1. HOSPITAL PHYSICIAN INTEGRATION ACHE WEST VIRGINIA CONFERENCE MAY 30, 2014

2. PHYSICIAN-HOSPITAL INTEGRATION ARRANGEMENTS Employment Contracting to provide services Provider Service Arrangements Co-management arrangements Gain Sharing arrangements Physician Hospital Arrangements (PHOs) Risk Arrangements Medical Home Arrangements (ACO)

3. CAMC ARRANGEMENTS 1. Affiliation/partnership with WVU physicians of Charleston to provide the teaching physicians for our residency programs and to teach WVU students and other students 2. traditional private practice model 3. employment 4. contract model to provide services: radiology, anesthesiology and emergency room services 5. employment model 6. provider services arrangement

4. BALDRIGE FRAMEWORK Deployment of 32 systems to run the business and manage the quality Leadership, Governance, Communications, and strategic planning are key system that guide the physician integration efforts Workforce development, learning, data management, and process improvement are key systems that help deliver results

5. KEY PROCESSES Governance process with all physician board for the employed physicians CAMC is part of the practice plan board of directors of the WVU PC Charleston Division Physicians in the Physician Advisory Group, Physicians from the employed group are part of the strategic planning process Leadership of these groups help set aims, communicate the aims, execute the plans, reassess progress, and revise plans

6. KEY PROCESSES Key requirements are determined as part of the strategic planning process for the physicians and their patients Improvement and learning issues are determined as part of the strategic planning process Physicians are engaged in many improvement efforts for patient care

7. KEY REQUIREMENTS Quality Safety Timely Efficiency

8. METRICS Patient Engagement and Satisfaction Employee Engagement and Satisfaction Quality and Performance Improvement Programs involvement outcomes Safety Initiatives Financial Performance Office Level Physician Level Affiliate and Company Level

9. VALUE OF HOSPITAL PHYSICIAN ARRANGEMENTS Porter, “What is the Value in Health Care?” NEJM, 2010 High Value: health outcomes achieved per dollar spent with the goal being what matters to the patient and unites the interest of all actors in the system. Value should define the framework for improvement in health care and would include all services and activities that meet the set of patient needs.

10. VALUE FOR PHYSICIANS Great outcomes for my patient Efficient practice environment Home/work balance environment Don’t waste my time Process and procedures that are effective and efficient Arrangements that are fair and equitable and reward equally and appropriately Page appropriately Culture of respect and trust

11. VALUE FOR HOSPITALS Physician engagement/partners Physician providing high quality care Physicians engagement in quality improvement Physician engagement in utilization of resources Physician engagement in processes of care improvement Access for patients to receive care Culture of respect and trust Physicians understanding the deal and communicate often

12. INCENTIVES Physicians: better work/lifestyle balance; better compensation security; more efficient, high quality care for patients; better security; better feeling that patients are safely cared for by the system. Hospitals: High quality care for patients; patient safety; access to care; better design of systems and processes; predictable flow and revenue

13. RISKS Physicians: time waste; life work imbalance; unpredictable income; hassles; frustrations Hospitals: inefficient processes of care; poor quality; increase patient risk; patient safety concerns; imbalance of revenue and expense Government policy changes for reimbursement, payment methods (bundled payment), quality indicators and reporting Value Based Payments for physicians

14. LESSONS LEARNED Culture is a key issue that creates the trust Transparency in goals and numbers Agreed communication channels Have clear articulated and understood goals and expectations Have mutual commitment and clarity on actions required to meet the goals In compensation arrangements have clear defined exit strategies Have clear measurable targets Respond to Physicians promptly

15. COMMON GROUND The Patient is the center of the efforts and all need to focus on patient requirements and expectations for service and clinical quality/safety System/processes of care understood and measured and communicated Safety/quality/respect are common values Goal setting from all parties (plan together not plot separately) Common understanding of the numbers and the data Consistent communication regarding the deal and data

16. PATIENT BENEFIT 1.Access to care 2.Consistent application of Evidence Based Care 3.Use of systems helps with more timely information for the physicians 4.Well trained specialists and primary care 5.Consistent Quality and Safety

17. OBSTACLES AND BARRIERS TO INTEGRATION 1.Physicians are from Mars and Administrators are from Uranus 2.Common understanding of issues, language, and data for example 3.Knowledge of how to work together 4.Federal laws, rules and regulations are sometimes barriers such as Stark, Antitrust, Anti-kick Back Laws 5.Agreed to measurement systems and trust in them and processes to validate the data and information 6.Physicians and management having common understanding of expectations and processes of care