Summary of UPMC Hamot Significant (Top 10) FY15 s 1. Continue to achieve top quartile performance in patient safety and quality measures 2. Monitor volume and assess efficiency: inpatient beds, workforce, physician practices 3. Pursue growth strategies: inpatient rehab, kidney transplantation, medicare 4. Leverage regional relationships to grow market share and rationalize service delivery. 5. Consider physician employment arrangements to secure access to care 6. Improve access through: MyUPMC, RHS Centralized Scheduling, Expanded primary care hours, Urgent Care 7. Work closely with the Health Plan to grow local and regional relationships and community involvement** 8. Develop narrow network products in conjunction with the Health Plan. Specific markets include Chautauqua County, NY and Crawford County, PA** 9. Submit Nurse Magnet standards of evidence document. 10. Maintain staffing and quality profile for major tertiary services including: cardiac, critical care, neurosciences, orthopedics, trauma, and women s services 6 ** Achievement is highly dependent on UPMC Health Plan
Objective: Assess Inpatient Capacity Inpatient med/surg admissions Sound finance Budget 19,249 Actual Dec FYTD: 9,818; at budget Optimize the utilization of South Tower staffed beds in a manner that results in high rates of occupancy (80%) and focused specialization. Smart Technology Regularly monitor bed usage and determine resources required. Implement Teletracker Bed Management System Occupancy rate for Jul- Dec is 85% Overflow unit has been opened periodically as needed. Teletracker implementation scheduled for July 2015. Determine main hospital infrastructure needs. Good science Finalize plans for ICU renovations and consolidation of like services. On hold 7
Objective: Collaboration with UPMC Health Plan Design narrow network products to secure market share Integrated payer/provider model Chautauqua County narrow network developed in conjunction with Independent Health Meadville Medical Center added to Inside Advantage Discussions progressing. Product development meeting scheduled for Jan. 30 Discussions continue, goal is to have MMC enrolled in HP Shared Savings Program by March 2015 Leverage UPMC Hamot Corporators and other executive relationships in order to sell UPMC Hamot and UPMC Health Plan services Integrated payer/provider model Regular communication with the Health Plan to determine needs for relationship management Ongoing Create convenient access to medical records, medical professionals, and health information for our patients Integrated payer/provider model Measure 5% of UPMC Hamot Discharges enrolled in MyUPMC. Measure 5% of RHS patients using MyUPMC. (Meaningful Use Stage 2 Requirement) 20% of UPMC Hamot December Discharges activated in MyUPMC All except 2 floater RHS physicians > 5% event planning to ensure UPMC is represented 9 and recognized at important it t Corporate Citizenship Regular communication with the Health Plan regarding events and sponsorships Ongoing
Objective: Primary Care Framework Focus Strong primary care market share maintained: 93,000 lives (Note: was set prior to the Highmark consent decree. We still expect to see some loss due to Medicare Community Blue and the tiered commercial Community Blue product. Revised goal maintains 6/30/2014 lives) Access and inclusive insurance 117,000 95,000 lives in the Erie County primary care practices (RHS, EPN, CPI, UPP) 122,474 lives as of 1/1/2015 Continue to ensure care is provided in the appropriate setting by improving access to primary care Access and inclusive insurance Each primary care practice offers increased hours and days of operation. Each practice has at least 1 provider accepting new patients (including MA) 26 of 28 practices offer extended hours. The only practices not accepting new patients are solo-practitioners. Ensure access to care is available throughout Hamot s service area 10 Access and inclusive insurance Evaluate office locations for efficiency and access. 2 solo practitioners will merge with larger practices by 6/2015. Discussions with 2 additional solo practitioners have begun. Additional consolidations being evaluated.
Objective: Ambulatory Care Ensure care is delivered in the most appropriate setting. This will be evident by growth in primary care and urgent care and reduction in non-critical emergency department visits Diversified revenue, Good science Urgent care volume: 36,000 visits December FYTD: 19,084 (annualizes to 38,168) Monitor UPMC Hamot Surgery Center volumes and case mix Diversified revenue Evaluate trends by physician and service line. Surgery Center volume is 6% lower than FY14 Jul-Dec due mostly to pain management physician on leave. GI, Ophthalmology, and General Surgery have increased volumes. Monitor UPMC Hamot Surgery Center regulatory readiness Good science Implement periodic reviews of the surgery center by UPMC Hamot regulatory staff. Ongoing. Surgery Center is currently fully accredited. Improve patient access to physician offices through centralized scheduling. 11 Smart technology Establish a centralized department to schedule appointments at all RHS locations Proactively schedule ED patients for follow-up primary care visits Outpatient Coordination Center (OCC) opened on July 1 to coordinate scheduling, referrals, and find-a-doc inquiries. Also assists with other back office functions for practices. Done
Objective: New Models of Care Framework Focus (If applicable) Transition primary care practices to implementation of pre-visit workflow to obtain necessary labs and information from patients in advance of their scheduled pcp visit. New care models Each primary care office conducts pre-visit workflow for at least one population All offices do pre-visit workflows for their diabetic population. Some have expanded to additional populations. Implement primary care medical home model New care models 6 practices operating as primary care medical homes. 3 practices awarded NCQA Patient- Centered Medical Home Recognition. All offices are following established policies and procedures. alignment with post-acute providers in preparation for accountable care. New care models Quarterly meetings with at least 3 long-term care providers to share quality data and care protocols Process in place. Hamot participation includes RHS, Care Management, Nursing, Disease Mgmt Assess and react to market forces 12 Access and inclusive insurance Build business among participating payers Market bundled pricing for CABG and Total Joint Price transparency tool launched Most commercial accounts renewed with their current payer. UPMC is monitoring continuity of care issues closely. GE Maternity Care Select Program response submitted. UPMC s price transparency tool Recondo is in the pilot phase.
Objective: Clinical Service Line Management Implement inpatient rehabilitation services at UPMC Hamot Diversified revenue Ownership structure determined, program opened by December 31, 2014 Outside valuation completed and under review by UPMC Implement kidney transplant services at UPMC Hamot Secure and engage the orthopedic service line Stabilize critical care service Evaluate structure of cardiac service line Maintain market leader position for Womens Services 13 Good science Symbiotic relationships Symbiotic relationships Symbiotic relationships Program designed, stakeholders engaged, first transplant performed by March 2015. Add to employed orthopedic complement. Recruit two pulmonologists and two intensivists. Partner with Medicor to evaluate COSA restructuring or employment Symbiotic relationships Maintain NICU ADC 15 Expand Magee at Hamot Subspecialty Services UNOS interim approval granted. Recruiting a transplant nephrologist. Estimating first case by May 15 Discussions continue 1 pulmonologist and 1 CCM signed. Recruitment continues. COSA renewal is April 1. Physicians evaluating employment options. Jul-Dec NICU ADC=17 Subspecialty services continue to be busy Children s Express Care opened
Objective: Physician Alignment UPMC Affiliate EHR offered to independent physicians. Smart technology 2-3 practices live. (Rollout will depend on availability of UPMC resources) Medicor live on Epic Practice Management and EpicCare. Regularly measure and improve physician engagement Symbiotic relationships Develop an action plan based on the February 2014 survey Work groups established to address Recognition, Communication, and Onboarding. Focus groups conducted. Regular meetings with the Advisory Board. Collaborative leadership events offered to local and regional medical staff Symbiotic relationships Variety of programs and opportunities for education and interaction with hospital and system leadership offered throughout the year. Educational topics scheduled for Quarterly MedStaff meetings. UPMC retreat held November 2014. 14
Objective: Ring Hospitals Continue to evaluate and prioritize regional relationships Symbiotic relationships Chautauqua County providers (hospitals and physician groups) rationalized to provide appropriate and efficient care to the entire County JAMA practice has transitioned to RHS ownership. Discussions continue with WCA and Brooks. Maintain Warren General Hospital hospitalist and ED contract and evaluate merger. Contract maintained. Continued board-toboard discussions. Continue to develop closer relationships with Meadville Medical Center Discussions continue. Recent topics include trauma and medical mall development. 15 Continue to evaluate relationships with providers in McKean County, Potter County, and other regional markets Bradford physician employment under discussion. Shinglehouse JV with Cole opened. UPMC cancer affiliation with Cole announced.
Objective: Financial and Operating Performance 16 Framework Focus (if applicable) Operating Income Sound finance FY15: $14 million Q2 FY15: $9 million Improved RHS financial performance as measured by loss per physician: PCP $100,000; Specialist $125,000 Ensure staffing levels are sufficient and appropriate for patient access. Leverage Hamot Health Foundation to fuel new ideas, programs, and initiatives OR efficiency improved to best-in-system Sound finance Sound finance Sound finance Sound finance Symbiotic relationships 75% of PCPs at $100,000; 55% of Specialists at $125,000 Achieve superior labor metrics as measured via MRS: worked hours per patient day, turnover, and overtime utilization. $2.5 million raised 1,200 donors (including increased participation from physicians and employees) On time starts: 70% Avg incision time: 7:45 Room turnover time: 28 min OR utilization: 65% $9 million 72% of PCPs at $100,000; 45% of Specialists at $125,000 Pay period 14 FTE budget variance: Direct Support Paid FTE 80.2 6% 32.7 5.2% OT FTE 2.7 7% 0.4 4.9% Paid Hrs per Pt Day: Actual 45.72; Budget 46.61 $1.2 million raised through December. 805 donors On time starts: 68% Avg incision time: 7:55 Room turnover: 33 min OR utilization: 63%
Objective: Clinical Quality and Safety Continually refine the Patient Safety and Quality matrix. Set stretch goals for the most relevant clinical measures. Maintain a safe workplace for our employees as measured by an improving OSHA incident rate. Continually refine the Patient Satisfaction matrix. Set stretch goals for the most relevant patient satisfaction measures. Good science Achieve 80% of the patient safety and quality matrix goals. Corporate citizenship OSHA incident rate < 6.0 and less than industry average. Corporate citizenship Inpatient/HCAHPS: 76% 9,10 overall rating ED: 88.1 (mean) overall rating Medical Practice: 92.3 (mean) overall rating 78% CY12: 5.4 industry: 7.0 CY13: 5.6 industry: 6.8 FY14: 5.7 industry: 6.5 Inpatient/HCAHPS: 70% 9,10 overall rating ED: 86 (mean) overall rating Medical Practice: 92.6 (mean) overall rating 18
Objective: Workforce Framework Focus Measure employee satisfaction every two years and implement improvement plans based on feedback. Corporate citizenship Action plan developed and implemented based on 2014 MyVoice results. Specific improvement plans being developed for several depts. Hamot-wide efforts underway related to common themes identified across UPMC. Nurse Magnet Designation Corporate citizenship Demonstrate substantive progress toward Magnet Designation as evidenced by completion of a comprehensive standards of evidence document that adheres to the ANCC 2014 guidelines. Nursing counsels continue to be active. Document is being written, scheduled to be submitted on June 1. Continue leadership and staff development efforts to ensure succession planning. Engage administrative fellow in meaningful projects. Recruit second admin fellow to start summer 2015. Current fellow engaged and leading projects such as MedCall, transplant, hepatobiliary, and ArrowSight. Second recruit on hold. Promote career awareness among local high school students to improve 21 the recruitment pool in Erie. Corporate citizenship Hold 6 events, provide opportunities for 150 students to learn about careers at UPMC Hamot. Two sessions were held this fall for approx. 65 students. Four additional sessions are scheduled.
Objective: Other Hospital or Community Services Specific Objectives Continue 3-year implementation of the Community Health Needs Assessment (CHNA) and begin planning for the next CHNA. Continue to provide care to the community regardless of ability to pay as measured by uncompensated care (bad debt + charity care). Inclusion: By ensuring inclusion is at the core of what we do everyday, UPMC Hamot will not only be a great company and community citizen, but also a great place to work. 22 Framework Focus Corporate citizenship Corporate citizenship Corporate citizenship Action Plans implemented: 1. End of Life Care 2. Maternal and infant care 3. Preventive Screenings Collaborate with local partners to begin the FY16 CHNA. Charges (full year): $94m Charges FYTDQ2: $47m Cost FYTDQ2: $9.4m Execute UPMC Hamot Inclusion Workplan See attached FY16 Erie County DOH plan underway. Focus groups being conducted Jan-Feb. Charges: $40.7 million Cost: $8.1 million Workplan is reviewed and discussed in detail at the Community Partnership Meetings held quarterly and progress is monitored by the Board Inclusion and Diversity Committee