“Access Transformation Techniques for Medical Groups and ......engage, and align physician leadership to foster access lead to broader physician disengagement, turnover, and burnout

Welcome to today's Healthcare Web Summit Event

“Access Transformation Techniques for Medical Groups and Healthcare Systems:

Rapidly Drive Quality, Volume and Financial Improvement”

This webinar offers participants the convenience of listening to the session with your computerspeakers via broadcast audio and watching the ‘live’ web presentation. If you encountertechnical issues listening to the broadcast audio, please refer to your meeting notice to directdial and listen via your phone. If you encounter technical issues on the web, here’s the link tothe PDF of this presentation: www.healthwebsummit.com/BDC062717.pdf. For any otherassistance during the ‘live’ webinar presentation, please contact us at 209.577.4888.

http://www.healthwebsummit.com/BDC062717.pdf

Access Transformation

Techniques to Enhance

Strategic Positioning and Improve Value

June 27, 2017

Copyright © 2017 BDC Advisors, LLC. All rights reserved.

Today’s Goals

Introduction

Why Access?

What is the Definition of Access?

How do you Approach Transforming Access Performance?

2


An Introduction to BDC Advisors

3

UNMATCHED EXPERTISE✓ Highly experienced, top-ranked

consulting teams working hand-in-hand

with you

✓ Unparalleled team of physician

consultants that understand and engage

your physicians

✓ BDC has created more lasting physician-

led organizations and strategies than

anyone

LASTING CHANGE✓ Physician Involvement: Transformation in

healthcare requires true physician

involvement in strategy

✓ Client Partnership: Participative and

interactive approach

✓ Continuous Innovation: Sustaining

transformation by creating the capacity

for ongoing innovation

BOLD SOLUTIONS✓ Defining the Right Problem: To help you

reveal the true underlying drivers of cost

and create maximum value

✓ Thinking Big, But Being Practical: Because

game-changing transformation goes

beyond “the plan.”

OVERVIEW

200+clients served

>50published

articles

25+years

experience

30+consulting

support staff

We are a national, boutique healthcare strategic and transformation consultancy

serving complex healthcare systems and Academic Medical Centers

SERVICE AREAS

Health Enterprise

Strategy

PayerProvider

Innovation

Physician Enterprise

Transformation

Population Health

Management

Organization Design &

Development


Academic

Medical Centers

Catholic Health

Systems

Children’s

Hospitals

Health Plans

Medical Groups

and Networks

Health Systems

BDC has Helped Many Organizations Address Their Problems

4

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=UuPVRsi_Dp1AhM&tbnid=1ZUNzIm9Id1xOM:&ved=0CAUQjRw&url=http://mybaycare.org/sysreq.aspx&ei=h7IoUoudA_KlsQSrnICQAQ&bvm=bv.51773540,d.cWc&psig=AFQjCNH8OPcVRFi7QhPg9Ld_dAFjVdXe0Q&ust=1378485221839797


Our Access Transformation Leadership Team

David Fairchild, MD, MPH, Managing Director

• 20 years as a healthcare executive, practicing clinician, researcher, and consultant

• Expert in physician organization and engagement, clinical quality improvement, and shared-risk contracting

• Former SVP, Clinical Integration, UMass Memorial Health Care, and former CMO, Tufts Medical Center

• Professor of Medicine, University of Massachusetts

Alan London, MD, Director

• 30 years of experience as a senior business and healthcare executive, entrepreneur, CMO, and consultant

• Significant expertise in mergers and acquisitions, partnership development, and consumer health

• Former VP, Strategic Clinical Partnerships for Walgreen Company

• Former Executive Director, Managed Care and International Business Development, Cleveland Clinic

5


Today’s Goals

Introduction

Why Access?



6


Access Bridges Volume and Value Based Worlds

Curve One – Fee-for-Service Curve Two – Value-Based Care

• Volume-driven

• Maximize unit price / volume

• Little reward for quality

• Patient preference

• Reward lower cost / higher quality

• Engaged consumer; price sensitivity

• Coordination of care; incentives to

reduce utilization

• Lines blurred between payers and

providers

Although there is uncertainty about the future of ACA and the political landscape, the basic

business model for healthcare delivery will continue to face unprecedented change where a

focus on access is key to meeting patient needs

Access

$$$

7


Access Addresses Three Strong Market Demand Trends

Increasing patient expectations and choice

Need to improve medical group performance

Continued shift to value demanding lower costs

Although healthcare markets can be unique in the demographics, access to healthcare

influences three market demands across many markets:

Source: BDC Advisors analysis

8


By Addressing Access, Quality and Revenue Often Increase

For example, approximately 20-30% capacity exists in medical group practices due to no

shows, cancellations, transportation issues, etc.

9


Today’s Goals

Introduction

Why Access?



10


Quality and Coordination

Governance and Leadership

Measurement

Scheduling Optimization

Technology and

Telephony

Care Team Models

Scheduling Ease and Location

Convenience

Capacity

Alignment Activities

Access Transformation

Incentives and Compensation

Medical Group

Performance

Patient Centered Activities

Operational Infrastructure Activities

Defining Access = Defining a Healthcare Delivery Strategy

Payor Contracting

Source: BDC Advisors analysis

11


Today’s Goals

Introduction

Why Access?



✓ Patient Centered Activities

12


Patients Demand Easy Scheduling Options and Convenience

Call Centers are critical, but increasingly the ability to schedule, pay, and in some cases, get

transportation in a streamlined manner are shifting market share and changing markets

Case Study - Geisinger

Source: Geisinger Zoc Doc/Uber Announcements13


Patients Demand Location Options and Proximity

Location and facility infrastructure are critical choices in the patient determination of care

Sutter now generates more than

50% of their revenue from

outpatient services

Sutter has the largest hospital

network in the region anchored by

ambulatory “hubs” in San Francisco

and Sacramento

Concierge competitors have arisen

that are VC funded offering premier

facilities, technology, etc.

Case Study - Sutter

14


Patients Demand Coordination of Care

Mercy proactively developed a strategy to fill “gaps” in the care process to avoid

unnecessary visits and/or hospitalizations through leveraging technology:

Mercy Virtual Center was the first of its

kind in the country and now serves the

network by lowering costs through

enhancing access care coordination:

eICU

Telestroke

Virtual Hospitalists

Home Monitoring

Post Acute Strategy

Case Study – Mercy St. Louis

Source: Mercy Virtual website15


16

Lessons Learned

• Moving beyond the Call Center mentality

o Assessing patient needs and wants

o Creating a patient engagement plan

o Creating the “right” access channels for the targeted patient audience

• Using advanced outpatient placement techniques

o Reviewing your outpatient capacity and locations

o Performing an infrastructure study to determine preferences

o Aligning capital with preferences

• Leveraging technology to fill the coordination “gaps”

o Making vs. Aligning with technology provider for services

o Viewing access beyond the medical group to the whole patient journey

o Developing a transition of care plan across the journey

Patient Centered Lessons Learned to Improve Access


Today’s Goals

Introduction

Why Access?



✓ Alignment Activities

17


Physician Leadership and Engagement are

Requirements for Access Success

Organizations that rapidly employ physicians often fail to appropriately enculturate,

engage, and align physician leadership to foster access lead to broader physician

disengagement, turnover, and burnout.

Case Study – Wellspan Health

Clinical and administrative leaders “tied at

the hip” at each clinical site, on a regional

level, and then corporately.

“We use a Dyad model starting at each

practice site starting with the site medical

director and a lay practice manager. We take

the Dyad model all the way up the organization

from practice sites to regional organization, and

then to corporate.

Tom McGann, MD, the EVP of Clinical Affairs for the

System

18


Test What-If Scenarios for

access improvement

opportunity and create action

plans to implement

Based on access metrics and

their impacts

To align around access, a common set of performance indicators are

required to identify milestones and opportunities

19

Case Study – UHealth Miami Medicine


20

Fixed (guaranteed base)

70%30%Variable

Compensation

15% Productivity/Access

15% Quality

Compensation design is also an effective tool to align

around access goals

Access is increasingly becoming a core component of compensation models and can

complement panel and/or productivity goals in compensation design.

Metrics (Examples)

Patient access is prioritized by

ordering same-day

appointments or as soon as

possible

Additional hours of operation

E-mail and phone access

Source: MGMA -http://www.mgma.com/Libraries/Assets/Store/Books/8652-excerpt.pdf


21

Exclusive and/or value based risk contract structures can ensure

patients gaining access to your system

The Contracting Strategy is an essential component in developing an overall access

transformation course of action. Organizations who ignore this often may become

irrelevant to their patients due to ”steerage”.

Source: Based upon Health Affairs article


22

Lessons Learned

• Engage physicians in leadership around access

o Develop a leadership and communications plan for access

o Identify physician partners to grow and lead access

• Create an access performance dashboard

o Create common standards and policies

o Identify the technological partner and/or internal tools

o Regularly communicate the metrics with leaders

• Align provider compensation and team incentives

o Ensure that the access metrics are tied to bonuses

o Tie physicians and care teams

• Create a contracting strategy that supports patient population access

Alignment Lessons Learned to Improve Access


Today’s Goals

Introduction

Why Access?



✓ Operational Infrastructure Activities

23


Performing an assessment of medical group operations is

essential to ensure access goals are achieved

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Identify Challenges• Preliminary Data Request for Existing Internal Performance Reports (e.g. Financials, Dashboards, etc.)

• Review of Standard Care Team Model and Care Team Outputs (Quality/Access/Productivity/Financials)

• Assess Clinical Productivity Goals and Support Staff Levels/Mix based on Performance Reports

• Identify Key Interviews and Site Visits for 2-3 Days Onsite Time

Provider/Operational Staff Interviews• Operations Framework and Practice Flow

• Clinic Hours/Days, Types of Visits, and Patient Population (require additional time, should notoccur back-to-back, etc.)

• Provider Specific Information

Shadowing/Observations (Sample of under-performers)• Verify Responses Compared to Internal Reports

• Obtain First Hand Information of Operations

• Observe Clinical Care Team/Flow Needs and Issues

Determine the Scope and Approach• Debrief with Leadership the High- Level Challenges, Findings, and Opportunity Impact Range

• Develop Scope and Project Approach for Proposal to Realize Opportunities

• Develop Access Goals in Concert with the Medical Group Transformation

1

2

3

Outcomes


Note: size of bubble = volumes

Prioritize opportunities with review of medical group

productivity versus access metrics

25

For academics, balancing clinical and non-clinical time is key. For all types, determining if you

have the right number and type of providers is essential


26

In areas of low productivity and high access, evaluate the scheduling templates and

common access statistics to identify “hot spots”

Identify hot spots through close examination of provider

templates, scheduling policies, and statistics


Review the care team model to ensure:

Care team roles are fully leveraged to top of license

Appropriate skill mix for effective

team to ensure access

Optimal structure to deliver quality care in cost efficient manner

Roles are defined based on best practice

Leveraging the roles of your care team is key (especially

Advanced Practitioners) for access

27


Sample

The care team model includes all aspects of the delivery team to ensure access. Evaluate the

levels against common benchmarks (e.g. MGMA cost survey).

394.7

173.4

92.9

660.9

388.4

188.6

100.6

677.6

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

MSH MSBI MSSLR Total

Clinical Actual

Clinical Target

606.2

324.9

159.4

1090.4

562.0

342.2

159.8

1064.0

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

MSH MSBI MSSLR Total

Clerical Actual

Clerical Target

Clinical FTEs by Facility Clerical FTEs by Facility

28

Review medical group volume against care team model

staffing roles, skill mix, and levels to support access:


29

Lessons Learned

• Medical group performance success = access success

o Start with an assessment of medical group operations (core stats)

o Develop an action plan to achieve performance goals that support access

• Correlate access with provider productivity

o For academics, recognize and evaluate impact of non-clinical duties

o Perform a provider capacity and need review based on the demand

• Perform a thorough review of scheduling templates and

policies/procedures

o Visit types, arrival rates, length, etc. (avoid the IT ”sandpit”)

• Align care team to meet access needs

o Leverage the care team to the top of their license

o Perform a care team level and skill mix review against benchmarks

Operational Infrastructure Lessons Learned to Improve Access


30

Questions and Answers Session

Thank You!

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“Access Transformation Techniques for Medical Groups and ......engage, and align physician leadership to foster access lead to broader physician disengagement, turnover, and burnout