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Crossing the Bridge to an Integrated Delivery System in Cedar Rapids, April 19, 2011

Crossing the Bridge to an Integrated Delivery System in Cedar Rapids, April 19, 2011. Non-Economic Integration. Employment, Directorships, Subsidies, Etc. Contractual Joint Ventures. Financial Integration. Equity Joint Ventures. Integrated Delivery Model. Strategic/ Economic Relationships.

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Crossing the Bridge to an Integrated Delivery System in Cedar Rapids, April 19, 2011

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  1. Crossing the Bridge to an Integrated Delivery System in Cedar Rapids, April 19, 2011

  2. Non-Economic Integration Employment, Directorships, Subsidies, Etc. Contractual Joint Ventures Financial Integration Equity Joint Ventures Integrated Delivery Model Strategic/ Economic Relationships Emotional Connection Communication.. …Openness… ..Trust…Respect Multiple strategies For alignment of Economic interests Substantive Involvement in Decision Making Infrastructure Improvements to Increase efficiency/ Accessibility of care Positive Organizational Culture Visibility/ Accessibility of CEO/Mgmt. Appropriate support For physician Practice growth Information systems Physician Leadership development High quality/ safe Patient care The Cedar Rapids Story

  3. St. Luke’s Hospital Strategic Framework Demonstrably Better Quality Partner of Choice for Physicians Partnership with Associates Strengthen the Core Regional Resource

  4. Workshop of Choice For Physicians • Old Language: 2003 – 2008 “With a focus on clinical quality, efficiency, and service, St. Luke’s will create an environment where physicians prefer to practice and bring their own family members. St. Luke’s will continue to seek ways to achieve strategic and economic alignment with physicians in an effort to create mutually beneficial relationships.”

  5. Partner of Choice for Physicians Established in 2008 St. Luke’s will be a trustworthy strategic partner with physicians in the delivery of demonstrably better quality healthcare. St. Luke’s will create an environment where physicians prefer to practice and to bring their own loved ones for care. St. Luke’s will be the first choice of physicians for strategic alignment be it emotional, clinical, or organizational.

  6. A Two-Part Framework: • Emotional Connection: • Developing a preferred practice environment provides an underlying structure which demonstrates St. Luke’s is ‘a better place to be’ for patients AND physicians. • Economic and/or Strategic Relationships: • Provide a platform upon which physicians believe that St. Luke’s is a willing and capable partner that can be trusted and relied upon if and when their practice environment is no longer self-sufficient.

  7. The Emotional Connection …..Building Trust Desired Outcome: To Build relationships which will foster two way communication between all levels of management and physicians with an emphasis on CEO / C-Suite level contact and development.

  8. The Emotional Connection …..Building Trust • Consistent CEO / C-Suite Communication Plan • Establishment of Physician Liaison Support • Annual Physician Satisfaction Survey, Focus Groups, and Pulse Surveys / Rounding. • Specific patient acquisition plans • Communication, Communication, Communication • Images for Physicians • Open Forums 2x per year • Doctor’s Mailbox • Recognition / Events

  9. Economic and/or Strategic Relationships … Guiding Principles • The physicians have got to want it: buy-in. • Mutual trust and respect between the parties; openness of communication / transparency of information. • Method of integration is founded on a viable economic model (risk = return). • The approach is consistent with both parties strategic plan and there is a track record of a strong relationship between the organizations. • There is evidence of strong physician leadership in place. • The partnership will enhance and provide accountability for clinical quality, service line growth / advancement, customer experience, and efficiency.

  10. Economic and/or Strategic Relationships…Building Partnerships • Hospitalist Program (s) • Surgery Center Cedar Rapids and other Joint Ventures • Peri-Operative Governing Council • Service Line Management • Recruitment Support • W-2 Partnership

  11. Partner of Choice for Physician Goals

  12. Enter the IHS Strategic Plan … The Vision for the Future IHS will need to reposition itself from a statewide, hospital-centric delivery system to an integrated care management organization that is physician driven and patient centered, positioned as the primary healthcare utility for the state of Iowa and bordering areas.

  13. Integration 101 Definition: A network of organizations that provide or coordinate and arrange for the provision of healthcare services to consumers and are willing to be held clinically and fiscally responsible for the outcomes and the health status of the populations served. Generally consisting of hospitals, physician groups, health plans, home health agencies, hospices, skilled nursing facilities, or other provider entities. The networks may be built through virtual integration processes encompassing contractual arrangements and strategic alliances as well as through direct ownership. Source: MGMA

  14. Working Toward An Integrated Delivery System

  15. What Integration is NOT • A hospital that employs physicians • A physician practice subordinate to a hospital • Hospital led without physician input or influence

  16. The Key to integration is Physician Alignment

  17. Physician Alignment – Common Principles IHS’s Physician alignment goals will require some significant changes to accomplish.

  18. Physician-Driven Systems Corporate Structure Health System/Hospital (Parent) Physician Entity Hospital The physician entity is usually incorporated as a “sister” corporation of the hospital

  19. IHS Corporate Administration and Services Physician Clinic Division Hospital Division Des Moines Clinic Iowa Health – Des Moines Methodist, Lutheran, Blank Cedar Rapids Clinic St. Luke’s Healthcare St. Luke’s Hospital Waterloo Clinic Allen Health Systems, Inc. Allen Memorial Hospital Quad Cities and Muscatine Clinic Trinity Regional Health System Trinity Medical Center and Unity Healthcare Fort Dodge Clinic Trinity Health Systems, Inc. Trinity Regional Medical Center Sioux City Clinic St. Luke’s Health System St. Luke’s Regional Medical Center Dubuque Clinic Finley Tri-States Health Group, Inc. The Finley Hospital A Model For Our Future

  20. Cedar Rapids Physicians Clinic Steering Committee Charter • Aim(s): • 1. From a Cedar Rapids perspective this committee will serve as the Regional Physician Leadership Council to inform and provide input to the statewide steering committee working on the establishment of NewGroup. • Timeline: July 1, 2011 • 2. Create the ideal integrated healthcare delivery system in the Cedar Rapids region by providing physician leadership and direction to the vision, strategies, and specific initiatives. • Timeline: FY 2011. Steering committee will meet 2x/month (2nd and 4th Tuesday). • 3. Support the strategic framework of St. Luke’s Healthcare as the region makes the transition to an integrated delivery system. • Timeline: FY 2011 and ongoing. • Team • System Sponsor: Alan Kaplan, M.D. • Chair: Ted Townsend • Members: Ken Anderson, M.D., John Roof, M.D., Todd Langager, M.D., Dustin Arnold, D.O., Dennis Rosenblum, M.D., Judy Bernhard, M.D., Shannon Throndson, M.D., Charles Schauberger, M.D., Robin McNichols, John Sheehan, Support Staff: Leigh Christensen

  21. Dr. Dustin Arnold Hospitalist Med. Dir.&CMIO Dr. Shannon Throndson Family Practice Physician Dr. John Roof IHP Med. Dir-Central Reg. Dr. Todd Langager Med. Dir.for Cardiology Dr. Dennis Rosenblum Med. Dir. Neonatology Dr. Julie Bernhard Pediatrician Physician Leadership Academy—Cedar Rapids

  22. Integration Hierarchy Shared Leadership defined as physician led, professionally managed. Source: Integrated Delivery Systems / AMGA

  23. Critical Success Factors for Integration • Structure • Aligned Strategic Planning, Goals, and Initiatives • Aligned Physician Compensation Plan • Culture of the Organization • Continuum of Services / Coordination of Care • Physician Leadership

  24. Cedar Rapids Physicians Clinic Agenda • Complete committee education regarding St. Luke’s market position, competitor overview, strategic plan, and master facility plan. • Complete committee education regarding other integrated delivery systems – focusing on those that are most relevant to the Cedar Rapids region. Areas of interest include governance, compensation structure, and start-up struggles/successes. • Develop a better understanding of the current initiatives and future direction of PCI. • Develop Regional Clinic and Integrated Delivery System structure. • Establish and engage regional IHS Physicians Clinic Steering Committee. • Assess and recommend human resource support for partner physicians. • Identify and formalize the physician/administrator dyad for major service lines. • Identify future priorities for expansion of partner physicians. • Identify next round of leaders in the IHS Physician Leadership Academy. • Develop regional outreach strategies/hubs. • Establish a revenue capture measurement tool for the Integrated Delivery System’s closed economy. Develop internal approach and philosophy related to a closed economy.

  25. Jump Start to Integration • Identify integration champions. • Set a clear vision for integration, tie it to the mission. • Assure patient care is top priority. • Let the physician leaders be the voice. • Demonstrate a culture of teamwork, inclusion and transparency. • Develop a specific plan.

  26. How does Integration Benefit Patients?

  27. Not for the Faint of heart ….must have ice water in your veins. “Embarking on the path of creating an integrated healthcare organization from a matrix of private practice is a little like driving a truck loaded with nitroglycerin along a bumpy bridge. Leaders without the political skills to sense the bumps before they hit them will never know what happened.” Jeff Goldsmith, PhD Healthcare Futurist

  28. Non-Economic Integration Employment, Directorships, Subsidies, Etc. Contractual Joint Ventures Financial Integration Equity Joint Ventures Integrated Delivery Model Strategic/ Economic Relationships Emotional Connection Communication.. …Openness… ..Trust…Respect Multiple strategies For alignment of Economic interests Substantive Involvement in Decision Making Infrastructure Improvements to Increase efficiency/ Accessibility of care Positive Organizational Culture Visibility/ Accessibility of CEO/Mgmt. Appropriate support For physician Practice growth Information systems Physician Leadership development High quality/ safe Patient care The Cedar Rapids Story

  29. Next Steps • Answer the big questions: • Do we believe this plan? • How would it work in our market? • What can I do tohelp achieve it?

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