Strategic Integration of Non-MD Providers in a Healthcare Delivery System

1. Strategic Integration of Non-MD Providers in a Healthcare Delivery System James Chang, MDAssociate Executive Director TPMG Presentation for: Residency Elective in Health Policy CONFIDENTIAL Strategic Integration of Non-MD Providers – October 2017, James Chang MD

2. Strategy is Destiny • An effective strategy uses KP's competitive advantages to achieve our goals and aspirations • Empowering and fully leveraging non-physician providers in KP is part of an overarching strategy for KP • Building MD-PA teams is aimed to systematically improve our specialty care efficiency, patient experience, and cost effectiveness Strategic Integration of Non-MD Providers – October 2017, James Chang MD

3. The Setting Strategic Integration of Non-MD Providers – October 2017, James Chang MD

4. Kaiser Permanente NCAL An integrated healthcaredelivery system 4 million members 21 Hospitals 35 Medical Offices 9,000+ Physicians 33,000+ Nurses and staff Strategic Integration of Non-MD Providers – October 2017, James Chang MD

5. Kaiser Permanente NCAL –An integrated healthcare delivery system Strategic Integration of Non-MD Providers – October 2017, James Chang MD

6. Kaiser Permanente NCAL –An integrated healthcare delivery system • Anatomy is not Physiology • Integration in multiple functional interlocking processes: Strategic Integration of Non-MD Providers – October 2017, James Chang MD

7. Kaiser Permanente NCAL –An integrated healthcare delivery system • Collaborative and matched leadership between entities • Functional linkages: • Labor-Management Partnership Strategic Integration of Non-MD Providers – October 2017, James Chang MD

8. Kaiser Permanente NCAL –An integrated healthcare delivery system • Conjoin Twins – mutually dependent welfare • Long shared history – we exist in each other’s lore • Simplicity • Direct line of sight partnership Strategic Integration of Non-MD Providers – October 2017, James Chang MD

9. Capitated Pre-payment : PMPM dues • Easier revenue projection matched with planned and expected expenditures • Singular and unified clinical and operational strategy for population management based on: Prevention, Screening, Early Detection, Rapid Assessment and Effective Treatment • Operational design – most efficient, most effective, most safe • Aligned member, payer, and KP interests Strategic Integration of Non-MD Providers – October 2017, James Chang MD

10. Additional Operational Concepts : Applied Information and Communication Technology • Leverage Moore’s Law • Advance integration and virtual connectedness • Understand our care and the consequences, so we can improve • Combine retrospective analysis with prospective and predictive operational and clinical modelling        Strategic Integration of Non-MD Providers – October 2017, James Chang MD

11. Systems Thinking and Approach • Design to care for large population and to lower marginal cost • Lower unwarranted variation and increase consistency • Create a common operational language and ease performance improvement • Interlocked processes to sustain competitive advantage Strategic Integration of Non-MD Providers – October 2017, James Chang MD

12. Specialty Redesign Strategic Integration of Non-MD Providers – October 2017, James Chang MD

13. Specialty Redesign • Systematically improve – our quality, patient experience, and cost effectiveness • Eliminate chance – serendipity, happenstance and geography, increase consistency and reliability • Build teams – leverage physician time, improve care coordination, help navigate patient care journey Strategic Integration of Non-MD Providers – October 2017, James Chang MD

14. Specialty Redesign • Principles of Redesign Empowernon-physician providers Specialization Strategic Consolidation Consistency Leverage Technology Integrated Collaboration Strategic Integration of Non-MD Providers – October 2017, James Chang MD

15. Rethinking & Redesign MD-PA Teams Strategic Integration of Non-MD Providers – October 2017, James Chang MD

16. Four Pillars and Our PA Redesign Strategy Create a consistent practice across the NCAL care experience utilizing a skill mix that leverages the things that only physicians can do and leverages the activities where PAs can excel Strategic Integration of Non-MD Providers – October 2017, James Chang MD

17. Components of Strategic Integration Medical Center PA leader, specialty physician leader, administrative leader Regional Coordination Senior medical group leaders Specialty Chair, Medical center Chiefs, Managers Strategic Integration of Non-MD Providers – October 2017, James Chang MD

18. Redesign TPMG Specialty Care into a Matrix Y Medical Center Subregions PA PA PA PA PA PA PA PA PA Specialties X PA PA PA Regional Service Z Strategic Integration of Non-MD Providers – October 2017, James Chang MD

19. Four Pillars of PA Redesign Strategic HR Operational Design Governance LeadershipDevelopment Strategic Integration of Non-MD Providers – October 2017, James Chang MD

20. Four Pillars of PA Redesign Strategic HR PAs as a TPMG Strategic Differentiator • Recruiting and Hiring • Onboarding and Mentoring • Cultural assimilation • Career development Strategic Integration of Non-MD Providers – October 2017, James Chang MD

21. Four Pillars of PA Redesign Operational Design Specialized and Consistent • Specialty based workflows • Full scope of practice • Consistent design across the Region • Team based, with individual task accountability Strategic Integration of Non-MD Providers – October 2017, James Chang MD

22. Four Pillars of PA Redesign Governance Leading in the Matrix • Collaborative design  medical center + specialty + region • Accountability-based decision making rights • Performance and Quality assessment Strategic Integration of Non-MD Providers – October 2017, James Chang MD

23. Four Pillars of PA Redesign Leadership Development Basis of Success • Structured lectures  leadership and management • Feedback and Mentoring • Communication skills training Strategic Integration of Non-MD Providers – October 2017, James Chang MD

24. Four Pillars of PA Redesign Strategic HR Governance PAs as a TPMG Strategic Differentiator Leading in the Matrix • Recruiting and Hiring • Onboarding and Mentoring • Cultural assimilation • Career development • Collaborative design  medical center + specialty + region • Accountability-based decision making rights • Performance and Quality assessment Operational Design Leadership Development Specialized and Consistent • Specialty based workflows • Full scope of practice • Consistent design across the Region • Team based, with individual task accountability Basis of Success • Structured lectures  leadership and management • Feedback and Mentoring • Communication skills training Strategic Integration of Non-MD Providers – October 2017, James Chang MD

25. Strategy is Destiny • An effective strategy uses KP's competitive advantages to achieve our goals and aspirations • Empowering and fully leveraging non-physician providers in KP is part of an overarching strategy for KP • Building MD-PA teams is aimed to systematically improve our specialty care efficiency, patient experience, and cost effectiveness Strategic Integration of Non-MD Providers – October 2017, James Chang MD