Quality and Efficiency of Care Improved with Analytics and Workflow Redesign

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1 Quality and Efficiency of Care Improved with Analytics and Workflow Redesign London Health and Care Leaders Forum June 2, 2015 Simeon Schwartz, MD CEO, WESTMED Medical Group, P.C.

2 WESTMED Medical Group Established in 1996 by 16 physicians 300 physicians caring for more than 250,000 primary care patients More than 40 specialties 5 polyclinics: 80-90,000 sq feet IT and shared EMR

3 WESTMED Practice Partners MSO providing turnkey physician practice management and development Centralized administrative and clerical services for quality and efficiency industrialization of medicine Mature EMR and Practice Management IT platform Process control system Population management and clinical cost control An agile development process for rapid design and implementation of workflow and analytics

4 WESTMED S Polyclinic Model doctors, both primary care and 20+ specialties 7 days per week, advanced, extended-hour urgent care Imaging including MRI, CT and PET Ambulatory surgical services Laboratory services Common IT platform

5 WESTMED S Culture Quality High percentile for both commercial and Medicare Level 3 PCMH Efficiency 20% fewer employees Physician overhead 12% below AMGA median ACO with successful cost control Service 85th to 90th percentile MDs Service excellence program

6 Medicare Cost Trends by Quarter $10,500 Expenditures per Beneficiary $10,000 $9,500 $9,000 $8,500 Legend MSSP FFS WMG $8, Qtr Qtr Qtr Qtr Qtr Qtr Qtr 4

7 Medicare Shared Savings Program ACO Utilization Rates (Per 1,000 person years) Baseline WESTMED All MSSP ACOs % Difference Hospitalizations % Emergency Room Visits % SNF Discharges n/a n/a %

8 Medicare ACO Quality Metrics Measure WESTMED All MSSP ACOs 2013 Median th %ile Pneumococcal Vaccination 75.9% 79.8% 55.7% 81.6% Mammography Screening 74.8% 81.5% 63.8% 77.7% Colorectal Cancer Screening 77.3% 78.0% 60.5% 77.5% Diabetes Composite (A1c, LDL, BP, tobacco, ASA) 43.9% 49.6% 24.3% 38.1%% Hypertension BP Control 68.4% 75.3% 68.7% 78.8%% Screening for Fall Risk 41.1% 50.6% 37.4% 72.7%

9 WESTMED United Oxford ACO: Quality Summary Conditions / Procedures / Q3 Annual monitoring for patients on persistent medication 89.9% 90.5% Breast cancer screening 82.9% 83.9% Cervical cancer screening 89.7% 92.1% Chlamydia screening 72.3% 72.0% Colorectal cancer screening 70.4% 71.0% Comprehensive diabetes care HbA1c testing 85.0% 92.7% Comprehensive diabetes care nephropathy screening 85.4% 84.8% Diabetic eye care 57.7% 58.7%

10 There is no secret sauce INGREDIENTS 1. Culture 2. Analytics 3. Workflow 4. Accountability

11 Culture Care and compassion Empathy, active listening and body language Transformation readiness You don t understand Community jobs program Waste is someone's profit Willingness to challenge sacred cows Sinai experience Value and reward innovation Lean thinking with agile process Hundreds or thousands of small wins Avoid large scale initiatives

12 WESTMED Success Factor Analytically driven health care transformation We do not tell providers what to do we show them what they do

13 Clinical Analytics Dashboards provide feedback to providers and nurses Process Control are we closing the loop? Periodic Reports show if we are reaching our goals Claims Analytics help with risk scoring and out-of-network costs Customized EMR Templates provide actionability at the point of care CRM automated processes decrease staff time

14 Why process control? The WESTMED Way Process control systems have been successful in manufacturing (Toyota Way) Cost control strategies and quality improvement are very complex to implement WESTMED has over 2,600 processes and procedures some with hundreds of steps Activating data from analytical systems including business, clinical and claims management, requires process control Accountability is essential for health care transformation

15 Redesign Strategies Shift clinical tasks from MD to nurses Streamline workflows enhance patient care Close gaps of care Increase patient satisfaction Reduce unwanted testing Maximize the scope of nurses licenses Dashboard analytics to track clinical staff performance

16 Internal Medicine Clinical Staff Task Manager

17 120.0% Percentage / Mammogram % Mammogram 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% MA 1 LPN 2 LPN 3 LPN 4 LPN 5 MA2 LPN6 MA3 MA4 LPN7 LPN8 MA4 LPN9 LPN10 LPN11 LPN12 LPN13 LPN14 LPN15 LPN16

18 IM LPN Dashboard 70% 60% 50% 40% 30% 20% Feb Mar Apr May June July 10% 0% Mammo Pneumovax HIV Hep C

19 OB/GYN Nursing CTM Form

20 OB/GYN LPN Dashboard 100% 90% 80% 70% 60% 50% 40% 30% Feb Mar Apr May June July 20% 10% 0% Mammo Chlamydia HIV Hep C

21 Ambulatory Pathways Empowered by Ontologies Disease-specific clinical decision guidance Standardization of care processes across multi-specialty Process management tool to improve patient healthcare Best practice to capture the foreseeable actions

22 Ambulatory Pathway Template

23 Cellulitis Pathway

24 Back Pain Pathway

25 90% Hypertension Control and Pathway Utilization 80% 77% 78% 78% 79% 79% 80% 81% 81% 70% 60% 62% 65% 67% 68% 67% 68% 50% 40% 42% 49% JNC HTN Control HTN Pathway 30% Sept 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Apr 2015

26 Mammography Same day mammogram routinely available Results of mammogram communicated to patient at the time of visit Additional studies needed to evaluate abnormality done at time of visit Patients with abnormal mammogram offered same day breast surgery appointments All biopsy modalities offered same day Preliminary pathological results by noon next day

27 Transition of Care Follow Up for Hospital Discharges 100% FOLLOW UP VISIT MED REC NURSE NOTE 92% 89% 90% 87% 80% 60% 73% 68% 81% 68% 55% 74% 75% 57% 60% 67% 60% 40% 20% Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015

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30 SUMMARY: The WESTMED Way Transition from a guild to an industrial model Analytically driven transformation Economies of scale and scope Process control Measured accountability Patient centered culture committed to quality, cost and service