PCD PARTNERS INTRODUCTION TO HOSPITALS

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Who is PCD Partners?

Align

Measure

Improve

PCD Partners is comprised of world class physicians, academics, and entrepreneurs who have decades of experience with collaboration in medical quality and practice improvement systems for large scale practice management and clinical practice improvement.

The founders and principals of PCD Partners have devoted their careers to establishing themselves as leaders in the healthcare field as physicians, academics, senior administrators, entrepreneurs, and lawyers. Their collective wisdom and experience is a critical component of every PCD Partners offering.

PCD Partners was formed to bring together the combined experience and intellect of our principals to apply towards solving many of the challenges that physicians and hospitals are facing. Our partners are committed to playing an active role in improving the efficiency, quality and consistency of healthcare delivery. We have the clinical, administrative, quality, and systems acumen to help any healthcare delivery system.

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• PCD Delivers Expertise And Experience In Dealing With Complex Organizational Challenges:

• Data Process & Capture,• Governance,• Complex System Integration and Implementation;

• Deep And Broad Clinical Expertise And Experience • Extensive Vascular, Cardiology and Orthopedic,• Operation “Reboot”,• Risk Adjusted Outcomes;

• Thoroughly Trained In Quality Standards And Process Redesign• Lean Six Sigma in Clinical Healthcare Applications,• ISO 9001 Quality System, • System-wide Quality Initiatives, • Process Redesign And Optimization.

PCD Core Competencies

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Improve

• Align co-dependent healthcare stakeholders (physicians, hospitals, payers and patients) using common metrics, structured relationships and financial incentives

• Measure the right quality and efficiency variables, ensure excellent data governance and buy-in, and make the data transparent to stakeholders

• Improve operations to reduce defects and increase efficiency using standardized tools in a way that reinforces the underlying stakeholder alignment

Align, Measure and ImprovePCD’s methods are grounded in a simple framework:

AlignWhat is it?

How does a CMA help with Alignment?

How can PCD add value?

What are the implications for a system wide quality initiative?

There are a myriad of alignment structures that are used to create different levels of integration between hospitals and physicians; some are more effective than others depending upon the specific objectives of creating the alignment.

A CMA can provide a structure to ensure that physicians and the hospitals that they practice in have their incentives aligned. The formation of an alignment structure requires input from all involved parties to determine physician and management roles and responsibilities, service line governance and CMA fees and compensation.

PCD’s clinical, operational and data experience enables us offer input into developing the right alignment structure. The CMA structure is the only structure that provides on-going financial rewards; it is also the only structure that requires the use of data to improve quality, and it can co-exist with any other alignment structure.

CMAs are typically implemented within a service line; once the initial service line has been implemented additional service lines can be added quickly. Having the right alignment structure that is repeatable across service lines can facilitate a facility wide quality initiative.

MeasureTo be useful, the right data needs to be in the right format in the right place at the right time. Data is required to be able to measure anything in a meaningful way; without data there is no knowledge.

CMAs require that quality and efficiency performance objectives and metrics, data management, training and operations plans, and valuation must be defined. Incentive bonuses are earned by producing data to demonstrate measurable quality improvements over specified time periods.

PCD can help define quality and efficiency performance objectives and metrics, structure a data management plan, develop and deliver training and operations plans, and provide an independent 3rd party Valuation Fairness Opinion. Our real time dashboards will help you to transform data into knowledge that is meaningful for all parties.

Having the right data available and in a useful format is the key to optimizing quality across a healthcare delivery system. The majority of data required to produce an effective system wide quality system comes from outside of the EMR. In order to effectively identify, collect and transform all of the data required into useful knowledge requires experience skill and the right tools.

What is it?

How does a CMA help with Alignment?

How can PCD add value?

What are the implications for a system wide quality initiative?

ImproveImprovement can come in many forms: increased throughput, reduced costs, reduced defects, improved efficiency and most importantly, improved patient outcomes. Realization of these improvements is the result analyzing and optimizing processes using best practice methodologies.

CMA quality incentive bonuses are structured to provide an incentive payment that is commensurate with measurable and demonstrable improvements that can be proven through the data in the quality system.

PCD’s clinical skills, operational know-how and data expertise will combine to develop the process improvements that ensure that you achieve optimal results. PCD’s consultants are Lean Six Sigma and ISO 9001 trained to identify and reduce waste, reduce defects and develop processes and procedures that are tracked by an exception and corrective action tracking tool to ensure compliance and visibility to quality performance.

Having the right alignment structure and measurement capabilities are pre-requisites to realizing meaningful improvement, but do not assure improvement on their own. The addition of Lean Six Sigma principles does not guarantee process improvements without the role definition, process standardization and reporting infrastructure that ISO 9001 compliance assures.

What is it?

How does a CMA help with Alignment?

How can PCD add value?

What are the implications for a system wide quality initiative?

When it is seeking a strategy to engage physicians in strategic planning, managing hospital product and service lines, or in programs to improve efficiency, clinical quality, and patient safety.

When it needs to collaborate with its disconnected silos of currently employed physicians, independently owned practices, and joint ventures to manage costs and quality.

When it needs a way to recruit, retain and involve private practice physicians who not interested in hospital employment.

When its existing quality initiatives are not delivering optimal results.

When it wants to build a foundation for measuring and improving quality to better position itself for shared risk reimbursement models and accountable care.

When it is struggling to create a single hospital-physician “brand.”

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When Should a Hospital Consider a CMA?

Clinical (or service-line) Co-Management Arrangements (CMA) are one of the most successful strategies that physicians and hospitals can use to achieve clinical integration, strategic alignment and collaboration.

The CMA can be used to define physician and management roles and responsibilities, service line governance, quality metrics and on-going financial rewards for physicians without violating Stark, anti-kickback or other regulations.

The CMA can co-exist with any other alignment structure and it is the only structure that requires the use of data to improve quality.

A CMA allows physicians to share in the hospital’s service line revenue in exchange for providing operational oversight of the service line and achieving defined quality goals.

A CMA can foster a close working relationship between a hospital and its physicians to work toward common economic and patient-centered goals.

A CMA can be used to build the foundation to position physicians and hospitals with ACOs that are looking for efficient partners.

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Why a CMA Versus Other Structures?

A co-management agreement is generally set up to provide additional administrative and bonus compensation to reward physicians for taking responsibility for improving metrics related to quality, efficiency, and budget in a hospital service line.

Physicians are directly rewarded for improvements in a service line’s operational, clinical and budgetary performance and compensated in addition to their professional fees.

The CMA can provide the incentive for physicians to do more work in that particular hospital, subsidize the physicians’ incomes, and reduce the incentive for the physician to compete with the hospital.

The CMA incentive compensation can be an attractive alternative to hospital employment, while still aligning interests to help the hospital to become more competitive.

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How Do CMA Financial Incentives Work?

What is the Result of a Properly Implemented CMA?Patients get the

benefit from a system that is working closely together to achieve a

common set of objectives.

A common plan and vision that

was created jointly by the

physicians and the hospital;

Physicians having greater impact on achieving

operational and process improvements;

Financial incentives for physicians for measuring

and improving quality and efficiency;

Joint implementation of quality and safety

standards by the physicians and the hospital;

PCD can help define quality and efficiency performance objectives and metrics, structure a data management plan, develop and deliver training and operations plans, and act as an independent 3rd party to the arrangement. Our real time dashboards will help to transform data into knowledge that is meaningful for all parties.

PCD can help to maximize quality improvements by leveraging our experience in gathering meaningful clinical data and transforming it into evidence based treatment protocols to improve patient outcomes.

PCD has the clinical skills, operational know-how and the data expertise to help to develop the process improvements that ensure the realization of measurable and meaningful results.

PCD’s consultants are trained in Lean Six Sigma and ISO 9001 to identify and reduce waste, reduce defects and develop processes and procedures that are reinforced by a variance reporting and corrective action tracking tool to ensure compliance and visibility to quality improvements.

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What Are PCD Partners’ Deliverables?

Operational Consideration

Typical Alternative PCD Recommended Solution

Initial System DesignExecuted by teams with

limited experienceExecuted by PCD personnel together with experts with

decades of integrated operational activities

Metric Selection and Design

Local CommExecuted by PCD personnel together with experts with

decades of integrated operational activities

Data Gathering & Management Systems

Local systems onlyPCD has decades of experience with data management

problems and potential solutions in these situations. We have ‘best-in-class” systems under license for our clients.

Data control and management systems

Not donePCD uses web based ISO 9001 solutions, and guarantees certification for clients who elect this recommended option

Training and evaluation

Limited & localPCD has partnered with a number of specialized providers to

provide the highest quality deliverables to its clients.

Data Legal Status None done This is done through the Dartmouth based Patient Safety

Organization PSO

Financing Local resources onlyPCD can provides all needed financing as required to design

and complete the physical and soft cost (such as training)

Ability to assist with ACO conformance

NonePCD is on the leading edge of ACO developments and builds

ACO readiness into all of its solutions.

Expansion into RAO Communities of

PracticeNot Done

This is an area in which PCD is uniquely qualified and capable of supporting our partners.

PCD Partners Value Add Considerations

World Class PartnersCHARLES HUTCHINSON, PhDChairmanCo-founder and CEO, GlycoFi, Inc. (acquired by Merck in 2006), Founder, M2S, Inc. and SustainX, Inc., Dean Emeritus, Thayer School of Engineering at Dartmouth, Ph.D., Stanford M. WESTON CHAPMAN CEOChairman, President & CEO, M2S (acquired by AIG affiliate), Managing Director, Oppenheimer & Co. and Donaldson, Lufkin & Jenrette, Adjunct Professor, ISO medical quality systems, Dartmouth Medical School, A.B. Dartmouth, M.B.A. Tuck GRANT BAGLEY, MD, JDPartnerPast Managing Partner, Healthcare Practice, Arnold & Porter, Past Director, Coverage and Analysis, Centers for Medicare & Medicaid Services

DONALD S BIALEK MD MPHPartnerManaging Director, Huron Consulting Group; SME, CSC Global Health Services; Physician Executive, Dearborn Advisors;CEO, Alliance Medical Practices; CEO, Paradigm Medical Teams;Faculty, Harvard University;NLM Informatics Fellow, Harvard/MIT;BSc, Univ of MD; MD, Univ of MN; MPH, Harvard University

COLIN C. BLAYDON, AM, PHDPartnerDirector, Center for Private Equity & EntrepreneurshipDean Emeritus, Tuck School of Business at DartmouthProfessor, Harvard Business SchoolDept. Of Defense, OMBBEE Univ. of Virginia, AM Harvard, PhD Harvard

MICHAEL A. CHOUKAS PartnerPresident and CEO, Oncopartners, EVP United Biosource Corp., Chairman & CEO, Scirex Corp., Chairman & CEO Springborn Laboratories (Now STRI,NYSE),Partner, Bain & Company, Legislative Director, US Senator Patrick Leahy, B.A. Dartmouth, M.B.A. Harvard Business School JOHN C. COLLINS, MPH, JDPartnerChair and President, Hampden Assurance Co. Ltd.,Chief Executive Officer, Dartmouth-Hitchcock Clinic, Dartmouth-Hitchcock Medical CenterDirector BCBS of VermontAssist. Prof. Dartmouth Medical SchoolBS Cornell, MPH Michigan, JD Georgetown JACK CRONENWETT, MDPartner, Chief Medical OfficerChair Emeritus, Section of Vascular Surgery, Dartmouth-Hitchcock Medical CenterMedical Director, Vascular Study Group of New England, Professor of Surgery, Dartmouth-Hitchcock Medical Center, B.S. Michigan, M.D. Stanford ADAM GROFF, MD, MBAPartnerDivision Director, Bayada Nurses, Inc., Hospitalist, Dartmouth-Hitchcock Medical Center, Assistant Professor, Dartmouth Medical School and The Dartmouth Institute for Health Policy & Clinical Practice, A.B. Dartmouth, M.D. Penn, M.B.A. Wharton MARK ISRAEL, MD Partner, Chairman of the Medical Advisory BoardDirector, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Professor, Pediatrics and Genetics, Dartmouth Medical School, B.A. Hamilton, M.D. Albert Einstein

World Class Partners

DR. GERRY O’CONNOR, PhDConsultant, Design and Implementation of Clinical Quality Programs, Principal Investigator, National Quality Program, Cystic Fibrosis FoundationPartner, Quality Program DirectorResearch Director, Northern New England Cardiovascular Disease Study Group, Corporate, Professor, Dartmouth Medical School and The Dartmouth Institute for Health Policy & Clinical Practice, B.S. Columbia, Ph.D. Union, Sc.D. BU, M.P.A Harvard

StaffPAUL CARREIRO, PACorporate ConsultantMedical Staff Officer, U.S. Merchant Marine Consultant, New England Center for Emergency Preparedness, Dartmouth Medical SchoolBoard of Advisors, Franklin Pierce University Physician Assistant ProgramA.B. Harvard, B.S. University of Texas, JFK Special Warfare Center for Low Intensity Conflict, Flight Surgeon - School of Aviation Medicine, U.S. Army

VEKRAM JENARTHANANProject ManagerVekram has previously worked in the fields of data analytics and information management in the banking and insurance verticals. His experiences and interests in project management and TQM make him an ideal fit for PCD. His work at PCD involves the technical design and implementation of quality management systems. B.E. (Electrical and Electronics Engineering) College of Engineering Guindy - Chennai, India M.E.M. Duke University

JON LEETDirector of Sales & MarketingJon brings 25+ years of sales and marketing accomplishments with both large companies (Oracle, IBM) and startup companies across a variety of technologies and industry verticals. Jon is responsible for working with PCD management to implement a structured sales process and develop a focused marketing plan. B.A. Colorado College.

World Class Partners