Crossing the Bridge to an Integrated Delivery System in
Cedar Rapids, April 19, 2011
The Cedar Rapids Story
Strategic/
Economic
Relationships
Non-Economic
Integration
Employment,
Directorships, Subsidies,
Etc.
Communication..
…Openness…
..Trust…Respect
Visibility/
Accessibility of
CEO/Mgmt.
Contractual Joint
Ventures
Equity Joint
Ventures
Substantive
Involvement in
Decision Making
Multiple strategies
For alignment of
Economic interests
Positive
Organizational
Culture
Infrastructure
Improvements to
Increase efficiency/
Accessibility of care
Information systems
Appropriate support
For physician
Practice growth
Emotional
Connection
Physician
Leadership
development
Financial
Integration
High quality/ safe
Patient care
Integrated Delivery
Model
St. Luke’s Hospital Strategic Framework
Demonstrably Better Quality
Partner of Choice for Physicians
Partnership with Associates
Strengthen the Core
Regional Resource
Workshop of Choice For Physicians
• Old Language: 2003 – 2008
“With a focus on clinical quality, efficiency, and service,
St. Luke’s will create an environment where physicians
prefer to practice and bring their own family members.
St. Luke’s will continue to seek ways to achieve strategic
and economic alignment with physicians in an effort to
create mutually beneficial relationships.”
Partner of Choice for Physicians
Established in 2008
St. Luke’s will be a trustworthy strategic partner with
physicians in the delivery of demonstrably better
quality healthcare. St. Luke’s will create an
environment where physicians prefer to practice
and to bring their own loved ones for care. St.
Luke’s will be the first choice of physicians for
strategic alignment be it emotional, clinical, or
organizational.
A Two-Part Framework:
• Emotional Connection:
– Developing a preferred practice environment provides an
underlying structure which demonstrates St. Luke’s is ‘a
better place to be’ for patients AND physicians.
• Economic and/or Strategic Relationships:
– Provide a platform upon which physicians believe that St.
Luke’s is a willing and capable partner that can be trusted
and relied upon if and when their practice environment is no
longer self-sufficient.
The Emotional Connection …..Building Trust
Desired Outcome: To Build
relationships which will foster two way
communication between all levels of
management and physicians with an
emphasis on CEO / C-Suite level
contact and development.
The Emotional Connection …..Building Trust
• Consistent CEO / C-Suite Communication Plan
• Establishment of Physician Liaison Support
• Annual Physician Satisfaction Survey, Focus Groups,
and Pulse Surveys / Rounding.
• Specific patient acquisition plans
• Communication, Communication, Communication
• Images for Physicians
• Open Forums 2x per year
• Doctor’s Mailbox
• Recognition / Events
Economic and/or Strategic Relationships …
Guiding Principles
• The physicians have got to want it: buy-in.
• Mutual trust and respect between the parties; openness of
communication / transparency of information.
• Method of integration is founded on a viable economic model
(risk = return).
• The approach is consistent with both parties strategic plan and there is a
track record of a strong relationship between the organizations.
• There is evidence of strong physician leadership in place.
• The partnership will enhance and provide accountability for clinical
quality, service line growth / advancement, customer experience, and
efficiency.
Economic and/or Strategic Relationships…Building
Partnerships
• Hospitalist Program (s)
• Surgery Center Cedar Rapids and other Joint Ventures
• Peri-Operative Governing Council
• Service Line Management
• Recruitment Support
• W-2 Partnership
Partner of Choice for Physician Goals
PARTNER OF CHOICE FOR PHYSICIANS
10
Maintain 95th% or above on the top 6 predictors of physician satisfaction – Using results from the 2011 Healthstream Survey, identify and address specific
areas for improvement. Maintain performance in 2012 and 2013.
11
Increase year-over-year encounters/contacts at St. Luke’s Physicians and Clinics by 6% in each of the years 2011, 2012, and 2013 (including urgent cares).
12
Maintain 2010 actual inpatient admission market share in the following areas:

Inpatient surgical market share (49.7%)

Medical/surgical market share (53%)

Pediatrics market share (73%)

Obstetrics market share (76.9%)
Increase market share for each of the inpatient services listed above by 0.5% in both 2012 and 2013.
Achieve 2011 Operating Budget targets for all employed physician groups and joint ventures.
13
14
Improve OR Throughput:

First case of the day (scheduled start times 0700 and 0730) will start on time as defined by the Perioperative Governing council – Patient and
anesthesiologist will be in the room within 5 minutes of the scheduled start time.
Targets – 80% by Q4 2011, 85% by Q4 2012, 90% by Q4 2013.

All electively scheduled surgical patients will be screened by the STAR department
Targets – 100% by Q4 2011, maintain 100% for years 2012 and 2013.

St. Luke’s surgery block times will managed by the Perioperative Governing Council to 80% utilization.
Targets – Block development in 2011, 80% utilization 2012 and 2013.
15
Achieve Medical Mall ground-breaking by 6/1/2011. Complete construction of SLH Medical Mall space on budget by the end of 2012.
16
Develop the Cedar Rapids Regional Clinic and Integrated Delivery System structure by 12/31/2011.
Enter the IHS Strategic Plan …
The Vision for the Future
IHS will need to reposition itself from a statewide, hospitalcentric delivery system to an integrated care management
organization that is physician driven and patient centered,
positioned as the primary healthcare utility for the state of
Iowa and bordering areas.
Integration 101
Definition: A network of organizations that provide or
coordinate and arrange for the provision of healthcare services
to consumers and are willing to be held clinically and fiscally
responsible for the outcomes and the health status of the
populations served. Generally consisting of hospitals,
physician groups, health plans, home health agencies,
hospices, skilled nursing facilities, or other provider entities.
The networks may be built through virtual integration
processes encompassing contractual arrangements and
strategic alliances as well as through direct ownership.
Source: MGMA
Working Toward An Integrated Delivery System
What Integration is NOT
• A hospital that employs physicians
• A physician practice subordinate to a
hospital
• Hospital led without physician input
or influence
The Key to integration is Physician
Alignment
Physician Alignment – Common Principles
IHS’s Physician alignment goals will require some significant changes to accomplish.
Category
Principles
Philosophy
Embrace physicians as partners/”owners” not employees.
Governance
A meaningful physician presence in leadership and governance at all levels within the
system.
Physician Practice
Physicians have authority and accountability for operating all medical practices.
Corporate Structure
The physician practice entity and hospital entity are organized as separate sister
corporations.
Infrastructure
Best practice physician practices support systems.
Clinical Coordination
Enhanced care accountability through a common EHR, standard outcomes reporting
and a consistent patient experience across group specialties.
Compensation
There is a single compensation plan that is aligned with the goals of the system.
Management
Mostly part-time and some full-time physician leaders are paired with administrative
leaders in dyad management roles throughout the organization.
Managed Care
Contracting
The system has single-signature managed care contracting authority, and physicians
have a substantial representation on the body making contracting decisions.
Branding
Strong quality and patient advocate brand.
Physician-Driven Systems Corporate Structure
The physician entity is usually incorporated as a
“sister” corporation of the hospital
Health
System/Hospital
(Parent)
Physician Entity
Hospital
A Model For Our Future
IHS
Corporate Administration
and Services
Physician Clinic Division
Hospital Division
Des Moines Clinic
Iowa Health – Des Moines
Methodist, Lutheran, Blank
Cedar Rapids Clinic
St. Luke’s Healthcare
St. Luke’s Hospital
Waterloo Clinic
Allen Health Systems, Inc.
Allen Memorial Hospital
Quad Cities and Muscatine Clinic
Trinity Regional Health System
Trinity Medical Center and
Unity Healthcare
Fort Dodge Clinic
Trinity Health Systems, Inc.
Trinity Regional Medical Center
Sioux City Clinic
St. Luke’s Health System
St. Luke’s Regional Medical Center
Dubuque Clinic
Finley Tri-States Health Group, Inc.
The Finley Hospital
Cedar Rapids Physicians Clinic Steering
Committee Charter
Aim(s):
1. From a Cedar Rapids perspective this committee will serve as the Regional Physician Leadership Council to inform
and provide input to the statewide steering committee working on the establishment of NewGroup.
Timeline: July 1, 2011
2. Create the ideal integrated healthcare delivery system in the Cedar Rapids region by providing physician leadership
and direction to the vision, strategies, and specific initiatives.
Timeline: FY 2011. Steering committee will meet 2x/month (2nd and 4th Tuesday).
3. Support the strategic framework of St. Luke’s Healthcare as the region makes the transition to an integrated
delivery system.
Timeline: FY 2011 and ongoing.
Team
System Sponsor: Alan Kaplan, M.D.
Chair: Ted Townsend
Members: Ken Anderson, M.D., John Roof, M.D., Todd Langager, M.D., Dustin Arnold, D.O., Dennis Rosenblum, M.D.,
Judy Bernhard, M.D., Shannon Throndson, M.D., Charles Schauberger, M.D., Robin McNichols, John Sheehan, Support
Staff: Leigh Christensen
Physician Leadership Academy—Cedar Rapids
Dr. Dustin Arnold
Dr. John Roof
Dr. Shannon Throndson
Hospitalist Med. Dir. & CMIO
IHP Med. Dir-Central Reg.
Family Practice Physician
Dr. Todd Langager
Dr. Dennis Rosenblum
Dr. Julie Bernhard
Med. Dir. for Cardiology
Med. Dir. Neonatology
Pediatrician
Integration Hierarchy
Shared
Leadership
Shared Leadership
defined as physician led,
professionally managed.
Alignment &
Mutual
Dependency
Resource Sharing
Source: Integrated Delivery
Systems / AMGA
Organizational Structure
Organizational Composition
Critical Success Factors for Integration
• Structure
• Aligned Strategic Planning, Goals, and Initiatives
• Aligned Physician Compensation Plan
• Culture of the Organization
• Continuum of Services / Coordination of Care
• Physician Leadership
Cedar Rapids Physicians Clinic Agenda
•
Complete committee education regarding St. Luke’s market position, competitor overview, strategic plan, and master facility
plan.
•
Complete committee education regarding other integrated delivery systems – focusing on those that are most relevant to the
Cedar Rapids region. Areas of interest include governance, compensation structure, and start-up struggles/successes.
•
Develop a better understanding of the current initiatives and future direction of PCI.
•
Develop Regional Clinic and Integrated Delivery System structure.
•
Establish and engage regional IHS Physicians Clinic Steering Committee.
•
Assess and recommend human resource support for partner physicians.
•
Identify and formalize the physician/administrator dyad for major service lines.
•
Identify future priorities for expansion of partner physicians.
•
Identify next round of leaders in the IHS Physician Leadership Academy.
•
Develop regional outreach strategies/hubs.
•
Establish a revenue capture measurement tool for the Integrated Delivery System’s closed economy. Develop internal
approach and philosophy related to a closed economy.
Jump Start to Integration
• Identify integration champions.
• Set a clear vision for integration, tie it to the mission.
• Assure patient care is top priority.
• Let the physician leaders be the voice.
• Demonstrate a culture of teamwork, inclusion and
transparency.
• Develop a specific plan.
How does Integration Benefit Patients?
Not for the Faint of heart ….
must have ice water in your veins.
“Embarking on the path of creating an integrated
healthcare organization from a matrix of private practice is
a little like driving a truck loaded with nitroglycerin along a
bumpy bridge. Leaders without the political skills to sense
the bumps before they hit them will never know what
happened.”
Jeff Goldsmith, PhD
Healthcare Futurist
The Cedar Rapids Story
Strategic/
Economic
Relationships
Non-Economic
Integration
Employment,
Directorships, Subsidies,
Etc.
Communication..
…Openness…
..Trust…Respect
Visibility/
Accessibility of
CEO/Mgmt.
Contractual Joint
Ventures
Equity Joint
Ventures
Substantive
Involvement in
Decision Making
Multiple strategies
For alignment of
Economic interests
Positive
Organizational
Culture
Infrastructure
Improvements to
Increase efficiency/
Accessibility of care
Information systems
Appropriate support
For physician
Practice growth
Emotional
Connection
Physician
Leadership
development
Financial
Integration
High quality/ safe
Patient care
Integrated Delivery
Model
Next Steps
• Answer the big questions:
– Do we believe this plan?
– How would it work in our market?
– What can I do to help achieve it?