Welcome to our Practice Challenge!

1. Welcome to our Practice Challenge! We’re glad that you are here and hope that you find this session to be valuable in terms of learning and highly entertaining as well.

2. Introduction Will Latham Primary facilitator

3. What is this session? • New and different • We hope: • Enjoy yourselves • Learn a lot • You’ll provide us with an open and honest critique

4. Objectives: • Propose and test innovative solutions in a safe environment • Evaluate issues from multiple perspectives • Reflect on solutions in new and different ways

5. Rules Today we’ll be playing a game of sorts: There are rules – but not too many.

6. Rule #1 • Everyone needs to play their part. • Three distinct groups of people • Participants • 30 people who signed up to play the game • Observers • Can participate during our report out & reflection • Can wander in/out of the discussion rooms • Facilitators/ Subject Matter Experts • Joan, Laura, Jeff, Steve, Dave, Ken, and Tom • Guides & facilitators for the game today • They can help, but will not be LEADING the conversation

7. Rule #2 - Agenda 2:00pm – 2:15pm Introduction (15 Minutes) 2:15pm – 2:25pm Form the Teams (10 Minutes) 2:25pm – 3:10pm Groups to Discuss (45 minutes) 3:10pm – 3:20pm BREAK (10 minutes) 3:20pm – 4:05pm “Board Meetings” (45 Minutes) 4:05pm – 4:10pm Return to Main Room (6E) 4:10pm – 4:30pm Report out and Wrap Up (20 minutes) 4:30pm – 5:00pm (Optional) Add’l Reflect (30 minutes)

8. How the Game Works • Booklet of materials • story of Acme Family Medicine • important details about the practice. • Review of story, • Pose some questions • Divide into groups • Each group becomes one of the doctors at Acme • Formulate answers to the questions

9. After Discussion We’ll bring your groups back together • Two separate board meetings • Negotiate IF and HOW the practice might be saved.

10. Board Meeting Consists of: • Three physician personas • One facilitator. physician persona –perspective that your group has been assigned and everyone in group can advocate for their group’s perspective.

11. Next All participants come back together and compare and contrast how the two board meetings went Were decisions similar or different? How did it all work out?

12. Is this sounding like fun or what?

13. Situation • Acme Family Medicine: • In practice 30 years • Nine providers – all 1.0 FTE • Two founding partners, ages 65 and 63. • Four partners, ages ranging between 40 and 50. • Two non-partners; starting their second year of a two-year contract • One Salaried PA • There are 21 support staff • Administrator of practice is not around today

14. EHR • EHR was implemented five years ago • not adopted by two of the senior partners, so paper charts are being used for their patients; the senior partners are happy with this.

15. Building Lease • Acme Group’s current building lease expires in 15 months. • ABC Hospital owns the building • Hospital will be expanding into this space • Acme Group must move. • No other available building space within 10 miles with adequate space

16. Current Physical Space 30 years old Renovated 10 years ago Has 16 exam rooms Total of 7,160 square feet.

17. Additional Challenges One of newest physicians is expecting twins in seven months and intends to take 12 weeks off and possibly come back only part time. The founding docs are closed to new patients. The remaining partners have the first available new patient appointment four weeks out. The new docs and PA are at 60 percent capacity.

18. Contracting • Payer contracting managed through an IPA. • The IPA is: • Associated with ABC Hospital and a competing hospital • Actively pursuing participation in shared-risk, value-based contracts with three major payers who represent more than 50 percent of its patient base. • Contract with IPA expires in six months.   • Current contract rates - highest in the primary care community due evergreen contracts • Acme Group call partners are in the IPA.

19. Materials Your materials will also provide you with key financial and contractual information.

20. Your Challenge In your assigned role we would like you to: • Perform an operational assessment • Look at future scenarios: • Should the Group stay with the IPA and move to value-based contracts (VBCs) or group leaves IPA and decline VBCs. • Location: Group stays nearby or group leaves campus and/or aligns with the other hospital.

21. More Rules: You can’t hire an outside consultant. You must remain profitable. Patients have to maintain access to care. Administrator is not leaving the practice.

22. You READY???? Divide you into your groups. Find the facilitator holding up your group number Go stand with your group Follow your facilitator to a room for discussion Let the FUN begin!

23. Breakouts Dave Jeff Steve Joan Laura Ken Group 1Group 2Group 3 Stuart Schwartz Marvin Schutzius Steven Nord Brian Ramos Josheila Crandall Marie Walton Gena Weir Kari Turk Debra Sundberg Patricia Mullins Kerri Gantt Cindy Alkire Kevin Dwyer JinousRouhani Robert Rosso Janice Guy Group 4Group 5Group 6 John RaginJolineBetsch Colleen Norris Maria Bakaleinik Robert Libberton Brenda Hall Diane Bennett Skip (Vivian) Kasprzak Amanda Smith Jonathan Tamir Scott Shollenbarger Larry Epstein Otis Fagan Donovan Miske Jane Parrish

24. Questions?