Brigham and Women’s Physicians Organization Overview Center for Expertise in Healthcare Management Allen Smith, MD, MS January 20, 2010

Agenda Introductions BWPO Introduction BWPO Areas of Focus Overall corporate structure Mission Senior Management Role Physician statistics BWPO Areas of Focus Patient Experience Pay for Performance Physician Experience: Volunteerism Network Development Challenges and Opportunities

Partners HealthCare System, Inc. (PHS) Partners Community HealthCare, Inc. Newton- Wellesley Health Care System, Inc. Brigham and Women’s/ Faulkner Hospitals The Massachusetts General Hospital North Shore Medical Center, Inc. Newton- Wellesley Hospital, Inc. The Brigham and Women’s Hospital, Inc. Brigham and Women’s Physicians Organization Faulkner Hospital, Inc. The Salem Hospital AtlantiCare Medical Center, Inc. The General Hospital Corporation

BWPO is a faculty practice plan which supports its physicians and departments in their aspirations to: Provide the highest quality patient care Develop the next generation of physician leaders Be world leaders in translational research

Management Team President Allen Smith, MD, MS Chief Medical Officer Jessica Dudley, MD Chief Financial Officer William Johnston Vice President of Ambulatory and Women’s Health Sharon Vitti Director of Administration Sharon Cohen

Role of BWPO Streamline operations where possible Organize and manage billing, administration and financial components of its 17 business units Foster departmental autonomy while supporting the overall mission and goals of the organization Support physicians in contracting and providing “medical management” support for high quality, efficient care Includes efforts in ambulatory experience Focus on physician work life Leadership, Volunteerism, IT systems

Employed Physicians

BWPO Physician Total

BWPO Areas of Focus Patient Experience Physician Experience Financial Health Our Staff Systems

Patient Experience Patient First Staff Training Launched by the Ambulatory Council Helped focus attention on improving patient satisfaction Staff Training Lean Practitioner Training Ambulatory operations improvement Ambulatory patient satisfaction scores surpass 75th percentile mark BW/F Ambulatory Services in top tier of UHC facilities that use Press Ganey 42 managers trained in Lean model including RNs and MDs

Ambulatory Patient Satisfaction Scores: Overall Trend of Percentile Rank Target: 75th Percentile Our scores are moving in the right direction Our overall mean score is better than the overall UHC mean scores Awareness effect is focusing our attention Small changes in mean score can result in big jumps in percentile rank Our survey peer group is competitive (like AMC facilities)

Pay-for-Performance Contracts Ability to negotiate collaboratively as a physician network Pay-for-performance contracts with the 3 major commercial insurers for shared financial responsibility (risk) and interdependent clinical programs Withhold of an annual amount of revenue Withhold returned when network achieves certain efficiency and quality measures

2009 BWPO MD Withholds at Risk by Category

Diabetes Performance 2003 v. 2007: MHQP Data

Pay for Performance: Training, Education, and Management (TEAM) BWPO TEAM program focuses on improving patient care outcomes and preventing unnecessary hospital admissions A team of nurses, doctors, pharmacist, social work, and administrative staff identify high risk patients and provide the following: High risk patient mgmt – face to face counseling and coaching Immediate access to necessary MD visits Programs for getting patients to LDL, BP, A1c targets + getting right meds prescribed

Volunteerism: Indian Health Service Goal: Provide opportunities for teaching and clinical care in an impoverished setting Indian Health Service (IHS): Compelling health care needs of Navajo population Relatively easy for physicians to volunteer there IHS Sites: Gallup, NM Shiprock, NM Progress: Assessment of needs (both IHS and BWH) and initial visits completed Next Steps: Regular site visits and additional fundraising for program Christian Arbelaez, MD, MPH and staff at Gallup Indian Medical Center

Map of BW/F Relationships in Southeastern Mass Quincy Medical Ctr Providing Cardiology dept chair Tertiary trauma services Near West 1. OB/Gyn, CIRS practice @ NWH Map Key: MACC** Sites Physician Relationships Metrowest Area BWPO Rheumatology BWPO Cardiology South Shore Hospital DFBWCC with SSH Expanded Surgery, Cardiology, Neurology and OB/Gyn affiliations Milford DFBWCC at Milford New PCHI group (Tri-County) OB-Gyn (MIGS) services Compass Medical BWH MRI service BWPO surgery BWH Vein center, Center for Repr. Medicine BWPO Cardiology Foxboro MACC Primary Care Dx. Imaging Surg Specialties Med Specialties Amb Surgery Pathology, etc Plymouth Relationship Mgmt with new PCHI groups Cape Cod Hospital BWH cardiac surgery and anesthesia services BWPO radiology services BWPO cardiology services South Coast PrimaCare, Hawthorne (PCHI) relationship mgmt. BWPO Rad Onc services at St.Anne’s Hospital Rhode Island Memorial Hospital (Pawtucket) affiliation Emergency Medicine management & Cardiology consulting services *Map represents primarily “major” external relationships where we have on-the-ground presence or provide key on-site leadership **MACC is a Multi-specialty Ambulatory Care Center

Challenges and Opportunities Health Care Reform Patient Experience Meeting ambulatory goals consistently at practice level Structured approach to ambulatory quality and safety Referring Physician Experience Access, communication, transitions, cost Faculty Experience Worklife satisfaction and balance Future of Primary Care Financial Health Controlling expenses Ambulatory revenue growth Alternative revenue streams to offset declining reimbursements

Health Care Reform: Models Payment Model Fee for Service P4P Augmented Primary Care Bundled Payments Global Capitation BW/F is engaged in all three models Big 3 Contracts Bundled Payment Pilot CMS Demo Foxborough Medical Home Level of financial risk borne by payor Level of financial risk borne by provider Adapted from Dr. James Mongan presentation 5/26/2009