ucsf clinical enterprise strategic plan

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UCSF Clinical Enterprise Strategic Plan Retreat 1

May 6, 2013

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Retreat AgendaTime Activity Speaker

8:00am – 8:30

Welcome Overview of Opportunities & Challenges Facing UCSFCEBrief Summary of Planning ProcessPerspectives on the Clinical Strategy

Mark LaretJack Stobo

8:30 – 9:20 A Health Plan View of the California MarketDavid Joyner, Hill COO, formerly of Blue Shield

9:20 – 9:45 Academic Medicine for the Future Tom Enders, Manatt9:45 – 10:00 Break --10:00 – 10:30 Emerging UCSFCE Vision & Draft Strategic Priorities Sam Hawgood

10:30 – 11:10 Building a High Value System of Care in Northern California

Jonah Frohlich, Manatt----Mark Laret & Jay Harris (Q&A)

11:10 – 11:40 Clinical Enterprise Economics: Challenges & Opportunities

Barrie Strickland & Mike Hindery----Sam Hawgood (Q&A)

11:40 – 11:55BreakBoxed LunchesBreak to Tables

Tom Enders

11:55 – 1:15pm Retreat Participant Breakout Group Sessions Participants

1:15 – 2:00 Groups Report Out; Q&AClosing Discussion

M Laret, S Hawgood, T Enders

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UCSFCE Strategic Planning Process – Project Overview

May - July August - OctoberFebruary - April

4. Clinical Enterprise Group & Steering Committee Meetings

1. Engage USCF Leadership to

Define UCSFCE’s Vision & Strategic

Imperatives

2. Engage UCSF Community to

Develop Strategies & Tactics

3. Create Implementation Plan for Success

4

Leadership of the CE Strategic Planning Process

Executive Sponsors (M Laret, S Hawgood)

Clinical Enterprise Group (CEG)

Clinical Enterprise Strategic Planning (CESP) Steering Committee

Strategic Initiative Workgroups 1. Grow Complex Care Referrals Via Innovation &

Distinction2. Lead a High Value System of Care 3. Build a Culture of Continuous Process

Improvement 4. Strengthen Fiscal Position & Resource the Plan

• Teams of 15 – 20 faculty and clinical enterprise leaders that will recommend strategies, tactics and requirements to the CESP Steering Committee

• Teams will meet 5 times, between May – late July

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8:00am – 8:30










Tom Enders




A Health Plan View of the California Market

UCSF Clinical EnterpriseStrategic Planning Retreat

May 6, 2013

1

My Perspectives 8 Years of Consulting, Physician Practice Management

14 Years at Blue Shield of California• Strategic Planning• Network Contracting• Employer Sales and Account Management

Hill Physicians• 3 Weeks as Chief Operating Officer

2

What’s Important

Three most important priorities for health plans (and should be for the rest of the healthcare delivery system)…

1) Affordability2) Affordability3) Affordability

We’ve been discussing this for years, but now it is much, much more serious…

3

Drivers of Change

Social/Political Tipping Point• Health reform put healthcare front and center• Visibility/transparency of prices in the exchange• Sticker shock driven by health reform impacts• Premium rate setting legislation is being proposed

Employers are Struggling• Health insurance costs are equal or greater than the profit

margins of many companies• Health insurance costs = fully loaded salary of a software

programmer in India• Companies that compete in global industries can’t afford it

4

Drivers of Change (cont’d.)

The value proposition is not compelling• Prices of health insurance rise ~10% per year the last 15 years…

• About the same networks• About the same outcomes (that the system can show)• Similar member experience

One organization is providing a differentiated product: Kaiser

• More affordable• More integrated• More standardized• Attracting superior (healthier) risk

5

Erosion of Employer Based Coverage

6

AveragePremiums

2002 vs. 2012+169.7%

Inflation2002 vs. 2012

+32%

Political View: Health insurance inflation is the health plan’s fault

Reality: Health insurance inflation is due to health care cost inflation

71%

60%

2002 2012

% of

employersofferinghealth

coverage

Why will there be Sticker Shock?

Individual policies in the exchange will be expensive due to…• Risk selection (a big unknown)• 3:1 Age Rating• Benefit levels (“essential” benefits) Employer premium may also rise due to…• Age rating limitations• Essential benefits Few people today understand what health

insurance costs – the exchange will make it much more visible and politicians will react

7

The Challenge

How can our system achieve dramatically lower cost/trend and demonstrate quality and outcomes, while maintaining the vitality and innovation of individual provider organizations working together?

If we do not solve it, the government may try to solve it for us.

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Implications

Plans/Hospitals/Physician Organizations must find ways to work together in an integrated manner…• Aligning incentives• Integrating data and using data to improve care• Building systems of care• Breaking down silos• Avoiding waste• Moving from reactive to proactive• Focusing on total cost of care for populations

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Reasons for Optimism

Sacramento ACO for CalPERS• Blue Shield, Dignity Health, Hill Physicians• 0% trend year 1, dramatically lower trends years 2 and 3• Aligned incentives, focused attention• Leadership engaged at the highest level• Focusing on outcomes of system as a whole• Membership migration to the ACO

Before the ACO• 8-10% trends every year• Loss of members to Kaiser.

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Reasons for Optimism (cont’d.)

ACO in San Francisco with Health Net, UCSF, Dignity Health and Hill Physicians• Started 1/1/13• Promising engagement• Sharing data• Aligned incentives• Focusing on improving care while managing costs

• UCSF has been a great partner !• Too early for results, but encouraging signs

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Implications for Plans and Providers

Work closely together with aligned incentives – make decisions that drive a better overall outcome not maximize the result for one party/department/facility/group

Share and use data to move from fee-for-service fragmented care to population health management

Use new technologies and approaches to improve care, such as team-based care, use of secure messaging, in-home technologies

Change organizational structure and decision making to break down barriers and silos

Work with plans to design benefits with meaningful incentives for members to improve health status

12

Thoughts on UCSF

Incredible reputation and brand for high quality (and expensive) healthcare

A magnet for higher risk patients (e.g. in The Exchange), and very important to purchasers who are less price sensitive (e.g. high-tech companies)

Need to find a way to partner with others to combine broad-based and cost effective care in the community with high quality tertiary and quaternary care delivered by UCSF

Requires a difficult shift away from “heads in beds” and expensive clinical programs to finding ways to keep people healthy (and get paid for it)

Need to move away from cost shifting: compensating for inadequate Medicare and MediCal reimbursements by increasing margins on commercial insurance is killing the golden goose

Questions?

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8:00am – 8:30










Tom Enders




Academic Medicine for the Future

May 6, 2013UCSF Clinical Enterprise Retreat

Tom Enders, Managing DirectorManatt Health Solutions

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NIH Doubling

HealthReform

Managed Care and Capitation

Despite dire predictions, the last two decades have been excellent for academic medicine

NIHStimulus

Innovation in Medicine — Aging of the Population — Specialty Services Boom

1990 1995 2000 2005 2010 2015

Gro

wth

of t

he A

MC

Mis

sion

s

Stoc

k M

arke

t B

ubbl

e20

03 –

200

8

Excellent Clinical Margins

Philanthropy Boom

23Erosion!

AMC

Relentless Forces

Defenses

24The AMC Business Model….

Talent2 x Pricing Power x (Enterprise

Costs)

AMC Sustainability

∫(Δ)(Technology Introduction - Diffusion) (Regulation)

26The Challenge of Change

Risk of change perceived as greatConnection to people who succeeded in the

old modelFear of lacking the competence to succeedOverloadHealthy skepticism about new ideasThe fear of hidden agendasFeeling of personal threat from the changesGenuine belief that “next generation” models

are a bad idea

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Strategy

28Options for AMCs

Population Health Manager

Merge / Affiliate with Mega-System

Specialized Complex Care

Leader

High Performance Regional System

Regionally distributed health care system Risk bearing “population manager” Health Plan or payer partnership to supportClinically integrated network of faculty and community based physicians $ Multi-Billion Scale

Merge or establish primary preferred affiliation with large health system and become the “academic brand” for the system

Renown regional, national, international for a selected comprehensive specialty service (e.g. Cancer) Contractor to large systems Expert at Complex Care management Very strong Brand promise

Independent AMC with tightly controlled system of care in attractive geography Market share leader in an attractive “sub-regional” geography with “must-have” status Strong brand promise

29Clinical Strategies of Research Intensive AMCs

NIH RANK INSTITUTION1 JOHNS HOPKINS2 UCSF3 U MICHIGAN4 U PENNSYLVANIA5 U WASHINGTON6 U PITTSBURGH7 UCSD8 WASHINGTON UNIVERSITY9 YALE UNIVERSITY10 UNC CHAPEL HILL

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Sufficient scale to build a regional system of care Highly differentiated programs of excellence

with well integrated basic & clinical research Economic alignment with physician, academic

and hospital partnersIncreasing integration of clinical servicesPrimary care & ambulatory care expansionSophisticated analytics and IT infrastructureMaximizing brand valueQuality: Measurable, Demonstrable, Superior

Some Consistent Themes

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AMCSystem

32

Strategy

Organization Execution

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8:00am – 8:30










Tom Enders




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Vision Questions

• What mission will our clinical enterprise meet?

• What will distinguish our clinical services and operating model from Kaiser? From Sutter? From Stanford?

• If the distinctiveness is innovation, what does that mean?

• Who will be part of the clinical enterprise? At what scale will we operate?

• Will we be independent or part of a system?

• What settings of care will be invested in?

• What payment model will we operate under and how will we succeed with it?

Clinical Enterprise SWOT

• Regional leader in select tertiary/quaternary services

• Research innovator• Talent and commitment• Capital investment in plant, IT• Nascent network development

Strength Weakness

Opportunity Threat35



• Cost structure• Limited regional primary care• Hard to access specialists• Limited access to capital• Limited population health

experience or infrastructure• Highly federated governance

Strength Weakness

Opportunity Threat


36





• Provider consolidation and competition

• Changing insurance models• New world challenging to our

‘core’ identity & competencies

Strength Weakness

Opportunity Threat


37





• UCSF brand development• Trainer of the workforce• Nascent ACO experience• Regional relationships – getting to

scale

• Provider consolidation and competition

• Changing insurance models• New world challenging to our

‘core’ identity & competencies

Strength Weakness

Opportunity Threat


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Proposed Vision as Developed by the Clinical Enterprise Group & Clinical Enterprise Strategic Planning Committee

UCSF will be Northern California’s preeminent high

value health system as defined by our success in

providing innovative, high-quality, cost-competitive

clinical services, and delivering an unparalleled

patient experience across the entire care continuum.

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Vision: UCSF as the Preeminent High-Value System in Northern California

Wor

ld C

lass

Ed

ucati

on

Specialist Network

Home & Sub-Acute Care

Long-Term Care

UCSF

Cutti

ng E

dge

Rese

arch

High

-Val

ue, Q

ualit

y Cl

inic

al C

are

Strong Primary Care Teams

Clinical Research Implementation

Leading Acute Facilities

Regional T/Q Partnerships

Strategic Regional Expansion

Northern California System of Care

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Strategic Priority 1:Grow Complex Care Referrals Via Innovation & Distinction

Patient Outcomes & Breakthrough

Research

System of Care with Referring Providers

Excellent Patient Experience

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Strategic Priority 2: Lead A High Value System of Care

UCSF

Hospitals / Systems

(Marin General, UCSF oncology affiliates etc.)

Existing UCSF Distributed

Services

SCCIPAPediatric System

Kaiser? Other?

Physician Groups(Hill, One

Medical, etc.)

Existing Relationships On Which To Build

Relationships Under Development

Potential Transformation of Existing Relationship

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Strategic Priority 3:Build a Culture of Continuous Process Improvement

Today:Organization in silos….

Tomorrow: Integrated organization that is high-quality and efficient

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Enablers of UCSF’s Strategic Priorities and Vision

Build UCSF Brand

Lead in Precision Medicine

Align Financial and Administrative Operations

Establish Risk Management Capability

Apply Research to Clinical Care

Train and Recruit The Next Generation

Develop Physician Services

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UCSFCE Vision

Grow Complex Care Referrals Via Innovation &

Distinction

Lead A High Value System of Care

Build a Culture of Continuous Process

Improvement

Build the UCSF Brand Lead in Precision Medicine Align Financial &

Administrative Operations Establish Risk Management

Capability

Apply Research to Clinical Care

Train & Recruit the Next Generation

Develop Physician Services

The preeminent high-value health system in Northern California

ENAB

LERS

S

TRAT

EGIC

PRI

ORI

TIES

46


8:00am – 8:30










Tom Enders




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UCSFCE Vision

Grow Complex Care Referrals Via Innovation

& Distinction

Lead A High Value System of Care

Build a Culture of Continuous Process

Improvement

Develop Physician Services Build the UCSF Brand Lead in Precision Medicine Establish Risk Management

Capability

Apply Research to Clinical Care Train & Recruit the Next

Generation Align Financial & Administrative

Operations

The Preeminent High-Value Health System in Northern California

ENAB

LERS

S

TRAT

EGIC

PRI

ORI

TIES

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Imperatives

Transition from FFS to Risk-Based Contracting

Develop Population

Health Management Capabilities

Grow Bay Area Market

Share

Establish an Integrated Physician Platform

Deliver a World Class

Patient Experience

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UCSF Market Position: Overall Bay Area Market Share - Adults

Adult IP Market Share – Bay AreaCY 2011; Market Discharges = 524,170

UCSF3% Stanford

4%

Kaiser Hospitals25%

Sutter19%

Dignity3%

Others45%

Source: UCSF Data Reports and OSHPD; Excludes MS-DRG 795Note: Counties included: San Francisco, Marin, Napa, Solano, Sonoma, San Mateo, Santa Clara, Alameda, Contra Costa

?

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UCSF Overall Adult Market Share by County

Kaiser dominates the Bay area

markets and parts of Sacramento

Sutter is the second major player in SF County, and is very strong in the East

Bay and Sacramento

Stanford’s overall modest market strength

remains mostly in the South Bay and Central

Coast, but is aggressively moving into the East Bay

Dignity Health’s positioning is strongest in the Far North, Sacramento &

pockets of South Bay & Central Valley marketsUCSF’s Strongest

Overall Market Share

Filed Knox-Keene license to become a

full service health plan

Brown & Toland has an approved

Knox Keene license to manage

global risk

UCSF Overall Market Share

by County

51

Building on UCSF Regional Outreach

UCSF’s current outreach is strongest in the SF, North & East Bay markets and coastal areas of Far Northern CA. There may be opportunity to expand specialty

outreach to the south and east in order to build T/Q referrals

UCSF Overall Tertiary/Quaternary Market Share by

County

52

Establishing a Robust, Clinically Integrated Physician Network

South Bay – SCCIPA• Develop medical group

and establish a strong provider presence in the South Bay

• Enhance MSO capability

North Bay• Marin General/PRIMA

and Marin IPA are good partners and represent significant opportunities to build stronger ties

• Other regional relationships (Queen of the Valley and Santa Rosa Memorial) could be expanded further

East Bay• Children’s Oakland enhances

pediatric presence• Additional adult physician

partners are needed – Alta Bates and John Muir are well established options

SacramentoClose Coordination with UC Davis (and potentially Dignity) could help establish more integrated system in Sacramento, and across far North and Central Valley

UCSF Overall Market Share

by County

53

Ingredients of a High-Value System of Care

UCSF ACO

Analytics and Reporting

Governance and

PartnershipsPatient

Centered Care

Population Health

Management

Health Information Technology

Risk Contracts

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Strategies to Promote Clinical Integration

1. Rapidly developing primary care physician practices employed by UCSFCE

2. Increasing the ability of the faculty practices to function in a highly effective group practice mode

3. Enhancing the scope and scale of clinical affiliates that are aligned and clinically integrated with the faculty practice and other employed UCSF physicians.

4. Building the relationship with SCCIPA so that it flourishes and provides UCSF a major position in the South Bay. Build stronger relationships with other IPAs.

5. Integrating Children’s Oakland physicians, enhancing the ability of the pediatric strategy to succeed

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Measures of Success

Adapted from The Commonwealth Fund, Framework for a High Performance Health System for the United States, August 2006

High Quality- Medical Home

- Patient-Centered- Evidence-Based

Accessible- Timely

- Convenient- Affordable

Innovative- Continuous Improvement

- Translating Discovery

Efficient- Information Driven

- Right Care in the Right Environment

High-Value System of Care

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8:00am – 8:30










Tom Enders




Clinical Enterprise Financial View

UNDERSTAND & PROJECT THE FINANCIAL PERFORMANCE OF THE UCSF CLINICAL ENTERPRISE IN ITS ENTIRETY

Integrate Finance with StrategyLeverage scale of our EnterpriseAlign assumptions, planning, and decision

makingCreate new financial resources that will be

needed for investment in the strategy and our missions of research and education

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UCSF Clinical Enterprise Financial View

Clinical Operating Margin

Expenses

Institutional & Technical

Revenue

Pro-Fee Revenue

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UCSF Clinical Enterprise Financial View

Debt

Clinical Operating Margin

Clinical Departments Medical Center

Research and Education

Operating Expenses/Program

Investments and Reserves

Non-Operating Revenue/Philanthropy

Program and Capital

InvestmentsReserves

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UCSF Clinical Enterprise Key AssumptionsFY 2013-FY22

(Medical Center and Medical Group)

VolumeInpatientOutpatient

0%-1.5% annually2.3-3.7% annually

Payor Mix FY 2013 Budgeted Payor Mix: 0.5% shift from Commercial to Government; additional 1% shift to Government in FY 2020 (1)

Net RevenueGovernmentCommercial

0%-2.5% annually4.0%-5.0% annually

Salaries (2) 3.0% annually (UCSF MG)3.0-%-4.7% annually (UCSF MC)

UCRP Benefits (Covered Comp Only)

12.8% in FY 201414.8% in FY 2015 and beyond

Net New Clinical Faculty 89 for FY 2013-FY 2023Increase to 3.6M from 3M wRVUs

Notes:(1) Base to be updated to the UCSF Medical Group historical payor mix(2) Variance in salary rate increases are reasonable due to the difference in staffing mix between the

UCSF Medical Group and the Medical Center

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61

UCSF Clinical EnterpriseFY 2012 Actuals

Dollars (000's)UCSF Med

GroupMedical Center

Eliminating Entries

Consolidated Clinical

EnterpriseNon Medical

Group

Total Operating Revenue 575,338 1,581,631 (126,726) 2,030,243 1,327,037

Labor Expense 312,164 846,429 0 1,158,593 822,135Non Labor Expense 205,216 671,172 (89,788) 786,600 531,519Total Operating Expenses 517,380 1,517,601 (89,788) 1,945,193 1,353,654

Nonoperating Revenue 0 42,451 0 42,451 0

Excess of Revenue over Expenses 57,958 106,481 (36,938) 127,501 (26,617)

Changes in Net AssetsStrategic Support - School of Medicine 0 (27,870) 27,870 0 0Strategic Support - Cancer Center 0 (9,068) 9,068 0 0Other Strategic Support 0 (22,546) 0 (22,546) 0Total Changes in Net Assets 0 (59,484) 36,938 (22,546) 0

Excess Revenue after change in Net Assets 57,958 46,997 - 104,955 (26,617)

Margin % 10% 7% 6% - 2%

UCSF Clinical EnterpriseConsolidated Income Statement

*Projections based on FY 2013 Budget*Note: Medical Center margin is negative only in FY 2016; FY16-FY18 combined negative margin takes into account strategic support to Medical Group.

2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 $(100,000.00)

$(50,000.00)

$-

$50,000.00

$100,000.00

$150,000.00

$87,234.00

$104,660.00

$4,380.00

$(75,916.00)

$(26,019.00)

$(3,457.00)

$18,170.00 $25,469.00

$52,274.00

$77,535.00

Revenue Minus ExpensesFY 2013 - FY2022

Reve

nue

Min

us E

xpen

ses

(000

’s)

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Balance Sheet DetailsUCSF Medical Center

2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

Net Income Margin % (1) 5% 6% 1% - 2% 0% 1% 2% 2% 3% 3%

Debt Service Coverage (2) 3.6 3.9 3.3 3.3 4.0 4.2 4.7 4.8 4.4 4.6

Days Cash on Hand (2) 74 65 38 28 29 30 36 40 44 49

Notes: (1) Clinical Enterprise Net Income Margin (2) Medical Center Balance Sheet Indicators

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UCSF Clinical EnterpriseMedical Center Net Income - Mitigation Strategies

($150,000)

($100,000)

($50,000)

$0

$50,000

$100,000

$150,000

FY 2013 FY 2014 FY 2015 FY 2016 FY 2017

Net Operating Income ($000's)

Net Income with Mitigation Net Income without Mitigation

FY 2013 FY 2014 FY 2015 FY 2016 FY 2017Revenue Enhancements 8,000 16,700 18,300 20,400 22,900 Expense Reductions 11,300 44,300 52,200 60,300 68,500

19,300 61,000 70,500 80,700 91,400

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Dollars (000's) FY 2013 -

FY 2014 FY 2015 -

FY 2018 FY 2019 - FY 2022 (4)

Mission Bay Project (1) 734,626 327,132 APeX Electronic Medical Record (2) 21,815 - Strategic Investments 10,000 160,531

Renewals and ReplacementsInformation Technology 25,299 55,050 Equipment 29,695 69,087 Construction (3) 72,912 126,415 Sub- Total 127,906 250,552

Total 894,347 738,215 650,000

Notes:(1) Total Mission Bay Project $1.5B(2) Total APeX project $165M(3) Includes Backfill projects(4) Allocation among categories to be determined

UCSF Clinical EnterpriseMedical Center Capital Allocation Proposal

UCSFCE IS CERTAIN TO NEED MORE!!

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UCSF Clinical Enterprise

A. Forecast Challenges B. Needs

• Downward pressure on reimbursement rates (Medi-Cal, Medicare, DSH, IME, insurance exchange)

• Pressure on professional fee margin to support sponsored research and education

• High pension and retiree health insurance rates

• Expanded fixed costs (i.e.. Mission Bay)

• State Budget impact (specifically on education and research)

• Philanthropy targets not met

• Strategic & Program Investment

• Capital demands for IT and routine replacement and infrastructure (i.e. non-clinical facilities needs)

• Capital investment issues• Limited or no debt capacity

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67

UCSF Clinical EnterpriseBalancing Sources and Uses

How should these tradeoffs be optimizedwithin an appropriate credit and risk context?

Cash Debt

Capital Operations

How much cash?

How much capital?

How much debt?

How much profitability?Philanthropy and

Other Sources?

Source: Kaufman, Hall & Associates

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Clinical Enterprise Financial View

Must anticipate significant investment requirements our current economics will be hard pressed to meet

We will need to increase the yield from operations….

….while developing new & creative sources of capital

Take-Aways:

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69


8:00am – 8:30










Tom Enders




70

Leadership of the CE Strategic Planning Process

Executive Sponsors (M Laret, S Hawgood)

Clinical Enterprise Group (CEG)

Clinical Enterprise Strategic Planning (CESP) Steering Committee

Strategic Initiative Workgroups 1. Grow Complex Care Referrals Via Innovation &

Distinction2. Lead a High Value System of Care 3. Build a Culture of Continuous Process

Improvement 4. Strengthen Fiscal Position & Resource the Plan

• Teams of 15 – 20 faculty and clinical enterprise leaders that will recommend strategies, tactics and requirements to the CESP Steering Committee

• Teams will meet 5 times, between May – late July

71

Retreat Break-Out Groups

• Break-out groups’ findings will be used to provide content to the CESP Work Groups

• Each break-out group will focus on one of 3 topics:1. Grow Complex Care Referrals Via Innovation & Distinction2. Lead a High Value System of Care3. Build a Culture of Continuous Process Improvement

• Break-out groups will have approximately 60 minutes to engage in discussion on an assigned set of questions.

• Group leaders have been assigned to each break-out group to facilitate and share the group’s findings

72

Breakout Group Assignments

Topic Tables Facilitators Support Location

1 A: Grow Complex Care Referrals Via Innovation & Distinction 3, 6 Mark Laret &

Talmadge King Tom Enders Conference Room 1

1 B: Grow Complex Care Referrals Via Innovation & Distinction 9, 10 Mike Hindery &

Peter Carroll Alex Morin Conference Room 2

2 A: Lead a High Value System of Care 4, 5 Kevin Grumbach &

Bruce Wintroub Jan NorrisMain Conference Room

2 B: Lead a High Value System of Care 1, 2 Sam Hawgood &

Ron Arenson Jonah FrohlichMain Conference Room

3 A: Build a Culture of Continuous Process Improvement 7, 8 Ken Jones & Jay

Harris Min Zhu Conference Room 3

3 B: Build a Culture of Continuous Process Improvement 11, 12 Barrie Strickland &

Tad Vail Megan IngrahamMain Conference Room

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8:00am – 8:30










Tom Enders




74

Retreat Breakout Groups # 1 A & B: Grow Complex Care Referrals Via Innovation & Distinction

For the next 5 years, specify the critical issues & solutions the Complex Care Work Group should address to advance innovation and build our complex care referrals

• What are the critical issues to be addressed?

• What break-through solutions should be put on the table for further exploration?

75

A “high value system of care” rests on the foundation of clinical and financial integration between physicians and health service providers across the community. With this in mind:

• How can we establish a strong foundation of clinical integration between UCSFCE and community-based physicians & other health care providers?

• What needs to change at UCSFCE in order to achieve a “high value system of care” that can manage the health of a population?

Retreat Breakout Group # 2 A: Lead a High Value System of Care

76

How could the UCSF Medical Center and clinical practices work together to accomplish building a true regional system of care?

• What strategic opportunities should be prioritized and pursued?

• What needs to change at UCSFCE in order to address the prioritized opportunities and successfully achieve a regional system of care?

Retreat Breakout Group # 2 B: Lead a High Value System of Care

77

Retreat Breakout Groups # 3 A & B: Build a Culture of Continuous Process Improvement

How can UCSFCE migrate to a culture where every single person in UCSF shares the imperative to achieve and deliver world class quality, cost, safety & patient experiences?

• How do we achieve the magnitude of change that will be required across the enterprise in order for us to be successful?

78

Appendix

79

UCSF Clinical EnterpriseConsolidated Income Statement

Projections based on FY 2013 Budget

Dollars (000's) 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

Total Operating Revenue 2,121,245 2,180,007 2,255,421 2,371,033 2,487,320 2,597,608 2,706,395 2,801,507 2,919,776 3,041,681

Labor Expense 1,227,878 1,246,167 1,343,528 1,415,589 1,454,522 1,503,343 1,550,529 1,598,576 1,647,654 1,716,619Non Labor Expense 812,153 838,151 911,936 1,032,080 1,057,421 1,093,899 1,133,924 1,173,870 1,216,352 1,244,177Total Operating Expenses 2,040,031 2,084,318 2,255,464 2,447,669 2,511,943 2,597,242 2,684,453 2,772,446 2,864,006 2,960,795

Nonoperating Revenue 31,661 30,663 26,769 23,470 21,777 19,794 20,311 20,979 21,586 22,268

Excess of Revenue over Expenses 112,875 126,352 26,725 (53,166) (2,846) 20,160 42,254 50,040 77,355 103,153

Changes in Net AssetsStrategic Support - School of Medicine (3,634) (3,815) (4,006) (4,206) (4,417) (4,637) (4,869) (5,113) (5,368) (5,637)Strategic Support - Cancer Center 0 0 0 0 0 0 0 0 0 0Other Strategic Support (22,008) (17,876) (18,340) (18,544) (18,757) (18,979) (19,213) (19,458) (19,714) (19,983)Total Changes in Net Assets (25,641) (21,692) (22,346) (22,750) (23,173) (23,617) (24,083) (24,571) (25,082) (25,619)

87,233 104,660 4,379 (75,915) (26,019) (3,456) 18,171 25,469 52,273 77,534

Margin % 5% 6% 1% - 2% 0% 1% 2% 2% 3% 3%

Excess Revenue after change in Net Assets

80

Strategic Priority: Expand market position as a referral center for tertiary/ quaternary services* by achieving superior patient outcomes and efficiencies and continuously introducing innovation in the delivery of complex care throughout the UCSF health system

Objectives: • Consider the future state market dynamics regarding T/Q care in Northern California

and beyond• Define an approach that enables UCSF to deliver leading-edge, consistently

distinctive T/Q care to referral and network patients on an episode of care basis for specific services, with the necessary care management and outpatient care to achieve superior outcomes

• Consider how to succeed with bundles• Define an approach to demonstrate services’ outcomes and cost-effectiveness to

purchasers and patients • Consider how this model may align with an advanced partnership with Kaiser

Permanente

*Q/T services are defined based on the UC Health Tertiary / Quaternary Strategy, March 2013.

Workgroup 1: Grow Complex Care Referrals Via Innovation & Distinction

81

Workgroup 2: Lead a High Value System of Care

Strategic Priority: Transform health care delivery and partner with a network of Northern Californian hospitals and providers to create a comprehensive health care system accountable for a defined population’s health and providing a seamless continuum of coordinated, patient-centered, cost-effective care

Objectives: • Establish health care principles for the UCSF Health System, defining what it will stand for

and its value proposition to potential purchasers, leveraging external perspective as appropriate

• Define operating principles, the change management process, and accountability standards for a redesigned care model, including transformation of primary care into patient-centered medical homes, integration of care into service lines, and coordination across primary/secondary/TQ services and between inpatient, ambulatory, and community sectors.

• Define a regional network through partnership and outreach strategies, identifying specific types of target physician, hospital and sub-acute care partners in each region, the primary care capacity needed to care for the size of the targeted enrolled population for the health system, and the organizational models for an expanded physician network.

• Establish clinical integration among UCSF affiliated physicians – faculty and community physicians – for purposes of supporting value-based clinical practice, a lower-cost system of care and common payer contracting

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Workgroup 3: Build a Culture of Continuous Process Improvement

Strategic Priority: Rigorously and unrelentingly apply data-driven process improvement principles to reduce waste and improve safety and quality

Objectives: • Define enterprise-wide principles to transform UCSFCE culture into one

committed to continuous process improvement and related accountability

• Develop approach to identifying and rolling out efficient practices across the enterprise

• Identify 2-3 process improvements to launch enterprise-wide as a pilot over the next 18 months

ucsf clinical enterprise strategic plan

Documents

clinical enterprise

clinical enterprise

sam hawgood qa11

s hawgood

t endersa health plan

health plans

mark laret jay harris

qaclosing discussionm