1 Healthcare Governance and the Increasing Focus on Patient Safety and Quality: How This Trend Will Affect PAs Nancy McKeague SPHR April 5, 2014

Value of our $3 Trillion System

Top Occupations Employed by Hospitals Healthcare practitioners /technical occupations: 53.7% Office and administrative support: 13.37% Healthcare support: 12.76% Management occupations: 3.71% Building and grounds maintenance: 3.40% Food prep and service: 2.48% Community and social services: 2.40% Business and financial operations: 2.01% Computer and mathematics: 1.23% CEOs/ other top executives 0.5% Bureau of Labor Statistics April

The Role of PAs in Hospitals Almost 40 percent of clinically practicing PAs work in hospitals. How can we quantify the value that PAs bring to the hospitals? What will the role be of PAs in revenue generation and other aspects of hospital healthcare? Discussion must include PA counterparts in private practice and other settings. 4

PAs Helping to Transform Healthcare Growing recognition that: PAs not only treat disease, but also promote health, and decrease healthcare demand through preventive care. PAs are leaders in team-based, coordinated care. Healthy People 2020, an initiative headed by HHS, has four health principles that align with the type of care that PAs provide. 5

Healthy People 2020 Principles These principles are: 1.helping people to live longer through preventing disease, 2.eliminating health disparities, 3.creating environments that promote good health and, 4.promoting healthy behaviors through all life stages. 6

Prevention-focused and Holistic PAs can decrease demand for care by improving prevention, education and coordination of care. PAs assume some of the routine work for physicians to help maximize office hours and treat more patients. Preventive care will reduce overall healthcare spending by warding off diseases that strain the economy and work productivity. 7

PA Quality Ratings Studies have consistently shown that: PAs provide high-quality care with outcomes similar to physician-provided care. Incorporating PAs can improve outcomes. Patients are just as satisfied with medical care provided by PAs as with that provided by doctors, and sometimes more satisfied. 8

Patient-Centered Medical Homes One example of an emerging care model that is strongly supported by healthcare reform is the PCMH. This model makes use of all healthcare providers’ skills in ways that are most efficient and effective for patients and encourages open and continued communication between providers and patients. 9

Patient-Centered Medical Homes In a PCMH, all clinicians work together to provide care that is comprehensive, ongoing and coordinated. The clinical team provides primary, acute and preventive medical care. The team also integrates specialty referrals and other services from the health system and community. 10

Engaging Patients in Care Management PAs play a vital role in chronic care management. Chronic care management programs may reduce hospital admissions, readmissions, specialty care, and prescription drug use. This model relies heavily on patient education and empowering patients to play an integral role in their healthcare. 11

Blue Cross' Enrollment Breakdown For the 2014 open enrollment period: 56% of BCBSM and BCN members bought products on the Marketplace; 88% of on-Marketplace enrollments were subsidy eligible; 22% are experiencing reductions of $500 to $1,000 in their monthly premiums; and 55% of total enrollees were new to BCBSM and BCN. 12

Strategies to Improve Performance

Competency-Based Hospital Boards Health care boards are bombarded by constant change and complexity. Traditional decision-making methods often take too long, don’t always provide the answers Leaders struggle to manage the sheer volume of strategic initiatives Calls for different types of decision contexts, simple, complicated, complex, and chaotic. 14

Key Board Responsibilities Oversight of legal and regulatory compliance, Upholding efforts to improve health care quality and patient safety, Physician relationships and competition, Safeguarding the organization’s charitable assets, and Protecting the hospital’s credit rating. 15

Roles Expands for Compensation Committees Now responsible for aligning the health care organization's strategic goals and executive compensation. It is being called upon to oversee succession planning and senior executive bench strength development. It now performs virtually all important human resource functions related to the organization's top executives. 16

Competencies + Diversity + Culture Key Strengths and Experience: Executive leadership Business Management Finance, Investment and Audit Clinical Care and Quality Improvement Law Community Health Advocacy 17

Trustee Decision-Making How would you define the relationship between the board and hospital management? Is the board’s decision-making process inclusive, or do a few board members dominate key decisions? Is the board getting the educational guidance it needs to understand the hospital, its market area and the health care industry? 18

Trustee Decision-Making Are you comfortable speaking up when you disagree with management proposals or the direction the board is going with a particular decision? What is the board chair’s role? How does the chair relate to the CEO and other board members? 19

Issues Facing Hospital Trustees Costs will continue to grow at a rate faster than payment increases. Insurance exchanges will put downward pressure on premiums, which will result in lower payments in Use of less costly delivery sites — such as post-acute versus acute — will reduce hospital revenue. 20

Issues Facing Hospital Trustees Physician alignment will continue to be one of the top concerns for CEOs. Hospitals will be focused on strengthening relationships with physicians through employment, economic risk sharing or shared savings with payers. Primary care is still the key focus and episodes of care require a close, economically aligned specialty connection by major service line. 21

Models and Demographics Changing New models of care, such as accountable care organizations, clinical integration, bundled payments or patient-centered medical homes require a close working relationship, including economic incentives, between the hospital and healthcare providers. Many physicians are approaching their retirement age, which will require new and innovative uses of this workforce. 22

Quality and Transparency Transparency will grow and data will become more available to the public, employers and purchasers. There will be increasing visibility of quality scores and pricing, making value much more important. Expect employers, organized labor, the public, health plans, and, competitors to access publicly available data to see performance scores. 23

Connecting the Boardroom to the Bedside Many boards demonstrate their focus on patient safety and harm-reduction by regularly hearing from the front-line clinicians at meetings. Board members occasionally attend clinical team meetings after receiving permission from the front-line staff. A chance to and drive home the message of board involvement in quality. 24

Culture Must Change Without meaningful culture change, no hospital can sustain best practices that rely on open, transparent communication between clinicians with varying roles. 25