10/1/2014. » This session will provide you with the knowledge to: LEARNING OBJECTIVES AGENDA

Transcription

1 MGMA 2014 Annual Conference 10/27/2014 Las Vegas, NV Aligning Physician Compensation Plans Towards Pay for Value Presented by: Rick Cameron, Navigant Consulting Malcolm Isley, Greenville Health System Shon Brink, GHS University Medical Group LEARNING OBJECTIVES» This session will provide you with the knowledge to: Create your own approach to evaluate and change compensation plans Integrate governance, leadership and management tools throughout the process Establish, integrate and sustain support for the desired outcomes throughout the process 2 AGENDA I. II. III. IV. A Bit of History: Greenville Health System University Medical Group Compensation Plan Articulation Compensation Plan Redesign Process Convert Planning Into Actions V. Lessons Learned VI. Questions/Answers 3 1

2 GREENVILLE HEALTH SYSTEM OVERVIEW Malcolm W. Isley Vice President, Strategic Services 4 GHS: A Critical Community Resource FY 13 Actual FY 14 Budget Revenue* $1,807.6 $1,855.1 Expenses* $1,745.8 $1,800.8 Discharges 46,897 50,875 Patient Days Outpatient Visits Data Snapshot 308, ,632 2,883,297 3,097,703 *In Thousands (These statistics include Baptist Easley Hospital data) Fast Facts More than 12,000 employees $1.7 million per week on our own employee health care Academics 202 medical residents and fellows in 8 residency and 7 fellowship programs USC School of Medicine Greenville first and second class matriculated USC medical students receive 3rd and 4th year training at GHS More than 1,350 nursing students receive part of their training at GHS each year Training for multiple allied health professions 5 BIRD S EYE VIEW 1. Greenville Memorial Medical Campus 2. Greer Medical Campus 3. Laurens County Memorial Hospital North Greenville Medical Campus 5. Oconee Medical Campus 6. Patewood Medical Campus 7. Simpsonville Medical Campus 8. Baptist Easley Hospital 3 8 Campuses 1,756 beds* 12 Specialty Hospitals 746 bed Tertiary Care Center More than 170 Practice Sites (and growing) *Includes Baptist Easley 6 2

3 WHO WE ARE AND WHAT WE STAND FOR Our Vision Transform health care for the benefit of the people and communities we serve. Our Mission Heal compassionately. Teach innovatively. Improve constantly. Our Values Together we serve with integrity, respect, trust and openness 7 HEALTHCARE IS CHANGING Traditional Fee for Service At-Risk Payment 8 GHS INNOVATION CYCLE Organizational Success -Achieving the Vision Quality Market Presence Affordability Value - Community Impact - Growth Freestanding Hospital Risk Capable Operation Regional/ Statewide Network Clinical University System Integration Regionalization and Growth Hospital System GHS Organizational Evolution Academic Health Center Integrated Delivery System 9 3

4 VISION/MISSION/VALUES TO ANNUAL GOALS Strategy to Annual System Goals Vision, Mission, and Values Why we exist; who we serve Multi Year Strategies Bridge annual system goals and strategic plan 3 5 Years 10+ years Strategic Plan Organizational development, markets, products, platforms, partnerships, customers 5 8 years VP Goals / Chair Goals Executive Priorities Annual Management Staff Goals Management Priorities Annual System Goals/Pillar Goals Organizational Priorities Annual 10 CREATING A RISK CAPABLE ORGANIZATION Multi-Year Strategy What the SC Market Will Look Like in 2020 Total Health Organization Health Care Value Leader System Integration Innovations in Academics Sustainable Financial Model GHS will be part of a Clinically Integrated Network that includes providers across South Carolina representing more than 250,000 lives under population health agreements Populations actively managed by GHS and the Clinically Integrated Network have better quality outcomes and cost payers less than un-managed populations GHS participates, either as a single system or through a collaborative with others, in a SC-based initiative GHS Clinical University trains a significant portion of our workforce skilled in delivering Total Health, attracts biomedical interests that advantage our patients, and brings new revenue streams to the system and the region GHS is able to make a sustainable margin on Medicare fee-forservice, commercial capitation, exchange products, Medicaid and other lines of business through standardized care processes and efficient operations 11 WE WILL MAKE VALUE-BASED CARE WORK IN THE UPSTATE; AND WE NEED TO CONNECT STATEWIDE Upstate Midlands Low Country Pee Dee 12 4

5 CAREFUL CONSIDERATIONS Managing Transition Economics in a Market Moving to Value-based Reimbursement Early Stage Pilots and Payer Demonstrations (e.g., employees) Preparing for a Change in the Basis of Payment Completing Transition to a New Model Operating Margin ($s) Cost of Moving Too Fast Well-Timed Transition Early Transition Lagging Transition Transition Zone Cost of Moving Too Slow (and growing) Fee-forservice 5-Year to 10-Year Time 13 Horizon Value-based Reimbursement 13 Becoming a Risk-Capable Organization Optimize Integrate Align Aggregate V E R T I C A L I N T E G R A T I O N Advancing on 2 Axes of Integration Over Time Serving Populations Achieving Economies of Scale & Scope Initiant Health Collaborative System Ambulatory Optimization Network CIN System-Wide Cost Development Advancement Reduction Spartanburg Health MyHealth First Initiatives Anderson Facilities Greenville Right-Sizing the Contracts w/ System Physician Laurens Major Employers M&A Organization EPIC Laurens Pickens Development Oconee Oconee UMG Greenwood Laurens/Oconee MDs GHS employees Primary/Specialty BlueChoice MDs MSSP Upstate s Value Leader H O R I Z O N T A L I N T E G R A T I O N Integration of services Expanded shared services & joint clinical program development Enterprise health systemto-health system integration 14 UMG s Transformation into a High Performance Medical Group 15 5

6 UNIVERSITY MEDICAL GROUP (UMG) Specialty Physicians Specialty # MDs Cardiology 25 Emergency Medicine 52 Hospitalists 46 Neurology 8 Neurosurgery 6 OB/GYN 22 Oncology 27 Ophthalmology 2 Ortho/Sports Medicine 39 Other Medicine Specialties 56 Otolaryngology 9 Pediatrics 55 Physiatry 10 Psychiatry 15 Pulmonary 16 Radiology 39 Surgery 62 Urology 9 TOTAL 498 Physician Extenders Extender # Extenders Advanced Practice RN 2 Audiologist 5 Certified Nurse Midwife 7 CRNA 142 Doctor of Philosophy 4 Doctor of Psychology 5 Doctor Podiatric Medicine 2 Nurse Practitioner 111 Occupational Therapist 5 Physicians Assistant 69 Registered Dietician 1 Social Worker/Counselor 9 Speech Pathologist 2 TOTAL 364 Contracted Physicians Specialty # MDs Anesthesia 41 Neonatal Intensive Care 8 Pathology 17 TOTAL 66 Community Practice Physicians Specialty # MDs Family Medicine 47 General Internal Medicine 55 MD OB/GYN 31 Pediatrics 89 Primary Care Sports 4 Medicine TOTAL 254 Contracted Extenders Extender # Extenders Pathologist Assistant 3 TOTAL Total MDs (752 employed and 66 contracted) 1,185 Total Providers Source: SyMed Database, dated UNIVERSITY MEDICAL GROUP PHYSICIAN EXPANSION AS OF 6/06/ Contracted Physician Count * Fiscal Year Specialty Care Primary Care Total *Estimate 17 WHAT IS UMG? Anesthesia Emergency Medicine Pathology Family Medicine Psychiatry Radiology Medicine Pediatrics Ob Gyn Orthopaedics and Neurosurgery Surgery 18 6

7 HISTORICAL PERSPECTIVE» UMG was based upon a Department model Facilitated rapid growth in clinical and academic affairs, and alignment within medical staff affairs Chairs had significant responsibility and authority of their departmental activities» And this was all good, but created silos that did not advance System/UMG priorities» UMG is NOT a faculty practice plan or foundation model: it is part of the System 19 THE ROLE OF THE CHAIRS The primary business of UMG Board Ambulatory and Acute Care practice Practice operations/business Growth and regionalization Service and access Clinical University Research Clinical Education GME CME UME Academic Affairs Clinical Affairs Medical Staff Affairs Patient and employee satisfaction Faculty composition Compensation models and practices Clinical Quality Medical Executive Committee Credentialing and privileging Medical Staff policies Regulatory and Accreditation Compliance 20 WHY CHANGE? There is a better way.» To care for and serve our patients and families Serve the needs of the patient across the continuum through clinical integration Provide interdisciplinary evidence-based protocol-driven standardized care Identify and fill gaps in care and service profile» To bring more value to health care Payment model is changing to focus on outcomes rather than inputs Eliminate inefficiencies found in silos Engage with businesses, payors and patients who look at us horizontally rather than vertically Focus physicians on system goals and alignment with the hospital: patient safety, quality, cost, growth» To create a healthier Upstate Expand collaborations across Greenville and the Upstate to improve community health status Leverage a multidisciplinary team to tackle previously intractable issues that drive health disparities Create opportunities for community engagement in developing a healthier Upstate 21 7

8 THE JOURNEY TO A HIGH PERFORMANCE MEDICAL GROUP Graphic: HCAB 22 WHAT IS THE UMG BOARD?» Decision-making body for University Medical Group; Governance is through GHS Board of Trustees» Comprised of all 11 department chairs, Executive Vice President Clinical and Academic Services, Vice President and President of GHS Clinical University, VP Clinical Integration/CMO, UMG Chief Administrative Officer, Executive Vice President and COO of GHS» Activities are informed by a set of Guiding Principles and bylaws developed by the members 23 UMG COMMITTEES: STRATEGIC AND POLICY ORIENTED» Executive Committee Policies and procedures; bylaws Agendas and priorities Leadership development and succession planning ; nominations» Finance Committee Operating budget Capital Reimbursement and revenue cycle Alternative payment; pay for performance» Provider Workforce and Compensation Committee Manpower planning Compensation models and standards Physician services contracting» Information Technology and Data Information systems Data flow and integrity» Academic Affairs Academic Council» Medical Staff Affairs - MEC» Clinical Operations Practice operations Administrative Structure Quality Human resources» Commitment to Excellence Employee and patient satisfaction Patient experience Communication strategies and mechanisms» Clinical Practice and Value Based Health Care Evidence-based care Professional standards and conduct Value based health care» Market and Business Development Clinical priorities, marketing priorities Network development/expansion Regionalization and affiliations Growth New business and product development 24 8

9 WHAT THE UMG BOARD IS NOT» The Board will NOT run the departments» The individual Chairs will retain responsibility for: Implementing policy and strategy decisions within their own departments Conducting professional practice evaluations for physicians Serving as clinical role model and leader of the department and promoting teamwork both within a department and between/among other departments Ensuring quality Focusing attention on physician recruitment and retention Promoting research, academics and education within their own department» System will invest in UMG and Departmental support structures to ensure success Vice Chairs, Division Chiefs, Medical Directors, Academic Support, Administrative support, etc. 25 COMPENSATION PLAN ARTICULATION (JUNE SEPT 2012) This was one of the outcomes of Chairs Leadership Integration GHS Strategy - how does changing physician compensation plans impact strategy Recognized that healthcare landscape was changing Needed to have closer coordination of System and physician goals Had 25 variations of legacy compensation plans which incented different behaviors UMG BOD formed Work Force and Compensation Committee 3 year term Very large Committee - 20 members Department representatives, administrative leaders Had non-employed specialties(ed/ Anesthesiology/Pathology) also, as effort toward System Integration No Department Chairs other than Chair of Committee Compensation Consultant provided expertise, insight and guidance throughout the Compensation Planning process 26 COMPENSATION PLAN ARTICULATION (JUNE SEPT 2012) The formal charge of the Compensation Committee with regard to Physician Compensation was: Create guiding principles for compensation models that advance GHS strategies, priorities, vision and mission Inventory all compensation models within each department, evaluate effectiveness and alignment with guiding principles, and develop approved UMGwide compensation models with implementation plan and timeline Key role was to recommend to Chairs as UMG Board for approval 27 9

10 WORK FORCE AND COMPENSATION COMMITTEE (SEPT 2012 MAY 2013) Twice a month 2 hour meetings with 1 day Retreat near end (17 total meetings). Basic education for members on plan design principles and legal environment All Department Chairs/Directors prepared and presented their existing plans in a standardized format (2 months) Presentations by internal content experts on payer relationships, GHS strategies and network development, and medical education funding associated with Physician Compensation Developed Principles and Behaviors to be incented through a compensation plan Developed initially 4, and ultimately 2, compensation plan templates that were used by each department/division to craft specific plans 28 WORK FORCE AND COMPENSATION COMMITTEE (SEPT 2012 MAY 2013) Leadership updates and connections/how and why they worked Schedule was developed and followed Committee Chair (Chair of Psychiatry) reported regularly to UMG Board Key recommendations approved as developed rather than whole plan as package Larger physician leadership group of approximately 100 physicians had 3-4 special meetings with inside and outside presenters to keep information flowingno surprises GHS management provided updates to GHS Governance Committee the board committee responsible for compensation oversight 29 SHARED PRINCIPLES AND BEHAVIORS TO INCENT Committee developed and the UMG Board approved the following Compensation Plan Design Principles: Overall Goal Attract and retain quality physicians Align compensation with services delivered Aligns with system direction, goals and performance Integration and Alignment Recognizes individual and group performance Rewards activities in academics, quality, growth, and outcomes Promotes integration and cooperation across departments and medical specialties 30 10

11 SHARED PRINCIPLES AND BEHAVIORS TO INCENT Committee developed and the UMG Board approved the following Compensation Plan Design Principles: Structure and Application Easy to administer, understandable, and manageable number of plans Fair market value and commercially reasonable Plan changes have adequate time for transition Economics Financially sustainable Internally equitable and externally competitive Sensitive to changing reimbursement and payment landscape 31 SHARED PRINCIPLES AND BEHAVIORS TO INCENT From the Principles and an understanding of GHS strategies, the following behaviors were identified that the new compensation plans should incent: Higher Priority Behaviors to Incent Physician Productivity Work RVU Physician Productivity Access Revenue Cycle Support (chart completing, coding, etc.) Group Based Outcomes/Quality Group Based Clinical Cost Effectiveness Practice Operational Performance/Budget Management Other Behaviors to Incent Patient and Employee Satisfaction Academic and Research Contributions Division/Department Participation 32 COMPENSATION MODEL TEMPLATES Phase A Committee formed 4 subgroups to consider plan designs unique to each of 4 specialty-based groupings Primary Care Model (Internal Medicine, Family Medicine, Pediatrics, OB/GYN) Hospital-Based Specialty Care with Ongoing Program Support Model (Hospitalists, Inpatient Psychiatry, Radiologists, MD360 Physicians, Psychiatrists, Pediatric Sub Specialists) Hospital- Integrated Specialty Care Model (Cardiology, Surgery, Pulmonary) Specialty - Outpatient Based Model (Dermatology, Allergy, Rheumatology) Three items became apparent as the 4 Plans were developed Particular physician practices may not fit into the model plan initially conceived for the specialty grouping Need to assure that compensation was aligned with system initiatives and having upside potential be based on maximizing same behavior types across all plans Desire to accommodate different specialty physicians/groups = resulted in more complexity than originally intended 33 11

12 COMPENSATION MODEL TEMPLATES Therefore, Committee determined that 2 plans were appropriate one based on a salary model and one based on a productivity model Was important to seek simplicity for ease of use going forward Also determined that wrvus were preferred productivity measure until such time as population health contracts became a material part of any UMG practice Further determined that relative weighing on various activities needed to be established annually by the department and potentially at the group/practice level as well Ranges were established which may vary across and within departments» Example: difference in practice and system needs for IM physicians practicing in a community setting versus IM physicians more closely aligned with teaching, or which takes a lead in risk based contracting Flexibility provided to departments to develop detailed plans unique to circumstances using the 2 plan templates To achieve consistency across departments, a Compensation Management Committee was also established to oversee ongoing development/application 34 COMPENSATION MODEL TEMPLATES Model Plan A Individual/Group Productivity Based Earned Income (70%-95% of total clinical compensation) System Initiatives (30% - 5% of total clinical compensation) Pool for Upside Potential (up to 10% extra for, first, hitting two affordability triggers and then, maximizing system initiatives and/or shared savings distributions under health plans) Non-Clinical Base Salary (for teaching, medical directorships, administration) Total compensation will comply with relevant federal laws and regulations Model Plan B Base Salary from Historic wrvu or other Appropriate Measure (80%-90% of total clinical compensation) System Initiatives (20% - 10% of total clinical compensation) Pool for Upside Potential (up to 10% extra for, first, hitting two affordability triggers and then, each group decides how to divide their portion of pool) Non-Clinical Base Salary (for teaching, medical directorships, administration) Total compensation will comply with relevant federal laws and regulations 35 MODEL PLAN A (DESIGNED AND ADMINISTERED IN COMPLIANCE WITH RELEVANT LAWS AND REGULATIONS ) Individual/Group System Initiatives Pool for Upside Potential Non-Clinical Based Salary Productivity Based (if applicable) Earned Income 70% - 95% 30% - 5% +10% Will Vary $ per wrvu earned pool with quarterly reconciliation; potential other measures of productivity such as panel size for medical home Revenue Cycle Support with coding and charge capture standards and consistency Each group decides how to divide production based pool Adjust $ per wrvu annually (methodologies could include historic collections wrvu; third party benchmarks; others) Based at Practice Unit Level Separate payments for specific initiatives established at the beginning of each year, such as: 1) Quality 2) Patient Satisfaction 3) Achieving Budget at Practice or Group Level 4) Access improvement at practice/unit level 5) Others as established at the department Examples of measures include: CMS All Care Measures, Containment Initiatives, CGCAPS, HCAPS, use of appropriateness and Evidence-Based criterim for care. Annual System Quality Initiatives or System Clinical Cost Containment Initiatives Shared savings which offset utilization losses in $ wrvu Productivity would be incorporated into this pool This column is payable only if the following two triggers are met: 1. Only payable if payment of aggregate earned Pools for Upside Potential by UMG would not result in a system operating margin of less than an amount to be established by the GHS Board of Trustees and 1. Group meets system stretch goal metric Can earn up to 10% based on maximizing system initiatives and/or shared saving distributions under health plans. Each group decides how to divide pool Examples include maximizing access improvement goal established as a system initiative Other potential stretch goals could include group/umg budget performance or patient medical home financial performance Offset base % for teaching, administration or medical directorships Use of faculty portfolio as work standard and update annually Administrative $ paid per agreement with specified duties Medical Director $ paid per agreement with specified duties Notes: Primary goals of this model are to incent productivity, access and system alignment. Goals in System Initiatives should be set so they are reasonably attainable in a given year. Upside potential goals should be stretch goals awarded for maximizing System Initiatives. Reset % allocations between buckets 1-4 at beginning of each subsequent year. In the initial year, it is contemplated that the total of columns 1, 2 and 4 will be cost neutral for UMG as a whole. Special payer arrangements may impact productivity in different specialties in different ways. Where those arrangements decrease productivity, offsetting savings would be recognized in the System Initiative and Upside Potential payments 36 12

13 MODEL PLAN B (DESIGNED AND ADMINISTERED IN COMPLIANCE WITH RELEVANT LAWS AND REGULATIONS) Base Salary from Historic wrvu or other Appropriate Measure System Initiatives Pool for Upside Potential Non-Clinical Based Salary (if applicable) 80% - 90% 20% 10% +10% Will Vary Use appropriate minimum work standard Based at Practice Unit Level This column is payable only if the Offset base % for teaching, to earn salary following two triggers are met: administration or medical directorships 1) Hours per year 1. Only payable if payment of aggregate earned Pools for 2) Shifts per year Upside Potential by UMG would 3) Panel size not result in a system operating 4) Other standards appropriate for margin of less than an amount to specialty be established by the GHS Standards set at Department level Board of Trustees and Group meets system 1. stretch goal metric Revenue Cycle Support with coding and Separate payments for specific Each group decides how to divide Pool Use of faculty portfolio as work charge capture standards and consistency initiatives established at the beginning for Upside Potential standard and update annually of each year, such as: 1) Quality 2) Patient Satisfaction Additional payment for excess shifts 3) Achieving Budget at Practice or Examples include maximizing access Administrative $ paid per agreement Group Level improvement goal established as a with specified duties 4) Access improvement at system initiative practice/unit level Other potential stretch goals could Medical Director $ paid per agreement 5) Others as established at the include group/umg budget performance with specified duties or patient medical home financial department performance Examples of measures include: CMS All Care Measures, CGCAPS, HCAPS, use of appropriateness and Evidence-Based criterim for care. Annual System Quality Initiatives or System Clinical Cost Containment Initiatives Notes: This model provides some stability to alary based on work standard performance. Secondary goals are to provide Department Chair with ability to align system goals. Reset % allocation between buckets 1-4 at beginning of each subsequent year. In the initial year, it is contemplated that the total of columns 1, 2 and 4 will be cost neutral for UMG as a whole 37 COMPENSATION PLAN PROVISIONS Common characteristics for model plans for all groups: Each has a component based on Practice unit quality and cost effectiveness, which is annually earned based on specific targets set for each Practice Percentages of total compensation earned in each of the four buckets are expected to be modified annually to align with GHS goals and external market The 4 th bucket (Individual Non-Clinical Based Salary) is for compensation associated with teaching, medical directorships, medical administration and research. Specific accountabilities will be established for each physician who earns compensation for these activities. Productivity and incentive earned pools can be divided among physicians based on pre-approved distribution methodologies. 38 COMPENSATION PLAN PROVISIONS Compensation per wrvu to compensate for productivity is preferred method, being mindful that Individual productivity based compensation based directly on compensation per wrvu is OK, but UMG would prefer the creation of a group/practice pool from which $ are distributed to participating physicians Compensation per wrvu rate should be evaluated annually A UMG-wide set of measures for physician revenue cycle performance will be used Budget estimates of productivity will be used to set salary draws with quarterly reconciliations to actual productivity 39 13

14 MID-LEVEL PROVIDER INTEGRATION» Effective use of mid-level providers is important to providing cost effective patient care» Incentives will be provided to physicians to use mid-level providers 40 KEY ISSUES FOR IMPLEMENTATION (JULY 2013 TO PRESENT) Development of a detailed compensation plan in one of 2 models at practice/subspecialty level which translates existing compensation model to new plan Attempting to be both budget neutral and also not create big winners or losers at the individual physician level In parallel, doing testing for reasonableness and other compliance issues prior to final review and implementation Development of System Initiative Quality metrics and associated compensation components 41 CONVERT PLANNING INTO ACTIONS Roll out and communication with Department Administrative Directors and Financial Analysts Series of Departmental Meetings with Consultants assistance Template Excel Models of Plan A and B developed with Consultants assistance for use in detailed plan development (see examples starting next page) Plan decisions including proposed Compensation per work RVU done at department and division and physician levels System Initiative dollars identified, with specific criteria to be developed Ongoing internal assistance meetings from UMG Finance and Consultants Periodic meetings to monitor progress Reconciliation of submitted/proposed new compensation plans using two Models Draft plans at Division/physician level were reviewed both internally by UMG Finance and by Consultants Consultants did reasonableness testing and provided results to UMG Finance for selective further review 42 14

15 REAL EXAMPLE, PRACTICE COMP PLAN INPUTS, PAGE 1/ REAL EXAMPLE, PRACTICE COMP PLAN INPUTS, PAGE 2/ DETAILED DESCRIPTION, PRACTICE COMP PLAN INPUTS, PAGE 1/

16 DETAILED DESCRIPTION, PRACTICE COMP PLAN INPUTS, PAGE 2/ CONVERT PLANNING INTO ACTIONS Development by a separate physician led process of System Initiatives with metrics and integration with electronic medical record based measurement processes Communication and updating new compensation plans at division levels conducted by Chairs/Administrative Directors Shadow period status/results Originally hoped to run old and new plans in parallel after fully developed for 3 or more months Some Departments had either less change to deal with or more capacity to make changes. As a result, some have moved into parallel/shadow testing. Some have determined that the changes are minimal enough that no parallel/shadow testing is necessary. Official effective date(s) October 1, 2014 with renewal of physician contracts 47 LESSONS LEARNED Though a large Committee can be unwieldy, buy-in is better with a broad crosssection of physicians represented Changing compensation plans is a very detailed time consuming process. The dual goals of being budget neutral and not trying to harm existing physician compensation developed in a totally different plan can be very difficult to achieve. It is hard to have exact plans replicated across Departments in a large organization. Allowances were made to have Department-specific measures and incentives. Being purposeful and deliberate on creating and implementing a transparent and inclusive process paid huge dividends. Consistency and Commitment of UMG and System Leadership to working together to achieve changes vitally important to the Organization s future success was most important

17 QUESTIONS / ANSWERS 49 NAVIGANT/GHS/UMG TEAM Thank you!! Rick Cameron Managing Director, Navigant Healthcare [email protected] Malcolm Isley Vice President, Physician and Strategic Services, Greenville Health System [email protected] Shon Brink Executive Director, Finance and Business Operations, GHS University Medical Group [email protected] APPENDIX 51 17

18 UMG GUIDING PRINCIPLES» Is committed to creating a high performing, patient-centered, multispecialty medical practice focused on optimizing patient access, enhancing health care value and improving regional health status» Is responsive to the healthcare needs of its individual patients and the entire region served, recognizing the imperative to balance needs and resources» Is committed to leading the transformation of health care within a diverse, dynamic environment, which will require embracing change» Is committed to providing the best health care through inter-professional teams with strong patient engagement» Is committed to continuous improvement, innovation, professionalism, strategic growth, and increasing the value of health care 52 UMG GUIDING PRINCIPLES» Realizes that the individual departments within the group are of significant importance, but none rise above the interests of the entire group and the health system» Is committed to seeking mutually beneficial solutions when conducting its operations; striving to authentically engage all potential stakeholders» Is committed to medical education that advances the clinical enterprise, contributes to growth, improves the quality of care, and positions GHS as an integrated academic health system» Is committed to the success of the health system 53 18