Mergers & Acquisitions Creating a Common Culture April 3, 2014 Donna Dieman, PHR, CMPE Director of Human Resources Pre-Merger 2 separate and unique medical practices Both owned by St. Elizabeth, but with own identity Company A 501(c)3 organization working closely with St. Elizabeth Hospital Company B For profit organization 2 1
The Merger Begins With a 90 day notice period, both companies were merged under the tax ID number of Company A. 3 About the Merged Companies Company A Primary Care 64 providers 298 associates Company B Multi-Specialty 83 providers 338 associates 4 2
Initial Hurdles No new company name, though the legal name remained under the Company A name No standard processes were in place Lack of common much less standard polices and procedures Varying provider compensation models Differing cultures, beliefs and styles within the combined leadership group CEO from one company and a COO from the other, both with differing opinions and styles 5 Any sign of creating a common culture was non-existent. Duplicate Retirement Plan 401(k) requiring a freeze 18 month process to obtain IRS Letter of Determination Additional 12 month process to completely terminate 6 3
Need For Speed Identifying priorities was a process urgently needed. What was a priority? 7 Immediate HR Issues 8 Determine common job titles Create job descriptions that fit both companies Develop common associate handbook and HR policies Fix a clear inequity in pay structure Determine the pay increase policy Merit versus Tenure versus COL Development of a common rating system Development of a common bonus structure 4
What we needed was a Leader National recruitment effort Dr. Glenn Loomis, M.D., M.S., FAAFP President of St. Francis Medical Group in Indianapolis, Indiana and Sparrow Medical Group in Lansing, Michigan. Served in the U.S. Air Force and in civilian life as residency faculty and as a residency director in family medicine. 9 Finally - Infrastructure Board of Directors New By-Laws Committee Structure Advisory Groups 10 5
The Building of a Leadership Team 11 Human Resources Operations Quality and Compliance Finance/Billing Marketing Service Excellence Training and Development Information Technology/IS Informatics Growth 6
And then Acquisitions Here We Come From 350 Providers and Associates to close to 800 within a 90 day period and over 1400 in the past four years. 13 What is SEP now? Wholly owned subsidiary of St. Elizabeth Healthcare; We are a separate company; With a separate Board; With a separate pay and benefits structure; SEH reserves certain powers. 14 7
St. Elizabeth Physicians 384 Providers 313 Physicians 71 Mid-Level Providers 1,399 Associates (including providers) 28 Specialties & Services 97 Locations 30 Primary Care 3 Hospitalist 10 Heart & Vascular 5 OB/GYN 2 Express Care, 4 Urgent Care 3 states / 8 Counties All eligible PCPs designated Level 3 PCMH Participating in the CMMI Comprehensive Primary Care Initiative Serving over 279,000 patients In 2013 Over 1.1 Million visits Over $190 Million in revenue 15 450 400 350 300 250 200 150 100 50 0 28 Specialties & Services Family Medicine Internal Medicine Pediatrics Internal Medicine/Pediatrics Bariatric Surgery Behavioral Health Breast Surgery Cardiology - electrophysiology, interventional Diagnostic Services Endocrinology Gastroenterology General Surgery Nephrology 132 152 December 31, 2009 December 31, 2010 Primary Care 239 December 31, 2011 Business Health Hospitalists Express Care Urgent Care Specialty Care Neurology Neuro-Oncology Obstetrics & Gynecology Ophthalmology Orthopedics Pain Management/Spine Pulmonology Rheumatology Surgical Oncology Vascular Surgery Wound Care Number of SEP Providers 300 369 384 December December March 3, 31, 2012 31, 2013 2014 SEP Corporate Structure SEP CFO Business Services SEH Board of Trustees SEP Board of Directors SEP President/CEO SEP COO Operations SEP Chief Medical Officer 16 8
450 Number of SEP Providers 400 350 300 250 239 300 369 384 200 150 100 50 132 152 0 December 31, 2009 December 31, 2010 December 31, 2011 December 31, 2012 December 31, 2013 March 3, 2014 17 Percent Change in Growth of Providers 75% 60% 57% 45% 30% 15% 15% 26% 23% 0% Dec. 2009 to Dec. 2010 Dec. 2010 to Dec. 2011 Dec. 2011 to Dec. 2012 Dec. 2012 to Dec. 2013 Average percent change in number of providers from 2009 to December 2012 is 33% SEP has grown its providers by 180% from December 2009 to December 2013 18 9
120 Number of SEP Offices 100 80 77 89 97 60 59 40 44 20 0 August 2010 December 2011 December 2012 December 2013 March 2014 19 Building a Culture 10
Our Vision: We are innovative professionals working with our community to provide the region s best patient-centered healthcare; We want to be the best physician group in the region. 21 22 11
What Culture is SEP Aiming to Create? Physician Led / Professionally Managed Physicians to feel and participate like owners Management is a combined effort of physician leaders and professional managers Aligned incentives and shared accountability for outcomes Associates take ownership of processes in the office Quality Assuring great outcomes Patient Experience SEP takes ownership for the health of our communities and our population of patients 23 Building a Culture SEP Management: Dyad Model Physician Led Board Committees Professionally Managed Executives Manager / Physician Leader Teams Management Dyads Work as a team Physicians = provide leadership Managers = provide business acumen 24 12
Building a Culture Our Management Structure Executive Team Strategy Operations Finance Division Medical Leads & Directors of Operations Primary Care Specialty East South West Medical Surgical H&V Hospital 25 Lead Physicians & Practice Managers Our first assignment By: Quint Studer 26 13
Building a Culture of Service c o m m u n i t y e x c e l l e n c e a c c o u n t a b i l i t y Who we are at St. Elizabeth Physicians, built upon the foundation of our mission, vision, values and service standards What we do to demonstrate our commitment to our culture in our interactions with customers and the services we provide What we do when we have not met the needs or expectations of those we serve The tools-both physical and virtual-we use to aid us in meeting our excellence goals t e a m w o r k How we recognize, reward and improve service to our customers through reinforcement of expected and exceptional behaviors 27 J U L Y 2 0 1 2 J U N E 2 0 1 3 Engrain e d in Excelle nce: p h ase o n e J u l y 2 0 1 2 J u n e 2 0 1 3 Engrain e d in Excelle nce: p h ase tw o J u l y 2 0 1 3 J u n e 2 0 1 4 Engrain e d in Excelle nce: p h a s e t h r e e J u l y 2 0 1 4 J u n e 2 0 1 5 Engrain e d in Excelle nce: phase four J u l y 2 0 1 5 J u n e 2 0 1 6 28 14
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33 The SEP Service Standards is the foundation for our annual associate evaluations and is incorporated into each new hire orientation. All providers, executives and associates are expected to sign the SEP s Service Standards. 34 17
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Importance of Meetings Senior Leadership Bi-weekly Meetings Manager Monthly Meeting Department Monthly Meetings Standard agendas and minutes are key! A quarterly All Provider meeting is also on the schedule. Though not mandatory, it is heavily attended. 39 Impact of a new culture Accountability increased our turnover upwards of 14% of both voluntary and involuntary combined Performance Attendance Attitude 40 20
On a positive note Provided SEP with higher performing associates Increased associate and provider satisfaction Higher level of engagement on all levels Values are stronger across the organization Results in higher patient satisfaction!! 41 Do whatever it takes to make patients feel cared for. Each of you are empowered to go the extra mile and do whatever is feasible to make our patients feel how much we care. It doesn t take much a smile, a hug, concern about their situation, walking them to their destination, holding a door just that little bit extra! 42 - Dr. Glenn Loomis President and CEO, St. Elizabeth Physicians 21
Questions? 22