Presentation to:
Trinity Health Care
Administration Students
Tuesday, November 10, 2015
Joel T. Allison, FACHE
Chief Executive Officer
Today’s Agenda
• Baylor Scott & White Health Merger
• Population Health Management
• Partnerships
• Opportunities/Challenges going
forward
• Thoughts on leadership
2
“If the rate of change on the
outside of your organization
is faster than the rate of
change on the inside of
your organization, the end
is near.”
Jack Welch, former
chairman and CEO of GE
Baylor Scott & White Health
4
Merger Creates Largest Not-for-Profit Health Care System in
Texas and the 12th Largest in the US (in revenue)
•
•
•
•
•
•
•
•
Health Plan/Members *
Quality Alliance/Members*
Assets
Revenues (annualized)
Hospitals
Patient Care Sites
Licensed Beds
Affiliated Physicians
– Physician FTEs
– Adv. Practice Provider FTEs
• Employee FTEs
• Community Benefits **
1 / > 238k
1 / > 248k
$9.3B
$7.3B
52
>880
5,410
6,000
1,674
1,205
39,000
$664mm
Baylor system footprint
* Includes NTX and CTX employees and their dependents
** Represents 12 months of data
Scott & White system footprint
Scott & White Health Plan footprint
A Union Of Complementary Strengths
•
•
•
•
•
•
•
•
•
Enhance our missions
Advance clinical care for our patients
Build on exceptional reputations
Enhance medical education and research
Enhance recruitment and retention opportunities
Generate economies of scale
Optimize care delivery sites
Expand integrated health care delivery model
+ Patient Experience + Functional Status Post Episode of Care
Create value Value = Quality
Cost of Event + Cost of Episodes of Care + Ongoing Costs Post Care
Source for Value Formula: American College of Physician Executives
6
Shared Values Support a Defined
Mission and Vision
Baylor Scott & White Health exists to serve
all people by providing personalized health
and wellness through exemplary care,
education and research as a Christian
ministry of healing.
To be the most trusted name in giving
and receiving safe, quality, compassionate
health care.
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What Brought Us to the Table
• Common Mission, Vision, Values
• Previous work together-HCT/TCA (respect)
• Similar physician engagement models
• Shift/emphasis from acute care toward
population health management
• Health Care Reform – Affordable Care Act
(reimbursement pressures)
• Data aggregation/analytics/transparency
• Captive Health Plan and infrastructure
• Geographical distinction
• Scale – capital formation
8
Triple Aim
Better Health
Transparency
CQI/Lean
Shared decision-making
Standardization
Clinical guidelines and
Care paths
Better Health Care
Triple Aim
Information
Incentives
Integration
Integrity
Big data
Data analytics & predictive modeling
Social/community support
Transportation/housing
Priority setting
“The Mediterranean Diet”
Delivery redesign
Scope of practice
Lowest cost site of care
Telehealth
Digital substitution
Self-care
Palliative care
Lower Per Capita
Costs
THE
SHARING
OFafter
SAVINGS
Synergies
gained
the merger achieved an
annual savings of more than $100 million.
Integration Highlights|Synergies Overview
FY 2014
Year One
Five Year
$37,406
$53,278
$576,868
35,738
50,522
423,052
Legend
Total Synergies
Supply Chain
Information Services
Risk Management
53,603
Human Resources
715
1,073
Medical Education
37,260
23,722
Support Services
22,192
Research Administration
792
1,468
35,738
155
206
Finance
7
9
15,897
1,094
48
FY 2014 – October 1, 2013 to June 30, 2014
Year One – October 1, 2013 to September 30, 2014
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Integration Highlights|Synergies Overview
• FY 2014 (October 2013 – June 2014)
Plan: $37,406,000
Actual: $39,645,000
106%
• FY 2015
Plan: $ 91,503,000
Actual: $108,990,000
119%
Integration Highlights|FY 2015 through June
YTD Realized Synergies
$120,000
$108,990
$100,000
In thousands
$91,503
$80,000
$60,000
YTD Actual Savings
YTD Budgeted Savings
$40,000
$20,000
$-
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
YTD Actual Savings
May
Jun
$8,271
$14,477
$22,581
$32,832
$40,182
$47,560
$57,103
$66,038
$75,480
$85,893
$96,305 $108,990
YTD Budgeted Savings
$7,361
$15,001
$23,397
$32,009
$40,523
$48,973
$57,033
$64,721
$72,083
$78,710
$85,197
$91,503
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Integration Highlights|Marketing and Branding
Increasing BSWH brand awareness through high-visibility
facility signage
Hillcrest
McLane Children’s Clinic - Temple
Waxahachie
Irving (Spring 2015)
Integration Highlights|Internal Brand Building
and Communications
One Name. One Team. One-Year-Old. Internal Anniversary Celebrations!
Creating Internal Value
• Since we serve two geographically distinct
areas, our merger:
— Resulted in few employee layoffs
— Strengthened internal culture
— Created new employment opportunities
Integration Highlights|Overview Integration Survey
Purpose:
The purpose of the Integration Survey is
to identify ways to improve and
accelerate integration of our two
organizations to become one. Baseline
survey was April 2014.
Survey Questions:
Questions for the survey were developed
based on John Kotter’s 8-step change
framework for effectively leading change
•Survey Focus:
– Degree of urgency to integrate
– Integration leadership effectiveness
– Clarity of BSWH vision and direction
– Communication effectiveness
(Dec’14)
•Sample:
– 30% Service Company (1,858)
– 35% Operations & All Others (9,381)
Response Rates April, August and December
60%
50%
40%
Design Considerations:
•
•
•
•
Cost-effectiveness
Data confidentiality
Simple and fast for employees to take
Random sample
39.1%
30%
20%
25.8%
47.6%
44.5%
40.9%
39.1%
30.5%
29.7%
21.4%
17.9%
North
Division
Central
Division
10%
33.5%
27.3%
0%
BSWH
Response Rate April '14
Response Rate December '14
Service
Company
Response Rate August '14
Integration Highlights|December 2014 Integration
Survey Showed Positive Progress
August Survey Results
December Survey Results
• Continued progress in leadership
effectiveness (64.2% fav) and vision
(62.5% fav)
• Progress in urgency (51.2% fav) –
understanding of why the merger
was necessary and involvement of
leadership in leading change
initiatives
• Solid progress in leadership
effectiveness (69.8% fav) and vision
(66.4% fav)
• Most favorable: “I think our vision, if
realized, will make us more
competitive” (72.4% fav)
• Least favorable: “I have seen clear
evidence that the merger is
succeeding” (38.9% fav)
• Results in sense of urgency (51.8%
fav) are flat from August
• Most favorable: “I think our vision,
if realized, will make us more
competitive” (76.3% fav)
• Least favorable: “We couldn’t have
remained competitive without
merging.” (40.8% fav)
Lessons Learned
• Naming leadership early is key. For example;
delay in naming chief human resources officer
resulted in challenges meeting targeted timelines.
• Never underestimate the impact of Culture
• Never underestimate the value of Communication
• Geography continues to be a challenge.
• Complexities involved in re-branding facilities
• Employees want the new brand!
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Population Health
Management
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Circle of
Care
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Vision for the Future of Health Care
•BSWH is integrating care delivery by
implementing a population health
strategy:
• Better health.
• Better health care.
• Lower per capita costs.
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Strategies for Accountable Care
Strategy 1:
• PATIENT-CENTERED MEDICAL HOME
• One of the largest PCMH networks in the
nation.
• Enhances preventive health services and
disease management.
Strategies for Accountable Care
Strategy 2:
• CHRONIC DISEASE MANAGEMENT
THROUGH DATA ANALYTICS
• Identification in the top 5%.
• Risk stratification matches appropriate
resources to patient’s need.
Strategies for Accountable Care
Strategy 3:
• COORDINATION ACROSS
THE CONTINUUM OF CARE
• Helps patients follow physician's plan of care.
• Supports transitions and disease management
and closes gaps in care.
Baylor Scott & White Quality Alliance
Focused on patient-centered clinical integration across all points of care
Entry Point Redesign:
Primary Care strength, PCP PCMH;
physician-designed best care and quality
improvement processes, access &
capacity challenge.
Entry Point
Redesign
Care Integration/Specialty Alignment:
CI/ Specialty
Alignment
Financing
Standardized order sets, clinical
protocols, care redesign. Large scale
physician partnering, EHR adoption, and
connectivity via HIE challenges.
Population Health Infrastructure:
Population
Health
Infrastructure
Predictive analytics, comparative
effectiveness, care coordination and
population health management.
Intended consequences: Quality
Improvement, patient satisfaction and Financing: New innovative payment
cost reduction – otherwise unachievable models, product & benefit redesign, data
repository and control.
Population Health Management
Baylor Scott & White Quality Alliance
• Baylor Quality Alliance became Baylor Scott &
White Quality Alliance and expands into CTX.
• Physician members grew from 2,346 to 4,018.
• Covered lives increased from 42,300 to
248,004.
• Clinical Integration Care Protocols expanded
from 86 to 120.
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Population Health Management
Baylor Scott & White Quality Alliance, cont’d.
• Care Coordination & Data Analytics programs
continue to mature.
• Point of Care Delivery Program (PODs)
expanded from six (NTX) to eleven (five in CTX).
• Linking of BSWQA to Scott & White Health Plan
to establish an enhanced value proposition is
underway.
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BSWQA/SWHP Value Proposition
A SWHP/BSWQA collaboration results in economies of scale by
offering a system approach to the delivery and financing of care.
The outcome of these efficiencies is:
A SWHP/BSWQA collaboration establishes a financing/delivery
model under a unified structure capable of delivering a
seamless and personalized member experience.
PRIVILEGED AND CONFIDENTIAL
Employer
Plan sustainability • Premium predictability • Trendability (lower
than national plans) • Data sharability • Performance Measurability
• Improved employee well-being and productivity
Member
A common corporate mission, vision, aligned focus, and
resources allows for permeating boundaries typically found
between payors and providers operating separately.
30
Data and Analytics Tools
Optum One
Explorys
Library of
comprehensive
Overall data aggregator analytic reports for
of BSWH
specific cohorts
comprehensive data:
• Identify
• Clinical
actionable
• Financial
clinical
• BSWQA
opportunities
independent
for care
physician members
coordinators
• Develop patient
"hot lists"
Crimson Real
Time
Risk stratification
and predictive
modeling for our
individual patients
and patient
populations.
Enables
identification of
at-risk patients
earlier, preserves
patient health,
reduces costs and
prevents
complications.
CPO and Epic
EHR platform to
support
management
throughout the
continuum,
including:
• Inpatient care
coordination
• Post-acute care
• Payer-based case
management
dbMotion
(implementation)
BSWQA’s Health
Information
Exchange Solution
• EHRs and data
repositories at
other sites are
queried for usable
information to
help complete the
patient record.
• Clinical
information
comes directly to
HER.
Results – First Two Years
• Hospital admissions among the member population
of 34,000 employees and beneficiaries is down an
impressive 9%.
• Hospital readmissions (30 days) are down 10%.
• Total cost of providing health care to the group is
down $24 million – a 7% savings.
• Rise in prescribing rate for less expensive generic
medications – 4.6%.
• These exciting results show we are providing the
right care, in the right way, at the right time, in
the right place, at the right price and we are able
to prove it.
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Cleveland Clinic Alliance
The alliance between
BSWH and the Cleveland
Clinic brings high-quality
cardiovascular care
to the Southwest and
offers exclusive providers
for Texas and Oklahoma
cardiac patient referrals.
BSWH/TGEN
Personalized Medicine Consortium
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BSWH and the Dallas Cowboys
Joining with the Dallas Cowboys,
BSWH will construct a center of
excellence in Sports Medicine at
the Star in Frisco.
•Ambulatory surgery center,
diagnostic imaging center, physical
therapy and more.
BSWH & Walgreen’s Coming Together
• Recent collaboration with Walgreen’s gives
BSWQA members increased access to
quality, after-hours care.
—HTPN physicians oversee nurse
practitioners and physician assistants
delivering care.
– 11 healthcare clinics at select Walgreen’s are
open and fully operational.
Coming Together for Better Health
Through a joint venture with Tenet
Healthcare, BSWH will partner on providing
care through five North Texas hospitals.
—
Will deliver value-based care to Rockwall, Collin and
Dallas counties.
—
Four hospitals will enter BSWQA.
—
All hospitals will operate under BSWH brand.
Training Expert Health Companions
BSWH & Canine
Companions for
Independence are
bringing premier service
dogs to the Southwest.
—
Building the first training
center in Irving.
—
First dog training school
in the nation connected with a
health care system.
Joint Venture Partnerships - Mission
(JV formed 1998)
(JV formed 04/2011)
(JV formed 06/2012)
(JV formed 07/2013)
To provide first-class surgical services for the
local community in a safe, comfortable and
welcoming environment; one in which we
would be happy to treat our own families.
To provide an exceptional patient care experience
that promotes healing and recovery in a
compassionate environment.
To provide patients with easy access to the
same compassionate, high-quality, efficient
acute medical care we would want for our
families.
To offer patients and physicians the highest
quality outpatient imaging services and to
support them with a deeply instilled work
ethic of personal service and integrity.
Opportunities and Challenges
Going Forward
1. Capital formation/constraints
2. Increasing primary care network across System
3. Growth of Baylor Scott & White Quality Alliance
and Scott & White Health Plan as an integrated
delivery network
4. Complete integration of HR
5. Preserve 1115 Medicaid Waiver
6. Develop state-wide network
7. Pricing of pharmaceuticals
The Way Forward – Four Focus Priorities
1. Operational Excellence centered around
the Circle of Care
2. Population Health/Growth – Create
statewide network
3. People and Culture
4. Digital Patient Experience
“You can’t list your iPhone as your primary care physician.”
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Each hospital/system has to
make a decision of where they
want to play.
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New Roles for the Journey
“The dogmas of the quiet
past are inadequate to the
stormy present. The
occasion is piled high with
difficulty and we must rise
with the occasion. As our
case is new, so we must
think anew and act anew.”
Abraham Lincoln
Vision 2020
(Video)
Thoughts on Leadership
Leadership Traits
• Integrity
• Vision
• Compassion
• Passion
• Communication Skills/
Listening Skills
• Risk-taker
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Leadership Traits
• Relationship-builder
• Innovative/creative
• Servant-leader
• Humorist
• Competent
• Inspiring
• Principled
• Trust
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Principle-Centered Leadership
• Be continually learning
• Be service-oriented
• Radiate positive energy
• Believe in others
• Lead a charmed life
• See life as an adventure
• Be synergistic – be a change catalyst
• Exercise for self-renewal: spiritual,
physical, mental and emotional
Mentors/Advisors
• Appreciate the
importance of
mentors.
• Have a strong
network.
• Have several close,
trusted advisors.
What Leadership Skills are
Necessary for Future Success?
• Strategic thinking
• Team building
• Communication
• Creativity
Leadership Quick Test
1. I am aware of the way I am perceived by
various groups.
2. I have complete control over my calendar.
3. I invest two-thirds of my time to
relationship improvement.
4. I invest more time in the future than the
present or the past.
5. I know the capabilities and capacity of the
talent needed to be successful.
Leadership Quick Test, cont’d.
6. Coaching and professional development
are a big part of my daily work.
7. I am a servant leader.
8. I routinely use active listening techniques.
9. I deal with difficult behaviors, problems
and conflicts quickly and effectively.
10.I am trusted throughout the organization.
“Leadership is all about
people. It is not about
organizations. It is not
about plans. It is all about
people -- motivating
people to get the job
done. You have to be
people-centered.”
Colin Powell
Questions/Discussion
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