Increasing Consolidation in Health Care - a provider’s perspective

1. Increasing Consolidation in Health Care - a provider’s perspective 2016 Washington State of Reform Health Policy Conference Hiroshi Nakano Director | Value Based Care Hiroshi_Nakano@Valleymed.org

2. Why VMC and UW Medicine Affiliated • Increase access to healthcare services for South King County residents. • Improve efficiency of care; align best practice models expand clinical, teaching and research programs. • Position both organizations for future healthcare reform opportunities, such as the creation of an Accountable Care Organization (ACO). • Affiliation agreement signed in mid 2011.

3. UW Medicine|Valley Medical Center Structure • VMC assets remained district assets. • VMC continues to offer all core and clinical services. • UW Medicine offers additional clinical services in agreed upon service gaps. • VMC employed physicians and employees remain VMC employees. • District Board of Commissioners remains on the board. New board oversees VMC management. New board consists of: • 3 UW Medicine Designated Trustees • 5 Community Trustees • 5 Commissioner Trustees • Two VMC Commissioners sit on UW Medicine board.

4. UW Medicine Puget Sound Locations UW Medicine Shoreline Clinic UW Medicine Woodinville Clinic Northwest Hospital UW Medicine Residency Clinic Seattle Children’s UWMC Roosevelt UW Medical Center Hall Health Primary Care Center VMC and its … clinic network Seattle CancerCare Alliance UW Medicine Belltown Clinic UW MedicineEastside Specialty Center HarborviewMedical Center Puget SoundHealth Care System UW Medicine Factoria Clinic AirliftNorthwest UW Medicine Issaquah Clinic Newcastle Clinic (Primary & Urgent Care) Renton Landing Clinic (Urgent Care & Sports Medicine) Valley Medical Center North Benson Clinic (Urgent Care) Fairwood Clinic (Primary Care) Cascade Clinic (Primary Care) Highlands Clinic (Primary Care) Valley Family Medicine Clinic (Primary Care & Residency Program) Occupational Health Services Kent Clinic (Primary & Specialty Care) Covington Clinic North (Primary & Specialty Care)Covington Clinic South (Urgent & Specialty Care) UW Medicine Kent/Des Moines Clinic Lake Sawyer Clinic (Primary Care) Valley Women’s Healthcare (OB/GYN) UW Medicine Federal Way Clinic

5. aco Networks in Puget Sound - Commercial ​

6. Does Consolidation Impact the Triple Aim? • UW Medicine and VMC: • Access to commercial ACO contracts • Access to clinical expertise • Access to research opportunities • Sharing of best practices within the system • Sharing of best practices with community providers

7. Are delivery systems changing? ----The VMC Experience • Changed RN Focus to Care Management (2013) • RN Care Manager Training (AAACN) • Evolved Disease Management to High Risk Holistic Care Management (2014) • Re-Aligned Quality Metrics • Re-Aligned Team Metrics • Focused on Patient Experience (2013) • Created RN Panels (2014) • Medical Home Recognition (2015) • Risk Scoring Imbedded in EMR • Healthy Planet/Registry Development • Shadowing/Teaming with IP Care Mgt

8. Challenges…. • Open Medical Staff (ex. 60-65% of patients seen in urgent care and specialty care have PCP out of network) • Alignment of leadership • Changing demographics: South King County increasing obesity, low income, low literacy, more diversity • Provider burn out (ex. too many clicks) • Complicated and overly prescriptive care management contract specifications • Conflicting ACO contract(s) objectives • RN Care Manager panel growth and management (65-200 patients/RN) • And more………..

9. Challenges…. • Fee For Service/Volume/Visit orientation in Shared Savings arrangements • Reliance on downstream revenue • How to fund population management infrastructure • Pot at the end of the rainbow? • Volume based Chronic Care Management? • Capitation?

10. Challenges… Is it getting better? You tell me.