NCHS Recruiting & Retention

1. NCHS Recruiting & Retention Barbara kennedy, MHA, FACHE president & CEO May 2018

2. NCHS Recruiting & RetentionChallenges & Strategies for Recruiting and Retaining Providers Agenda: • Recruiting & Retention Challenges • NCHS Recruiting & Retention Strategies • Provider Retention Trends 4. Provider Turnover – Breakdown of Data 5. Recruiting Trends 6. Action for 2018 and Beyond Confidential - For NCHS

3. Quality of care • Work quantity & pace • EHR • Autonomy of work • Practice leadership • Collegiality, fairness, respect • Support staff • Income stability • Regulatory environment • & Health reform Source: https://www.rand.org/health Confidential - For NCHS Executive Committee 3.8.16

4. Recruiting & Retention Challenges • The Primary Care Provider Shortage • Out of the 800,000 practicing physicians in the United States, only 32% are at the primary care level. • Between 1985 and 2011, the number of medical graduate students going into primary care declined by 24% though fewer than 18% of medical graduate students will ultimately practice primary care. • There are estimates that the 2010 ACA coverage expansions increase the current shortage of 25,000 primary care physicians to 45,000 primary care physicians by 2020. Confidential - For NCHS BOD

5. Recruiting & Retention Challenges Satisfaction of Providers with Primary Care • Primary care providers are the most unsatisfied group of doctors • A panel size of 2,000 patients would require 17.4 hours per day of work in order for a primary care physician to provide the recommended care outside of PCMH. (Bodenheimer, 2010) • Lowest paid providers Confidential - For NCHS BOD

6. Recruiting & Retention Challenges NCHS: Evidence Based Approach “The spike in reported burnout is directly attributable to loss of control over work, increased performance measurement (quality, cost, patient experience), the increasing complexity of medical care, the implementation of electronic health records (EHRs), and profound inefficiencies in the practice environment, all of which have altered work flows and patient interactions.” • - Health Affairs March 2017 Confidential - For NCHS BOD

7. Recruiting & Retention Challenges • Success Factors: • Build trust; providers must trust their clinical and admin leadership; and, we can’t ‘ask for it’ –needs to be earned 24/7 • Yes, compensation and benefits “count”. We are competing with Kaiser and other entities for good primary care providers who can literally work anywhere • The biggest “dissatisfier” for providers in practice is realizing they are unable to provide a high/acceptable standard of care…. • The biggest “satisfier” for providers is knowing that they are providing high quality care. So, for NCHS, acknowledging our quality achievements plays an important role in “provider maintenance therapy” • For providers, “time” is more valued than “money”; especially administrative time to do things, professionally, that yield a sense of knowing one is making a difference Confidential - For NCHS BOD

8. Recruiting & Retention Challenges Provider Productivity in an Alternative Payment World • Patients seen per hour should not change • Potentially, will need additional administration time for: • Panel and case management reviews • Risk and utilization reviews • CQI (Continuous Quality Improvement) projects Visits Per Hour Actual Goals Confidential - For NCHS BOD

9. NCHS Recruiting & Retention Strategies Optimizing employee investment and support by providing the employee training and professional development needed to support a successful and high performing employee base. Example: Lead Clinician Development Program with professional training that covers administrative and clinical topics including: Leading Teams, Managing Conflict, Facilitating Productive Meetings, Healthcare Economics, and Clinic Management. Strengthen employee investment and support by providing valued and competitive incentives and total rewards. Example: To better align with market we initiated NP and PA Market adjustments in 2017 totaling $163k; continuance of 457b retirement and Deferred Compensation plans; added NCHS paid-for Long Term Disability; added PPO benefit plan with tax advantage Health Savings Account. Confidential - For NCHS BOD

10. NCHS Recruiting & Retention Strategies Encourage employee investment and support by providing the management tools, resources and systems to allow for rewarding and retained employment relationships. Example: Admin time added; PET committee established; Mentorship pilot starting now. Unify the philosophy that successful retention is formed as a collective of strategies, tactics, and measurements in a collaborative process between managers, staff and the organization as a whole. Example: Employee Engagement Survey and department action planning, continuance of Employee Referral program with a pay out of $3500 per successful referral. Confidential - For NCHS BOD

11. NCHS Provider Retention Confidential - For NCHS BOD

12. Provider Turnover 2016 - Current Turnover - by Role Turnover - by Reason Confidential - For NCHS BOD

13. Provider Turnover 2016 - Current Turnover - by Location Confidential - For NCHS BOD

14. Recruiting 2016 - Current Providers Hired: 70 Providers Recruiting Sources Confidential - For NCHS BOD

15. Recruiting 2016 - Current Average Days-to-Fill Recruiting Costs Confidential - For NCHS BOD

16. 2018 and Beyond - Action Training & Development • Focus on Manager and Lead Clinicians • Identify high potential employees • Identify staff who may represent a retention risk • Prepare for and conduct retention interviews • Create and define formal career ladders • Include technical paths and leadership paths • Develop employee-specific action plans Confidential - For NCHS BOD

17. 2018 Retention Action • Employee Engagement • Past employee opinion survey • Furthered by Department Action Plans • Assess real-time engagement feedback tools in an open system Benefits & Compensation • Identify gaps • Recommend enhancements • Comp adjustments • CA / Federal law change forecasting Confidential - For NCHS BOD

18. Questions / Comments Confidential - For NCHS BOD