UW Medicine s Response to Request for Proposal

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2 UW Medicine s Response to Request for Proposal Executive Summary UW Medicine is the largest and most comprehensive health system in the Puget Sound region. 1 In Fiscal Year (FY) 2012, we had over 64,000 inpatient admissions at our four hospitals and over 1.5 million visits at our clinics and other ambulatory sites. Our hospitals, clinics and other facilities are broadly distributed throughout King County and South Snohomish County. UW Medicine serves as the only health system in a four-state region to provide the complete continuum of care (primary, secondary, tertiary and complex quaternary care). UW Medicine holds one-third of the ownership of the Seattle Cancer Care Alliance (SCCA) and fifty percent ownership of Children s University Medical Group (CUMG) that staffs Seattle Children s. Cancer care is delivered through the UW Medicine/SCCA model. Pediatric and neonatal care is also coordinated between UW Medicine and Seattle Children s. UW Medicine has performed well financially, producing a positive bottom line and operating cash flow. For decades, UW Medicine has served as a national leader in healthcare innovation and in applying the newest and most efficacious diagnostic, treatment and prevention approaches that directly benefit our patients. UW Medicine is committed to and has a proven track record in successfully partnering with community hospitals in a variety of ways to help these hospitals meet the needs of their community. We would offer these same resources to support the service offerings of Cascade Valley Hospital and Clinics (CVH), Island Hospital (IH) and Skagit Regional Health (SRH) (collectively, the Interlocals ) with our tertiary and quaternary care while at the same time assisting the Interlocals to evaluate and enhance their existing programs to best meet the needs of their communities. We believe that to improve the health of the public there must be affordable, high-quality healthcare in our communities, both urban and rural. Like the Interlocals, we have a demonstrated culture of quality and accountability, and commitment to the uninsured and underinsured in our community. Our mission, vision and values are an excellent fit with the mission, vision and values of the Interlocals, and we share a commitment to lead the transformation of healthcare while reducing overall healthcare costs and improving the value of services provided to the community. As described in the following response, we are transforming our clinical delivery model and developing efficient enhancements to our infrastructure to be an accountable care organization (ACO). We believe we would add value to the Interlocals through an affiliation, partnership or other relationship (collectively, the Affiliation ). We are prepared to discuss an array of options to best meet the needs identified, depending on the Interlocals interests, but have highlighted two Affiliation options in particular in the enclosed response. 1 UW Medicine includes the following eight entities: Harborview Medical Center (Harborview) as managed by the UW pursuant to a Management and Operations Contract; UW Medicine Northwest d/b/a Northwest Hospital & Medical Center (Northwest Hospital), Public Hospital District No. 1 d/b/a Valley Medical Center; University of Washington Medical Center (UW Medical Center); UW Physicians Network d/b/a UW Neighborhood Clinics (UWNC); The Association of University Physicians d/b/a UW Physicians (UWP); University of Washington School of Medicine (UW SoM); and Airlift Northwest (Airlift). 1 P age

3 A. Strategic Vision for the Interlocals Describe your 3-year strategic plan for your organization and for the Interlocals 1. Describe your organization s strategic vision. UW Medicine s mission is to improve the health of the public, which aligns with the missions of the Interlocals. As a tertiary and quaternary resource for the WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho), we value and work with our community partners in a fivestate region and are committed to supporting the ability of patients to receive excellent care in their local communities. At the same time, ongoing healthcare reform highlights the importance of building health systems and networks for the delivery of care to avoid all entities building costly infrastructure in every location. Strategic Goals and Objectives The UW Medicine strategic plan recognizes the importance of healthcare being delivered in the lowest cost setting possible. Identified strategic goals and objectives include: Review and strengthen Centers of Excellence and other core clinical programs; Deliver consistent, excellent service and improve patient access; Improve UW Medicine s strategic outreach to patients and healthcare professionals throughout the WWAMI region; Identify or develop additional primary and secondary care services in strategically placed locations that align with UW Medicine s tertiary and quaternary care activities; Enhance the quality, cost-effectiveness and integration of UW Medicine s educational programs to address the region s healthcare workforce needs and to maximize the focus of future healthcare professionals on quality, safety, efficiency and reduction of per capita cost; Enhance the integration of UW Medicine s research programs to promote rapid and effective translation of research from laboratory to clinical settings; and Incorporate strategic financial modeling with sophisticated analyses and long range plans as a component of all major initiatives. Five Priority Areas For FY 2013 (July 1, 2012 through June 30, 2013), we are focused on five priority areas to support our strategic goals and objectives to optimize our ability to perform as an Accountable Care Organization (ACO): Build key clinical programs. Improve existing patient care programs that are central to UW Medicine s ongoing success in improving health and develop new programs suited to UW Medicine s preeminence in specialized tertiary and quaternary care. 2 P age

4 Build networks and affiliations. Develop strategic affiliations and alliances locally and throughout the region that support our ability to improve health; broaden clinical programs in primary and secondary care to support the needs of our patients, sustain patient access, and secure our ability to serve as an ACO with a strong focus on reducing per capita cost. Deliver excellent service. Enhance UW Medicine s ability to deliver excellent care by ensuring that all care and service provided are outstanding, compassionate, timely, coordinated and complete. Deliver high-quality, safe and effective patient care. Implement initiatives to maintain the highest quality care and safety standards that support UW Medicine s mission of improving health. Enhance the integration of research, teaching and patient care. Increase the efficiency and effectiveness of services that support UW Medicine s core activities of research, teaching and patient care on behalf of improving health through workforce development, human resources, facilities growth and renovation, and information technology advances. 2. How you do you envision positioning the Interlocals to remain competitive in their respective markets? UW Medicine consistently supports the delivery of primary and specialty care being provided in the local community, close to patients homes. As noted above, it is a strategic objective to partner with primary and specialty care in markets that align with and benefit from UW Medicine s tertiary and quaternary expertise. UW Medicine would be prepared to collaborate and assist with the development of key programs at the Interlocals that meet the needs of the community and achieve the overall mission. The addition of Northwest Hospital & Medical Center (Northwest Hospital) and Valley Medical Center to UW Medicine reflects our commitment to primary and specialty care being provided locally in the community in the lowest cost setting possible, and we have realigned, and continue to realign, care within UW Medicine accordingly. We envision positioning the Interlocals as the primary locations for primary and secondary care for patients in their communities and we will commit to providing access to UW Medicine s tertiary and quaternary care expertise when needed. This will increase the confidence of patients in the local community in choosing the Interlocals for care, knowing that the facilities have direct access whenever needed to more complex consultation or care. UW Medicine operates a 24 hour a day, 7 day a week MedCon physician consultation line to further assist community physicians with care. In addition to tertiary and quaternary expertise, an Affiliation with UW Medicine brings increased linkage to our teaching and research activities, including access to clinical applications of cutting edge research. We would position the Interlocals as the destination of care for the Interlocals existing and growing service areas. We envision that as we redesign our delivery of care to be an ACO capable of caring for populations, the Interlocals would play an important role in the network of entities necessary to provide comprehensive integrated care for a population with primary, secondary, tertiary and quaternary needs. 3 P age

5 3. To position the Interlocals for growth, what services or programs do you envision growing or adding? Key areas for expansion of specialty services would be planned jointly with the Interlocals based on their desires to expand services to meet the needs of the community. UW Medicine is open to considering expansion of any clinical programs that support the mission of improving health. Our initial assessment would include opportunities for cardiac, stroke, neurosciences, obstetrics, orthopedics, sports medicine, emergency medicine, cancer care, rehabilitation medicine, pain relief services, vascular and thoracic surgery, pediatrics, behavioral health, primary care and telemedicine. 4. How do the services and geographies of the Interlocals support or augment your organization s current capabilities? How do they align with your organization s strategic plan? UW Medicine is committed to achieving the Triple Aim of better care for individuals, better health for populations, and lower per capita costs. Achievement of the Triple Aim requires close coordination of clinical care and transitions among different healthcare professionals. Supporting the delivery of and access to high quality, cost-effective care in the community is in everyone s best interest. The geographies of the Interlocals present an opportunity to align more fully to provide the full range of primary, secondary, tertiary and quaternary care to patients in your communities and as noted above, to meet the goals and promise of ACOs. A strategic Affiliation also presents an opportunity for increased access and coordination with nationally and internationally known clinicians who are on the cutting edge of discovery and know how to move those discoveries to the bedside quickly. UW Medicine s mission is to improve health not just in Seattle but throughout the region, nation and world. With the Interlocals significant role in North Puget Sound, an Affiliation among us would provide an opportunity to build on our existing relationship. Benefits would include making available the high-level tertiary and quaternary care that is appropriately provided in an academic health setting while also building programs in the community to assure community access to quality care. On average, UW Medicine currently accepts more than 400 inpatient transfers a year referred from the Interlocals when patients require complex tertiary and quaternary care. We would work with the Interlocals to educate healthcare professionals on our ability to meet their patients needs by providing a continuum of care and real-time access to electronic health information through our U-Link program, which allows referring providers to follow their patients when admitted and supports the resumption of care when returning patients to their communities for any ongoing or follow-up care that can be best met in that setting. 5. What marketing initiatives would you intend to implement? UW Medicine would work with the Interlocals to develop a marketing plan tailored to meet the objectives and needs of each Interlocal. An affiliation with UW Medicine lends tremendous brand strength to the Interlocals that is of benefit in patients choosing those sites for care. We 4 P age

6 have had success over the past two years in increasing market share for Northwest Hospital and Valley Medical Center through our brand campaign initiatives. 6. How does your organization intend to brand the three Interlocal hospitals? The nature of any branding would depend on the Affiliation structure. To the extent the Interlocals remain separate and individual entities, branding protocols would need to take into account the individual identities of each entity. In any Affiliation, we would carefully consider the potential for branding or co-branding depending on the nature of the relationship. The strong brand recognition and reputation for excellence in the UW Medicine name is a valuable asset. Each Interlocal also has brand strength and recognition in the community. The ability to leverage existing brands, through co-branding or other models, is important to patient and physician recruitment. For example, the eight entities of UW Medicine participate in a coordinated marketing and branding strategy. The marketing strategy of entities with which UW Medicine shares in the ownership and governance (such as SCCA) is coordinated with the goals and strategic priorities of that entity consistent with the governance structure. In an Affiliation, we would work with Interlocals to develop a strategy to further our collective business objectives. 7. How do you envision supporting the Interlocals efforts to become more integrated? UW Medicine would support the Interlocals efforts to become more integrated but also recognize the significant role each Interlocal s Board of Commissioners plays in determining the scope of desired integration. We would work with the Interlocals to evaluate opportunities for integration with each other and with UW Medicine to achieve the goals of the Interlocals boards and the ultimate goals of the Triple Aim. Our integration successes to date will be helpful in providing guidance to the Interlocals on strategies for areas to integrate and approaches that lead to positive outcomes. 8. How would you support/enhance current GME and teaching efforts at the Interlocals? UW Medicine has significant experience in graduate medical education (GME) and teaching in multiple settings. We support continuation of the relationship between SRH and the Pacific Northwest University of the Health Sciences and, at the same time, we could provide additional opportunities for inclusion in other GME and teaching activities through UW Medicine. UW Medicine, through the UW School of Medicine, is the largest sponsor of GME programs in the five-state WWAMI region. Approximately 1,200 trainees participate in 27 residency and 66 clinical fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and two fellowships approved by the American Board of Obstetrics and Gynecology. We accept trainees with both M.D. and D.O. undergraduate medical degrees into many of our programs. In addition, more than 300 trainees participate in non-accredited fellowship programs, many of which are approved by national specialty societies. GME programs are essential to the creation and maintenance of the physician workforce population and play a vital role in reducing regional and national physician shortages. With research showing that the 5 P age

7 site of residency training is one of the strongest predictors of where physicians will practice after training, GME programs are strong drivers of regional physician workforce supply. Current accredited residency programs (with the number of subspecialty fellowship programs in parentheses) sponsored by the UW School of Medicine include: Anesthesiology (4) Orthopedic Surgery (1) Dermatology (1) Otolaryngology Emergency Medicine Pathology (10) Family Medicine (1) Pediatrics (13) Internal Medicine Boise Physical Medicine/Rehabilitation (3) Internal Medicine Seattle (16) Plastic Surgery Medical Genetics Psychiatry (4) Neurological Surgery Radiation Oncology Neurology (3) Diagnostic Radiology (4) Nuclear Medicine General Surgery (3) Obstetrics & Gynecology (2) Thoracic Surgery (1) Occupational & Environmental Medicine Vascular Surgery (1) Ophthalmology Urology (1) GME Training sites. Among nearly 700 sponsoring institutions nationally, UW School of Medicine ranks fifth in the number of ACGME-accredited programs and tenth in the number of trainees. Trainees are located at four primary teaching sites in Seattle: UW Medical Center, Harborview Medical Center (Harborview), Seattle Children s and the VA Puget Sound Health Care System. Numerous (>250) other community hospitals and clinics, such as some of your Interlocals facilities, also serve as important training sites for UW residents and fellows. The four UW Medicine hospitals all serve as clinical training sites for a variety of healthcare professionals (for example, nursing, physician assistants, social work, pharmacy and therapists). We would envision working with the Interlocals to support, and expand if necessary, existing training opportunities for our trainees and the Interlocals trainees in appropriate geographic locations. 9. Are there any services provided by your organization or an affiliate that conflict or overlap with the Interlocals service offerings? If so, how do you plan to address this issue? There are three entities that provide services in the Interlocals service areas. PeaceHealth: UW Medicine has a long and valued relationship with PeaceHealth, whereby UW Medicine has served for decades as a complex tertiary, quaternary and teaching resource for Peacehealth hospitals and professional practices. We share a common commitment to primary, secondary, and tertiary care being delivered in the community. We would support PeaceHealth s continued activities in that regard and would continue to be a complex tertiary, quaternary and teaching resource when needed for PeaceHealth. 6 P age

8 Seattle Children's: UW Medicine has been closely affiliated with Seattle Children s for many years. Seattle Children s is ranked as one of the top 10 children's hospitals in the nation by U.S. News & World Report and provides subspecialty care in nearly 60 areas, from adolescent medicine to virology. UW Medicine would support the continuation of services that Seattle Children s currently provides in the Interlocals service areas. These services are provided, in general, by UW faculty who are members of CUMG owned by UW Medicine and Seattle Children s. Seattle Cancer Care Alliance (SCCA): In 1998, UW Medicine, the Fred Hutchinson Cancer Research Center (FHCRC), and Seattle Children s made an investment of more than $100 million to launch SCCA. SCCA is a not-for-profit corporation, and UW Medicine, FHCRC and Seattle Children s share equally in its ownership and governance. Clinical services are provided for adults by UW faculty who are members of the UW Physicians practice plan, and care for children is provided by UW faculty who are members of the CUMG practice plan. SCCA has regional network members in Alaska, Montana and Washington. Because of their relationship to SCCA, these network members can provide their patients with the latest cancer diagnostic and treatment information as well as access to SCCA clinical trials. We support the continuation of existing network relationships with SCCA. B. Health Reform and Related Strategies 1. Explain your organization s strategic visions for how it plans to participate in new payment models, population health management, etc. Like many organizations locally and nationally, UW Medicine is redesigning its delivery of care to be an ACO. To realize our ACO vision, we are engaged in the immediate strategies below: Increasing our ability to deliver value through improved cost, quality and service performance that exceeds best practice standards; Designing and implementing models of care and supporting infrastructure required to meet the value-based expectations of our patients; Re-engineering interprofessional healthcare teams and infrastructure to reduce practice variation; Implementing decision support-guided physician and healthcare professional order entry; Implementing rapid process improvement methodologies that reduce waste, eliminate duplication and improve efficiency; Providing patient care in the most appropriate and cost-effective setting; Expanding the medical home model in primary care to reduce emergency department visits and inpatient hospitalizations while maximizing quality; Using our 24/7 Community Care Line to provide nurses advice directly to patients for urgent care management and to reduce unnecessary emergency department visits; Establishing new partnerships with payers and healthcare professionals on innovative approaches to care delivery; and 7 P age

9 Actively piloting, refining and implementing new approaches to care delivery and care management. UW Medicine ACO services will involve a network of healthcare entities, including but not limited to our eight component entities, entities in which we have an ownership interest, and closely affiliated organizations. In addition, we will selectively partner with entities whose services and/or geographic presence is necessary to provide the full spectrum of care for identified populations. We would be very interested in further discussing the role of the Interlocals in the UW Medicine ACO network. 2. How would the Interlocals fit into this vision and help your organization to achieve its goals? UW Medicine s northernmost hospital is approximately 40 miles from the nearest Interlocal hospital. At the same time, UW Medicine treats more than 400 inpatients a year from your geographic region and many more on an outpatient basis. We fully support primary and specialty care being provided in the local community, close to patients homes. It is a strategic objective to partner with primary and specialty care in markets that align with and benefit from our tertiary and quaternary expertise. We also strategically evaluate the expansion of more complex specialty care in those locations, and in an Affiliation with Interlocals, we would do the same analysis as part of strategic planning. 3. Explain your organization s current initiatives related to payment reform. UW Medicine is actively redesigning its delivery of care to be a healthcare organization that provides accountable care via contracts with payers. In order to do so, UW Medicine is enhancing its infrastructure to deploy evidence-based clinical care protocols system-wide; increase care management coordination; engage in high-risk patient population management; and implement system-wide quality benchmarking, including patient satisfaction metrics. To the extent that we contract with other healthcare entities to participate as part of the UW Medicine ACO, this same infrastructure will need to exist in each as well as the shared commitment to achieve ACO quality of care, patient satisfaction, cost objectives, implementation of agreed-upon performance metrics, and coordination with other UW Medicine ACO network entities in the delivery of care. These activities are foundational to full participation and success in ongoing payment reform. 4. Does your organization have any risk-sharing contracts with payers? If so, please explain what types of arrangements you have developed. UW Medicine has strong relationships with key payers in the area and we are working in partnership to implement innovative approaches to care that reduce the total cost of care while improving our service to patients and the quality of care patients receive. We are also working with third party payers and others to transition to value-based reimbursement models. UW Medicine has experience with risk arrangements, including bundled payments for specific clinical services, types of patients, and types of payers and is willing to engage with payers and others in such 8 P age

10 discussions. We have substantial experience with a variety of organizational arrangements and would carefully analyze and structure any Affiliation with the Interlocals with the regulatory environment in mind to assure we could achieve mutually-agreed upon strategies and objectives. C. Affiliation Structure 1. Describe, in as much detail as possible, your proposed affiliation structure (e.g., joint operating agreement, joint venture, long-term lease) for achieving the mutual objectives of the Interlocals and your organization, including implications related to debt restructuring. As noted in our response to the request for indications of interest, there are many models we could consider. The driving strategic priority for UW Medicine in selecting a structure is the ability of the structure to support and sustain the Interlocals inclusion in the UW Medicine ACO network. Our ideal model would enable a shared commitment to achieve ACO quality of care standards, patient satisfaction, cost objectives, implementation of agreed-upon performance metrics, and coordination with other UW Medicine ACO network entities in the delivery of care. This ideal model could take the form of one of two options which vary in depth but not in the overall substance of the participation. The first structure is a contractual clinical programming affiliation agreement in which the overarching affiliation agreement would form the basis of our working relationship with programspecific collaborations entered into as the Interlocals and UW Medicine agree. Any such programspecific collaboration would require commitment to ACO goals and objectives. Such a structure would not require changes in the existing governance of the Interlocals or UW Medicine. One strength of such a model is that it allows for targeted collaboration in the areas that make the most sense in light of each organization s strategic goals. An example of this type of relationship is the relationship Northwest Hospital entered with UW Medicine in the late 1990s in which there was an overarching affiliation agreement and program-specific collaborations such as cardiac surgery services. The second preferred structure is also a contractual affiliation agreement. In this model, the affiliation is not limited to program-specific collaborations but instead reflects a full commitment to being part of the UW Medicine ACO and commitment to the ACO goals and objectives for all services provided. One strength of such an affiliation is that it would promote the appropriate delivery of primary and secondary care in the patient s community by the Interlocals and their affiliated healthcare professionals, and would enhance, to the degree clinically warranted, the ability for the Interlocals to provide additional tertiary care in the community. We would focus on supporting community-based healthcare professionals in rural areas and their unique needs, while leveraging all our collective strengths. Like the first structure, this model would not require a change in the governance of the Interlocals or UW Medicine. 9 P age

11 In both models, we would work together to achieve the promise of ACOs, such as increased efficiency and reduced costs of healthcare; achieving improved clinical outcomes and patient satisfaction through shared clinical protocols and evidence-based medicine guidelines; joint physician recruitment; shared metrics to assess improvement related to adoption of clinical protocols; increased telemedicine capabilities to provide cost effective specialty consultations; and access to participation in clinically-focused multi-disciplinary continuing education. 2. In addition, indicate your openness to evaluating alternative models or structures, and identify the potential alternatives your organization would be willing to consider. UW Medicine is open to evaluating alternative models, including models with third parties that leverage UW Medicine s strengths as a tertiary and quaternary partner. For example, should the Interlocals desire a partnership with a health system that does not have our tertiary and quaternary expertise, we would be willing to consider an Affiliation with the Interlocals that included another health system. 3. The Interlocals desire to create a high degree of integration among the three hospitals; please describe how your organization s proposed affiliation structure will support this initiative. In our proposed Affiliation models, UW Medicine would closely coordinate with the three hospitals to avoid duplication of unnecessary services and leveraging shared business infrastructure to reduce costs. 4. List any specific concerns or opportunities related to creating a partnership with the Interlocals that may have differing levels of integration and separate agreements. To the extent the Interlocals are not coordinated and integrated on key business objectives and do not have a shared vision, there may be inefficiency for all involved as each Interlocal engages in separate discussions and negotiations with UW Medicine. 5. Please identify whether you believe that there are any potential antitrust concerns with the proposed affiliation model. What are your plans to mitigate any potential antitrust issues? In the current regulatory environment, antitrust is always an important consideration. Any Affiliation will need careful review and a shared understanding of the parameters for collaboration. D. Commitment to Future Capital Investment in the Region 1. Describe your organization s willingness/ability to commit capital for both routine and strategic purposes. What is the process that your organization would use to arrive at a decision surrounding capital investment for each facility? 10 P age

12 UW Medicine is a significant component of the University of Washington s (UW) financial profile. UW received an Aaa stable rating from Moody s Investors Service for a recent debt offering. The nature of any Affiliation would drive how bond rating agencies, lenders and others view the Affiliation for purposes of cost of capital, credit rating and other aspects of capital formation. UW Medicine has an annual capital budgeting process at each UW Medicine site, as well as a five year long-range strategic and capital plan. The nature of the Affiliation would determine whether the Interlocals are part of the UW Medicine strategic planning process in which we engage in budget planning to determine needs, ability for the entity to fund its own needs, and any opportunities for leveraging capital assets to support system-wide goals. In any model, just as we expect our eight entities to do, we would expect each Interlocal to determine and support the necessary capital for routine and strategic purposes at the Interlocal within its local budget. We are willing to work with the Interlocals in a multi-party transaction that leverages our clinical programming strength. 2. How much capital does your organization intend to invest in each Interlocal hospital over the next 5 years? How would this vary by hospital? As noted above, UW Medicine would not directly invest capital dollars in each Interlocal hospital. Rather, we would work to create revenue-generating programs and activities that would support the Interlocal hospital s ability to fund its own capital needs. 3. What portion of the cash flow (before management fees or comparable corporate overhead expenses) generated by the relationship would your organization be willing to reinvest in the Interlocals? UW Medicine would expect that the liabilities and assets of each Interlocal would remain in the local community for reinvestment in the local community. E. Local Governance 1. Describe how your proposed affiliation structure(s) would offer accountability to and input from the community and public hospital districts. Our proposed affiliation structures would maintain accountability and input from the community and public hospital districts while leveraging the strength of UW Medicine to collaborate and develop strong clinical programs and position the Interlocals for success as payment models move to accountable care contracts. 2. Provide a current organizational chart, including a description of the management structure and reporting relationship for any campus administrators. We have provided a current organizational chart (see Attachment A). UW Medicine has one chief executive officer (CEO) who also serves as executive vice president for medical affairs and dean of the School of Medicine for the University of Washington. The majority of the lead executives for 11 P age

13 each of our clinical entities hold the title executive director and report to the chief health system officer (CHSO). At the time Valley Medical Center joined UW Medicine, the existing title for its lead executive was chief executive officer and that individual retained the title, consistent with the strategic alliance agreement developed with Valley Medical Center. All the leaders of the clinical entities report into the CHSO, who reports to the CEO of UW Medicine, with the exception of the CEO of Valley Medical Center who reports to the CEO of UW Medicine but also works directly with the CHSO on a day-to-day basis on all operational and clinical integration efforts at Valley Medical Center. These reporting relationships reflect that the clinical entities are all component entities of UW Medicine. In an Affiliation with a different structure (i.e., not a component entity of UW Medicine) we would discuss appropriate reporting relationships based on the agreed-upon structure. 3. Indicate your organization s willingness to allow the public hospital district boards the following reserve powers: a. Approval of any significant change in clinical services. b. Approval of local administrators appointed by your organization. c. Reduction in off-campus clinics. The nature of reserve powers in an Affiliation would depend on the nature of the Affiliation. In the two models described in Section C, we would anticipate that the above reserve powers would be retained by the public hospital district. 4. Indicate your organization s willingness to receive input from the public hospital district boards regarding the following a. Annual physician recruitment plans. b. Plans to expand/enhance clinical services. c. Annual capital and operating budgets. d. Strategic plans for the region and campuses. In any Affiliation, we would view the input from the public hospital districts to be vital and welcome. 5. Describe your organization s process for providing updates to the public hospital district boards regarding: a. Quarterly financial performance. b. Clinical quality performance. c. Plans to join another organization or participate in other strategic affiliations. Again, the nature of the Affiliation would determine the process for providing updates but it is important from UW Medicine s perspective that, in any affiliation arrangement, the public hospital district boards are fully aware of current financial performance, clinical quality performance and other aspects of the hospitals operations. 12 P age

14 6. How would the local board have influence on and provide input to your organization s board on matters that affect the local community? In any Affiliation, a key governance principle for UW Medicine is that any governance structure should include and continue local participation while facilitating the mission of improving health in the community. Each entity within UW Medicine has a slightly different arrangement, tailored to its unique local needs, history and legal structure. In a non-component entity Affiliation, we would work with Interlocals to develop a governance structure that meets the needs of the community. F. Clinical Excellence 1. The Interlocals are evaluating options with regard to the formation of Centers of Excellence to increase specialization within their hospitals. If these centers are formed, how would your organization support these models? Does your organization have any history of developing Centers of Excellence? UW Medicine operates multiple hospital-based and ambulatory centers and comprehensive programs providing primary, secondary, tertiary and quaternary care. We have considerable experience with Centers of Excellence. UW Medicine is the site of nationally and internationally recognized Centers of Excellence in the following areas, described further in Attachment B: Level I Adult and Pediatric Trauma Regional Burn Center Neurosciences Institute Comprehensive Acute Rehabilitation and Reconstruction Limb Viability and Re-implantation Solid Organ Transplantation Liver, Kidney, Lung, Heart, Pancreas and Intestine Oncology and Stem Cell/Marrow Transplantation High Risk Obstetrics & Neonatal Intensive Care/Level III Regional Heart Center including Left Ventricular Assist Device and Heart Failure Program Regional Vascular Center (including minimally invasive repairs for aortic dissection) Multiple Sclerosis Center Spine, Sports Medicine & Orthopedics Eye Institute & Vision Science Center Center for AIDS/HIV Behavioral Health/Mentally Ill and Medically Vulnerable Following a strategic planning process, we would envision working with Interlocals to develop additional Centers of Excellence. 2. Does your organization currently operate any regional or multi-campus service lines? If so, please describe these services. How would the Interlocals be incorporated into the service lines? How would this impact the services offered at the Interlocals? 13 P age

15 UW Medicine currently operates multi-campus service lines and would evaluate the inclusion of Interlocals into such service lines through a strategic planning process. One well-known example, described further in Attachment B, is the UW Medicine Regional Heart Center. Another successful multi-campus service line is orthopedics. Across four hospitals, UW Medicine provides orthopedic services that leverage the strengths of each hospital and their associated physicians. At Valley Medical Center, there is a top-ranked joint center offered in collaboration with a longstanding private physician group in the community. At Northwest Hospital, UW Physicians have joined forces with Bone and Joint Center of Seattle to expand the orthopedic services available in North Seattle. UW Medical Center and Harborview both offer highly specialized orthopedic services. Patients are triaged to the four locations based on their clinical needs and anticipated care. 3. How would the relationship enhance measureable levels of clinical quality and patient satisfaction, including successful patient outcomes? What resources and processes can your organization contribute to clinical performance improvement? UW Medicine has engaged in sustained work to achieve the Triple Aim of better care for individuals, better health for populations, and reduction of per-capita costs. As a key element of our strategic plan, we focus on implementing a culture of mutual accountability, including implementing effective processes and monitoring outcomes. The UW Medicine workforce strives to deliver high-quality care in a cost-effective manner. Our programs foster accountability at all levels, within all departments, and across all clinical disciplines. The status of the UW Medicine quality metrics and the initiatives in progress to enhance our quality are viewed monthly by each entity s board of trustees. In addition, the overall program is reviewed and discussed by the UW Medicine Board s Patient Safety and Quality Committee. Data transparency is valued throughout our system and numerous tools have been developed to provide the data needed to enhance workflow and achieve our quality and cost containment goals. UW Medicine quality and safety initiatives are built on the foundation of Patients Are First, TeamSTEPPS and the formation of a Just Culture. Each is described below and are key initiatives to improve successful patient outcomes and patient satisfaction that we would consider involving Interlocals in depending on the nature of the Affiliation. Also described are some key decision support activities that we have deployed to improve patient care. Patients Are First Our Patients Are First service and quality initiative has been implemented throughout UW Medicine as the organizational framework for delivering consistent service excellence to every patient, every time. In support of this initiative, UW Medicine has engaged the Studer Group, LLC, a national expert consultant group on implementing evidence-based practices that improve service, satisfaction, quality and safety while reducing costs. Through Patients Are First, UW Medicine is creating greater consistency and team performance across our hospitals and clinics, refining our metrics to support systems of accountability, and providing staff, managers, physicians and senior leaders with the tools, tactics and reports to achieve our strategic outcomes. 14 P age

16 UW Medicine has established four pillars as the foundation for building a Patients Are First culture: Focus on Serving the Patient and Family: serve all patients and family members with compassion, respect and excellence. Provide the Highest Quality Care: provide the highest quality, safest and most effective care to every patient, every time. Become the Employer of Choice: recruit and retain a competent, professional workforce focused on serving our patients and their families. Practice Fiscal Responsibility: ensure effective financial planning and the economic performance necessary to invest in strategies that improve the health of our patients. Each pillar has measurable core goals that, when cascaded throughout the hospitals and clinics and teamed with the other evidence-based leadership tactics, reinforces our commitment to Patients Are First. The Patients Are First dashboards contain quality metrics system-wide so each entity can view its performance and the system s performance as a whole. Specific results achieved by the Patients Are First program that support the Triple Aim include improvement in quality indicators, such as achieving a 5.8 percent increase in the Medicare core measure composite score; a 14.1 percent increase in patient access to specialty clinics; and a greater than 17 percent increase in percentile ranking over the 2010 baseline for inpatient satisfaction. Just Culture and TeamSTEPPS In 2009, UW Medicine embarked on the journey to become a Just Culture. The UW Medicine Just Culture focuses on creating a learning culture, designing and implementing safety systems, and managing behavioral choices that promote and improve patient safety. The Just Culture approach emphasizes the importance of training and systems to support personal accountability and incorporate self-regulation in safety matters. Faculty and staff are encouraged to provide essential safety-related information based on establishing a clear line between acceptable and unacceptable behavior. UW Medicine began deployment of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in 2008 to improve patient safety by improving communication and teamwork skills among its healthcare professionals. UW Medicine is a national training site for TeamSTEPPS, with 127 master trainers on staff. Over 1,000 UW Medicine faculty and staff have trained in TeamSTEPPS, including operating room, intensive care unit, emergency room and labor and delivery personnel. Since 2010, all incoming residents and fellows (over 200 per year) have been trained in TeamSTEPPS during orientation. Transforming Care with Real-Time Decision Support Tools for Quality Care UW Medicine strives to deliver high-quality care in a cost-effective manner. The following tools have been developed internally by UW Medicine faculty and staff. These tools provide the data 15 P age

17 needed to enhance workflow and achieve our quality and cost-containment goals. The tools have been integrated into the UW Medicine electronic health record (EHR) to support essential functions of patient care at the point of care. As real-time decision support tools, they directly benefit patient care and improve quality. CORES. CORES (Computerized Rounding and Signout) is a product developed by a team of UW Medicine developers and clinicians that was originally a stand-alone web tool used to communicate patient information from one clinician to another. Because of the tool s value, it was re-formatted as a live link and has been made available to all clinicians using the inpatient EHR. CORES is included for rounding reports, call schedules, and current medication and lab data, among other domains. Most recently, a feature has been added to track the name, pager and role of each member of the team active in each patient s care on a 24/7 basis. This permits a bedside nurse to open the tool in the EHR, quickly locate the name and role of the covering physician, and page the physician with a single mouse click. The tool has been highly successful. Intensive Care Unit (ICU) Quality and Safety (Q/S) Dashboard. The ICU Q/S Dashboard was initially developed as a tool to track major quality and safety parameters in the ICU. Over time it was further enhanced to reflect real-time measures for glycemic control, deep venous thrombosis prophylaxis, ventilator-associated pneumonia prevention, ventilator parameters and gastrointestinal prophylaxis. The dashboard was also mapped to a screen that is visible to all medical personnel at ICU work stations. With one glance, the status of all time-sensitive quality and safety parameters is visible for each patient in each ICU. Electronic White Boards. The first white board was developed as a product of the Radiology/IT development team. This is an extra-large screen set up in the operating room (OR) to track all activities in and out of the OR rooms (linked to the EHR), with icons noting an array of information relevant to each case. Examples include OR start-time, participant names, interval time in-room, special equipment needs, and other unique features. The white board in the OR is highly visible, helping all team members receive prompt, accurate and important data at all times. The success of the tool led to the development of white boards with similar functionality in the acute care units and the ICUs. Rapid Response Team (RRT) Trigger Tools. The inpatient EHR has been enhanced to query clinical data on a real-time basis in order to screen for parameters that would trigger a RRT. In the event of a clinical RRT-initiating event, the chart alert is triggered and pages are sent to the team responsible for responding to RRT events. With this tool, prompter care can be provided to patients who exhibit signs of a clinical compromise. Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) Identification Tool. All vascular lab reports and CT angiogram reports are monitored electronically on a continuous basis. When the criteria are reached for a new hospital-acquired thrombotic event, the event is flagged. These results are linked to the pharmacy data and other nurse-entered fields. The product is an online tool to view every newly acquired DVT or PE in the hospital, with the ability to determine rapidly 16 P age

18 if guideline-directed DVT prophylaxis was in place from admission until the time of the DVT event. Institute for Simulation and Interprofessional Studies (ISIS). Simulation labs and training centers to enhance team learning and patient safety and quality are available at three of our hospital sites. These centers provide education for UW Medicine physicians and staff as well as community healthcare professionals. ISIS training has resulted in improved quality of care and reduced cost in clinical services such as the insertion of central venous catheters. Peri-Operative Antibiotic Assessment Tool. Centers for Medicare & Medicaid Services (CMS) and the Surgical Care Improvement Project (SCIP) Core Measures define appropriate preoperative prophylactic antibiotics for selected groups of patients, such as those with hip replacement or colectomy. UW Medicine physicians at Harborview have developed a similar set of guidelines for all 1,200 types of surgery cases performed at the hospital. All surgery cases are tracked electronically to determine if an appropriate antibiotic was given, as represented by the Surgical CPT code. Other Tools. Additional real-time tools linked to the EHR include a wide array of infection control reports made available to medical teams, nursing managers, bedside nurses and infection control professionals. These tools have helped achieve substantial reductions in transmission of nosocomial infections. Similar tools are in place for fall risk assessment, glycemic control and vaccine triggers. Many additional new products are currently under development. 4. How is your organization equipped to deal with management of clinical measures from organizations such as CMS, TJC, DNV, and AHA? What are your publicly reported clinical results, and how do they compare with regional, state, and national norms? UW Medicine monitors patient safety, quality and satisfaction scores in all hospitals and clinics and has a unified Patients Are First dashboard and intranet website to view quality and safety data transparently. These measures include measures defined and tracked by the organizations noted above. Both Harborview and UW Medical Center currently score in the top third among academic medical centers on the University Healthcare Consortium Quality and Accountability scorecard, which includes assessments of risk-adjusted mortality, Core Measures, Patient Safety Indicator (potentially preventable adverse events), patient satisfaction, and cost efficiency. UW Medicine s Northwest Hospital and Valley Medical Center have continued to improve HCAHPS scores and other measures post affiliation. Northwest Hospital and Valley Medical Center both exceed the national average on their current HCAHPS scores in the area of patients who said "yes" they would definitely recommend the hospital. Northwest Hospital s score is at 78 percent and Valley Medical Center s score is at 73 percent. The national average is currently 70 percent and the Washington State average is 73 percent. Northwest Hospital and Valley Medical Center also both received Excellence Awards from Healthgrades in Northwest Hospital received the Distinguished Award for Clinical Excellence, being in the top 5 percent of hospitals in the nation for the lowest mortality and complication rates among 26 common conditions and procedures. Valley Medical 17 P age

19 Center received the Distinguished Clinical Care Excellence Award from Healthgrades for Orthopedic Joint Surgery, Spine Surgery and Pulmonary Care. 5. Describe and give specific examples of how you provide continuing education and staff development within your organization. UW Medicine provides continuing education and staff development in many venues. Through our Departments of Clinical Education and Organizational Training and Development, UW Medicine provides a comprehensive array of clinical courses and organizational development offerings. These courses and offerings would also be made available to the Interlocals depending on the nature of the Affiliation. UW Medicine believes that consistent messaging from our leadership team is vital to ensure alignment with our staff and physicians. Each quarter, UW Medicine hosts a full day Leadership Development Institute for over 450 of our combined hospital, physician, and health system leaders. These formal educational and training institutes are convened in partnership with the Studer Group, LLC to provide leaders with the tools and strategies needed for leadership development related to meeting our UW Medicine pillar goals. In addition, there are opportunities for staff development through topic-specific training and education, skills-based advancement opportunities and ongoing mentoring. Another critical aspect of leadership and development is continuing professional education. The health science schools of the UW provide continuing education programs for the various healthcare professional needs. For example, the UW School of Medicine provides a robust continuing medical education (CME) program to meet the postgraduate educational needs of physicians and allied healthcare professionals on a local, regional, national and international level. The UW School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME). The CME Program includes a broad range of AMA-PRA Category 1 activities including departmental grand rounds, lecture series, live courses ranging from one to ten days and online self-study activities. The CME Program continually strives to improve the quality and variety of activities offered, including a major focus on simulation-based and telemedicine facilitated active learning. We would welcome the opportunity to partner with the Interlocals to understand your needs further and to coordinate on implementation of successful strategies to meet your workforce needs. Telemedicine consultation offers an excellent platform for meeting accountable care needs and provision of continuing interprofessional education at the same time. G. Local and Regional Services 1. How would the relationship improve local access to care and attraction of patients to locally provided services? What specialty clinical services would you proposed adding or augmenting? We believe that an Affiliation with UW Medicine would bolster the Interlocals position in the market through our engagement in building specific clinical programs in the community, 18 P age

20 providing streamlined access and continuity of care when tertiary and quaternary resources are necessary, and through the many other positive attributes of a world renowned academic health center. As noted previously, we would work with the Interlocals to evaluate expansion of clinical programs that support the mission to improve health and our initial assessment would include cardiac, stroke, neurosciences, obstetrics, orthopedics, sports medicine, emergency medicine, cancer care, rehabilitation medicine, pain relief services, vascular and thoracic surgery, pediatrics, behavioral health, primary care and telemedicine. 2. How would the relationship enhance the position of the Interlocals as community hospitals? In a relationship with UW Medicine, a key business objective is to enhance, strengthen and promote the Interlocals as community hospitals able to meet the needs of their thriving communities. UW Medicine s activities would be in furtherance of those objectives and in providing continuity of care when a level of care is needed that is not available in the community. We believe strategies to further these objectives will strengthen the Interlocals. 3. How will you help the Interlocals educate the community regarding the value of the affiliation? There are a variety of outreach mechanisms that can help to educate the community regarding the value of the affiliation, and we would discuss all such outreach opportunities. At the same time, we have found that one of the most effective strategies is putting patients first each and every time and having local patients and their physicians share their stories. 4. What type and level of services do you believe are essential to the regions the Interlocals serve? UW Medicine believes thriving communities need access to high quality primary and secondary care in their communities. UW Medicine would also support, to the extent a community can financially support, tertiary care services that are consistent with the goals of accountable care. 5. How will you commit to substantially sustaining and enhancing the same types and level of services as currently offered? UW Medicine would seek to sustain and enhance the same types and levels of services currently offered in an Affiliation provided there are mechanisms in place to discuss and reevaluate such services when there are significant demographic shifts, changes in financial support, emerging replacement technologies and so forth that dictate a reevaluation. 6. Please describe how your organization would augment or support the Interlocals as they move forward with consolidating services. 19 P age