Strategic Planning Boot Camp Building a Strategic Plan for the Value Transformation

Transcription

1 Strategic Planning Boot Camp Building a Strategic Plan for the Value Transformation Drs. Angood and Cacchione; and Ms. Jaskie Moderators: Dr. Chazal and Mr. Jacobovitz

2 Disclosures Peter Angood, MD Nothing to disclose Joseph G. Cacchione, MD, FACC Consultant Fees/Honoraria: Aim Speciality Health; United Healthcare Scientific Advisory Board Richard A. Chazal, MD, FACC Nothing to disclose

3 Disclosures Shalom Jacobovitz Officer, Director, Trustee or Other Fiduciary Role: Clene Nano Medicine Suzette Jaskie, MBA Consultant Fees/Honoraria: Boston Scientific Corporation

4 Disclosures Howard T. Walpole Jr., MD, MBA, FACC Salary: Zoll Medical (Spouse)

5 Agenda Strategy and the healthcare environment What does an effective strategy process look like Break Physician compensation is a strategic issue Programs must address these strategic issues Discussion Q&A

6 Strategy and the Healthcare Environment - Trends Peter Angood, M.D. February 18, 2016

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8 A Brave New World! 9

9 1 0 Changing Definition of Hospital More Integration Opportunities M&A Activity Physician Integration Community Coordination More Risk Management Increased Accountability R. Umbdenstock-Healthcare Executive Mar/Apr 2014 (pp.78-79)

10 Global Health Care CEO s Challenges for Future: Leadership Characteristics: Managing Change Innovative Funding Care Insightful on Patients Define/Measure Quality Insightful on Providers Managing Regulation Collaborative Data Analytics R. Herzlinger & GENIE Humility

11 1 2 FSMB Updated Stats Nearly 900,000 licensed physicians in the US (280 physicians/100,000 population) Avg. age = 51yrs and ~79% are certified by an American Board 2/3 of physicians are Male but Female physicians increased by 8% in past 2 years compared with only 2% of male physicians 34% of female physicians are < 39 years compared with only 18% of male physicians. Actively licensed physician population grew faster in older population 11% increase those > 60 years vs. 1% increase those < 49 years 26% of physicians are now over age 60 years, a demonstrable actuarial need for an increased supply of physicians JMR 2013;99(2):11-24.

12 Surge With Physician Employment ~75% increase in number of active physicians employed by hospitals since 2000 ~75% of hospital leaders plan to increase physician employment within next 12 to 36 months. (MGMA Survey) Share of physician searches for positions with hospitals hit ~75% in 2014 (Merritt Hawkins) Trend is accelerating => 3 in 10 physicians are now hospital employees 2001 to 2011, # physicians & dentists employed by US hospitals grew by >40% 60% FP & Peds; 50% Surgeons; 25% Surg Spec are employed not independent (AHA & AMA) 1 3

13 Medscape: Employed Doctors Report (~4600 Physicians in 2014) 1 4

14 Employed or Considering It 1 5

15 American Association for Physician Leadership By the Numbers: The oldest and largest educational organization solely dedicated to physician leadership 250K educated & currently with 11,000 physician members representing 45 countries 75 expert faculty across dozens of disciplines Approximately 100 physician leadership courses and several certificate programs 4 Master s degree programs with more than 1,200 graduates (PhD in development) More than 21,000 physicians have completed the popular Physician in Management series More than 2,200 physicians with board certification (Certified Physician Executive) >220 in-house leadership courses taught each year at hospitals and health systems More than 3,200 online courses delivered annually 4 major live educational conferences per year 1 6

16 So What Are We Hearing Out There?? 1 7

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18 1 9 DiSC Preference Instrument Total respondents: 2,663 physicians Forced choice instrument 28 sets of 4 words: most like me least like me Statistically validated; some similarity to Myers Briggs

19 Conscientious Dominators 50% Dominance Quick to act Likes challenges Forceful Influence Considers people first Is talkative Likes to meet new people 14% 29% Conscientiousness Gathers data before acting Is precise Likes to be perfect Steadiness Performs consistently Ponders all angles of any problem Likes stability 7% 2 0

20 2 1 How physicians identify with predetermined personalities and links to perceived performance and wellness outcomes: a cross-sectional study JB Lemaire, JE Wallace BMC Health Serv Res. 2014; 14: 616.

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22 MDs vs. Non-MDs as Leaders 2 3

23 Transformational Leaders: Measurement of Personality Attributes and Work Group Performance High scores on transformational leadership were associated with a distinct personality pattern characterized by higher levels of pragmatism, nurturance, and feminine attributes and lower levels of criticalness and aggression. This enabling pattern formed the core of transformational leadership. SM Ross, LR Offermann Personality and Social Psychology Bulletin 10/1997; 23(10):

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25 Physicians as Hospital Leaders How are hospitals and health systems different when run by physicians? Better understanding on nature of challenges & common knowledge base Improved understanding of patient care operational issues Unwilling to compromise quality/safety/labor for profit Finance as a means not an end Aligning differing values (RNs, PHAs, DOCs, etc.) & improved interactions Greater value on physician leadership, compensate appropriately Anticipate change within health care industry and selectively embrace new technologies/methods, e.g., new trends, governmental regulation Better coordination with referral sources (private offices/clinics) Less duplication of similar services within region, more collaboration among local hospitals Greater insight into clinical/patient care activity on local and regional level (Kearns et al - Physician Executive Journal, Jan/Feb 2009) 2 6

26 Physicians as Hospital Leaders Rank Organization State Name of CEO/Presdient Physician? 1 Johns Hopkins Hospital MD Paul B. Rothman Yes 2 Massachusetts General Hospital MA Peter Slavin Yes 3 Mayo Clinic MN John H. Noseworthy Yes 4 Cleveland Clinic OH Delos M. Cosgrove Yes 5 UCLA Medical Center CA David T. Feinberg Yes 6 Northwestern Memorial Hospital IL Dean M. Harrison No 7 New York-Presbyterian University Hospital of Columbia and Cornell NY Steven J. Corwin Yes 8 UCSF Medical Center CA Mark R. Laret No 9 Brigham and Women's Hospital MA Elizabeth G. Nabel Yes 10 UPMC-University of Pittsburgh Medical Center PA Jeffrey A. Romoff No 11 Hospital of the University of Pennsylvania PA Ralph W. Muller No 12 Duke University Medical Center NC Victor J. Dzau Yes 13 Cedars-Sinai Medical Center CA Thomas M. Priselac No 14 NYU Langone Medical Center NY Robert I. Grossman Yes 15 Barnes-Jewish Hospital/Washington University MI Richard Liekweg No 16 IU Health Academic Center IN Dan Evans No 17 Thomas Jefferson University Hospital PA Stephen K. Klasko Yes 18 University Hospitals Case Medical Center OH Thomas F. Zenty III No U.S. News Best Hospitals : the Honor Roll 2 7

27 2 8 Physicians as Hospital Leaders Among the nearly 6,500 hospitals in the United States, only 235 are run by physicians ( Academic Medicine) Overall hospital quality scores 25% higher when doctors ran the hospital, compared with other hospitals. For cancer care, doctor-run hospitals posted scores 33% higher scores Physician-Leaders and Hospital Performance: Is There an Association? (Goodall July Social Science and Medicine)

28 2 9 ACOs MSSP (CMS: 1/30/14) 367 groups of providers formed ACOs 5.3 million Medicare patients serviced (1 in 8) 115,000 US doctors involved in some way First class of ACOs saved $380 million (LEAVITT PARTNERS) Of 114 ACOs in the program, 54 ACOs saved money and 29 saved enough to receive bonus. 21 of 29 successful ACOs with received bonuses were physician-led.

29 (Dreyfus Model) 3 0

30 Where is Cards Where are YOU 3 1

31 What Does an Effective Process Look Like? Joseph Cacchione, M.D. FACC Chairman, Strategic Operations HVI February 18, 2016

32 1) Does your Organization have a plan? A. Yes B. No 2) Are you part of the planning process? A. Yes B. No 3) Are you seen as an owner or customer? A. Owner B. Customer Question- 1

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34 Important Concepts Mission Who we are? Vision Where are we going? Strategy How are we going to do it? Tactics What are we going to do?

35 Question - 2 1) Are you aware of these concepts for your organization? A. Yes B. No C. Don t care

36 A Working Definition: Strategy Strategy is the process of profitably matching internal resources with constantly changing external demands

37 Five Iron Laws of Strategy 1. History Drives Strategy 2. Focus 3. Innovation 4. Diversification 5. All Growth Will End

38 Strategy Nuts & Bolts Industry Analysis What is our position? How do I appeal to my customers? How do we organize?

39 Industry Analysis Suppliers Buyers Rivals (competition) Complimentors Substitutes(competitors)

40 1) Are we different? A. Yes B. No Question 3 -Competition 2) Is There Excess Capacity in your market, driving competition? A. Yes B. No 3) Switching costs / inertia (are your customers loyal?) A. Yes B. No

41 Tacit Coordination Public data Concentration in Markets Capacity Exit Barriers

42 Elements of Strategic Investment Decision Financial Planning IE ROI What are the uncertainties? (sensitivity analysis) Contingency Technology Forces Market forces

43 Strategic Investment Decision Tree New Product IE TAVR Capacity Expansion New OR Shut Down Close programs within the system Sequential Investment

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45 Two Growth Paths Incremental, year-to-year sustaining innovations (exploiting what we know) Bringing a better product or service to current customers Breakthrough, disruptive innovations (exploring the known and unknown) Finding new customers with product or service offerings that are not interesting to current customers Strategic Business Leadership, March 2007

46 Scenario Planning A disciplined method for Imagining Driving Forces Ranges Create Scenarios using the portfolio of driving forces Paul Shoemaker, Scenario Planning: A Tool for Strategic Thinking, 1995

47 Creativity is an idea (tangible and /or intangible) that changes a social system Creativity is any act, idea or product that changes an existing domain, or that transforms an existing domain into a new one. And, the definition of a creative person is: someone whose thoughts or actions change a domain, or establish a new domain. M. Csikszentmihalyi, Creativity, 1996

48 Combine Facts and Imagination Facts Observe Reality New Facts Logic & Deduction Narratives Make Believe Invent Realities Create Illusion Intuition

49 Strategy Summary Does your organization have a plan? Are you aware of that plan? Are you an owner, constituent, customer or barrier? Does your strategy have an execution plan and how are you measuring success?

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51 BREAK Tick- Tock

52 Compensation is a Strategic Issue Suzette Jaskie, President MedAxiom Consulting February 18, 2016

53 Question- 1 1) I am employed by a health system? A. Yes B. No 2) My compensation plan is based 90% or more on physician productivity. A. Yes B. No 3) My performance is reviewed annually A. Yes B. No

54 Is Fee for Service the Culprit or ANTI-VISION Notion of Clinical or Blind Operations Strategy? ED PCP PCP Cardiologist Cardiologist Cardiologist Admit Hospitalist Refer to EP Retain patient medical management Retain patient medical management Consult, no procedure no follow up Refer to EP Discharge Primary Care AF Ablation No AF Ablation CORP AA July 2015

55 Compensation is a strategic issue Value incentivized healthcare system creates integrated health systems.

56 Question- 2 1) I am involved in either an ACO or a bundled payment initiative. A. Yes B. No 2) My compensation plan has changed since the introduction of healthcare reform. A. Yes B. No

57 Requires new skills: Clinical Standardization, Team based care, Care and transition management and I.T. integration PROGRAM VISION Based on Clinical Standards and a Systematic Approach Medical Management Primary Care Diagnosis Based Treatment Medical Management Cardiology Procedure And new strategies: Programmatic approach, Clinical integration, Dyadic leadership, Ambulatory V.2.0 and Value performance

58 Productivity Compensation Frameworks Productivity Models Productivity + Incentive Models Base Salary + Incentive Models P P I Base P I RVU or Revenue Expense Allocation Sharing Compensation Pool % Productivity % Sharing %Incentive Allocation Base Salary Productivity Incentives Other Incentives Productivity Thresholds KEY Base = Base pay P = Productivity Incentive I = Other Incentive Source: Suzette Jaskie, MedAxiom

59 Will historical models support transitioning to value based care? Transforming to value based care will require organizations to redesign their delivery models Traditional models only value direct clinical activity Models based on productivity have no connection to outcomes

60 Productivity Comp and Salary Alignment Fee-for-Service Transitioning Value P P I Base P I RVU Models RVU + Incentive Models Base + Incentives Models KEY Base = Base pay P = Productivity Incentive I = Other Incentive Source: Suzette Jaskie, MedAxiom

61 Potential Compensation Incentives DOMAINS Deliverable examples Compensation Physician participation Quality based incentives Operation Financial Program Leadership participation Medical director Program development Quality metric improvement Clinical process improvement Patient satisfaction Bundle coordination EMR/CPOE functionality On-start times Purchasing Budget variance Cost per unit Outreach development Program expansion Hourly or job description based fee Incentive pool Incentive pool Multiple Expense support and/or physician time

62 Other Metric Examples Clinical Outcomes Readmission rates Patient safety National quality indicators Efficiency/Process Standardization Length of stay Cost per case Supply cost Documentation Patient satisfaction Surg/Card coordination Program development Outreach development AUC Quality assurance programs

63 Rsrc Sts OPS Finance Quality Improvement Goal Incentive Weighting Operative Mortality for CABG (Estimated Odds Ratio) 15% Surgical Re-Exploration (Estimated Odds Ratio) 15% Prolonged Intubation 10% Surgical pts Pts given Pre-Operative Beta Blockade 5% Develop CABG bundle task force and base-line assessment and plan 15% Reduce OR supply cost 15% 5% 90% adherence to CABG order sets 10% 80% appropriate discharge by 9:00 am daily 10% Post surgical discharge follow up visit within 7 days 5% 90% of patients enrolled in clinical research protocol 10% Improvement incentives are worth 20% of physician compensation

64 Summary: Health systems strategies are generally in pursuit of some aspect of the Triple Aim Achieving the triple aim, or value based healthcare will require a whole-sale change to care delivery Hospitals want & need active physician participation at every level Physicians want & need active participation at every level Long-term success depends on it Creates the best environment for improving quality, cost & service Compensation frameworks must be reframed in order to align strategy and incentives

65 Key Strategic Issues Peter Angood, M.D. Joseph Cacchione, M.D. FACC Suzette Jaskie, President February 18, 2016

66 CV Delivery Model 1. Will the current delivery model result in high value care? 2. Do I offer my patients programs or services? 3. Have I organized CV delivery that results in the best possible patient experience? 4. How will MACRA and Value Based Modifier impact the organization s revenue stream?

67 Physician Strategy 1. Is the delivery model organized to maintain physicians in diagnosis and treatment mode MOST of the time? 2. Do I have the right people on the bus? 3. What is my recruiting and succession strategy? 4. Will the way we evaluate quality and physician performance be relevant in the future? 5. Is the physician compensation plan aligned with the organization s strategy?

68 Ambulatory Strategy 1. Can I afford my outreach strategy? 2. Do patients and referring physicians have adequate access to my program? 3. What e-health strategies make sense for my program? 4. Does my ambulatory strategy support growth? 5. Is the program offering the right services in the right locations?

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