Engaging Physicians in the Transition from the Volume to Value-based Care Model

1. Engaging Physicians in the Transition from the Volume to Value-based Care Model Lani Berman VHA Vice President Performance Services Richard D. Parker, MD Professor of Surgery, CCLCMChairman, Department of Orthopaedic SurgeryOrthopaedic Rheumatologic InstituteCleveland Clinic Foundation

2. Disclosures • Lani Berman, MBA, MPH, VP, VHA has nothing to disclose • I, Richard D. Parker, MD have relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation as follows:  • Smith & Nephew: Consultant/Education • Zimmer: Consultant/Royalties • Cleveland Clinic: Chairman, Orthopaedics

3. About VHA • Member-based, national network of 5,100 not-for-profit health systems and affiliates—representing both traditional acute-care hospitals and a diverse mix of providers that operate as extensions of the health system • Help hospitals reduce costs through group purchasing contracting across their hospital or health system • Highly focused on clinical improvement and Member collaboration • Leader in consulting in the areas of clinical, operational, supply chain and financial performance for health systems

4. About Cleveland Clinic 4 • Became a hospital system in 1990s • Mantra is “Patients First” • “To Act as a Unit” and “All for One” • Physician-led • Culture of leadership • 60% employed physicians and 40% private practice physicians • Physician employment contract is for one year • Annual Professional Review • Each Staff has a different “formula” • Patient Care – Research - Education • Salary is adjusted each year

5. Cleveland Clinic Foundation: Department of Orthopaedics 5 Ranked #3 for Orthopaedics by U.S. News & World Report magazine

6. CCF Department of Orthopaedics: Patient Care/Research/Education 6 • Two Orthopaedic Residencies • Allopathic • Osteopathic • One Podiatry Residency • Eight Clinical Fellowships • Hand/UE • Adult Reconstruction • Sports & Exercise Medicine • Sports Ortho • Spine Ortho/NS • Pediatric Ortho • Foot/Ankle • Shoulder • Research Fellows • CCLCM (32 Medical Students/year)

7. Orthopaedic Locations“More than Main Campus” 24 Locations in Northeast Ohio CCF Florida CCF Canada

8. Reality of Being An Orthopaedist: “It doesn’t suck to be us!” 8 We improve quality of life We provide “Episodic Care” Baby Boomers Orthopaedics is fun! Innovation We make a great living

9. Bridging the Divide Between Physician Alignment and Clinical Integration

10. The New Era of Health Care

11. Three Areas of Critical Focus for Health Systems During Transition to Value Based Care Model Optimize cost and quality to remain competitive in current acute care model Engage and align physicians to new value-based care model Assess and stage the transformation to integrated care across the continuum

12. Equation for a Value-Based Model Quality (Outcomes) Value = Cost We are here Physicians Where we need to be Cost Quality (Outcomes) 12

13. How Will Physicians be Valued in the Equation? Quality (Outcomes) Value = Engagement x Cost 13

14. Components of Physician Engagement 14 Track Outcomes (OrthoMiDas) Cost Effective (Care Path) Appropriateness of Care Comparative Effectiveness Professionalism Efficiency Skill Lifelong Learner Malleable (Cooperation) Participation Leadership

15. Components of Physician Alignment 15 • Communication • Financial ROI • Dashboards (SSI, SCIP, HCAPS, etc.) • EMR/Outcomes (OrthoMiDas) • Care Path (TKRA and THRA) • Physician meetings with Supply Chain • EMB driven • PPI (Physician Preference Items) • Quality & Patient Focus • Transparency (COI) • Vetted • Examples: (Total joint/Spine/Trauma/Bone Graft) • RFP (ACT AS A UNIT) with Vendors

16. Summary: Achieving Physician Engagement and Alignment Requires… CULTURE OF FAIRNESS LEADERSHIP Sharedgoals Ongoingeducation Transparentdata sharing Adaptability Opencommunication

17. Contact Lani Berman (lberman@vha.com) or Dr. Richard Parker (pparkerr@ccf.com) for more information