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 Co-Management: Successfully Improving Care Along the Surgical Continuum  Co-Management: Successfully Improving Care Along the Surgical Continuum

Co-Management: Successfully Improving Care Along the Surgical Continuum - PowerPoint Presentation

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Co-Management: Successfully Improving Care Along the Surgical Continuum - PPT Presentation

Gerald Biala SCA Senior Vice President of Perioperative Services Matt Kossman SCA Vice President of Perioperative Services Hillary Rosenfeld SCA Director of Perioperative Services The Partner of Choice ID: 775829

management surgical physician hospital management surgical physician hospital physicians care health quality perioperative strategic clinical system case operational integration

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Slide1

Co-Management:Successfully Improving Care Along the Surgical Continuum

Gerald Biala, SCA Senior Vice President of Perioperative Services

Matt Kossman, SCA Vice President of Perioperative Services

Hillary Rosenfeld, SCA Director of Perioperative Services

Slide2

The

Partner of Choice

for Leading Health Systems

45+ Health System Partners | 750K+ Surgical Procedures | $1.3+ Billion NPR

Slide3

Learning Objectives

Define the basics of co-management agreements

Identify critical success factors in working with co-management arrangements

Demonstrate how co-management agreements are utilized in partnering with physicians to achieve surgical integration

Slide4

Shared Decision Making and Management

Many publications/bond rating agencies citing the need for physician engagement

Sg2, Innovation Snapshot: Integrating Physicians, Hospitals and Innovation, Nov 2011

“Clinical culture can be a roadblock to health care innovation, so it is imperative to include physician leaders in innovation activities. These clinical leaders are instrumental in promoting more rapid positive change in organizational culture. Creating culture change among physicians generally plays to the characteristics physicians value in their life and work, including capitalizing on their variety of skills, their role as an expert and having responsibility for significant tasks.”

Becker’s Hospital Review, Top 10 Strategic Initiatives for Hospitals in 2013

7. Explore new physician alignment strategies. Again, this initiative ties in with the move to population health management. Trying out new physician relationship strategies, such as physician-hospital organizations, clinical co-management, ACOs, employment or joint ventures can join hospitals and physicians together on the same platform and can be used to support the population health strategy as well as capture market share. "There are multiple vehicles for alignment. All of them are important and many play a role in the same marketplace.”

Fitch 2014 Outlook: Operational strategies to achieve the lowest possible cost per unit of service can help hospital credit ratings

Moody’s 7/2013: Concerns regarding physician alignment, supply costs, readiness for emphasis on value

Slide5

Brief Background and History of Physician Engagement

Slide6

Physician Engagement in Management

ClinicalQuality/Safety OutcomesEnforcement of P&PsDisease Specific OutcomesStaff Competency

OperationalUtilization ManagementEfficiency MeasuresCost ManagementSatisfaction Outcomes

StrategicProgram DevelopmentPhysician PreferencesCapital InvestmentProfitable Growth

Effective physician alignment strategies can generate clinical, operational, and strategic improvements to perioperative programs to achieve positive margins on Medicare and increasingly fixed commercial reimbursement.

Medical Chair /Directorships

Co-Management Agreements

Governance Councils

Medical Staff

OR Committees

Slide7

Traditional Surgery Physician Alignment Models

Fee for service arrangement with hospitalSingle point of engagement with physicians

Executive Committee with select members blending senior admin and physician leadership Decision making in a voluntary role

A physician group contracted and paid to jointly manage resourcesDecision making authority with responsibility for implementation

Medical Chair/Directorships

Co-Management Agreements

Governance Councils

Oversight for quality of care often extended to management of resourcesAppointed members with limited involvement in final decision making and implementation

Traditional OR Committees

Slide8

The Unique Role of a Governance Council

Senior Administration

Governance Council

OR Committee

Hospital strategic planning

Surgical services strategic planningOverall hospital performanceHospital budget

Operational planning and managementPerformance improvement and monitoringRapid response for decision makingDepartment budget

Focus on quality of patient careIdentification of needs for performance improvementInput to governance council

Slide9

Co-Management Arrangements

Slide10

Common Clinical Co-Management Themes

Align with physicians and grow market share

Seek alternatives to traditional employment models

Build a high-quality, lower-cost delivery model

Implement alternative payment methodologies

Optimize service line performance

Disengaged physicians; non-inclusive decision making process

Decreased focus and loss of interest after agreement signed

Slide11

Physician Co-Management Evolution

First Generation Co-Management – Individual

Hospital

A

“First Generation” co-management agreement is specific to one hospital and the participating physiciansResults are contained to the individual hospital and physicians practicing therein

service line leader

First generation co-management is focused on a single specialty or subspecialty goals and often lacks true physician integration extending into overall strategic planning

Single or

M

ultiple

S

pecialties

Slide12

Co-Management Roles and Expectations

Shared involvement of management and operations for individual or multiple service lines to achieve surgical integrationAdministrative team partnered with physicians in improving quality and operational indicatorsNecessary clinical services are covered

Purpose is to provide leadership to improve quality and efficiency of careAdministrative services, medical director services, and quality improvement initiativesQuality improvement initiative targets established and compensation at risk based on performance

Hospital

Physicians

Page 12

Surgical continuum

Compensation

Management & Accountability

A hospital/physician alignment strategy

to delivery greater quality and financial value along the surgical continuum of care

Slide13

Example Co-Management Structure

Co-Management Agreement

Executive Council

Hospital

Quality

Physician LLC

Medical Director

Efficiency

Operations

Strategy

Finance

Slide14

Economics of Co-Management

Limited physician start-up, ~$3K per participant

Physician ROI ~40%

Hospital ROI 25% to 50%

Hospital ROI achieved through benefits of physician alignment:

Population health management

Accountable care organization

Strategic planning/growth

Efficiency improvements

Expense management

Slide15

Factors for Successful Co-Management

Transparency and cooperation between all parties

Balance needs of hospital and physician leaders with industry dynamics, evolving business models

Collaborative development of strategic plans

Common language, objectives, and attainable goals

Recognition and acceptance of baseline data

Effective leadership structure and commitment to delivery

Be intuitive

Slide16

Implementation Expectations

Program

Maturity

Pre-Signing

First and Second Year

Succeeding Years

Focus

Defining

co-management focus and goals while establishing trust

Organization

and clarity around goals; building successful partnerships between different physician practices and hospital leaders

Program evolution into strategic

areas across multiple sites and specialties

Outcomes

Heavy

investment in establishing structure, data analysis, and setting base line measures

Early results achieved through collaboration and alignment of financial and clinical objectives

Achievement of quantifiable results;

positive ROI

Slide17

Co-Management to Achieve Surgical Integration

Slide18

Achieving Surgical Integration through Co-Management

Slide19

Surgical Integration: Strategic Benefits

Source

:

Harris, Elizonda, & Isdaner. January 2013. “Medicare Bundled Payment: What is it worth to you?”

Healthcare Financial Management Association.

Slide20

Surgical Integration: Interdependence Along the Surgical Continuum

Pre-Surgery

Day of Surgery

Post-Surgery

Strategic

PlanningAssemble and lead a multi-disciplinary team of stakeholder sponsors Help replicate capitated episode model with top payersEnhance ancillary network where value gaps exist

Disease ManagementDevelop evidence-based pre-peri-post operative protocols

Utilization ManagementAppropriate pre-op testing and surgical setting to maximize margins

Transition PlanningOptimize site of surgery, post-acute placement

Transition PlanningFinalize post-operative rehab & pain management program

Operational OptimizationThroughput efficiency, costs per case

Transition PlanningDeliver progress notes to surgeon and PCP; coordinate post-acute destination

Care Management1:1 coaching of high-readmission risk patients

Utilization ManagementIdentify and steer to optimized network of rehab partners

Operational OptimizationQuarterly clinical case review of exceptions

Care ManagementMultidisciplinary physician planning and collaboration of pre- & post-surgical care plan

Slide21

Physician Co-Management: A Strategy for Surgical Integration

Slide22

Physician Co-Management Evolution

Second Generation Co-Management – Multiple Hospitals/Health

System

A

Second Generation”

co-management agreement adds to the core by integrating additional hospitals and

physicians to expand the surgical care continuumPatient outcomes and operating efficiencies are optimized through implementation of comprehensive Utilization, Disease, Periop, and Transition management across the entire community as part of the health system surgical integration strategy

ASCs &

HOPDs

Engaging physicians in a second-generation co-management agreement is an ideal

t

actic for surgical population management, ACOs, bundled payment strategies, and

v

alue-based purchasing

Slide23

Expanding Co-Management Agreements Across Continuum

Designing third iteration of co-management service agreementEmbed standardized protocols to align resources, costs, and outcomes with contemporary reimbursementEmpower physicians to lead the way in increasing risk capacity to prepare for surgical population managementProactively engage payers and employers to e

Health System

Service Line

Contract

Slide24

Case Studies

Slide25

Case Study: Florida Hospital – Carrollwood

System Profile

9 OR hospital, heavily focused on orthopedics

Large orthopedics group engaged in clinical co-management agreementMultiple in-efficiencies and disenfranchisement with perioperative leadershipHospital seeking to grow surgery volume and expand market share

ProcessRealignment of co-management with newly developed perioperative governance structure provided integration of initiatives and expanded authorityEducational programs on management process and roles/expectations of physicians, hospital leaders and staffCommittees and task forces established for action OutcomesImproved case on time starts from 36% to 95%Achieved consistent 100% SCIP measures and reduced surgical site infections rates from 2.73% to 0.8%Improved patient satisfaction for four key physician measures from 36th percentile to 90th percentileHospital experienced a 10% increase in surgical case volume as a result of improved schedule management resulting in approval to add 3 additional OR suites

Co-Management Outcomes

Adventist Health System

Slide26

Case Study: Genesys Health System

System Profile

450 bed regional medical center

20,000 surgical cases across three operating room sitesEstablished 3 co-management companies with one overall Coordinating CouncilContracting economy with decreasing market share and surgery volumes

ProcessPhysicians engaged to manage perioperative resourcesIntegrated leading management and clinical practiceDeveloped clinician led supply/implant expense managementOutcomesImproved efficiency and quality measures85% OR utilization (from 65%) 20 minute average turnover 95% on-time starts90% or better SCIP scoresReduced labor and implant expensesCoordination of care across continuum for pre-surgical and postoperative care of the diabetic patientActive engagement on Quarterly Strategic Planning with Primary Care Physicians linked to Operational tactics allowing for capturing of surgical cases leaving community

Design and Manage Co-Management Relationships

Ascension

Health

Slide27

TriHealth: Integrated Health System

System Profile

Bethesda

North: 17 OR hospitalGood Samaritan: 22 OR hospitalBethesda Surgery Center: 4 OR HOPDCo-management agreement includes >30 physicians managing clinical, operational, business, and quality aspects of surgical hospital/HOPD in conjunction with TriHealth and SCADevelopment of health system wide perioperative council

ProcessLeadership development for transition of new perioperative directorFormation of daily huddle and planning to add cases and consolidate to maximize utilizationStrategic planning related to right case/right location initiative, development of laparoscopic center of excellenceOutcomesImproved efficiency and quality measuresSCIP measures 100%Turnover times <15 minutes25% decrease in instrument repair expenseFirst case on-time starts 88%Implementation of case profitability analytics, scheduling and optimization models, financial and operational benchmarking, and quality best practices

Co-Management

Outcomes

Slide28

Q & A

Gerry BialaSVP, Perioperative ServicesSurgical Care Affiliates772-713-3278gerald.biala@scasurgery.comMatt KossmanVP, Perioperative ServicesSurgical Care Affiliates404-617-5734matt.kossman@scasurgery.com

Hillary Rosenfeld

Director, Perioperative Services

Surgical Care Affiliates

276-759-3446

hillary.rosenfeld@scasurgery.com