Session 34AB When Competitors Become Partners: The Keys to Success in Collaborative Relationships

Transcription

1 Prepared for the Foundation of the American College of Healthcare Executives Session 34AB When Competitors Become Partners: The Keys to Success in Collaborative Relationships Presented by: Daniel E. Barr, FACHE Jamie C. Phillips, FACHE

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3 When Competitors Become Partners The Keys to Success in Collaborative Relationships Disclosure of Relevant Financial Relationships The following faculty of this continuing education activity has no relevant financial relationships with commercial interests to disclose: Jamie C. Phillips Daniel E. Barr 2 1

4 Learning Objectives Gain an understanding of how hospitals are collaborating yet still remaining competitive in the relative markets. Identify tools and best practices in developing successful affiliations and partnerships with pediatric hospitals. Methods and models in identifying the right partner for collaboration Create strategies to extend pediatric specialty services across the continuum in rural/small community hospitals Generate economies of scale and elevate care quality through collaborative affiliations 3 Jamie C. Phillips Jamie.Phillips@nationwidechildrens.org Jamie C. Phillips is the Senior Vice President of Operations at Nationwide Children's Hospital in Columbus, Ohio since Jamie leads the administrative functions for inpatient, outpatient and research areas for The Heart Center service line. In addition, Jamie has responsibility of hospital-wide laboratory, regional hospitalist and community pediatric operations. Previous she led the hospital-wide supply chain operations and procurement services. She has extensive years of diverse health care administration experiences with leading edge health care delivery systems and organizations, including Trinity Health System, Novi, Michigan, Cincinnati Children s Medical Center and OhioHealth Corporation, Columbus, Ohio. Jamie earned her Master s Degree in Healthcare Administration from The Ohio State University in Columbus, Ohio. She has a Bachelor s in Science from Ohio University in Healthcare Administration with minor in Business Administration. Jamie serves as an adjunct professor in Health Administration for Franklin University. Jamie is an active fellow with American College of Healthcare Executives. 4 2

5 Daniel E. Barr Daniel E. Barr (Dan) is the Vice President of Operations at Nationwide Children's Hospital in Columbus, Ohio since Nationwide Children's Hospital is the largest children s hospitals in America. Mr. Barr leads the administrative functions for inpatient, outpatient and research areas for Hem/Onc/BMT service line. In addition, Mr. Barr has responsibility of hospital-wide employee safety with the focus on developing and executing interventions to achieve zero preventable employee injuries. Prior to NCH, Dan worked at University Hospitals of Cleveland, University of Pennsylvania Health System, Tenet Health Care and Community Health Systems. Dan is a recipient of the American College of Healthcare Executive s Regent Award for Early Healthcare Executive, University of Central Florida s College of Health and Public Affairs Rising Star, as well as the 2016 "Outstanding Alumni". He was also the Nationwide Children's Hospital Business Process Improvement Champion of the Year in 2015 and the recipient of the Dr. John P. Shultz Quality Award in Agenda Overview of Nationwide Children s Hospital Quick Facts Landscape of Market Strategic Plan Community Patient & Family Experience ACO- Partner for Kids Behavioral Health & Corporate Engagement Local and Regional Evaluation Criteria Range of Options How it Works National and International Consortium International Program Questions 6 3

6 NCH Campus 7 8 4

7 9 Highly Competitive Market - Eight Children s Hospitals Serve Over 2.6 Million Ohio Children (U.S. Census Bureau, 2015) 10 5

8 11 Strategic Plan Well Positioned for the Future Strong integrated delivery system built on quality programs and people Largest most effective Pediatric ACO in the county. Strong and creative partnerships with a host of providers and community organizations. Well positioned from a resource perspective to react to a changing environment. 12 6

9 Strategy Direction Growth & Partnerships through: Patient & Family Experience ACO Hospital Affiliations Regional Clinics Physician Alignment Service Line Programs 13 Foundational Elements 1. Wellness/Population Health a. PFK b. Schools c. HNHF d. Primary Care physicians e. Commercial PFK 2. Partnerships a. Dayton/Rainbow b. Affiliate Hospitals c. Primary Care physicians d. Adult facilities Columbus 14 7

10 Community Local & Regional National & International 15 Agenda Patient Experience Corporate Sponsorship - Behavioral Health Community Level Welcome Center 16 8

11 Patient Satisfaction Patient Experience 17 Empathy Prototype 18 9

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13 AIM: To increase compliance with communication every 2 hours during CT surgery from 47% to 85% by Dec 2014 and sustain indefinitely. 21 The Burden of Mental Illness on our Children Only 50% of youth with a mental health disorder receive any behavioral health treatment 25% 25% 50% Start by age 14 Start by age 24 75% of all lifetime mental illness starts by age 24 Source: National Health & Nutrition Examination Survey, 2010; National Comorbidity Survey Replication-Adolescent Supplement, 2010; NIMH, Mental Illness Exacts Heavy Toll: Beginning in Youth,

14 Local Impact 175,000 children & adolescents in NCH s service area 63,000 Franklin County 37,000 Primary Service Area 75,000 Secondary Service Area Source: US Census, Behavioral Health Strategic Plan Our Aspiration: To develop a national model for pediatric mental health care Discovering Causes Creating Programs & Interventions that Change the Outcome Sharing Knowledge that can be Replicated Everywhere 24 12

15 Big Lots Behavioral Health Pavilion 8 stories 250,000 GSF Acute/Crisis Center Inpatient Beds Outpatient Services Welcome Center Supports non-clinical needs of patients and families arriving from out of town or out of the country. Travel arrangements Financial information Housing options (RMH, hotel, extended-stay) Interpretation services Transportation Entertainment offers Family support services 26 13

16 Agenda ACO- Partner for Kids Neonatology Cancer Center Local and Regional Affiliations Heart Center 27 What is Partners for Kids? Partnership between NCH and >1,000 physicians caring for children Responsible for improving the quality of care and lowering costs for >320,000 children Full financial risk through the 5 managed Medicaid plans as an intermediary organization 28 14

17 Why PFK Matters to All of Us Mission Focused on serving those most in need Outcomes Total health for every child in the region Finance Success translates directly to NCH bottom line Reputation NCH has become known as the national leader Mandate Defining the future of the health care for children 29 PFK s Place in the System 30 15

18 Saving Society Money

19 How Do We Evaluate Partners? Source: Advisory Board 33 How Do We Evaluate Partners? Source: Advisory Board 34 17

20 A full range of options to consider Value of Integration (Improved Product/Financial/Quality Performance) CME Variety of models to consider that will create alignment across hospital campuses, geographies and subspecialties Research Collaboration Timeshare Space Call Coverage Agreement IT Integration Clinical Advisory Councils Medical Directorships Exclusivity/ Non Compete Agreement Physician Lease Arrangement Clinical Services Mgmt Agreements Payor/PFK Arrangement Faculty Practice Plan Equity Joint Ventures Degree of Integration 35 Practice Alignment Every practice is different. Alignment options are determined by practice needs. 1 2 CareNetwork Acquisition CCP No Alignment LEVEL OF Level ALIGNMENT of Alignment Fully Aligned Practice Support / PFK EMR / HIE Management Services NCH doc or NP placement Recruitment 36 18

21 Local Adult Hospital Affiliation Landscape 37 NICU Model Delivery Hospital NICU RN & NNP staff Laboratory Radiology Therapy Physical Space Service Agreement Neonatologist Practice Medical Director Physician Coverage Delivery Room NICU Professional Billing Nationwide Children s Hospital NICU NICU Management Policies/Procedures Quality Program Pharmacy EMR Bed Management Regulatory Billing/AR Supply Chain Equipment / Biomedical 38 19

22 Regional Adult Hospitals Affiliation Landscape Knox Community Hospital 39 Hospital Affiliation Strategy Non-affiliate CareNetwork solutions CareLink (ED / Nursery) Regional education offerings Neonatal & pediatric transport Liaison support PFK enrollment/engagement Level 1 Nursery Affiliate Services range from OP clinics, Diagnostics and Telemedicine Co- Branding/Marketing Neonatal Ambassador Recruitment assistance Physician/staff education Level 2 Nursery Affiliate Services range from the following IP Pediatric Unit mgmt, Pediatric Hospitalist program, Urgent Care and Comprehensive subspecialty clinics Neonatal Ambassador+ Reverse transport support Marketing Advanced education offerings Research Consortium & OSU Academic Appointment Potential Outpatient development 40 20

23 Regional Adult Hospital Affiliation St. Rita s Medical Center Relationship Components: Formal affiliation agreement for pediatric services; includes first right of refusal on any expansion of services NCH-employed pediatric hospitalists and NNPs that cover well-baby nursery, Level II NICU and pediatric unit Education agreement including: Neonatal Ambassador to NICU hospitalists Annual Pediatric Collaborative Colloquium for community providers Ongoing clinical education to nursing and support staff MercyHealth Healthcare System 28 pediatric beds; 28 well-baby nursery; 16 Level II NICU 1,500 births per year 600 pediatric IP/Obs discharges 7,500 pediatric ED visits 41 Regional Adult Hospital Affiliation St. Rita s Medical Center Relationship Components: Sub-specialty clinics across 8 service lines Cardiology, Endo, ENT, GI, Genetics, Pulmonary, Urology, Cardiac Fetal Echo Interpretation agreements for pediatric echocardiography and EKG Co-marketing to consumers and pediatricians in the community MercyHealth Healthcare System 28 pediatric beds; 28 well-baby nursery; 16 Level II NICU 1,500 births per year 600 pediatric IP/Obs discharges 7,500 pediatric ED visits 42 21

24 Co-Branding Strategy

25 A Strategy for Health Care Reform Toward a Value Based System It costs a lot to develop the infrastructure for a congenital heart or a cancer ACO and that cost is passed onto consumer Repetitive services between organizations is wasteful Competition for workforce (surgical, medical, nursing) almost guarantees service gaps Contract leveraging Motivation to keep state dollars in state 45 Nationwide Children s Hem/Onc/BMT Service Line 8 hematologists, 14 oncologists, 6 BMT and 3 neurooncologists >60 transplants, >13,000 clinic visits and >1,700 discharges diagnostic test in 2015 Expertise: leukemia/lymphoma, embryonal tumor, brain tumor, sarcoma, sickle cell, hemostasis/thrombosis, bone marrow failure, cellular therapies, apheresis, Past 3 years ranked in the top 10 cancer programs for U.S. News & World Report

26 Mansfield 1 2 Zanesville Chillicothe 3 47 Partnering with OSU Wexner Medical Center and The James Cancer Center? National Cancer Institute (NCI) NCH Hem/Onc/BMT is the pediatric arm of the NCIdesignated Ohio State University Comprehensive Cancer Center (The James) Clinical Histocompatibility Laboratory (OSU Wexner) HLA matching, donor specific antibody, consultation Radiation Oncology Patient transport by medical ambulance Pediatric-certified care including sedation Cell Therapy Laboratory (CTL) Processes all stem cell grafts and cell therapies (Courier service) 48 24

27 Partnering with Dayton Children's Hospital 1 Physician Staffing 2 Program Development 3 Clinical Trials, Care Navigation and Training 49 Partnering with Cabell Huntington Hospital and Hoops Children's Hospital (WV) Clinical Research Office Clinical Trials Patients In Need of Clinical Research 50 25

28 Nationwide Children s 30 cardiologists, 2 interventional cardiologist & 3 surgeons 450 heart surgeries, 685 Cath/EP, 13,773 clinic visits and 27,761 diagnostic test in 2015 Expertise: Diagnostic imaging, non-invasive diagnostics, interventional cardiology, electrophysiology interventions, adult congenital, heart failure, cardiac anesthesiology and thoracic surgery including heart, lung, and heart/lung transplantation. Past 7 years ranked in the top 11 heart and heart surgery programs for U.S. News & World Report. 51 Why Partner? Pediatric Heart Programs 52 26

29 Current Environment of Congenital Heart Centers Cost Containment Social Media Outcomes Accountable Care Research Quality of Care 53 Congenital Heart Care What s to Come? Larger Pediatric Accountable Care Organizations that demonstrate: better outcome at a lower price Fewer highest-acuity congenital surgical centers Congenital Heart Service lines may themselves become ACOs 54 27

30 55 Service Line Regional Outpatient Presence 56 28

31 57 Findlay Lima Marion Mansfield Zanesville Chillicothe Marietta Athens Portsmouth Ironton 58 29

32 The Congenital Heart Collaborative Joint Venture Business Model * A joint venture (JV) is a business entity created by two or more parties, generally characterized by shared ownership, shared returns and risks, and shared governance. *

33 Scope of Collaboration NCH DCH Clinical Co- Management Services Pay for Performance Quality Metrics Regional Collaboration 61 Nationwide Children's Hospital Project Measures Quality Performance Dashboard Performance Matrix Min Target Mid Target Max Target Comp Rate Min Target Comp Rate Min Target Comp Rate Min Target Flu Vaccination 33% 87% 66% 91% 100% 95% Echo Surgical Discrepancies 50% 98% N/A N/A 100% 100% Hospital to Hospital Transfers Checklist Compliance 50% 97% N/A N/A 100% 100% Pre Procedure Checklist Compliance 33% 95% 66% 97.5% 100% 100% ACHD Transition Education 33% 75% 66% 82.5% 100% 90% Sport Participation Guideline Compliance 67% 75% 84% 85% 100% 95% Kawasaki Treatment Guideline Compliance 67% 50% 84% 65% 100% 80% Dayton Children's Hospital Performance Matrix Project Measures Min Target Mid Target Max Target Comp Rate Min Target Comp Rate Min Target Comp Rate Min Target Flu Vaccination 33% 75% 66% 82.5% 100% 90% Echo Surgical Discrepancies 50% 98% N/A N/A 100% 100% Hospital to Hospital Transfers 50% 97% N/A N/A 100% 100% Pre Procedure Checklist Compliance 33% 95% 66% 97.5% 100% 100% ACHD Transition Education 33% 75% 66% 82.5% 100% 90% Sport Participation Guideline Compliance 67% 75% 84% 85% 100% 95% Kawasaki Treatment Guideline Compliance 67% 50% 84% 65% 100% 80% Trend Trend 62 31

34 63 Key to Success Agreed Upon Operational Milestones 3 Months 6 Months 12 Months 24 Months 30 Months 48 Months 54 Months 60 Months 64 32

35 Co-Branding Strategy 65 Demonstrating Our Success

36 Agenda Clinical Research Consortium International Outreach National And International 67 NIH Funding Summary 343 federal, 751 total submissions in 2014 Each year, the number of applicants increases while award and success rate remain stagnant. NIH support to Children s Oncology Group is also seeing a similar trend

37 Children s Oncology Group Overview As funding trends continue to decrease for COG, the number of clinical trials available for children will continue to be reduced based on lack of federal financial support

38 NEXT Consortium National Experimental Therapeutics Consortium Utilizing a hub and spoke strategy, the NEXT Consortium maximizes efficiency and impact with patients enrolling in trials led here in Columbus, Ohio while the breakthroughs and impact are felt throughout the nation and the world. 71 International Landscape Hematology/Oncology/BMT International Patients 72 36

39 International Process PATIENT INTAKE PATIENT CARE COORDINATION PATIENT REPORTING FAMILY COMMUNICATION & FROM & & CARE ACCEPTANCE ARRIVAL TO DISCHARGE DATA COLLECTION ONGOING PATIENT / FAMILY FOLLOW-UP Welcome Center, Social Work & Foundation serve as family management liaisons throughout process 73 Domestic and International Volume P International Assessments & Patients % Out of Area Domestic Patients 7,000 6,000 5,000 4,000 3,000 2,000 1, % 4,653 3,029 1,629 1,796 1, Projected Int'l Patients International Patients Projected Int'l Assessments International Assessments Projected Domestic Patients Domestic Patients 74 37

40 Lesson s Learned External (and internal) relationships to develop Physician Engagement Must begin at grassroots level Trust & respect needs to be established Learn culture Investment of time Patience 75 38