1. Physician Leadership Bud Chumbley, M.D., MBA President, Aspirus Clinics, Inc., System CCIO MGMA – October 2013

2. Aspirus, Inc.  Clinical Sites Single tertiary care hospital and five Critical Access hospitals 35 clinic sites

3. Total revenue - $700 million Strong Balance Sheet  Structure Federation of inpatient and post-acute care facilities Large Board of Directors Loosely integrated Aspirus, Inc. (cont.)

4.  Clinic Culture 260 employed physicians and associate providers Purchased over time and assimilated but not integrated Different benefits, compensation and contracts Aspirus, Inc. (cont.)

5.  Aspirus Network – Physician Hospital Organization Strong independent single specialty physician groups Joint contracting – single signature Not all Network members are part of the Aspirus system. Traditional Payor Contracts  Competition Aspirus, Inc. (cont.)

6. Physician Leadership  Dyad Leadership in Clinics Senior Medical Director Five Regional Medical Directors Site Medical Directors

7.  Aspirus Physician Partnership Leadership Education – APPLE UW – Madison Executive MBA Template – Ten months Capstone Projects Twenty-five physicians and administrators per year Physician Leadership (cont.)

8.  Aspirus Physician Partnership Council Charter Members: Physicians and Senior Leaders Accomplishments  Aspirus Network, Inc. – PHO Board Medical Management Committee Physician Leadership (cont.)

9.  Compact Initiative Tertiary care hospital & medical staff Clinics System wide Physician Leadership (cont.)

10.  Recruiting CMO, CMIO, Senior Medical Director Network Executive Director  Template for interaction/with independent physician groups  High performing physician leadership structure – (MEC, APPC, Boards, PHO) Physician Leadership (cont.)

11. Ongoing Imperatives  Clinical Integration – alignment of goals and incentives  System wide Compact  Medical group culture  Restructuring of ANI - PHO  Clear “menu” of alignment options for independent physician groups  Standard physician contracts

12. Ongoing Imperatives (cont.)  Revised physician compensation plan o Base salary o 30% variable compensation component  Panel size  Patient satisfaction  System financial performance  Quality metrics  360 degree annual evaluation o Standard patient contact hours by specialty o Standard benefits

13. Lessons Learned  Employment, Assimilation, Engagement – progressively more difficult  Once trust is lost it is difficult to regain (Just like a marriage)  Size/scale without alignment/engagement does not lead to a sustainable competitive advantage  Finance cannot be the sole drive of change

14.  “Easy” on the front end leads to “pain” eventually  Dyad leadership structure on hospital side  Mixed model of employed and independent physicians is challenging  External drivers are helpful in change management  Involve allied health professionals Lessons Learned (cont.)

15. Bud Chumbley Bud.Chumbley@aspirus.org