Covenant Health Partners

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Covenant Health Partners
Hospitals and Physicians partnering together in
a clinically integrated model to improve quality
care, patient safety, patient satisfaction, and
economic outcomes

• Lee Memorial Health System
• Physicians and Administrative Team
• September 16th, 2008

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Today's Discussion

• Covenant Health System Background
• Definition of Clinical Integration
• Introduction to Covenant Health Partners
• Success

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Covenant Health System

• Member of St. Joseph Health System of Orange
  County
• Largest tertiary hospital between Dallas and Los
  Angeles(1498 licensed beds)
• 55,000 square mile market place
• 14 Regional Hospitals
• Aligned Physician Group
• Level II Trauma Center
• Neuroscience Institute
• Joe Arrington Cancer Center
• Covenant Pediatric Hospital
• 52 market share
• 2.8 Billion in Gross Revenue
• 1.8 Billion in Net Revenue

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2003 Physician Environment

• Hospital moving forward from merger activities
• Hospital has large aligned Medical Group of
• 200 Physicians
• Independent Physicians formed IPA
• Lack of trust with the hospital
• Fear of hospital market strength
• Failing reimbursement
• Fight for ancillaries

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2005 Market Conditions

• Physician exodus from certain patient populations
• Increased hospital risk on payment for outcomes
• Increased competition from University Medical
  Center
• Falling revenue stream
• Blue Cross is dominant commercial carrier
• Split medical staff
• Physician owned heart hospital
• Physician owned surgical center
• Low patient satisfaction scores
• Low employee satisfaction scores
• Average physician satisfaction scores
  (Administration)
• Poor quality outcomes
• New administrative leadership

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Covenant Health System Opportunities

• Re-engage medical staff
• Build an environment of trust
• Improve quality outcomes
• Improve patient satisfaction
• Enhance profitability

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CHP and CovenantBuilding a Foundation for Change

• Covenant Health System Goals
• Its all about the patient
• Perfect care
• Healthiest communities
• Sacred encounters
• Improved financial performance

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Hospital-Physician Roadblock

• Hospitals
• Reimbursed on a DRG methodology
• - case rate
• Physician
• Reimbursed under CPT methodology
• - daily rate
• - Procedure rate
• Methodologies do not align financial factors

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• Physicians always want to do the right thing

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• Clinical Integration gives physicians a financial
  stake to do the efficient thing

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• Clinical Integration demonstrates to the
  community our quality rather than expecting the
  community to assume our outcomes
• -Scott Robins, MD
• Covenant Health Partners
  Chief Medical Officer

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Plan for Success

• Create a structured collaboration among Covenant
  Health System and its medical staff on an active
  and ongoing program designed to improve the
  quality and efficiency of health care by
  developing a clinically integrated partnership.

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Clinical Integration is defined as
... an active and ongoing program to evaluate
and modify practice patterns by the network's
physician participants and create a high degree
of interdependence and cooperation among the
physicians to control costs and ensure quality .
. .
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What are the Characteristics of Clinical
Integration?

• Benchmark quality indicators
• Collaboratively work together (physicians and
  hospital) to improve care
• Improve patient outcomes, satisfaction, safety
  and reduce costs

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Current Successful CI Programs

• Covenant Health Partners
• Brown Toland Medical Group
• Advocate Physician Partners
• Greater Rochester IPA
• Memorial Hermann HNP
• MedSouth Healthcare

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Why Needed?

• Escalating Health Care Costs
• Healthcare premiums have increased on average 15
  since 1996 while incomes have only increased 4.8
  on average
• By 2016 health care spending will consume 20 of
  the GDP
• In the 2008 elections 52 of voters were in favor
  of some form of national health care
• Employers are demanding more value in the health
  care dollar

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Government Perspective Toward Clinical
Integration and Pay for Performance Partnerships

• It is time that we pay for the quality of the
  health care provided to our beneficiaries, not
  simply the amount. We are working to apply this
  in every setting in which Medicare and Medicaid
  pays for care.
• -Mark B. McClellan
  MD,PHD
• Former CMS
  Administrator

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Business Perspective on Health Care Efficiency

• Cost efficiency should be measured using the
  cost of the episode of care, not the discount
  rate from a fee schedule for providers
• -Randall Johnson,
• Citizens Health Care Commission

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Why should hospitals and physicians approach
clinical integration together

• Networks of independent physicians that are
  affiliated with hospitals or health systems enjoy
  a distinct advantage in the development of CI
• Existing hospital QI and patient safety
  initiatives
• Established medical management activities
• Hospital investments in advanced clinical
  technologies and information systems
• The presence of such infrastructure greatly
  accelerates the implementation of a comprehensive
  CI program
• CI activities entail reorientation and
  realignment between the hospital and its medical
  staff.

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CHP Mission Statement

• Covenant Health Partners is committed to
  providing quality and cost effective health care
  with improved patient outcomes to the medical
  consumers we serve.

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Covenant Health Partners 300 members

• Physician-governed subsidiary of Covenant Health
  System
• Texas 5.01(a) Medical Corporation Bylaws
  mandate Clinical Integration
• Physician membership open to any physician on the
  active medical staff who
• (1) meets credentialing criteria
• (2) is willing to engage in Clinical Integration
• (3) will hold self accountable to colleagues for
  performance
• Covenant has substantial reserve powers to
• (1) protect hospital non-profit, tax exempt
  status and
• (2) make sure physicians perform Clinically
  Integrated measures which improve patient safety
  care as well as use resources efficiently.

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Covenant Health Partners Organization Chart
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CHP Clinical Integration Infrastructure

• Physician Leadership
• Board of Directors (15)
• Committee Members (47)
• Support Staff
• Melinda Clark, RN - Strategic Vision
• Brett Esrock Hospital Services
• Bill Bopp Chief Executive Officer
• Scott Robins, MD Chief Medical Officer
• Felicia Gordon, RN Performance Improvement
• Michael Camacho Performance Improvement
• Dana Stokes Performance Improvement
• Pat Wheeler Physician Relations
• Jim Reid Technology Support
• Josh Pia Website Maintenance
• Cheryl Hayden Finance
• Shannon Dwyer Legal

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Clinical Integration Initiatives

• 11 Categories, with 86 QPMs
• Administrative Efficiency (7)
• Technology
• High speed Internet connection
• Valid e-mail address
• PHO Web portal usage 1x/month
• Crimson Web portal usage 1x/month
• Education
• View clinical integration education video
• View Crimson CI software training video
• Annual CI roundtable meeting attendance

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Clinical Integration Initiatives Continued

• Hospital-based (37)
• Hospital Readmission (1)
• Evidence-Based Medicine (19)
• Severity-adjusted Indices (3)
• Cost Reduction (5)
• Patient Safety (4)
• Patient Satisfaction (5)
• Physician Office Practice (41)
• Preventative Care (2)
• Pregnancy Care (2)
• Cost Reduction (2)
• Physician Quality Reporting Initiative - PQRI
  (34)

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Clinical Integration InitiativesContinued

• Physician Quality Reporting Initiative - PQRI
  (34)
• Major depression (3)
• Diabetic Retinopathy(2)
• Diabetes Milletus (4)
• GERD (1)
• Hepatitis C (1)
• Asthma (2)
• Non-specific cancer(1)
• Breast cancer (2)
• Chronic Lumphocytic Leukemia CLL(1)
• Prostate cancer(4)
• Colon cancer(1)
• Coronary artery disease (3)
• Chronic obstructive pulmonary disease COPD(2)
• Chronic kidney disease (4)
• Upper respiratory infection (1)
• Pharyngitis (1)
• Acute Otitis Exterma (1)

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Where Are We Going?

• Focus on Best Care
• Improved efficiencies
• Full continuum of care office to inpatient care
• Develop sustainability of health care in our
  market
• Its our mission
• Create an interdependent physician network that
  collaborates with the hospital to change care
  delivery
• Create direct relationships with Buyers of
  Healthcare

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Value for Physicians

• Better Alignment with the Hospital
• Economic support for startup costs and
  infrastructure development
• Provide vast inpatient and outpatient database
• Integrated entity has presence in the
  marketplace through added value to the medical
  consumer
• Incentives compensate for additional work
  through the ability to share in cost savings
• Focus is on documented physician driven
  improved clinical outcomes
• Inability for non CHP physicians to pool
  clinical resources to improve performance
• Shared cost for technology and
  infrastructure
• Learning how to practice under the P4P model
  that CMS is planning to implement

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Value for Hospitals

• Creates a business partnership with key
  physicians
• Focuses physicians on hospital quality goals
• Strengthens trust and loyalty

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Value for Buyers of Healthcare

• Complete network of providers committed to
  patient satisfaction, safety and quality
• Transparent outcomes
• Physicians using quality data to improve
  financial performance
• Direct relationship with providers of healthcare

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First Care Health Plan
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HealthSpring
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Covenant Health System
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Covenant Health System
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Accelerating Performance through Sharing of
Exemplary Practices

• Identify CHP physicians who demonstrate effective
  practices in implementing Clinical Integration
• Solicit input from them on practices they have
  adopted which drive performance
• Conduct presentation of exemplary practice
  session as part of Roundtables for physicians
• Share exemplary practices with others through
  presentations, discussions, and feedback

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Current Successes(Past 12 months)

• 300 Partners and growing
• 15 Board Members-Physicians
• 47 Committee Members-Physicians
• Covenant Health System has been awarded as one of
  the Top 100 Best Places to Work in Health Care
  by Modern Healthcare Magazine.
• (September 2008)

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Current Successes(Past 12 months) continued

• 86 Quality Improvement Measures
• 5,000,000 in Performance Pool
• 15,000,000 in Hospital Savings
• 88 Positive Patient Satisfaction Response
• 2008 Gallup Employee Satisfaction Survey
• top quartile in the nation
• Physician Satisfaction
• PRC Top National achievement award
• 73 Administration Satisfaction
• LOS Improvement (Medicare/Commercial) 1.1 days
  average reduction April
• GMLOS Improvement (Medicare/Commercial) 0.7 day
  increase
• Surgical Start Time Improvement (74-92)
• Weekly avoidable days have decreased (263 to 80
  in 3 months)
• Foley catheter prevalence decreased from 33 to
  20

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Lessons Learned From Established Programs

• Physician and hospital leaders draw similar
  conclusions given the same data
• Physicians are willing to make changes if they
  understand the reasons
• The need for trust and understanding prior to
  major change
• Physicians value control
• Outstanding results and/or increased savings
  overcomes the need for control

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Discharged Patients Coded TSI Update
5 WEEK STUDY Start
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