Physician Liaison Program Joan Brewer, RN Referral Relations Manager Billings Clinic Billings, MT
Organizational Highlights Employ 3,750 employees Group practice with 280 Physicians, 90 PA/NPs Clinic & Hospital Joint Commission Accredited Magnet Designation for Nursing Excellence in 2006 and re-designation in 2011 Multi-specialty Physician Clinic 900,000 patient encounters 10 clinic locations Hospital & Sub Acute Care 285 Licensed Beds 14,500 hospital admissions/year 743,000 Outpatient Registrations Level II trauma center 42,000 patient ED visits/year Psychiatric Services Youth and Adult Hospital IP & OP Behavioral Health Clinic Aspen Meadows 90-Bed Long Term Care and 55-bed Assisted Living Facility Sub-Acute Care Research Center for Clinical Translational Research Clinical research Billings Clinic Foundation Over $100 million raised Over $48 million in current assets Over $69 million granted to Billings Clinic
Over 50 Physician Specialties Allergy & Immunology Cardiovascular Services Cardiology Electrophysiology Interventional Cardiology Cardiovascular Surgery Dermatology Mohs Surgery Emergency Medicine Endocrinology Facial Plastics & Reconstructive Surgery Family Medicine Gastroenterology General Surgery Geriatrics Hospital Medicine Infectious Diseases Internal Medicine Metabolic/Bariatric Surgery Nephrology Neurology Neurosurgery Obstetrics & Gynecology Maternal-Fetal Medicine Reproductive Endocrinology & Infertility (IVF) Occupational Medicine Oncology (Cancer Center) Medical & Hematology Gynecologic Oncology Radiation Oncology Ophthalmology Orthopedics & Sports Medicine Otolaryngology Audiology Pathology Pediatrics Neonatology Pediatric Ophthalmology Pediatric Pulmonary Pediatric Neurology Pediatric Oncology Pediatric Cardiology Pediatric Gastroenterology Physical Medicine & Rehabilitation Podiatry Psychiatry Pulmonary, Critical Care & Sleep Disorders Radiology Rheumatology SameDay Care Thoracic Surgery Vascular Surgery Health Care, Education and Research Urology
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Physician Outreach Specialties Allergy Cardiology Dermatology Facial Plastics Gastroenterology Gynecologic Oncology Nephrology Neurology Reproductive Medicine Maternal-Fetal Medicine Oncology Ophthalmology Orthopedics Otolaryngology ENT Pediatric Cardiology Pediatric Diabetes Pediatric Pulmonary Pediatric Gastroenterology Podiatry Pulmonary Urology Health Care, Education and Research
Telemedicine at Billings Clinic 40 partners in 29 communities 4,823 conferences in FY13 served 27,062 participants By avoiding travel, participants saved an estimated $4,300,000 in out-of-pocket expenses 61 Billings Clinic providers regularly use telemedicine Offerings include: Allergy Burn follow-up visits Cardiology Dermatology Dietary Education Endocrinology Geriatrics Genetic Counseling Infectious Diseases Naturopathic consults Neonatology Nephrology Neurology Oncology/Hematology Orthopedics PM & R Pediatrics Gastroenterology Podiatry Psychiatry Pulmonary Rheumatology Reproductive Medicine/Fertility Diabetic Education Medication Assistance Metabolic Surgery patient education pre and post- op surgical consults
Successful Startup of Physician Liaison Programs Goals for Today Explore the pre program planning process and define the Physician Liaison scope and capacity Describe differences between a referral relations program vs. physician relations vs. sales program Identify key must haves for successful programs Align outreach with organizational strategies and ensure service lines are outreach-ready Health Care, Education and Research
Pre Start up What is the organizational Goal behind the development of the role/position? What is the need? Who will support the role? What are the tools available for the role? Will the role be relationship based or sales based? How will success be evaluated? Health Care, Education and Research
Scope Creep Health Care, Education and Research
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Why are Referral Relations valuable? Referral Relations positions have proven ROI by targeting identified providers and developing a relationship that allows the referring provider to have a voice in how referrals are managed. Deeper Hospital-Physician collaborations are needed for clinical quality improvement, utilization & cost control, care continuum integrations and population health management. Leverage of high quality network, limit of financial exposure, and monitoring and managing performance.» 21754, the Advisory Board, 2010 p10-13. Health Care, Education and Research
How does Billings Clinic define Referral Relations? Accountability for Referral Relations program and communication processes. Develop, coordinate and distribute communication and tools to support the flow of referrals and communication back to the referring providers. Develops and provides strategy support to administrative and service line leadership. Health Care, Education and Research
How does Billings Clinic define Referral Relations? Gather and share local and regional marketing intelligence. Support the development and implementation of marketing and planning strategies. Health Care, Education and Research
How does Billings Clinic define Referral Relations? Establishing, maintaining and enhancing organizational relationships with referring physicians and other healthcare providers. Establishing, maintaining and enhancing organizational relationships with organizations in local and regional service areas. Health Care, Education and Research
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Goal Facilitate New and Strengthen Existing Referral Relationships Health Care, Education and Research
Must Haves Referral Relations Physician Relations Marketing Relations Listening Skills Listening Skills Listening Skills Tenacity Tenacity Tenacity Internal C suite Internal C suite Internal C suite Support Support Support Organizational Organizational Organizational Readiness Readiness Readiness Great Boss Great Boss Great Boss
Referral Relations, Physician Relations, Marketing Relations Referral Relations Physician Relations Connector for all * Connector for Referral Sources Physicians Long Term * Long Term Established Internal * Physician Openness Relationships Key to Success to relationship Clinical +Sales * Clinical Building Key to Success Marketing Relations Program Connector Short Term-More Successful if long term relationship established External Relationship Key to Success Sales
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What are the tools of the Physician Access to the EMR Liaison? Access to Point Persons Access to Administration Access to physicians that share the same vision Health Care, Education and Research
What are the tools of a physician Trust liaison? Don t promise the moon, unless you can assure delivery Don t throw your internal colleagues under the bus. Remember* There is always more to the story Bring back the good stuff Follow up, Follow up, Follow up Health Care, Education and Research
What are the tools of the physician Data is our friend liaison? Administration needs it, physicians love it Make friends with the analysts Find out who else is tracking and trending data Look at and investigate CRM products Health Care, Education and Research
Planning your future Develop a plan for the year/quarter and month Assure it aligns with the strategic goals of the organization Develop processes that help and not hinder. Keep them flexible enough to allow growth and change. Health Care, Education and Research
Physician Liaison Outreach Program PeaceHealth Oregon West Network Susan Blane, MPH, CMPE Director, Market Development Strategy, Innovation and Development
The PeaceHealth Mission We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way. 2011 PeaceHealth 34
2011 PeaceHealth About PeaceHealth Founded by the Sisters of St. Joseph of Peace, PeaceHealth is a not-forprofit health care system with medical centers, critical access hospitals, medical group clinics and laboratories located in Alaska, Washington and Oregon. Has provided exceptional medicine and compassionate care to Northwest communities for more than a century. PeaceHealth consistently receives national recognition for innovations in patient-centered care, patient safety, health care technology and cost efficiency. During FY2012, PeaceHealth provided patient care to these communities through more than 78,000 inpatient admissions 743,000 outpatient registrations 1.2 million patient encounters 35
In the beginning. 2006: Director recruited to launch program around a technology acquisition and build department ongoing 2007: Budget allowed for one additional hire 2008: New Flagship hospital opens in August, economy tanks in October 2009 thru 2011: Outreach focus on retention 1 person, 7500 physicians 37,000 square miles 2011 PeaceHealth 36
Oregon Hospital Landscape SSA PSA 2011 PeaceHealth 37
2011 Introduction of Third Party Data 2011 PeaceHealth 38
and then there was light Environmental Changes New CEO in 2012 Transition from holding company to integrated networked System Shift of focus from cost containment to growth 2011 PeaceHealth 39
The Proposal 1 White Paper (3 page Narrative) 1 Spreadsheet (10 worksheets) Market Share Scenarios summarized by years 1 thru 5 w/ forecast by each add l liaison added Analysis of referral source and targets Outmigration Analysis Growth Opportunities One time setup costs Ongoing costs Summary by year Executive Summary Countless Powerpoints (network leadership, system leadership, stewardship, boards) 2011 PeaceHealth 40
APPROVAL January 2013 2011 PeaceHealth 41
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Implementation Phase Creation of New Positions HR approval of job descriptions Approval of Budget Variance Organizational Integrity Audit Compensation for Physicians Increased demands on Design & Marketing Increased demands on CME Department Interviews 2011 PeaceHealth 44
3 liaisons Assigned Geographic Territories Program Structure by primary, secondary and tertiary service areas By zip code Contains approx 2500 physicians per area Use Crimson Market Advantage to refine targets Sub Assignment by System of Care Access PeaceHealth ED Trauma Telemedicine Surgery Neuroscience CardioVascular Ortho Community Based Care Womens Pediatrics Behavioral Health 2011 PeaceHealth 45
Basic Training Every Possible Resource Other Programs Service Line Leadership Professional Societies Purchased Consulting Training Must Haves Organizational Strategic Message Visit Planning and Structure 2011 PeaceHealth 46
Outreach True North Referral decisions are based most often on relationships between the referring physicians and the specialists. Primary care physicians (PCPs) recommend specific specialists for 86% of referrals. Survey Says: personal knowledge of the specialist ranked highest followed by quality of prior feedback specialist s technical capacity appointment availability Sources: Halley MD. The Primary Care-Market Share Connection: How Hospitals Achieve CompetitiveAdvantage. Health Administration Press: 2007; Forrest CB et al. Primary care physician specialty decision making: patient, physician, and health care system determinants. Med Decis Making 2006;26:76 85;Forrest CB et al. Family physicians referral decisions: results from the ASPN referral study. J Fam Practice 2002;51:215 222. 2011 PeaceHealth 47
Issue Resolution One Voice majority of issues flow through one to two people within outreach department Starts with System of Care Leadership Most frequently: Missing Records Discharge report Ease of Referral Communication 2011 PeaceHealth 48
START Liaison initiates contact with physician/ group Liaison receives issue & documents in CRM Liaison evaluates issue, identifies responsible party No Forward to Director of Market Development Yes Liaison tracks pending status & identifies follow up date based on timeframe Ops notifies Market Dev that issue is in progress to be resolved Ops determines best course of action & timeline for resolution No Forward to responsible ops leadership (Can I solve this issue?) Liaison evaluates resolution progress (Was issue resolved in timeframe?) Yes Yes Responsible ops leadership resolves issue & facilitates communication of resolution No Liaison notifies Mar Dev Director to request immediate action Responsible party notifies Market Dev of issue resolution END Did mgmt respond within 24 hours? Yes No MarDev Director notifies appropriate Executive Team member ET member provides required support to resolve issue Responsible party resolves issue & facilitates communication of resolution Responsible party notifies Market Dev of issue resolution END
Communication Flow 2011 PeaceHealth 50
Access PeaceHealth Create a fully integrated patient transfer center, bed placement and consultation service RN Case managers field calls from beginning to end, ensuring communication between transferring facility, admitting physician, oncall specialists, hospitalists and bed placement. Web-based with real-time updating/editing Central Logic supported: HL7 Interface with credentialing system Configurable reporting Full auditing of changes HIPAA compliant paging/texting 24/7 support 2011 PeaceHealth 51
Outreach Future New Provider Onboarding Evidence Based and Value Based Care Customer Service Excellence 2011 PeaceHealth 52
Thank You! Joan Brewer RN, BSN Referral Relations Manager Billings Clinic (O) 406 435-8447 (C) 406 633-0161 Jbrewer2@billingsclinic.org Susan Blane, MPH, CMPE Director, Market Development PeaceHealth Oregon West Network 541-686-6856 desk 541-520-4216 cell & text SBlane@peacehealth.org