Israel’s Leading Health Care Organization Clalit Health Services Group Israel’s Leading Health Care Organization

Israel - Population Profile Heterogeneous population 7.7 million residents 1.4 million Arabs (84% Moslems) 1 million new immigrants from former Soviet Union since late 1980’s Young population (10% aged 65+ , OECD* Countries = 14.1%) Outcome comparable to international average Life expectancy : M- 79.7 , F-83.5 (OECD* countries = M-76.5, F-82.1) Infant mortality : 5.1 per 1000 live births (OECD countries = 6.1) *OECD = statistics provided by Organization for Economic Cooperation Development

Relative Economic Efficiency Israel spends less - yet its citizens live longer Total Expenditure on Health (% of GDP) Life Expectancy Females Life Expectancy Males OECD Report 2011

Clalit Health Services Established in 1911 Today there are over 4 million insured 54% of market share Elderly (65+) - 70% market share , 0.5 million Arab Population - 73% market share, 1 million

Clalit Vision and Core Values Clalit is dedicated to a healthy Israel: “We are committed to health through prevention of illness, promotion of healthy lifestyle, quality care and attention to the special needs of the patient and his/her family” Core Values: Respect for each individual Contribution to the community Professionalism and excellence Humility Integrity Dedication

HEALTH INSURANCE ALIGNMENT COMPTROLLER Director General LEGAL ADVISOR DIRECTOR ‘s ASSISTANT OMBUDSMAN SUBSIDIARIES SPOKESMAN HEALTH INSURANCE ALIGNMENT CHIEF NURSE CHIEF PHYSICIAN HOSPITAL DIVISION COMMUNITY DIVISION LOGISTICS & INFRASTRUCTURE DIVISION FINANCE DIVISION SERVICE & MARKETING DIVISION HR DIVISION HOSPITALS DISTRICTS SOUTH DISTRICT

Primary Care Clinic Team A Fully Integrated Community-Hospital System Primary Care at the Heart of the System 8 Family Doctor Primary Care Clinic Team

Management Strategy Promoting Patient Experience Monitoring Quality of Care Through Quality Indicators Decentralization and Self-management Clinics Hospital Departments Comprehensive Care Programs for Patients at Risk

Community Clinics’ Computerized Medical Record Cumulative Patient Visit Data (Diagnoses, Markers, Prescriptions, Lab results, Specialty Consulting Visit Report, etc… ) Decision Support Tools (Patient Lists, Good Medical Practice, Drug Interaction)

Prevention and Early Detection Screening Breast cancer- Mammography (Ages: 50-74 - every 2 years) Colon cancer - Occult Blood (Ages: 50-74 - every year) Cervical cancer- Pap Smear (Ages: 35-54 - every 3 years) Promoting Wellness Behavioral factors Focus by topic (ie: smoking, physical activity, nutrition) Target groups Influence consensus and public opinion

All general hospitals are accredited by the JCI The Only Health Organization in Israel that Runs its Own Public Hospitals Community outreach National centers of excellence Children’s hospital Comprehensive cancer center Organ transplant center Rehabilitation centers All general hospitals are accredited by the JCI

Hospital stay – average 4.1 days Clalit Hospital Statistics 1,900,000 hospital days 400,000 admissions 900,000 emergency visits 2.2 beds per 1,000 population Hospital stay – average 4.1 days 17,000 staff 5,500 beds 3,000 open heart surgeries 900 cranial surgeries 2,000,000 outpatient visits 19,000 catheterizations 170 transplants 40,000 births

Organizational Operations Management Strategic Map for Hospitals Balanced Finances 15% Controlled Budget Combined Financial Index Organizational Operations Management Strategic Map for Hospitals Clinical Quality & Excellence 30% Clinical Indices Quality Tests Teaching & Academics Risk Management Customer Experience ER Customer Service Hospitalization Customer Satisfaction Surgical Depts. Ombudsman Queue for Common Procedures Outpatient Clinics Image 5% Media Local Image Strategic Goals Internal Processes Operational Efficiency & Excellence 10% OR Utilization Weighted Outputs Non-Basket Activities External Income Growth Infrastructure Logistics Maintenance Human Resources Employee Systems Employee Satisfaction Internal Customer Survey Interns Satisfaction Complaints about staff attitudes Telephone Answering

Clinical Quality Indicators at Clalit Hospitals Based on pre-defined criteria: evidence-based, potential for improvement, validity, potential harm vs. benefit, size of target population, JCI accreditation requirements Process and outcome indicators Uniform numerical goals and weights that create a combined compound score for quality Some measures are built on self-reporting following review of medical records, with external audit of the data

Clinical Quality Indicators at Clalit Hospitals: examples Pressure sores acquired during admission Falls / falls with injury PCI done within 90 minutes for ST-elevation MI Medications at discharge following acute MI Antibiotics given within 6 hours for community-acquired pneumonia Hip fracture operated within 48 hours Laparoscopic cholecystectomy converted to an open procedure Extended length of stay following colectomy for cancer

Service Standards Definition - the basis of goals and grades in the hospitals ER length of stay Outpatient queue length Appointment cancellation rate at outpatient clinic Percentage of phone-calls answered at the hospital Speed of telephone answering in the hospital

Service Standards Definition - the basis of goals and grades in the hospitals Waiting time for outpatient doctor Rate of first customer delays. Surgery queue length Customer satisfaction- ER, inpatients and outpatient clinics Customer satisfaction – general hospital services Number of complaints about telephone and staff attitude per 100 beds

2011 - Clalit’s Hospitals EMR pilots completed PACS deployed throughout the organization Quality parameters in focus Accreditation of all general hospitals “Excellence units” concept developed

2011 - Clalit’s Hospitals Emphasis on ER service Dealing with waiting lists Improving oncology services Increasing income: medical tourism, Palestinians Special attention to shortage of doctors and nurses

Clalit Steps Ahead Patient care and risk management: “Ask Me 3”, safety rounds, controlling health care associated infections EMR deployment in 300 hospital departments Emphasis on the periphery 

Clalit Steps Ahead Purchase of new technologies (CT, MRI, PET-CT, Robots) Renovations and constructions Promoting research and collaboration Advancing patient experience Departmental budget

Creating an “American Friends” Group for Clalit Goals: To promote collaborative research To further institutional cooperation with hospitals, universities and research institutions Supplement government funding building and renovation of clinics, institutes and hospitals unfunded needs of the elderly, lower income populations and those living in Israel’s periphery Purchase of new technologies Introduction of electronic medical records