Webinar: Thriving in the New Healthcare Environment: 3 Key Strategies

Thriving in the New Healthcare Environment:
Three Key Strategies
David Bernd, CEO,Sentara Healthcare
David Feinberg, MD, MBA,President, UCLAHealth System
Jeff Jones, Managing Director, Huron Healthcare
Broughtto you by ModernHealthcare
June 17, 2014

David Bernd
CEO
Sentara Healthcare
Today’s Presenters
2
Jeff Jones
Managing Director
Huron Healthcare
Modern Healthcare Webinar |
David Feinberg, MD, MBA
President
UCLA Health System
© 2014 Huron Consulting Group. Allrightsreserved. Proprietaryand confidential.

NEW HEALTHCARE IMPERATIVES:
STRATEGIES FOR CHANGE
JEFFJONES,MANAGINGDIRECTOR,HURONHEALTHCARE
3Modern Healthcare Webinar |

Unprecedented Market Pressures
 Reimbursementcompression
– Organizations face the imperative of operating on/thriving on rates that are
at or near Medicare/Medicaid levels
 Volumecompression
– Reliance on volume growth no longer feasible. Many organizations forecast
flat volume levels
 Increasedportionof revenue at risk
 Major IT and capital costs for managingacross the continuum

Market Demands 20% to 40% Performance Improvement

Audience Question: Clinical Quality
Wheredo you see the greatest opportunity
for improvingclinicalquality?
1. Reducingunnecessarycare variation
2. Patient-centeredmedicalhomes
3. System-widequality standards
4. Partnerships withcommunityorganizations

DRIVING CLINICAL QUALITY
DR. DAVIDFEINBERG,PRESIDENT,UCLAHEALTH SYSTEM

9
The Patient Experience
• Our overarching focus is on the patient experience
• Safety, quality, and cost are all components of the patient
experience
• It’s the type of care I would want for my mom if she were sick
• Access, safety, quality, comfort, cost effective, timely, and seamless
• Achieving this comes from listening to patients and taking really good
care of them

UCLA’s ValU Initiative
• The ValU Initiative focuses on the quality and cost
components of the patient experience
• UCLA sees 45,000 inpatients a year and treats over
2 million throughout the UCLA Health System
• ValU is a way of improving the patient experience by
redesigning clinical service practices
10

Primary Care Redesign
• We began with primary care innovation
• Primary care redesign includes multiple service lines
• We then moved to specific service lines
• We prioritize service redesign by looking at four criteria
11

Prioritizing Service Lines – Four Criteria
• Are patients engaged in their care?
• Is there strong physician leadership and engagement?
• Is the service line important to UCLA’s long-term growth
strategy?
• Is the service line meeting financial benchmarks?
12

Service Line Redesign
• Requires a partnership including:
• Patients, Performance Excellence team, physician leaders, nurse
leaders, administrators
• Reduce medically unnecessary clinical practice variation
• Daily interdisciplinary meetings for care coordination
13

Potential Barriers
• Physician resistance to change
• Departmental or silo model
• Lack of robust cost accounting or financial data
14

Beginning of Our Journey
• We are early in this journey
• Learning from models outside the organization
• A year from now we will have data and trends showing where
we have succeeded and what we need to refocus on
15

Audience Question: Operational Excellence
Whatis the most significant obstacle to
achievingoperational excellencein your
organization?
1. Competingpriorities
2. Tools and technology
3. Physician/providerbuy-in
4. Siloed departments
5. Lack of a clear strategy

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Operational Excellence
David L. Bernd
Chief Executive Officer
June 17, 2014
SentaraStrategicPlan

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Sentara Healthcare
• Mission: We improve health everyday
• 126-year not-for-profit mission
• 12 hospitals; 2,727 beds; 3,799 physicians on staff
• 11 long term care/assisted living centers
• Extended stay hospital
• 4 Medical Groups (900+ Providers)
• 440,000 - member health plan
• Sentara College of Health Sciences
• $4.3B total operating revenues
• $5.9B total assets
• 27,000+ members of the team
• AA/Aa2 bond ratings
Virginia
North Carolina

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Sentara Strategic Plan
Always Improving

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Operational Excellence
1. Strategy of Integration; Execution of Strategy
2. Uniform Goals Across System
3. Transparency of Performance – External Benchmarks
4. Balanced Scorecard: Quality, Safety, Customer Satisfaction,
Members of Team Engagement; Financial (both revenue
& cost)
5. Keep operations and finances well disciplined –
gives you time to strategize, plan
and execute

Quality
Developed and implemented 3 System Cardiac
Score Cards:
Strategic
Operational
Reputation
Achieved 90% yellow or green on Operational
Score Card
Systemized CCEC
Policies and procedures (Compliance 360)
Outcomes report analysis
Nurse Stress Testing
Telemetry Pilot
LOS(AMI, Arrhythmia,Intervention)
Identified opportunities for improvement and
developed process to improve LOS
Strategic Imperative I
22
I. Be the Leader in Value as measured by quality,satisfaction, and cost for Heart Services
Cardiac Operational Scorecard (90% yellow orgreen)
Length of StayOpportunities
Example of System-Wide Cardiac Strategy Execution
22

23
I. Be the Leader in Value as measured by quality, satisfaction, and cost for Heart Services
Patient Satisfaction Initiatives
Discharge Planning
•Begins on admission
•Whiteboard utilization
•Multidisciplinary rounds daily
Quiet at Night
•Posters
•Complimentary ear plugs and sleeping
masks
•Preferences on whiteboard
Education about Medication
•Detailed, consistent education to all
patients and family
•Tiger Videos
Create “Best Practice” Forum
•Cardiac nursing leadership participation
•Share tactics, initiatives, etc.

In the Weeds
Homeostasis Patches
• Switched from Svek Patch to
QuickClot
• Annualized savings for 2014 will
be over $175,000
24
Cardiac PerformanceImprovement Plan(PIP)
Cardiac Service Line identified $6.2m in cost
savings opportunityin 2014
Key measuresuccessis improvedoperationsand
collaborationwithSMG and Hospitals
•Efficiency (scheduling/staffing) $2.65m
•Access (Rehab, EP, AIC, Clinics) $555k
•Quality (improve LOS) $510k
•Supply Savings (Physician scorecards,CVAC,
CCAP) $2.5m
•Productivity (102% is the new 100%)
SavingsYTD
Cardiac OR supplysavings
$125kytd, estimate$760k
RevenueGrowth
Ablations exceeding
budget by41 cases=
$200k net rev
Cardiac OP CTA
exceedingbudget
I. Be the Leader in Value as measured by quality, satisfaction, andcost for Heart Services

25
Physician Resource Utilization Report Card
John Doe, M.D.
AVG COST - ALL SUPPLIES Baseline Actual (SHH)
DIAGCATH $1,520 $801.98
INTERVENTION $3,000 $2,562.10
CATH W/INTERVENTION $2,800 $2,856.84
# OF CASES 700 658
FLUORO - MEDIAN MINS
DIAGCATH 7.20 5.60
INTERVENTION 9.5 10.51
CATH W/INTERVENTION 17.7 14.60
# OF CASES 540 651
MD On Time Start - First Case
% On Time 42% 64%
# On Time 50 72
# Late 70 40
TOTAL FIRST CASES 120 112
MD GlovedTime - MEDIAN MINS
DIAGCATH 42.1 33.86
INTERVENTION 45 47.17
CATH W/INTERVENTION 60.2 58.12
# OF CASES 540 659

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Caring for Defined Populations

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CarnegieMellon University, Paul Fischbeck 2009
Caring for Defined Populations = Solve This Problem

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Create Growth
Organic Growth
Product Re-design
Strategic Affiliations
New Care Models
Innovation
Unique Technologies
InnovationSentara
Hospitals
& Services
Physicians Optima
Health

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Sentara Five-Year Outlook
1. Sentara will be a larger integrated health system
2. Transformation of care and shared learning across the system will allow
Sentara to compete by demonstrating value through outcomes,
informatics and innovations;this is made possible by enhanced system
scale and integration – Health Plan, Hospitals, Physicians,Ambulatory
Care and Post-Acute Care
3. Positioned well for major system consolidationas the market continues
to aggregate
4. Provider and health plan diversification from a geographic position will
continue to offset inherent risk issues e.g. Tricare; Anthem
5. Leverage of infrastructure over large base of services will yield
efficiencies across the system

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Lessons Learned
1. Be Strategically Driven to Execute Your Strategy
2. Designated Strategic Capital– Innovate – Safe to Fail/Great to
Succeed
3. Focus on Quality, Patient Safety, Satisfaction and Members of
the Team – Finances Will Follow
4. Flexible Organization Structure –Change is Part of Culture
5. What Gets Measured and Reported Gets Done
6. REPEAT - Keep operations and finances well disciplined
– gives you time to strategize, plan and execute
7. Merger/Affiliations – Culture Fit – we do 1 in 4 opportunities
8. Enjoy the ride – our best days are in front of us

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Get Social With Us…

TRANSITIONING REVENUE STREAMS
JEFF JONES,MANAGINGDIRECTOR,HURONHEALTHCARE

Market Demands 20% to 40% Performance Improvement

Revenue Transition
 Happening at different speeds in different markets
 Regardless,CEOs are committedto preparing for the shift
 Organizations must build capabilitiesneeded to operate and thrive
under the value model – while remaining financially soundunder the
current model
 Organizations must developa granular understandingof where current
and futuretop-line revenue is coming from
 The type of revenue changes and the rate of change will help each
health systemset priorities for healthcaretransformation

Current and Forecasted Revenue Sources
 What portionof your top-line revenue is from traditional
fee-for-service, and what portion is from emergingvalue-basedmodels
(bundled payment, sharedsavings, sharedrisk, capitation,etc.)?
 What increases or decreases in utilizationare occurringacross the
health system?
 What shifts in utilizationare occurringacross the health system?
 What portionof revenue is from non-patient care sources?
 What changes are you forecastingfor top-line revenue mix, utilization,
and non-patient care revenue?

Organizations are Following Multiple Tracks
 Transformativechange
– Going beyond traditional revenue and cost improvement initiatives
 New patient care revenue
– Expanding market share and reach, expanding programs and services
 Non-patient revenue
– Exploring cautiously

Key Takeaways
 Over-relianceon revenuefrom inpatient care carries one set of risks,
while reliance on new, alternativerevenuestreams carries another
 Movingfrom volumemodels is essential, but moving too quickly
weakens revenues and puts significantpressureon the organization
 Improvingquality, improvingthepatient experience, and improvingthe
cost structureremains the winningcombination

David Bernd
CEO
Sentara Healthcare
Q&A With Today’s Presenters
38
Jeff Jones
Managing Director
Huron Healthcare
jdjones@huronconsultinggroup.com
503.347.0554
Modern Healthcare Webinar |
David Feinberg, MD, MBA
President
UCLA Health System

Webinar: Thriving in the New Healthcare Environment: 3 Key Strategies

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