Confidential and Proprietary – UnityPoint Health UPH 3 rd Generation Hospitalist Update UPH Leadership Symposium April 28, 2015 Theresa Lewis RN MPA FACHE

Confidential and Proprietary – UnityPoint HealthConfidential and Proprietary – UnityPoint Health

UPH 3rd Generation Hospitalist Update

UPH Leadership SymposiumApril 28, 2015

Theresa Lewis RN MPA FACHE

Tracy Ekhardt MD

Stephanie Burns MHA

John Nelson MD

Confidential and Proprietary – UnityPoint Health

Agenda

• Emerging Role of Hospitalists in driving acute care performance

• 3rd Generation Hospitalist Program Development

• Nelson Flores Key Findings and Recommendations

• Q/A

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Hospitalists: Best Outcome for Every Patient Every Time


THE EMERGING ROLE OF HOSPITALISTSTRACY EKHARDT MD

Brand Promise:

Best Outcome for Every Patient Every Time

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Emerging Role of Hospitalists• Hospitalists care for an increasing # of inpatients• “Captains” of the inpatient team, leading efforts to

drive performance• Triple Aim reimbursement models require

hospitalist leadership to reduce variation and drive performance

• Variability exists among UPH programs: scope, structure, governance and maturation

• As a result, hospital outcomes vary across UPH

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Goals of Hospitalist Program Management

• Top decile performance on Triple Aim– Improved individual quality (outcomes, patient

experience)

– Improved health of the community

– Improved efficiency (cost/case in hospital setting, improved total cost of care per member per month)

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System Sustainability: Role of HospitalistsFY15 Sustainability Target: $5.2 million

System Sustainability

Care Support Excellence

Care Delivery Excellence

Keeping Care in the System

Efficiency of Patient Stay

3rd generation Hospitalist

ModelLength of Stay Pharmacy Laboratory Blood

Utilization Cardiology Sepsis Orthopedics

Administrative Excellence

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Program Development

Program Management: Primary Focus for Hospitalists

Program Management: Secondary Role for Hospitalists

7Confidential and Proprietary – UnityPoint Health

System Sustainability: Next Generation Hospitalist Program Performance Management

System Sustainability

Efficiency of Patient Stay

Hospital Case Management

Hospitalist Programs

Hospitalist Program Operational & Performance Management

Hospitalist Program Development

3rd GenerationProgram Development

4th GenerationProgram Development

Hospital Performance

OSC Performance


System Sustainability: Efficiency of Patient Stay Priorities for Hospitalist and Case Management

SustainabilityCare

CoordinationService

OutcomesQuality

Outcomes

Direct Cost per Case

30-day All Cause

Re-admission Rate

RBC Utilization

# Redundant Tests

ALOS

Avoidable Days

7-day PCP Follow-up

% CM assigned to

High Risk Pts

HCAHPS: Post Hosp Care

HCAHPS: Communicatio

n with Physician

Discharge before 11 AM

Hospitalist Survey

DVT Prophylaxis for

all Hosp pts

Initial Abx Selection for

CAP


2015 Goals for CM initiatives that require collaboration/teamwork with Hospitalist

Implement best practices for: 1. Care Coordination (multidisciplinary) Rounds – Manage stay and discharge

planning - LOS

2. Reduction of Avoidable days - Reduces LOS

3. Palliative Care Referrals – Reduce unnecessary/unwanted utilization (Cost/case)

4. High Risk Intervention Order Set (High Risk for Readmission)

5. Medication Management

Implement LOS efficiencies for specific populations: Start with Respiratory/Pulmonary population – Estimated $1.18 million

opportunity for this population alone

Sustainability: Care Delivery Excellence - LOS Efficiencies


3RD GENERATION HOSPITALIST PROGRAM MODELSTEPHANIE BURNS MHA

Brand Promise:


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Goals of Hospitalist Program Development

1. High Performance– Of Hospital– Of OSC

2. Alignment– Engagement around UPH goals and priorities

3. Value– To marketplace– To stakeholders

4. Sustainability– Return on investments– Reliability– Evolutionary adaptability (to changing healthcare environment)

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2015 Hospitalist Program Development

• Establish 3rd generation standard program elements across all regions

• Engage Nelson Flores to review, refine 3rd generation program model and assess current state, recommend strategies to close gaps

• Establish hospitalist program development dyad leadership team within UPC

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2015 Hospitalist Program Development

• Develop regional and system level action plans to drive program evolution to 3rd generation standards

• Develop and implement system level solutions to address staffing needs

• Formalize leadership forums for hospitalist leaders to share best practices, identify issues needing common solutions and provide feedback on system level initiatives

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NELSON FLORES KEY FINDINGS AND RECOMMENDATIONSJOHN NELSON MD

Brand Promise:


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UPH Hospital Medicine PracticesUPC-Employed or Managed Hospitalist Programs

Non-UPC Hospitalist Programs

3/23/20153rd Generation Hospitalist Model 15

Des Moines Central Iowa

Hospitalists

Penn Avenue

Cedar Rapids Quad Cities Waterloo

Dubuque Fort Dodge Madison Peoria

Methodist

Proctor

Sioux City


Program Structure &

Inter-relationship

s

Program Medical Director

Management Support

Relationships and

Communication

Integration with Medical Staff

Hospitalist Group Decision-

Making

Goal Setting

Services

Clinical Scope

Performance Improvement

Qualifications

Staffing Standards

Skill Mix

Performance

Management

Core Competencies

Performance Expectations

Performance Metrics

Dashboards

Accountability Systems

Aligned Compensation

Cost/Revenue Optimization

Program Infrastructu

re

Operating Systems and

Processes

IT and Business Analytics

Communication and Care

Coordination

Talent Manageme

nt

Recruitment and

Onboarding

Temporary Staffing

Resources

Retention Strategies

Professional Development

Promotion and Job Enrichment

Pathways

3rd GenerationHospitalist Program



Recommended System-Level Activities Create a system-level hospital medicine service line

leadership infrastructure

Define and disseminate UPH goals the hospitalist programs are being asked to align with

Maintain and enhance inter-region collaboration of hospitalist program leaders (medical directors and program managers)

Develop a process for requesting local exceptions to 3rd Generation requirements

Establish a basic ongoing leadership development program for hospitalist medical directors and program managers

Make available productivity, compensation and other benchmarking information to guide local decision-making

Make available training in quality/process improvement, Crucial Conversations, language and cultural sensitivity improvement, etc.

Provide centralized resources for periodic pro fee coding audits and ongoing documentation/coding training

Establish system-level performance metrics and dashboard

Develop standardized methodology for reporting hospitalist productivity and program revenues, expenses and financial support amounts

Develop standardized format for annual “State of the Hospitalist Program” reporting

Develop minimum criteria for hospitalist compensation plans, and process for plan approval

Develop criteria for local hospitalist FTE definitions

Develop reporting capabilities to support hospitalist efforts at reducing clinical variation and waste

Turn on Epic IP charge capture across system

Evaluate HIPAA-compliant text messaging and other communication options

Develop dedicated hospitalist recruitment resources at the system level

Develop and administer internal moonlighting job board

Develop and administer an internal “float pool” of hospitalists who can help cover where needed

Negotiate corporate contracts with locums companies

Work with hospital leaders to develop hospitalist job satisfaction survey process

Identify and/or provide resources to assist underperforming hospitalists



UnityPoint HealthOverall Observations and Priorities

Key Observations Top Priorities

There is significant variability among hospitalist programs

Some fairly mature and some struggling

Many programs struggle with hospitalist recruitment and retention

Few programs have robust performance information collection, analysis, or reporting capabilities

Few programs have formal operating systems and processes in place

Case management/care coordination initiatives are crucial to improved hospitalist performance

Stabilize core hospitalist staffing Staffing standards for each program

Ensure adequate staffing coverage

Use of APCs and clinical support staff

Hybrids and locum/PRN providers

Ensure clear relationships and accountability between hospital leaders and hospitalist program leaders

Develop system-level resources and support Performance metrics, performance

reporting, and business analytics

Recruitment and temporary staffing

Professional and leadership development



Program Structure &

Inter-relationship

s

Program Medical Director

Management Support

Relationships and

Communication

Integration with Medical Staff

Hospitalist Group Decision-

Making

Goal Setting

Services

Clinical Scope

Performance Improvement

Qualifications

Staffing Standards

Skill Mix

Performance

Management

Core Competencies

Performance Expectations

Performance Metrics

Dashboards

Accountability Systems

Aligned Compensation

Cost/Revenue Optimization

Program Infrastructu

re

Operating Systems and

Processes

IT and Business Analytics

Communication and Care

Coordination

Talent Manageme

nt

Recruitment and Onboarding

Temporary Staffing

Resources

Retention Strategies

Professional Development

Promotion & Job Enrichment Pathways

UnityPoint Health



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Documents

Confidential and Proprietary – UnityPoint Health UPH 3 rd Generation Hospitalist Update UPH Leadership Symposium April 28, 2015 Theresa Lewis RN MPA FACHE