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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Employed Physicians

8. BWPO Physician Total

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

10. 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

11. 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)

12. 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

13. 2009 BWPO MD Withholds at Risk by Category

14. Diabetes Performance 2003 v. 2007: MHQP Data

15. 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

16. 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

17. Map of BW/F Relationships in Southeastern Mass
Quincy Medical Ctr
Providing Cardiology dept chair
Tertiary trauma services
Near West
1. OB/Gyn, CIRS 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

18. 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

19. 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