Making Better Healthcare Happen in the San Francisco Bay Area

Making Better Healthcare Happen in the San Francisco Bay Area

Brown & Toland s strength lies in the dynamic points of connection between our network physicians, our patients and our wider Bay Area community. Our mission is to coordinate and enhance these points of connection across our network, thereby helping our physicians to collaborate, share clinical information, run successful practices and deliver exceptional patient care. Who We Are Brown & Toland Physicians is a community of approximately 1,500 doctors and hundreds of healthcare professionals who share a single vision: to support our doctors in delivering the best possible care to their patients. Our Roots In 1992, Brown & Toland Physicians was founded on the belief that a coordinated network of independent physician practices could make a positive impact on the health of the Bay Area. In 2011, Alta Bates Medical Group became part of Brown & Toland Physicians, making us one of the premier associations of independent physician practices in California. This partnership allows us to provide exceptional healthcare to hundreds of thousands of people across San Francisco, the East Bay, Marin and the Peninsula. Our name and our work are inspired by the legacy of two nineteenth century San Francisco healthcare pioneers: Dr. Charlotte Amanda Blake Brown, who founded Children s Hospital in San Francisco, which later became California Pacific Medical Center; and Dr. Hugh Huger Toland, who established the Toland Medical College in 1864, which was transferred as a gift to the University of California in 1873. Guided by Dr. Brown s and Dr. Toland s pursuit of innovation and their commitment to the health of our community, our story includes many of its own history-making achievements: We were one of the first medical groups in the nation to deploy integrated electronic health records (EHRs) in a private practice setting. We are a Medicare Pioneer Accountable Care Organization (ACO) and leader in the development of ACOs across the Bay Area and nationally. Our patient-centered medical home My Health Medical Group was the first practice in San Francisco to earn the highest recognition (Level 3) from the National Committee for Quality Assurance. The California Association of Family Physicians named My Health Medical Group the 2013 Patient-Centered Medical Home practice of the year. Our Timeline California Pacific Medical Group is founded. PPO program launches. More than 500 physicians sign on. Electronic health record product is installed in first physician office. Close to 500 Brown & Toland physicians and staff are using the clinical results reporting component of the electronic health record. Brown & Toland launches accountable care projects for Cigna and Aetna PPO patients, and with Blue Shield and California Pacific Medical Center for City and County of San Francisco employees and retirees. Brown & Toland enters into partnerships with Blue Shield and Anthem Blue Cross to greatly expand its PPO and ACO line of business. As a part of Pioneer ACO program, Brown & Toland helps Medicare save $4.5 million. 1992 2001 2005 2009 1997 2011 2012 2014 2015 2013 Physicians from California Pacific Medical Center and the University of California San Francisco combine to form Brown & Toland Medical Group. Brown & Toland combines with Alta Bates Medical Group. The Group s 1,500 doctors care for approximately 135,000 HMO patients and 175,000 PPO patients. Brown & Toland is selected to be one of the 32 Pioneer Medicare accountable care organizations. My Health Medical Group receives level 3 NCQA recognition as a Patient-Centered Medical Home. Brown & Toland Health Services is launched, taking on facility-risk via a limited Knox-Keene license. 1 2

Our Patients At Brown & Toland Physicians we focus on the whole patient. Hundreds of thousands of residents throughout the Bay Area trust us with their care. Here are some of the reasons why: We are available in leading insurance networks. We work with the nation s leading health insurance companies, so you can get access to the doctors in our networks and all the services we offer when you enroll with one of our health plan partners. Brown & Toland and Alta Bates Medical Group physicians are available through many types of HMO, PPO, ACO, Medicare Advantage and Medi-Cal plans. We connect the Bay Area to leading doctors. When you have a Brown & Toland or Alta Bates Medical Group doctor, you have a doctor plus a whole team of healthcare experts here to help. In fact, we have more than 500 primary care physicians in our networks and approximately 1,000 physician specialists in San Francisco and the East Bay all collaborating to provide you with the best care possible. We help patients get the right care at the right time. Our Care Management team is a group of experts working behind the scenes with your doctors to make sure you get the tests, services and care you need. Coordinating care across our entire network for you always in the setting that is best for your health is the way we make care management work. We offer prevention programs to help you be your healthiest. Our resources include programs that help patients stay well, such as prenatal education, senior fitness and nutrition, as well as others. We support people who are living with a chronic condition. Our disease management programs for asthma, diabetes, HIV and patients with heart conditions focus on education, treatment and ongoing management all to provide coordinated care and make a complex health situation more manageable. We have answers. Our friendly customer service reps located right here in the Bay Area are resources to answer questions about our doctors and care services. We are your connection to finding a Brown & Toland or Alta Bates Medical Group physician and making the most of your healthcare. Investing in Our Employees In an environment of innovation, collaboration and mutual respect, Brown & Toland employees have the opportunity to learn new skills, build competencies and grow their careers. As a leader in accountable care programs and an early adopter of technology in the healthcare industry, Brown & Toland trains our employees to use leading-edge technologies to help our doctors provide their patients with great care. Brown & Toland is proud to have been recognized multiple times as a Best Place to Work in the San Francisco Bay Area. Patient and Caregiver Testimonials The company champions six core values: respect and teamwork; innovation; integrity; optimism; health; and being physician- and patient-focused. To live these core values, the company sponsors several employee committees such as: The Values Committee, which promotes, celebrates and maintains Brown & Toland s six core values through innovative tools, activities and practices. This committee identifies and organizes employee volunteer opportunities that make an impact on the community. The Live Well/Work Well Committee, which cultivates and promotes a health-focused work environment where employees have tools to sustain a healthy lifestyle. The Employee Recognition Committee, which hosts programs and supports a recognition culture by encouraging employees to recognize one another for their contributions. I am a high-risk patient, and my nurse care manager worked with me as a solid partner to get me on the road to recovery. Larry S., patient Brown & Toland really listened they did what was best for the patient, which was also cost-effective because it kept him out of the hospital. Christopher V., senior care advocate My wife has been seriously ill for the last eight months, and she s alive because of her Brown & Toland doctors. Tony N., patient s spouse 3 4

Accountable Care In today s healthcare environment, the key challenge for most healthcare organizations is how to reduce the cost of healthcare services for a population of patients while maintaining or even improving the quality of care those patients receive. Accountable care has emerged as a way to manage the total cost of care by compensating healthcare providers based on quality rather than quantity metrics. Under an accountable care model, a healthcare provider is evaluated and compensated not on the number of tests and procedures that are performed, but rather on his or her ability to help the patient get better. Brown & Toland has always been a champion of the accountable care model even before accountability was a buzzword in the healthcare industry. Patients with more complex and active medical problems merit higher levels of care coordination. Our programs are designed to assist patients who may have multiple chronic conditions. Proactive care management leads to improvement in patient health and allows the team to identify gaps in care. Our approach includes clinical integration through real-time connectivity. We apply predictive analytics, care coordination and a comprehensive set of care management programs to each population we manage. Brown & Toland s proprietary care management strategies are central to our success, especially in caring for Medicare Advantage members. Our innovative approach includes: Using technology to identify patient needs and provide enhanced care and support By joining with health plan and hospital partners, government organizations and employers to coordinate care and improve quality, Brown & Toland is helping to deliver more aligned, connected and cost-effective care. In turn, our doctors are able to deliver the right care in the right setting and improve clinical patient outcomes. Processes to identify gaps in care and to improve preventive screenings How We Manage Care Post-discharge calls for better transition of care and medication reconciliation that improves adherence and reduces readmissions Brown & Toland is leading the way forward with a proprietary set of care management strategies that can help enhance the patient experience, improve health outcomes and manage the total cost of care. Using population health management analytics, we identify and conduct outreach to specific populations of patients for instance, diabetics or patients with other types of chronic illness and match these individuals to different care management programs. Working with the patient s physicians, our team provides high-touch care and support where needed. 5 Access to After Hours Care, the Nurse Advice Line and home visits as alternatives to the emergency room Identification of patients admitted to hospitals and daily care management rounds with hospitalists Complex care management and chronic disease management, including outreach, individual care plans, caregiver support and high-touch care Good for Our Patients Good for Our Doctors Care management at Brown & Toland is unique in that we serve as a true extension of care, always working in close collaboration with our physicians, hospitals and other partners to connect patients to the right care at the right time. In doing so, we are achieving higher patient participation in preventive screenings and reducing hospital stays and readmissions, with the ultimate goal of improving health outcomes. The benefits of care management, and our ability to manage the total cost of care, are good for our doctors. When we manage the total cost of care, we are able to keep insurance products affordable to both employers and patients, which in turn keeps more patients in the Brown & Toland network. 6

Our Innovative Programs Brown & Toland has always embraced a spirit of innovation when it comes to the new programs we develop and support to meet the needs of both our patients and network physicians. To that end, Brown & Toland participates in numerous accountable care projects designed to improve patient care and reduce costs, and created My Health Medical Group a patient-centered medical home to make better healthcare happen in the Bay Area. Graph 1 BAY AREA MEDICARE AND MEDI-CAL POPULATION SAN FRANCISCO COUNTY 2013 ALAMEDA COUNTY 2013 71% Commercial/ ASO/Uninsured 71% Commercial/ ASO/Uninsured 2013 DR/Decision Resources, LLC. All rights reserved. Reproduction, distribution, transmission or publication is prohibited. Reprinted with permission. 29% Medicare and Medi-Cal 29% Medicare and Medi-Cal Medicare Advantage Every day for the next 18 years, roughly 8,000 American baby boomers will turn 65. For Brown & Toland, this huge demographic shift along with the increase in Medicare Advantage (MA) products it is spurring represents a tremendous opportunity. Through several initiatives, we are positioning the organization and our physicians proactively to reach this growing population, which is approaching close to one-third of the markets we serve (see Graph 1). Brown & Toland s contracted MA plans provide significant value to physicians and their patients who are eligible for Medicare. Many MA plans lower patients out-of-pocket costs and include additional benefits not covered by Medicare, such as prescription drug coverage, vision and dental. Brown & Toland provides additional resources, such as care management, to help physicians care for their patients who are covered by these plans. Brown & Toland also provides care management resources that include follow up on all in-patient admissions and complex case management. In 2013, Brown & Toland launched Brown & Toland Health Services (BTHS), and successfully enrolled almost 10,000 MA patients in the program by the start of 2015. Under its Knox-Keene license, BTHS assumes the risk not just for the care our physicians deliver to their patients, but for the total cost of care for that patient population. Our Care Management team provides the needed outreach and care management programs for these MA patients to ensure better health outcomes. My Health Medical Group Inspired by our patients to provide the best care possible, Brown & Toland established My Health Medical Group (MHMG) in San Francisco in 2012. Initially bringing together several physicians into a single shared practice, the doctors changed their practice styles to become a patient-centered medical home (PCMH) which, in recent years, has become a widely accepted model for organizing and delivering primary care. The value of the medical home is particularly noteworthy for its focus on personalized care, a team-based approach to care, and patients who need extra care and support. By analyzing data on all patients in the practice, MHMG focuses on quality, and on closing any quality gaps whether the patient is in an HMO, PPO or Medicare plan. The PCMH model provides the patient better access to care through an assigned care team of healthcare professionals who work together to coordinate their care. By improving access to primary care services, a personalized care approach and utilization of population health management tactics, MHMG has improved care coordination and achieved better patient outcomes. A Patient-centric Team Approach The PCMH model provides the patient an assigned care team of healthcare professionals who work together to coordinate their care including a physician, a nurse practitioner, social workers, medical assistants, data analysts and other office staff. MHMG patients also have access to on-site laboratory services, same-day appointments, extended hours and the ability to communicate securely with their physicians using an online patient portal. This collaborative approach to primary care has improved care coordination and achieved better patient outcomes. Furthermore, by providing high-touch care to patients with complex health situations, we have achieved a result of fewer visits to the emergency room, and less overall cost for medical care. In fact, patient costs have dropped 15% compared to other primary care physicians treating the same senior population. Industry Recognition My Health Medical Group has earned recognition from the National Committee for Quality Assurance (NCQA) as a Level 3 patient-centered medical home, and is the first practice in San Francisco to receive this honor. It is the highest recognition possible from NCQA, a nonprofit healthcare accreditation entity that validates practices as patient-centered medical homes using a rigorous set of national industry standards. In addition, MHMG was named a leading Patient- Centered Medical Home by the California Association of Family Physicians. 7 8

A Commitment to Community Giving Back Community is the heart of who we are and what we do at Brown & Toland. We are passionate about giving back and donating our time. Our community efforts focus on raising awareness about important health issues and on marshaling resources to help those in need. In this spirit, we have worked with both local and national organizations such as the San Francisco AIDS Foundation, San Francisco Hep B Free, HandsOn Bay Area and Meals on Wheels. Brown & Toland has had a decade-long corporate sponsorship with the American Heart Association (AHA) to promote awareness of the causes and signs of heart disease through the AHA s Go Red For Women campaign and annual Heart Walk. We sponsor the AHA s Lifestyle Change Award, which is presented to a person who has dramatically changed the quality of their life through diet and exercise. In addition, Brown & Toland also sponsors multiple community-based AHA events such as the Golf and Fitness Training for Stroke Survivors in Pleasanton, and the Power Cooking and Health Education event at the Beebe Memorial Church in Oakland, during which celebrity chefs demonstrate cooking healthy meals, while Brown & Toland nurses perform blood pressure testing, BMI screening and CPR training on how to recognize and respond to signs of a stroke. 9

Brown & Toland Physicians P.O. Box 640469 415.972.6000 San Francisco, CA 800.225.5637 941614-0469 brownandtoland.com About Brown & Toland Physicians Founded in 1992, Brown & Toland Physicians is a leading network of independent doctors focused on delivering personalized, high quality, and affordable healthcare to the San Francisco Bay Area. Brown & Toland s 1,500 physicians, who care for more than 300,000 HMO and PPO patients, are dedicated to improving care through a number of patient-centered programs and use electronic tools to coordinate and deliver care. Version 1.0 Copyright 2015 Brown & Toland Physicians