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Evolution of Internal Physician Roles and the Lead Physician Role in 2016

Introduction of Lead Physician and Associate Physician roles led to the expansion and enhancement of internal physician services, focusing on quality oversight, training, and structured reporting processes. The evolving role of Lead Physicians aims to drive teamwork, excellence, and accountability within the Clinical Group, supported by a comprehensive framework for onboarding, oversight, and performance evaluation.

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Evolution of Internal Physician Roles and the Lead Physician Role in 2016

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  1. Best Doctors Lead Physician Role 2016 1

  2. Our Internal Physicians! Confidential 2

  3. Background Historical Review of Internal MD Roles Initially was a unified model with the MDC as the internal resource • Wrote CS • All member facing tasks were performed by MA Addition of the Lead Physician Role • As volume grew could provide continued quality oversight and training • Approved reports and later created BDRS • Now in US/Canada does report delivery/discussion Evolution of Associate Physician (AP) role • Amalgam of MDC and Lead roles • Occurred with launching of IC Lite workflow • Has expanded greatly and can staff cases of equivalent complexity as MDC/Lead model • QA occurs through audit process by Lead MDs rather than real time report review • Does report delivery/discussion • Oversight primarily by medical director 3

  4. Associate Physicians Cardiology Hematology/Oncology Internal Medicine Gastroenterology Pulmonology Infectious Disease Neurology General Surgery Orthopedic Surgery Neurosurgery Radiation Oncology Anesthesia/Pain General Pediatrics Dermatology Endocrinology Nephrology Rheumatology OB/GYN Ophthalmology Pediatric Cardiology ENT Plastic Surgery Pediatric GI Vascular Surgery Surgical Oncology 16% 11% 9% 9% 5% 3% 1-2% 4

  5. Background 2015 - 2016 • Introduction of RD Specialists • Introduction of MD Intake pilot • Increasing need for specialty matching • Need for tailored solutions (ATE+ through MD Intake) • Need for scalable MD workforce that can meet dynamic needs Unified AP Staffing Model (retirement of the MDC role) AP pool of selected individuals with consistent high quality Majority of work performed without Lead oversight 5

  6. Drivers for Evolving the Lead Physician Role A more competitive environment has created pressures: • Need for a dynamic and scalable internal MD model • Need to ensure consistently high quality with a physician pool that is growing in size and scope of responsibilities • Need to provide more formal structure around roles and reporting Questions to address: • Should MD work be done by full time BD physicians rather than large group of consulting MDs? • We know the Leads are great but how do we objectively demonstrate their contributions? • How to we ensure quality, accountability, professionalism and availability with a large group of consulting MDs? 6

  7. Lead Physicians - Vision The Revised Lead Physician Role will: • Create a Lead-AP mentorship/oversight relationship intended to foster a culture of teamwork, excellence and accountability • Provide a structure for AP selection and on-boarding driven by the Lead • Provide a structure for AP oversight and accountability by the Lead • Place the Lead at the center of the Clinical Group by supporting clinical activities for complex cases / issues • Provide a structure to improve ongoing working with MAs through regular meetings • Provide a structure for performance and accountability 7

  8. New Model Evolution of the internal MD role is the deliberate expansion of MD responsibilities, simultaneously building the quality assurance infrastructure to drive ongoing improvement of our clinical services and impact. Associate Physician Lead Physician Perform MD intakes Writes CS Support team if questions Assists in BD selection Reviews BDR and approve/reject Writes BDRS Completes UPW Completes and document Report Discussion Case Support for MAs and APs General support of Clinical Group Case Triage support AP Work Quality and performance reviews New AP Selection New AP Onboarding MA / Clinical Group meetings Lead Meetings 8

  9. Clinical Group Support To provide primary leadership and guidance to the Clinical Group • Respond to case-based MA and AP requests • Service line triage • MRC guidance/streamlining • Service recovery • Treating MD outreach for high-impact cases* • New AP Onboarding • MA meeting/phone call every 6 months* • Also introductory meeting/call for new MA staff • Mandatory AP Quarterly Performance Review • Written evaluation* • Meeting/phone call q3-6 months* • Individual lead MD meeting/phone call with medical director every 6 months* *New component 9

  10. Clinical Groups 6.1.16 Clinical Group 1 - B Paul Lovely Clinical Group 3 - A Sara MacDonald Sara MacDonald Clinical Group 1 - A Paul Lovely Clinical Group 1 - C Clinical Group 2 - A Clinical Group 2 - B Clinical Group 2 -C Paul Lovely Paul Lovely Clinical Group 3 - B Clinical Group 1 Clinical Group 2 Micheline Corbeil Clinical Group 3 Manager Paul Lovely Paul Lovely Manager Chris Gibson/Kenny Varian Lead AP Lead AP Chris Gibson Kenny Varian Kayla Zomlefer Ariela Marshall Bill Wood Graham McMahon Mike Gavin Paul Cohen Ayal Aizer Francis Alenghat MA Team Lead Linnea Nelson Laurie Bayler Gillian Rodrigues Lori Cote Stephanie Brown Bree Everats Jackie Carroll Jodi Scholz William Pregmon Kelly Gillis Melissa Konieczka Sarah Alcorn Karen Chouinard Carley Leighton Shane Enochs Karen Arbeene Deana Manning Carol Walter Casey Anderson MA Shinead Callery Winnie Chu Nathalie Trifiro (Chris) Maternity/Med Leave Lia Sharpe Shelley Tremblay Stacey Jordan Lynne Peacock Jennifer Yapp Brianne Murphy Loriann Ryan Ama Cherebua Erin Sanborn Elizabeth Michel Marivic Bray Lindsey Parsons Danielle Rondeau Stephanie DaRosa Jason Smith Blanca Mesa Christina Illiano Sarah Beal Pamela Braithwaite Michelle Morrison Tania Pellizzari (Chris) Jessica Singh (Kenny) Theresa Febria (Kenny) Amanda Sellers Rhonda Nauth (M,T,Th) Ghislain Ives (part- time) Shahista Lalani Maria Cooper Lisa Mello Michele Tiano Carolyn MacManus Elly Neraida Isabelle Drolet Helene Draper Chris Gibson Kenny Varian Jared O'Leary (Med/Pediatrics, Cardiology) Matthew Lewis (Med/Pediatrics, Cardiology) Alana Chakrabarti (OB/GYN) Kiran Gupta (Medicine) Adam Sperling (Oncology) Brad Blaser (Oncology) Corrine Kliment (Pulmonary) Tyler Burpee (Pediatric GI) Zach Wallace (Rheumatology) Shika Pappoe (Nephrology) Mallika Mendu (Nephrology) AP AP Stephen Rotman (GI)Ibiayi Dadogo- Neil Sengupta (GI)Damaris Nou Neelam Vashi (Dermatology) Kavita Mishra (Urogynecology) Mitul Kadakia (Cardiology) Natalie Vokes (Oncology, Med) Dan Motola (GI) Jack (Oncology) (Medicine) Charlotte Rolle (Infectious Disease) Tom Finn (internal Medicine, GI) Nicholas Giacalone (Rad Onc) Louis Saddic (Anesthesia/Pain ) Luke Macyszyn (Neurosurgery) Laura Spring (Oncology) Katherine Dunn (General Surg) Sarah Kohnstamm (Dutch, Cardiology) Steve Nissman (Ophthalmology) Ravi Shah (Cardiology) Joanna Peloquin (GI)Amit Vora (Cardiology) Fred Lee (Infectious Disease) Jacob Soumerai (Oncology) Adrienne Gropper (Oncology) Michael Peluso (Medicine) Ramon Partida (Cardiology) Darshan Doshi (Cardiology) Judd Englert (Oncology) Joseph Bumgarner (Cardiology) Espy Schaefer (GI) Jan-Willem Middelbeek (Dutch, Endocrinology) Jessica Shanahan (Anesthesia/Pain) Alison Goldin (GI)Leana May Zwade Marshall (Anesthesia/Pain) Peter Monteleone (Cardiology) Julia Kendrick (General Surgery) Leonie Heyworth (Medicine) Ping Sun (Cardiology) (Pediatrics) Daniel Solomon (Infectious disease) Gaurav Sharma (Vascular Surg, Onc Surg,) Katy Kehl (Pulmonary) Tara Soumerai (Med Onc) W. Marshall Guy (Plastic Surgery) Edward Carreras (Cardiology) Cori Russel (Cardiology, Med) Daniel Gorovets (Rad Onc) Jonathan Casey (Pulmonary) Will Yao (ENT) Andrea Suarez (Dermatology/Rhe umatology) Steve Constantino (Anesthesia/Pain Medicine) Ben Nwachukwu (Orthopedic Surgery) Curtis Chong (Heme/Onc) Christian Strong (Neurosurgery) Mario Aycart (General Surgery) Ed Barnes (Gastroenterology) Omar Badri (Dermatology) Dave Saper (Orthopedics) Jimmy Kerrigan (Cardiology) Srini Viswanathan (Heme/Onc) Chulie Ulloa (Pediatrics) Anna Ross (Endocrine) Joey LaMartina (Orthopedics) Eddy Arous (Vascular Surgery) Nina Niu (Rad Onc) Jeffrey Lin (Cardiology) Michael Shy (Urology) Additional Lead MDs (not linked to clinical groups) Eric Nou Kalil Abdullah (Neurosurgery) Jessica Manning Thomas Metkus Gaurav Luther (Orthopedics) Feras Akbik (Neurology) AP 10

  11. AP Quality Review Form Confidential 11

  12. Interval Lead Meetings Coming together to share performance, issues, and creative solutions • Meeting with medical director and possibly other Lead MDs • Present your group’s metrics • Present quality initiatives and outcomes • Share and develop ideas 12

  13. Lead Activities Summary Daily Bi-Weekly Available daily to APs & MAs Available daily Review the PQRS report, send feedback to each AP, develop action plan Semi- Annually Monthly Quarterly Complex Case Report Case Triage PQRS Report Review expert feedback and provide to AP Expert Feedback Audit at least 1 case for each AP each quarter, more for “at risk” Review for each AP quarterly and provide feedback Review for each AP quarterly and provide feedback Review for each AP quarterly and provide feedback Review for each AP quarterly and provide feedback Estimate of 1 new AP trained per quarter Audit AP Score Report Mini-UPW Quarterly Performance Report Member RD Feedback New AP On boarding Feedback phone call with each AP Agenda to be developed collaboratively AP Phone Call MA Call Submit summary report to Medical Director documenting QA activities, highlighting quality issues, and outlining action plan Submit AP Report Summary 13

  14. Summary The Enhanced Lead Physician Role: • • • Increased support of the clinical group Increased involvement in AP selection and training More structured AP oversight Overall should provide a structure for each Lead to extend their knowledge and BD experience throughout their Clinical Group and AP Team to insure consistent high-quality work 14

  15. Comments, Questions, Feedback … 15

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