Intermountain Trustee AN EMAIL BRIEFING FOR INTERMOUNTAIN HEALTHCARE TRUSTEES

January 2018

INTERMOUNTAIN ISSUES AND INITIATIVES

Intermountain, Leading U.S. Health Systems Announce Plans to Develop a Not-for-profit Generic Drug Company New organization will help patients by ending shortages and reducing prices

To help patients by addressing the often unwarranted shortages and high costs of lifesaving generic medications, Intermountain Healthcare is leading a collaboration with Ascension, SSM Health, and Trinity Health, in consultation with the U.S. Department of Veterans Affairs (VA), to form a new, not-for-profit generic drug company. The five organizations represent more than 450 hospitals around the U.S. Other health systems will soon be joining this not- for-profit initiative, which will make essential generic medications more available and more affordable, bringing healthy competition to the market for generic drugs.

The new company intends to be an FDA-approved manufacturer and will either directly manufacture generic drugs or sub-contract manufacturing to reputable contract manufacturing organizations, providing patients an affordable alternative to products from generic drug companies whose capricious and unfair pricing practices are damaging the generic drug market and hurting consumers. The company will also seek to stabilize the supply of essential generic medications administered in hospitals, many of which have fallen into chronic shortage. The new initiative will result in lower costs and more predictable supplies of essential generic medicines, helping ensure that patients and their needs come first in the generic drug marketplace.

As has been widely reported, certain generic drug manufacturers have been widely criticized for unwarranted and arbitrary price increases and for creating artificial shortages of vital medications. These activities have resulted in some generic drugs increasing in cost by more than 1,000 percent in just a few months for seemingly no reason. Research into the actual costs of manufacturing and distributing generic drugs suggests that, in many instances, generic drug prices can be reduced to a fraction of their current costs, saving patients, and the healthcare systems that care for them, hundreds of millions of dollars each year. Many of the well-publicized problems in the U.S. generic drug market can be attributed to a reduction in the number of suppliers, consolidation of production volumes, and a concentration of market pricing power. These market factors are particularly problematic with older generic medications that hospitals rely on every day to take care of desperately ill patients. This new initiative will bring together healthcare systems from around the country to help address these generic drug market failures, providing the new not-for-profit generic drug company with plenty of customers ready and eager for its products.

Marc Harrison, MD, President and CEO of Intermountain Healthcare, believes this collaboration will be game-changing for the generic drug market. “It’s an ambitious plan,” said Dr. Harrison, “but healthcare systems are in the best position to fix the problems in the generic drug market. We witness, on a daily basis, how shortages of essential generic medications or egregious cost increases for those same drugs affect our patients. We are confident we can improve the situation for our patients by bringing much needed competition to the generic drug market.”

Laura Kaiser, President and CEO of SSM Health, stated, “All Americans deserve access to high-quality, affordable care. The best way to control the rising cost of healthcare in the U.S. is for payers, providers and pharmaceutical companies to work together and share responsibility in making care affordable. Until that time, initiatives such as this will foster our ability to protect patients from drug shortages and price increases that limit their ability to access the care they need.”

Anthony R. Tersigni, EdD, FACHE, President and CEO of Ascension, said, “This initiative has the potential to greatly expand the availability and affordability of critically needed medications for millions of Americans, especially for people living in poverty and those most vulnerable. Rather than waiting and hoping for generic drug companies to address this need, we are taking this bold step on behalf of those we are privileged to serve. I’m pleased to see our respective systems come together along with the VA to ensure affordability and access to these essential medications.”

Richard J. Gilfillan, MD, CEO of Trinity Health, said, “For people in the United States, there is a dangerous gap today between the demand and supply of affordable prescription drugs. If the only way to provide our communities with affordable drugs is to produce them ourselves, then that is what we will do. We look forward to more healthcare systems around the country joining this people-centered effort.”

Carolyn M. Clancy, MD, Executive in Charge, Veterans Health Administration said of this initiative, “As an organization which must have an affordable and stable supply of generic pharmaceuticals to fulfill its healthcare mission, the Department of Veterans Affairs looks forward to the value this new company will bring to healthcare in the United States and applauds Intermountain Healthcare, Trinity Health, SSM Health, and Ascension for this initiative. Increasing generic drug manufacturing capacity will generate a more stable generic drug supply and will reduce the negative clinical impact of chronic drug shortages, including the impact on our nation’s veterans.” The formation of the new not-for-profit generic drug company will be guided by an Advisory Committee that includes a roster of well-known experts from the pharmaceutical industry, business, and government. The Advisory Committee will include:

• Madhu Balachandran, retired Executive Vice President of Global Operations, Amgen • Don Berwick, MD, President Emeritus and Senior Fellow, Institute for Healthcare Improvement; former CMS administrator • Clayton Christensen, Professor at the Harvard Business School, Founder of Innosight, and member of Intermountain’s Board of Trustees. • Bob Kerrey, Managing Director, Allen & Company; former Nebraska governor, U.S. senator, and pharmacist • Martin VanTrieste, retired Senior Vice President and Chief Quality Officer, Amgen Senior-level leaders from the organizations founding the company

The Department of Veterans Affairs’ Veterans Health Administration is the largest integrated healthcare system in the country, providing healthcare to more than 9 million veterans. VA has provided no financial support for this project.

Read the article about this in The New York Times or see Dr. Harrison’s interview with CNBC.

NAVICAN Opens Precision Cancer Care Center in Downtown Intermountain company connects late-stage cancer patients with targeted therapies

NAVICAN—an Intermountain Healthcare company that uses precision cancer care to connect late-stage cancer patients with targeted therapies—has opened a new Precision Cancer Care Center in downtown Salt Lake City. The center breathes new life into the historic Felt Building at 341 S. Main Street, which was built in 1909 and was the first concrete and steel office building in the city. Now the building will serve as a next-generation cancer genomics sequencing facility and patient services center.

“Cancer is an old problem, and this is an old building. NAVICAN puts a new face on both of them,” said Ingo Chakravarty, President and CEO of NAVICAN. Precision medicine is a new approach to clinical care that allows care providers to select treatments for individual patients based on each patient’s genetic background.

NAVICAN, founded in 2016, uses a comprehensive service called TheraMap to help patients and oncologists access the technology, clinical recommendations, and therapies they need to improve cancer outcomes and reduce costs. The launch of the new Precision Cancer Care Center will allow them to increase the number of patients and clinicians they serve.

“We’re committed to providing precise medical care to all patients with advanced cancer, not just a few lucky ones,” said Ingo. “Precision cancer care, like we’ll provide at our new center, is for all. We’re focused and are now, more than ever, ready to deliver the highest-quality cancer care to patients.”

The NAVICAN Precision Cancer Care Center will be fully operational in March. UPDATES AND FEATURES

New Survey Process Provides Meaningful Insight into Patient Experience Partnership will help avoid multiple patient surveys for each care encounter

Intermountain has switched from phone-based patient experience surveys to mail- and email-based ones, which means patients can complete the surveys at their convenience and provide helpful information to improve the care experience. Patients have requested a reduction in surveys, and Intermountain’s partnership with Press Ganey will help us avoid multiple patient surveys for each care encounter.

Benefits of the new Press Ganey surveys:

• Less intrusive

• Higher response rates due to the addition of email

• More detailed questions about the areas and stages of care our patients receive

Improved reporting and analytics tools will offer integrated data and allow us to compare how well we’re doing regionally and nationally to more than 10,000 organizations in Press Ganey’s database “The new surveys will give us more meaningful information about how we can improve,” said Katy Jo Stevens, Intermountain’s Director of Patient Experience.

New 170,000-square-foot Intermountain Alta View Clinic Opens The new space houses more than 60 clinicians and 22 specialties

A new four-story, 170,000-square-foot medical tower is now open on the south end of the Alta View Clinic on the campus of at 9450 South 1300 East in Sandy. The new space houses more than 60 clinicians, 22 specialties, and other services, including:

Primary care Heart Institute ENT Allergy Orthopedics Plastic and oculoplastic surgery An outpatient surgery center InstaCare Outpatient pharmacy A café Scott Lindley, MD, South Salt Lake Medical Director, said: “The new Alta View Clinic provides an inviting, pleasing environment for clinicians to meet patients in their own neighborhood, offering convenient and quality care in a number of much-needed specialties for the area. This opening underscores our ongoing role in providing the best care possible, meeting patients where they are.”

The clinic is part of the ongoing renovation project of the Alta View campus.

Intermountain Healthcare’s New Medicare ACO Launched January 1 ACO model encourages and supports hospitals, physicians, and clinical teams

Intermountain Healthcare launched a new Medicare Accountable Care Organization (ACO) on January 1, 2018, called Intermountain Accountable Care. Medicare ACOs are groups of doctors, hospitals, and clinicians who come together voluntarily to give coordinated care to their Medicare patients. Intermountain’s ACO includes about 53,000 Medicare members and is one of about 500 ACOs in the United States, including five others in Utah.

“The ACO model created by Medicare encourages and supports hospitals, physicians, and clinical teams that work together to provide care that’s safe, high-quality, accessible, and affordable—all within a patient- and family-centered experience,” said Mark Briesacher, MD, Intermountain’s Senior Vice President, Chief Physician Executive, and President of Intermountain Medical Group.

“Having a Medicare ACO advances our mission, supports our vision to be a model health system, and is another step toward value-based care,” said Mikelle Moore, Intermountain’s Senior Vice President of Community Health and the President of Intermountain Accountable Care, LLC. “The goal is to ensure patients get the right care at the right time, while helping to safeguard against medical errors and avoid unnecessary duplication of services.”

Intermountain’s ACO currently includes physicians and advanced-practice clinicians employed by Intermountain Medical Group and hospitals, as well as certain physicians and APCs contracted by Intermountain who bill under Intermountain’s tax identification number. Skilled nursing facilities that are part of Intermountain’s Skilled Nursing Facility Quality Initiative are also part of the ACO.

“This year, we’ll develop participation requirements for interested affiliated physicians and advanced-practice clinicians to join the ACO in 2019, consistent with our open-staff model approach,” said Dr. Briesacher. RESEARCH

Intermountain Researchers Use Nobel Prize-winning “Nudge Theory” Study says patients are more likely to properly take medication when given a “nudge”

Researchers at the Intermountain Medical Center Heart Institute are conducting a study about medication compliance using the Nobel Prize-winning “nudge theory” to encourage patients to take their medications properly.

Preliminary results show patients are more likely to properly take their medication when given a personalized “nudge.” Nudging—a term coined by newly honored Nobel Prize laureate and economist Richard H. Thaler—is based on the idea that people don’t always make rational choices based on their own best interests. Rather, people are influenced by their emotions, resulting in choices that may not lead to the best outcomes. Thaler suggests people can be nudged in the right direction by simple processes, and the nudges can help people take actions that benefit them.

Benjamin Horne, PhD, a Cardiovascular Genetic Epidemiologist at the Intermountain Medical Center Heart Institute, is the principal investigator for the clinical trial called Improvement in Medication Compliance Through the Implementation of Personalized Nudges: the ENCOURAGE Trial. The 12-month study looks at how personalized nudges improve compliance with cardiovascular prescriptions.

“While the safety and efficacy of approved cardiovascular medications is well-documented, nationally only approximately 50 percent of patients comply with their heart medication prescriptions. Compliance at Intermountain Healthcare is only marginally better at approximately 60 percent,” said Dr. Horne. “Through this study, we hope to determine whether or not the behavior of taking medications actually changes in response to our nudge intervention. If so, we want to find ways to implement the nudge framework on a broader scale to improve outcomes and reduce hospital readmissions among patients at Intermountain.”

Learn more about the clinical trial.

Intermountain App Identifies Patients Who Need Advanced Heart Therapy Study shows the app delivers improved quality of life and greater longevity

A clinical decision support mobile application developed by Intermountain Healthcare researchers—which more quickly identifies when heart failure becomes advanced and a heart patient’s care needs have changed—is helping improve patients’ quality of life and longevity, according to a new study. The new app, which monitors heart failure patients’ medical tests and health status and promptly notifies clinicians, was developed by a multidisciplinary team of Intermountain Healthcare heart clinicians, medical informaticists, and home health specialists.

As researchers used the app during the study, they found it led to significantly improved detection of advances in heart disease. For instance, intervention patients’ survival rates increased. More intervention patients were alive compared to a control group at key intervals: 30 days (95 percent vs. 92 percent), 60 days (95 percent vs. 90 percent), 90 days (94 percent vs. 87 percent) and 180 days (92 percent vs. 84 percent).

Findings of a study on the effectiveness of the new app are published in the Journal of Cardiac Failure. “We found that clinical decision support can facilitate the early identification of patients needing advanced heart failure therapy and its use was associated with significantly more patients visiting specialized heart facilities and longer survival,” the study says.

More than six million Americans have heart failure, which means their heart fails to adequately pump blood. That results in an array of symptoms that include fatigue, shortness of breath, swelling, and a fast or erratic heartbeat.

“Heart failure is progressive, and when it becomes advanced, standard therapies are no longer adequate and quality of life plummets,” said Study Lead Author Scott Evans, MS, PhD, Medical Informatics Director at Intermountain Healthcare and a Professor of Biomedical Informatics at the School of Medicine. “The sooner advanced heart failure is diagnosed and patients begin to receive advanced, specialized treatment, the better they tend to do.”

“But patients typically aren’t monitored every day and it’s hard for doctors to stay up-to-date on all the research regarding heart failure,” he said. “Plus, no single test says the disease has progressed and often patients don’t end up in advanced heart failure clinics when they should.”

AWARDS AND RECOGNITION

Intermountain Named in 2018 Shatter List for Actively Working to Break Technology’s Glass Ceiling for Women Women’s Tech Council recognizes 44 companies nationwide

Intermountain has been recognized in the Women Tech Council’s 2018 Shatter List for actively employing measures to help break technology’s glass ceiling with respect to women and leadership. Intermountain was among 44 companies recognized based on the development and successful implementation of measures that create inclusive cultures where women can contribute and succeed.

“Being included in the Shatter List requires a holistic and active commitment to creating inclusive cultures from the executive level all the way down to entry positions,” said Cydni Tetro, president of the Women Tech Council. “The best practices these companies are developing and implementing to actively champion women boost the teams and individuals in their organization while simultaneously helping shatter the glass ceiling for the entire technology industry.”

In making the list, Intermountain was evaluated and scored against hundreds of companies on executive engagement, company programming, community investment and women’s or diversity and inclusion (D&I) groups. All data were gathered from 10 secondary data sets and required active demonstration of visible activities at all levels of the company showing commitment and progress in these four areas.

Women Tech Council (WTC) is a national organization focused on the economic impact of women in the technology sector through developing programs that propel the economic pipeline from high school K-12 to the C-suite. WTC offers mentoring, visibility, opportunities, and networking to more than 10,000 women and men working in technology to create business environments focused on inclusivity and high performance.

Intermountain Hospitals Earn Federal Praise in New CMS Star Rating Many Intermountain hospitals earn higher rankings than ever before

New “Star Ratings” have been issued by the Centers for Medicare & Medicaid Services, which ranks hospitals across the country with one to five stars based on their performance on 57 quality measures—and many of Intermountain Healthcare’s hospitals have earned higher rankings than ever before, including three ranked as five-star hospitals. Almost all our facilities received four stars or higher, and all but one are ranked higher than last year

“Our caregivers have been working very hard to improve performance on publicly reported measures related to patient safety and experience, and these ratings show that your hard work is paying off,” said Shannon Phillips, MD, Chief Patient Experience Officer.

The ratings are designed to help the U.S. government share data with the public simply and consistently and help healthcare consumers compare hospitals based on standardized quality measures. According to CMS, better outcomes mean more stars, and the most common overall hospital rating is three stars.

Intermountain’s hospitals are ranked as follows:

• Intermountain Medical Center: Five Stars • LDS Hospital: Five Stars • : Five Stars • Alta View Hospital: Four Stars • : Four Stars • Cassia Regional Hospital: Four Stars • Cedar City: Four Stars • Dixie Regional Medical Center: Four Stars • Heber Valley Hospital: Four Stars • McKay-Dee Hospital: Four Stars • : Four Stars • Riverton Hospital: Four Stars • : Four Stars • : Three Stars • : Three Stars

TOSH isn’t rated because it’s a specialty hospital, Primary Children’s isn’t rated because it’s a children’s hospital, and Bear River, Delta, Fillmore, Orem, and Garfield weren’t rated because their volumes weren’t high enough.

Only 7.36 percent of the hospitals in America achieved a five-star rating. Two non-Intermountain hospitals in Utah were also ranked five-star.

SelectHealth Named a “2017 Best Company to Work For” by Utah Business Magazine This is the 10th time since 2007 that SelectHealth has received this recognition

SelectHealth was named one of the “2017 Best Companies to Work For” by Utah Business Magazine. This is the 10th time since 2007 that SelectHealth has been honored with this recognition based on survey feedback from our caregivers. Participating companies undergo a rigorous examination of workplace elements, such as benefits and pay, fairness and opportunities, corporate culture, internal communication, and employee pride.

SelectHealth is part of an elite group of Utah companies whose employees are pleased with their benefits and engaged in workplace culture. Honorees are separated into categories based on company size.

INTERMOUNTAIN IN THE NEWS

What the World Is Saying About Us Recent news stories about Intermountain in the national and international media

Fierce Healthcare, December 12: Intermountain, Cerner Among Those Meeting With The White House About Interoperability “Intermountain Healthcare and Cerner are among the organizations that will have the ear of top White House officials on Tuesday for a meeting about EHR interoperability.”

Harvard Business Review, December 14: Is M&A the Cure for a Failing Health Care System? “Some of the nation’s most innovative, high-performing nonprofit health care organizations use this formula [combining insurance and delivery]. These include the Kaiser Health Plans, Intermountain Healthcare in Utah and , the Geisinger System in Pennsylvania, the Henry Ford System in Detroit, and HealthPartners in Minnesota and Wisconsin, among others.”

U.S. News & World Report, December 17: Couple Donates Device to Logan Hospital for Grieving Parents. “The Robbins memorialized their children…with a donation of the CuddleCot to Intermountain Logan Regional Hospital to aid other parents who have been in their situation.”

HealthNewsDigest.com, December 18: Clinical Decision Support App Helps Improve Quality of Life and Longevity for Heart Failure Patients. “A clinical decision support application developed by Intermountain Healthcare researchers that more quickly identifies when heart failure becomes advanced and a heart patient’s care needs have changed is successful in helping to improve patient’s quality of life and longevity, according to a new study.”

Healthcare Industry Today, December 20: Eighty-three Intermountain Healthcare clinics achieve NCQA medical home recognition. “The Intermountain Medical Group—the arm of Intermountain Healthcare that manages its clinics and employs physicians throughout Utah— recently announced that all 83 of its primary care clinics achieved National Committee for Quality Assurance (NCQA) recognition as Patient-Centered Medical Homes (PCMHs). Medical homes champion patient-centered care, and the NCQA has the most widely adopted medical home evaluation program in the country with more than 12,000 practices recognized.”

Utah Department of Health, December 21: Intermountain Healthcare Partners with Public Health to Combat Hepatitis A. “Intermountain Healthcare today announced a $248,000 grant to the Utah Department of Health to support the ongoing response to a hepatitis A outbreak in the state. The donation will be used to purchase nearly 9,000 doses of hepatitis A vaccine that will be administered to at-risk populations.”

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