1. PRIMARY CARE INTEGRATED PRACTICE & GOVERNANCE FY16; 9/16/15 Update

2. 2 Introduction of New Model A proposed new model of operations and funds flow has been developed by a Task Force comprised of:  Dresden Kalin,Hyung Kim, and Terrie Wehrwein, from the respective deans’ offices,  Joel Greenberg, Chair of the Finance Committee, and  Annette Cawley and Rick Ward from HealthTeam The Task Force was commissioned by the Board to develop a new model to replace the current “Transition Model” for FY16. The purpose of this document is to present an overview of the recommended model, along with the strategies, opportunities, and financial impact associated with it.

3. Model Overview 3 Under this model, the primary care practices of COM, CHM, and CON would be organizationally integrated into a single Primary Care Practice (Practice) operated by MSU HealthTeam, with the HealthTeam being responsible for the financial bottom line. The specific individual practices included would be:  COM Pediatrics,  Family Medicine,  CHM Primary Care Pediatrics,  Family Medicine,  Primary Care Internal Medicine,  CON Family Medicine

4. Model Overview 4 Key Characteristics The following are the key characteristics of this arrangement:

5. Model Overview 5 Key Characteristics  MSU HealthTeam would contract with the departments for providers to work in the Practice.  For these provider services, the respective departments would be paid at the 25 th percentile MGMA rate for all FFS wRVUs generated by their provider.  For contract activity, the departments would be paid the contract collections less any applicable overhead.

6. Model Overview 6 Key Characteristics  A new provider compensation plan would be developed for the faculty that mirrors the funding model to the departments.  The providers would be paid under the current departmental plans for the first year, with reports of the payment they would receive under the new plan.  In the second year, the providers would be paid based upon the new plan.

7. Model Overview 7 Key Characteristics  Providers would be eligible for an incentive payment, based upon specific quality and patient experience metrics.

8. Model Overview 8 Key Characteristics  MSU HealthTeam would pay departments for a clinic medical director, who would be the provider leader that works with the HealthTeam in the development and implementation of key initiatives.

9. Model Overview 9 Key Characteristics  In the initial year, MSU HealthTeam would contract with the departments for all current providers.  In subsequent years, MSU HealthTeam would work with the departments to identify those providers it wished to have work in the Practice.

10. Model Overview 10 Key Characteristics  Funding from the Provost’s office and the offices of the Deans of CHM and COM will subsidize the practice and cover losses in the first three years; these losses are expected to decrease over time  The College Program Support and University Administration Fees are not waived, but they are covered by the respective Deans’ offices for the first three years of the new practice.

11. Strategies 11 This new Practice model includes certain key strategies, as presented below:  The Practice will operate within specific benchmark standards, including support staff expense, operating expense, days in receivables, and net collection rate.  The Practice will operate under a philosophy of continuous quality improvement, and document improvements in patient experience, patient access, and improved workflows that reduce provider effort.  Providers will produce at or above the MGMA median.  The Practice will increase patient access.  The Practice will refer internally except for patient preference, insurance mandate, or lack of timely access.

12. Opportunities 12 The alignment that results from this practice integration provides opportunities to implement tactics that will allow the Practice to achieve the strategies. These opportunities include:  Elimination of the current expense boundaries allows certain efficiencies to be realized.  Staff are able to be shared by the various locations, to reduce staffing variability caused by staff and provider absences.  Providers can be relocated to optimize the use of space.  Certain services/overhead can be centralized, with a corresponding reduction in expense.  Expansion of the Patient Central Services functions, resulting in improved telephone access, reduction in front end billing rejections, increased co-pays at time of service, and more timely referral processing. continued…

13. Conclusion & Recommendation 13 Much effort and dialog has gone into the development of this New Primary Care Model. With the investment that is required, an opportunity is created that turns the current primary care practice which is shrinking, incurring greater losses, and failing to meet patient expectations, into one that is growing, is more financially stable, and is able to implement clinic best practices across all clinics, with a corresponding improvement in productivity, quality, and patient access. As a result of the benefits and opportunities identified in this document, it is recommended that the Primary Care Integrated Practice be implemented in FY16, with the Provost Office funding the net loss, after College Program Support and Administrative Fee.

14. 14 MSU HealthTeam Primary Care Integrated Practice Roles and Responsibilities

15. 15 Overview While the New Primary Care Model puts decision- making authority and financial risk with MSU HealthTeam, it is critical that the departments, faculty, and HealthTeam effectively work together to develop and execute the processes and protocols that will be used in running the clinics. To ensure that the respective parties all have a good understanding of their roles within this model, the following summary of roles has been developed.

16. 16 Department Chairs  Work with MSUHT in the development of the provider staffing plan. Recruit new provider positions that are identified through the plan. Work with faculty to change their clinical FTE component, commensurate with the level identified in the plan  Distribute clinical pay to faculty based upon the parameters of the new compensation model, and the information provided by MSUHT  Provide MSUHT with the provider academic and/or teaching schedule at least 3 months prior to its effective date

17. 17 MSU HealthTeam through Clinic Managers  Manage and operate clinics  Establish hours of operation  Establish schedules  Establish clinic workflows  Establish staffing requirements  Work with clinical medical directors to schedule providers

18. 18 Chief Medical Officer  Work with department chairs, clinic medical directors, and faculty to develop, monitor, report, and ensure provider effectiveness, to include:  Scheduling templates  Clinic coverage for call-offs, vacations, etc.  Workflows and protocols  Documentation requirements  Quality improvement

19. 19 Clinic Providers Participate in discussions regarding the development of clinic protocols, workflows, and scheduling parameters

20. 20 Chief Medical Directors  Participate in discussions regarding the development of clinic protocols, workflows, and scheduling parameters  Ensure compliance with the clinic protocols, workflows, and scheduling parameters that are developed  Work with HealthTeam Quality department, Chief Medical Officer, and Clinic Manager to develop appropriate quality metrics and use them for Quality Improvement

21. 21 Primary Care Advisory Committee  All primary care chairs and clinic medical directors are on the committee.  All primary care faculty are welcome to attend and participate in meetings.  Committee is used as a mechanism for soliciting faculty input into the clinic operations.

22. 22 MSU HealthTeam Board  Provides the authority for the roles and responsibilities described herein  Assesses the performance of the Primary Care Practice  Approves the strategy, budgets and policies  Makes final decisions, if needed

24. 24 Specialty Clinic Eyde Expansion  Eyde Clinic Space Lease began September 1 and build out of the space was started

25. Specialty Clinic Eyde Expansion  Build out of the space on the 4 th floor of the Eyde building is estimated to take 90 to 120 days  Anticipated move in is December or January 25

26. Other MSU Clinics in Eyde  General Radiology  Lymphedema Clinic  MSU Surgery – Eyde (coming in November)  Osteopathic Manipulative Medicine Clinic  Rehabilitation  Spine and Orthopedic Center  Sports Medicine Clinic  Women’s Imaging Center  Women’s Health Care – East Lansing 26