BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE
MEETING AGENDA
Monday, January 15, 2018 Palomar Medical Center 12:00 p.m. Raymond Family Conference Center Buffet lunch for board members & invited guests 2185 Citracado Parkway, Escondido, CA 92029
PLEASE TURN OFF CELL PHONES OFF OR SET THEM TO SILENT MODE UPON ENTERING THE MEETING ROOM
Form A Time Page Target
CALL TO ORDER 12:00
Public Comments1………………………………………………………………...……………………. 15 12:15
*Information Item(s)
1. *Approval: Minutes – Monday, October 16, 2017 (ADD A Pp4-19).………….………...... … 2 1 12:17
2. Board Meeting Follow Up………………………………………………………………………….. 15 12:32
3. Strategic Plan Review (ADD B Pp21-49)…….…………………...…………………….……….. 40 2 1:12
Public Comments1…………………………………………………………………………...…………. 15 1:27
ADJOURNMENT 1 1:28
**Doug Moir, M.D., Chair Della Shaw, EVP Strategy Hugh King, IEVP Finance **Jerry Kaufman, PTMA, Director Alan, Conrad, MD, EVP Physician Alignment Frank Beirne, EVP Operations ** Ray McCune, RN, Director Maria Sudak, RN, MSN, CCRN, NEA-BC, VP PMCE **Hans Sison, LVN, 1st Alternate Jeannette Skinner, RN, MBA, FACHE, VP PMCP **Diane Hansen, Interim President and CEO Foundation Philanthropy Officer Daniel Steeber, General Counsel **Franklin Martin, M.D., CoS PMCE PH Foundation Board Member Dan Farrow, AVP Hospitality & Facilities **Charles Callery, M.D., CoS PMCP Pam Sime, IEVP Human Resources
NOTE: If you have a disability, please notify us by calling 760-740-6375 72 hours prior to the event so that we may provide reasonable accommodations
______ Asterisks indicate anticipated action. Action is not limited to those designated items.
1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room
Minutes
Board Strategic & Facilities Planning Committee
Monday, October 16, 2017
TO: Board Strategic & Facilities Planning Committee
MEETING DATE: Monday, January 15, 2018
FROM: Debbie Hollick, Committee Secretary
Background: The minutes from the Board Strategic & Facilities Planning Committee meeting held on Monday, October 16, 2017 are respectfully submitted for approval (Addendum A).
Budget Impact: N/A
Staff Recommendation: Staff recommends approval of the Monday, October 16, 2017 Board Strategic & Facilities Planning Committee meeting minutes as presented.
COMMITTEE RECOMMENDATION: N/A
Motion:
Individual Action:
Information:
Required Time:
1
Strategy Update
Della Shaw, EVP Strategy
TO: Palomar Health Board of Directors Strategy and Facilities Committee
MEETING DATE: January 15, 2018
BY: Della K. Shaw, Executive Vice President Strategy
BACKGROUND: Chairman Moir requested that the committee undertake a review of the Strategic Plan over the next months. The January presentation will include review of two key Strategic Priorities, Population Health and Strong Physician Alignment and Networks. It will also include discussion of the Clinically Integrated Network (CIN) in relation to both Strategic Initiatives.
BUDGET IMPACT:
STAFF RECOMMENDATION:
COMMITTEE RECOMMENDATIONS:
MOTION:
INDIVIDUAL ACTION:
INFORMATION:
REQUIRED TIME:
2
ADDENDUM A
3
BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING MINUTES – MONDAY, OCTOBER 16, 2017
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / FINAL? RESPONSIBLE PARTY
DISCUSSION
CALL TO ORDER
The meeting – held in the Palomar Medical Center Raymond Family Conference Center, 2185 Citracado Parkway, Escondido, CA 92029 – was called to order at 12:00 p.m. by Committee Chair McCune
ESTABLISHMENT OF QUORUM
Quorum comprised of Directors McCune, Kaufman, Czerwonka Excused Absences: None
NOTICE OF MEETING
Notice of Meeting was posted at the Palomar Health Administrative office; also posted with full agenda packet on the Palomar Health website on Thursday, October 12, 2017, which is consistent with legal requirements
PUBLIC COMMENTS
There were no public comments
*INFORMATION ITEMS
1. * Board Strategic & Facilities Planning Committee Meeting Minutes – Monday, September 18, 2017
101617 Board Strategic & Facilities Planning Committee Minutes 4
BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING MINUTES – MONDAY, OCTOBER 16, 2017
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / FINAL? RESPONSIBLE PARTY
DISCUSSION
There was no discussion MOTION: by Director N/A Y Kaufman, 2nd by Director Czerwonka and carried to approve the Monday, September 18, 2017 Board Strategic & Facilities Planning Committee meeting minutes as presented. All in favor. None opposed. No abstentions
2. Board Meeting Follow Up Information only
Board Committee Follow Up Tracking Tool
Executive Vice president Della Shaw noted that, per request of Board Chair Czerwonka, a perpetual follow up tracking tool has been created for this and the Board Community Relations committee, which will facilitate follow up on requests from the board members for each committee meeting
3. Balanced Score Card: FY2018 Brand Goals Exception Report Information only
Utilizing the attached presentation, Ms. Shaw reported out on the latest data for the Brand Pillar, noting that they are currently rounding as to what methodology to use for the Balanced Score Card. The data being shared in this report is from the Studer Leader Evaluation Manager (LEM), which automatically rounds points to the closes whole number; based on rounding outcome, this format may change in the future
4. Strategic and Business Planning Update Information only
Utilizing the attached presentation, Ms. Shaw provided a strategic and business planning update, noting that Next Steps were to move to a Strategic Management System
ADJOURNMENT TO EXECUTIVE SESSION
1. Report involving Hospital Trade Secret Per Health & Safety Code 32106 – concerning potential new service or program – Estimated disclosure date TBD
RE-ADJOURNMENT TO OPEN SESSION
101617 Board Strategic & Facilities Planning Committee Minutes 5 2
BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING MINUTES – MONDAY, OCTOBER 16, 2017
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / FINAL? RESPONSIBLE PARTY
DISCUSSION
ACTION RESULTING FROM CLOSED SESSION, IF ANY -
MOTION: by Director Board of Director’s to N Czerwonka, 2nd by Director review transaction for Kaufman and carried to potential approval recommend full board approval of transaction. All in favor. None opposed. No abstentions
PUBLIC COMMENTS
There were no public comments
ADJOURNMENT
Meeting adjourned at 1:27 p.m. by Chair McCune
COMMITTEE CHAIR Doug Moir, M.D.
SIGNATURES:
Debbie Hollick COMMITTEE SECRETARY
101617 Board Strategic & Facilities Planning Committee Minutes 6 3 7 8 9 10 11 12 13 14 15 16 17 18 19
ADDENDUM B
20 Passion. People. Purpose.TM
Board of Directors Strategy and Facilities Planning Committee
Strategic Plan Review
Della K. Shaw EVP Strategy & Interim Chief Philanthropy Officer January 15, 2018
1 1 Palomar Health will be recognized as the dominant Strategy provider of integrated health services as measured by market position and value-based metrics of care.
s Mission Sustaining Financial Performance ome c t Customer Value Ou Quality | Cost | Experience| Brand
Operational Excellence ocess Clinical Integration | Efficiency & Effectiveness Pr Hassle Free Experience | Consumerism
Organizational Capabilities World-class Workforce | Technology eople P Patient First Culture 2 2017 – 2022 Strategic Priorities
Effective and Efficient Care Strong Physician Alignment and Networks
Develop effective and efficient systems that support Build physician-hospital alignment and physician achievement of the Quadruple Aim to enhance patient engagement as the foundation of a high-value network experience, improve population health, reduce costs, that will meet the Population Heath Management and improve the life of health care providers, including needs of our community and ensure that Palomar clinicians and staff. Health is the preferred provider of care in North County.
Create and Maintain Customer Value Population Health
Attract, create, and retain loyal customers – where We will serve as providers, coordinators, collaborators, customers are defined as our patients and their and aggregators in population health and population families, physicians, payers, and our community – by health management for our employees and the achieving the Triple Aim initiatives of enhancing communities we serve – our population. customer experience, improving population health, and reducing costs.
North County Network Collaborations, Partnerships and Alignments
Through collaborations, partnerships, and affiliations in the region, Palomar Health will build aligned networks that ensure community access to comprehensive, clinically integrated, value-based care that will meet the needs of the population we serve for generations to come. Focus | Population Health & Physician Networks
Population Health Strong Physician Alignment and Networks
We will serve as providers, Build physician-hospital alignment and coordinators, collaborators, and physician engagement as the aggregators in population health and foundation of a high-value network that population health management for our employees and the communities will meet the Population Heath we serve – our population. Management needs of our community and ensure that Palomar Health is the preferred provider of care in North County.
4 Setting the Stage | 2016 Community Health Needs Assessment (CHNA)
5 2016 CHNA
“Designed to provide a deeper understanding of barriers to health improvement in San Diego County.”
Report included “an analysis of health outcomes and associated social determinants of health which create health inequities – ‘the unfair and avoidable differences in health status seen within and between counties and communities – with the understanding that to the burden of illness, premature death, and disability disproportionately affects racial and minority population groups and other underserved populations”.
Insights were meant to “help hospitals identify effective strategies to address the most prevalent and challenging health needs in the community.”
6 2016 CHNA | San Diego Statistics
Nearly 15% of San Greater proportion of Approximately 1 in 7 Latinos, African Diegans live in San Diegans are food Americans, Native insecure. households with income Americans, and below 100% of the individuals of other race Federal Poverty level live in poverty compared to the overall San Diego population.
Almost 15% of San Approximately 46% of Approximately 10% of Diegans aged 25 and households in San Diego San Diegans aged 5 and older have no high have housing costs that older have limited school diploma or exceed 30% of their English proficiency and equivalency income. 8.5% are linguistically isolated.
7 2016 CHNA | San Diego Geographic Regions
2013 Community Need Index Scores 4.2 to 5.0 = High Need
Central East North Central Min 3.0 – Max 5.0 Min 2.6 – Max 4.8 Min 2.0 – Max 4.4
North Coastal North Inland South Min 1.8 – Max 4.6 Min 2.4 – Max 4.4 Min 2.2 – Max 5.0
8 2016 CHNA | San Diego Geographic Regions
2013 Community Need Index (CNI) Scores Zip Codes with a Score of 4.2 or Higher North County
Escondido Pala San Marcos 92025, 92027 92059 92069
North Coastal
Oceanside Vista 92054 92083, 92084
9 Behavioral Health – North Inland Behavioral Health – North Coastal Cardiovascular Disease – North Inland Cardiovascular Disease – North Coastal Diabetes Mellitus – North Inland Diabetes Mellitus – North Coastal CHNA | San Diego Top Community Health Needs (alphabetical)
1. Behavioral Health 2. Cardiovascular Disease 3. Diabetes (Type 2) 4. Obesity
16 CHNA | Ranking Results
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Who Takes Which Group? Segmenting Patients and Interventions Managing Three Distinct Patient Populations
5% of patients; Trade high-cost usually with complex services for low-cost High- Risk disease(s), management Patients comorbidities
15-35% of patients; Avoid unnecessary higher-acuity, higher- Rising-Risk Patients may have conditions not under control cost spending
60-80% of patients; Keep patient healthy, Low-Risk Patients any minor conditions loyal to the system are easily managed
19 What Do you Really Want to Own? Defining our Core Competencies Bricks and Mortar Components of Population Health
Prevention Worksite Clinics Schools
Primary Care Retail Clinics Pharmacy Medical Home
Urgent Care Urgent Center Primary Care Acute Care Long-Term Management Post-Acute Care Emergency Care Hospital Freestanding
Acute Care Hospitals Affiliate Hospitals Palliative Care
Ambulatory Care Surgery
Post-Acute Care Home Health SNF Hospice Primary Care Acute Care Long-Term Management
Long-Term Care LTAC Source: Population Health Advisor interviews and analysis.
20 The First Line of Tactical Management
• Contact Center Functions Supporting Population Health
Source: Population Health Advisor interviews and analysis.
21 Care Management as Connective Tissue of Population Health
Physician Practice Problem: Case Management Care management models are developed Medical Home independently, resulting in conflicting approaches and gaps in care Discharge Planning ACO Patient Placement ED Question: Do we have an overarching care Acute Care management model to control how PCP Follow-up methodologies are deployed in each area Home Health of the health system? LT Care Planning
SNF Need: Transitional Care Nursing Home A strong, centrally-managed, and continuum-wide care management System Navigation LTAC structure.
22 Organizing the Basket of Community Assets Surfacing, Addressing Social Needs Critical to Care
Social and Environmental Social, Environmental Factors Influencing Health: • Income and employment status 20% Individual • Housing and transportation Behaviors 40% 10% Health Care • Literacy and language • Hunger and access to healthy food options • Social integration and support 30% • Safety Genetics
80-90% 85% 20% Health status attributed Physicians reporting unmet social Physicians who believe they to non-clinical care factors needs lead directly to poorer have the ability to address social health outcomes needs
Source: “Powering Healthier Communities: Community Health Centers Address the Social Determinants of Health,” National Association of Community Health Centers, 2012, http://www.nachc.com/client/documents/SDOH1.pdf; B Booske et al, “Different Perspectives for Assigning Weights to Determinants of Health,” University of Wisconsin Population Health Institute, 2010, http://www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf; Population Health Advisor research and analysis.
23 Drivers of High-Risk MediCal Healthcare Costs
Based on results of over 4,000 assessments of high-risk patients conducted at Montefiore CMO
24 24 Passage to Population Health Management Sustainable, Population-Centered, Data-Driven, Coordinated Care
Network Care Model Economics Assemble a strong Establish ambitious Craft a sustainable value- provider network aligned clinical standards for based payment strategy with system-wide delivery system redesign with a solid financial performance goals and and care management foundation for engaged in health care resources profitability and growth improvement
Technology that supports delivery system redesign, provider accountability, value-based quality monitoring, and patient engagement
Advisory Board Company content
25 One-Stop Call Centers Co-locate Patient Information Central Platform Coordinates, Personalizes Care
Linking CRM and EMR Systems to Resolve Multiple Needs in One Call Case in Brief: Centura Health Emergency • department 16-hospital health system based in Englewood, Colorado • Moved multidisciplinary navigators Physician office Urgent care to single “CenturaConnect” platform clinic to manage care coordination pathways and increase collaboration Care coordination across care sites platform • Worked with Salesforce and Diagnostic Pharmacy TriageLogic to document every testing patient interaction in centralized EHR/CRM platform and offer seamless triage Health Information Exchange • Platform includes all patient information, including non-clinical Platform offers comprehensive patient information; nurses triage factors related to health care, make appointments Encounter triggers alert for nurse to follow up
Source: Centura Connect, available at: https://www.centura.org/our-network/centura-connect; Rogers J, “Working on the Edge: Integrating New Technology and Communication Platforms into Your Call Center,” CenturaConnect Virtual Resource Center, 2015; “TriageLogic Call Center Software Integrates with Centura Connect’s Salesforce Platform,” PRweb, Dec 2014, available at: http://www.prweb.com/releases/2014/12/prweb12383396.htm;26 Source: Population Health Advisor interviews and analysis. Technology Platforms and Capabilities • Data Sources | EMRs, Payer Claims, Patient-Reported Data • Reporting and Analytics – Required Measures – Costs/Utilization – Predictive Analytics – Quality Improvement • Practice Management • Program Measures | ACO, HEDIS, MACRA, MU Specialty Registry, etc. • Contract Alignment (Current & Potential) • Provider Analytics • Hierarchical Condition Category (HCC) Analytic
27 Mission POPULATION Vision Enhanced Operational Strategic Planning MANAGEMENT Practices Efficiency Skilled Patient-Centered Enterprise Ambulatory Acute Long Market Position Nursing Centers of Medical Homes Unified Behavioral Term Urgent Care Excellence Strategy Health Care Referral Operations Management Home Health Clear Retail Recruiting Rehab Transitions Utilization Relationship Managment Management Clinical Integration Physician At-Risk Alignment Care Management & Financial Model Bundled Contracting Coordination Resource Payments Disbursement Utilization Pool Funding ACO Contract Patient Community Health Margin Management Capitation Activation Needs Assessment Enhancement Provider Programs Reimbursement Person, Patient, Member Serivce Line P2 + M Business Model Optimization Shift Lean Six Sigma Performance Wellness Disease Improvement Operational Management Member Transformation Experience Interoperability Infrastructure Provider Insurance Analytics Descriptive Product Predictive Commercial Regulatory Technology Clinical Prescriptive Decision Payor Support CMS P4P Registries Care Solutions Organization EDW State Management MIPS and APM Self Insured Telehealth Employers Compliance Quality Reporting Patient Portal Contract Medicare/MediCal Management Governance Our Own Employees Culture eVisits Rural Outreach Leadership Questions & Discussion
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