a Multi-specialty Ambulatory Care Center

Map Key:

MACC** Sites

Physician Relationships

Challenges and Opportunities

Health Care Reform

Patient ExperienceMeeting ambulatory goals consistently at practice levelStructured approach to ambulatory quality and safety

Referring Physician ExperienceAccess, communication, transitions, cost

Faculty ExperienceWorklife satisfaction and balanceFuture of Primary Care

Financial HealthControlling expensesAmbulatory revenue growth Alternative revenue streams to offset declining reimbursements

Health Care Reform: Models

Global Capitation

Fee for Service

P4PAugmented

Primary Care

Bundled Payments

Payment Model

Adapted from Dr. James Mongan presentation 5/26/2009

Level of financial risk borne by provider

Level of financial risk borne by payor

BW/F is engaged in all three models

Big 3 Contracts CMS Demo

Bundled Payment

PilotFoxborough Medical Home