1. Physician Leadership Bud Chumbley, M.D., MBA President, Aspirus Clinics, Inc., System CCIO MGMA – October 2013

2. Aspirus, Inc. • Clinical Sites • Single tertiary care hospital and five Critical Access hospitals • 35 clinic sites

3. Aspirus, Inc. (cont.) • Total revenue - $700 million • Strong Balance Sheet • Structure • Federation of inpatient and post-acute care facilities • Large Board of Directors • Loosely integrated

4. Aspirus, Inc. (cont.) • Clinic Culture • 260 employed physicians and associate providers • Purchased over time and assimilated but not integrated • Different benefits, compensation and contracts

5. Aspirus, Inc. (cont.) • Aspirus Network – Physician Hospital Organization • Strong independent single specialty physician groups • Joint contracting – single signature • Not all Network members are part of the Aspirus system. • Traditional Payor Contracts • Competition

6. Physician Leadership • Dyad Leadership in Clinics • Senior Medical Director • Five Regional Medical Directors • Site Medical Directors

7. Physician Leadership (cont.) • Aspirus Physician Partnership Leadership Education – APPLE • UW – Madison • Executive MBA Template – Ten months • Capstone Projects • Twenty-five physicians and administrators per year

8. Physician Leadership (cont.) • Aspirus Physician Partnership Council • Charter • Members: Physicians and Senior Leaders • Accomplishments • Aspirus Network, Inc. – PHO • Board • Medical Management Committee

9. Physician Leadership (cont.) • Compact Initiative • Tertiary care hospital & medical staff • Clinics • System wide

10. Physician Leadership (cont.) • Recruiting CMO, CMIO, Senior Medical Director Network Executive Director • Template for interaction/with independent physician groups • High performing physician leadership structure – (MEC, APPC, Boards, PHO)

11. Ongoing Imperatives • Clinical Integration – alignment of goals and incentives • System wide Compact • Medical group culture • Restructuring of ANI - PHO • Clear “menu” of alignment options for independent physician groups • Standard physician contracts

12. Ongoing Imperatives (cont.) • Revised physician compensation plan • Base salary • 30% variable compensation component • Panel size • Patient satisfaction • System financial performance • Quality metrics • 360 degree annual evaluation • Standard patient contact hours by specialty • Standard benefits

13. Lessons Learned • Employment, Assimilation, Engagement – progressively more difficult • Once trust is lost it is difficult to regain (Just like a marriage) • Size/scale without alignment/engagement does not lead to a sustainable competitive advantage • Finance cannot be the sole drive of change

14. Lessons Learned (cont.) • “Easy” on the front end leads to “pain” eventually • Dyad leadership structure on hospital side • Mixed model of employed and independent physicians is challenging • External drivers are helpful in change management • Involve allied health professionals

15. Bud Chumbley Bud.Chumbley@aspirus.org