Understanding a Physician Organization


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  • 42 managers trained in Lean model including RNs and MDs
  • 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)
  • Understanding a Physician Organization

    1. 1. Brigham and Women’s Physicians Organization Overview Center for Expertise in Healthcare Management Allen Smith, MD, MS January 20, 2010
    2. 2. <ul><li>Introductions </li></ul><ul><li>BWPO Introduction </li></ul><ul><ul><li>Overall corporate structure </li></ul></ul><ul><ul><li>Mission </li></ul></ul><ul><ul><li>Senior Management </li></ul></ul><ul><ul><li>Role </li></ul></ul><ul><ul><li>Physician statistics </li></ul></ul><ul><li>BWPO Areas of Focus </li></ul><ul><ul><li>Patient Experience </li></ul></ul><ul><ul><li>Pay for Performance </li></ul></ul><ul><ul><li>Physician Experience: Volunteerism </li></ul></ul><ul><ul><li>Network Development </li></ul></ul><ul><li>Challenges and Opportunities </li></ul>Agenda
    3. 3. Partners HealthCare System, Inc. (PHS) Partners HealthCare System, Inc. Brigham and Women’s/ Faulkner Hospitals Partners Community HealthCare, Inc. North Shore Medical Center, Inc. AtlantiCare Medical Center, Inc. Newton- Wellesley Hospital, Inc. Newton- Wellesley Health Care System, Inc. The Brigham and Women’s Hospital, Inc. The General Hospital Corporation The Massachusetts General Hospital Faulkner Hospital, Inc. Brigham and Women’s Physicians Organization The Salem Hospital
    4. 4. <ul><li>BWPO is a faculty practice plan which supports its physicians and departments in their aspirations to: </li></ul><ul><ul><li>Provide the highest quality patient care </li></ul></ul><ul><ul><li>Develop the next generation of physician leaders </li></ul></ul><ul><ul><li>Be world leaders in translational research </li></ul></ul>
    5. 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. 6. Role of BWPO <ul><li>Streamline operations where possible </li></ul><ul><ul><li>Organize and manage billing, administration and financial components of its 17 business units </li></ul></ul><ul><ul><li>Foster departmental autonomy while supporting the overall mission and goals of the organization </li></ul></ul><ul><li>Support physicians in contracting and providing “medical management” support for high quality, efficient care </li></ul><ul><ul><li>Includes efforts in ambulatory experience </li></ul></ul><ul><li>Focus on physician work life </li></ul><ul><ul><li>Leadership, Volunteerism, IT systems </li></ul></ul>
    7. 7. Employed Physicians
    8. 8. BWPO Physician Total
    9. 9. Patient Experience Physician Experience Financial Health BWPO Areas of Focus Our Staff Our Systems
    10. 10. Patient Experience <ul><li>Patient First </li></ul><ul><ul><li>Launched by the Ambulatory Council </li></ul></ul><ul><ul><li>Helped focus attention on improving patient satisfaction </li></ul></ul><ul><li>Staff Training </li></ul><ul><ul><li>Lean Practitioner Training </li></ul></ul><ul><ul><li>Ambulatory operations improvement </li></ul></ul><ul><li>Ambulatory patient satisfaction scores surpass 75th percentile mark </li></ul><ul><ul><li>BW/F Ambulatory Services in top tier of UHC facilities that use Press Ganey </li></ul></ul>
    11. 11. Ambulatory Patient Satisfaction Scores: Overall Trend of Percentile Rank Target: 75 th Percentile
    12. 12. Pay-for-Performance Contracts <ul><li>Ability to negotiate collaboratively as a physician network </li></ul><ul><li>Pay-for-performance contracts with the 3 major commercial insurers for shared financial responsibility (risk) and interdependent clinical programs </li></ul><ul><li>Withhold of an annual amount of revenue </li></ul><ul><li>Withhold returned when network achieves certain efficiency and quality measures </li></ul>
    13. 13. 2009 BWPO MD Withholds at Risk by Category
    14. 14. Diabetes Performance 2003 v. 2007: MHQP Data
    15. 15. Pay for Performance: Training, Education, and Management (TEAM) <ul><li>BWPO TEAM program focuses on improving patient care outcomes and preventing unnecessary hospital admissions </li></ul><ul><li>A team of nurses, doctors, pharmacist, social work, and administrative staff identify high risk patients and provide the following: </li></ul><ul><ul><li>High risk patient mgmt – face to face counseling and coaching </li></ul></ul><ul><ul><li>Immediate access to necessary MD visits </li></ul></ul><ul><ul><li>Programs for getting patients to LDL, BP, A1c targets + getting right meds prescribed </li></ul></ul>
    16. 16. <ul><li>Goal: Provide opportunities for teaching and clinical care in an impoverished setting </li></ul><ul><li>Indian Health Service (IHS): Compelling health care needs of Navajo population </li></ul><ul><li>Relatively easy for physicians to volunteer there </li></ul><ul><li>IHS Sites: </li></ul><ul><li>Gallup, NM </li></ul><ul><li>Shiprock, NM </li></ul><ul><li>Progress: Assessment of needs (both IHS and BWH) and initial visits completed </li></ul><ul><li>Next Steps : Regular site visits </li></ul><ul><li>and additional fundraising for program </li></ul>Volunteerism: Indian Health Service Christian Arbelaez, MD, MPH and staff at Gallup Indian Medical Center
    17. 17. <ul><li>Rhode Island </li></ul><ul><li>Memorial Hospital (Pawtucket) affiliation </li></ul><ul><li>Emergency Medicine management & Cardiology consulting services </li></ul><ul><li>Foxboro MACC </li></ul><ul><li>Primary Care </li></ul><ul><li>Dx. Imaging </li></ul><ul><li>Surg Specialties </li></ul><ul><li>Med Specialties </li></ul><ul><li>Amb Surgery </li></ul><ul><li>Pathology, etc </li></ul><ul><li>South Shore Hospital </li></ul><ul><li>DFBWCC with SSH </li></ul><ul><li>Expanded Surgery, Cardiology, Neurology and OB/Gyn affiliations </li></ul><ul><li>South Coast </li></ul><ul><li>PrimaCare, Hawthorne (PCHI) relationship mgmt. </li></ul><ul><li>BWPO Rad Onc services at St.Anne’s Hospital </li></ul><ul><li>Compass Medical </li></ul><ul><li>BWH MRI service </li></ul><ul><li>BWPO surgery </li></ul><ul><li>BWH Vein center, Center for Repr. Medicine </li></ul><ul><li>BWPO Cardiology </li></ul>Near West 1. OB/Gyn, CIRS practice @ NWH Map of BW/F Relationships in Southeastern Mass <ul><li>Metrowest Area </li></ul><ul><li>BWPO Rheumatology </li></ul><ul><li>BWPO Cardiology </li></ul><ul><li>Plymouth </li></ul><ul><li>Relationship Mgmt with new PCHI groups </li></ul><ul><li>Cape Cod Hospital </li></ul><ul><li>BWH cardiac surgery and anesthesia services </li></ul><ul><li>BWPO radiology services </li></ul><ul><li>BWPO cardiology services </li></ul><ul><li>Milford </li></ul><ul><li>DFBWCC at Milford </li></ul><ul><li>New PCHI group (Tri-County) </li></ul><ul><li>OB-Gyn (MIGS) services </li></ul><ul><li>Quincy Medical Ctr </li></ul><ul><li>Providing Cardiology dept chair </li></ul><ul><li>Tertiary trauma services </li></ul>*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 Map Key: MACC** Sites Physician Relationships
    18. 18. Challenges and Opportunities <ul><ul><li>Health Care Reform </li></ul></ul><ul><ul><li>Patient Experience </li></ul></ul><ul><ul><ul><li>Meeting ambulatory goals consistently at practice level </li></ul></ul></ul><ul><ul><ul><li>Structured approach to ambulatory quality and safety </li></ul></ul></ul><ul><ul><li>Referring Physician Experience </li></ul></ul><ul><ul><ul><li>Access, communication, transitions, cost </li></ul></ul></ul><ul><ul><li>Faculty Experience </li></ul></ul><ul><ul><ul><li>Worklife satisfaction and balance </li></ul></ul></ul><ul><ul><ul><li>Future of Primary Care </li></ul></ul></ul><ul><ul><li>Financial Health </li></ul></ul><ul><ul><ul><li>Controlling expenses </li></ul></ul></ul><ul><ul><ul><li>Ambulatory revenue growth </li></ul></ul></ul><ul><ul><ul><li>Alternative revenue streams to offset declining reimbursements </li></ul></ul></ul>
    19. 19. Health Care Reform: Models Global Capitation Fee for Service P4P Augmented Primary Care Bundled Payments Payment Model Adapted from Dr. James Mongan presentation 5/26/2009 Level of financial risk borne by provider Level of financial risk borne by payor BW/F is engaged in all three models Big 3 Contracts CMS Demo Bundled Payment Pilot Foxborough Medical Home