Presentation to: Trinity Health Care

Administration Students

Tuesday, November 10, 2015

Joel T. Allison, FACHE

Chief Executive Officer

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Today’s Agenda

• Baylor Scott & White Health Merger• Population Health Management• Partnerships• Opportunities/Challenges going forward

• Thoughts on leadership

“If the rate of change on the outside of your organization is faster than the rate of change on the inside of your organization, the end is near.”

Jack Welch, former chairman and CEO of GE

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Baylor Scott & White Health

Merger Creates Largest Not-for-Profit Health Care System in Texas and the 12th Largest in the US (in revenue)

• Health Plan/Members *• Quality Alliance/Members*• Assets• Revenues (annualized)• Hospitals• Patient Care Sites• Licensed Beds• Affiliated Physicians

– Physician FTEs– Adv. Practice Provider FTEs

• Employee FTEs• Community Benefits **

1 / > 238k1 / > 248k$9.3B$7.3B52>8805,4106,0001,6741,20539,000$664mm

Baylor system footprint

Scott & White Health Plan footprintScott & White system footprint

* Includes NTX and CTX employees and their dependents** Represents 12 months of data

A Union Of Complementary Strengths

• Enhance our missions• Advance clinical care for our patients• Build on exceptional reputations • Enhance medical education and research • Enhance recruitment and retention opportunities • Generate economies of scale• Optimize care delivery sites • Expand integrated health care delivery model• Create value

Value = Quality + Patient Experience + Functional Status Post Episode of Care Cost of Event + Cost of Episodes of Care + Ongoing Costs Post Care

Source for Value Formula: American College of Physician Executives 6

Shared Values Support a Defined Mission and Vision

Baylor Scott & White Health exists to serve all people by providing personalized health

and wellness through exemplary care, education and research as a Christian

ministry of healing.

To be the most trusted name in giving and receiving safe, quality, compassionate

health care.

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What Brought Us to the Table

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• Common Mission, Vision, Values• Previous work together-HCT/TCA (respect)• Similar physician engagement models• Shift/emphasis from acute care toward

population health management• Health Care Reform – Affordable Care Act

(reimbursement pressures)• Data aggregation/analytics/transparency• Captive Health Plan and infrastructure• Geographical distinction• Scale – capital formation

Triple Aim

Big dataData analytics & predictive modelingSocial/community supportTransportation/housingPriority setting“The Mediterranean Diet”

Delivery redesignScope of practiceLowest cost site of careTelehealthDigital substitutionSelf-carePalliative care

TransparencyCQI/LeanShared decision-makingStandardizationClinical guidelines and Care paths

Triple AimInformationIncentivesIntegrationIntegrity

Better Health

Better Health Care Lower Per Capita Costs

THE SHARING OF SAVINGS Synergies gained after the merger achieved an annual savings of more than $100 million.

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Total Synergies

Supply Chain

Information Services

Risk Management

Human Resources

Medical Education

Support Services

Research Administration

Finance

Legend

$53,278

50,522

1,073

1,468

206

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$576,868

423,052

53,603

37,260

23,722

22,192

35,738

1,094

792

35,738

715

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FY 2014 Year One Five Year

15,897

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$37,406

155

FY 2014 – October 1, 2013 to June 30, 2014Year One – October 1, 2013 to September 30, 2014

Integration Highlights|Synergies Overview

• FY 2014 (October 2013 – June 2014)Plan: $37,406,000

Actual: $39,645,000

• FY 2015

Plan: $ 91,503,000

Actual: $108,990,000 119%

Integration Highlights|Synergies Overview

106%

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Integration Highlights|FY 2015 through June

Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun

YTD Ac-tual Sav-ings

8271.30833333333

14476.6166666667

22581.0916666667

32832.4724305556

40181.9365277778

47559.900625

57102.6147222222

66038.3288194445

75480.0429166667

85892.7570138889

96305.4711111111

$108,990

YTD Bud-geted Savings

7361.34682148663

15001.1278578614

23397.3337115629

32008.6413308529

40522.9300064251

48973.1933180285

57032.8188910791

64720.5720196524

72083.3547444004

78710.0940795151

85196.9223238756

$91,503

$10,000

$30,000

$50,000

$70,000

$90,000

$110,000 $108,990

$91,503

YTD Realized Synergies

YTD Actual SavingsYTD Budgeted SavingsIn

thou

sand

s

Integration Highlights|Marketing and BrandingIncreasing BSWH brand awareness through high-visibility

facility signage

Hillcrest

Waxahachie

McLane Children’s Clinic - Temple

Irving (Spring 2015)

One Name. One Team. One-Year-Old. Internal Anniversary Celebrations!

Integration Highlights|Internal Brand Building and Communications

Creating Internal Value

• Since we serve two geographically distinct areas, our merger:

— Resulted in few employee layoffs— Strengthened internal culture— Created new employment opportunities

Integration Highlights|Overview Integration Survey

Purpose: The purpose of the Integration Survey is to identify ways to improve and accelerate integration of our two organizations to become one. Baseline survey was April 2014.

Survey Questions:Questions for the survey were developed based on John Kotter’s 8-step change framework for effectively leading change

Design Considerations:• Cost-effectiveness • Data confidentiality• Simple and fast for employees to take• Random sample

•Survey Focus:– Degree of urgency to integrate– Integration leadership effectiveness– Clarity of BSWH vision and direction– Communication effectiveness

(Dec’14)•Sample:

– 30% Service Company (1,858)– 35% Operations & All Others (9,381)

39.1%

21.4%

27.3%

47.6%39.1%

30.5%

40.9% 44.5%

25.8%29.7%

17.9%

33.5%

0%

10%

20%

30%

40%

50%

60%

BSWH NorthDivision

CentralDivision

ServiceCompany

Response Rates April, August and December

Response Rate April '14 Response Rate August '14

Response Rate December '14

Integration Highlights|December 2014 Integration Survey Showed Positive Progress

August Survey Results• Continued progress in leadership

effectiveness (64.2% fav) and vision (62.5% fav)

• Progress in urgency (51.2% fav) – understanding of why the merger was necessary and involvement of leadership in leading change initiatives

• Most favorable: “I think our vision, if realized, will make us more competitive” (72.4% fav)

• Least favorable: “I have seen clear evidence that the merger is succeeding” (38.9% fav)

December Survey Results• Solid progress in leadership

effectiveness (69.8% fav) and vision (66.4% fav)

• Results in sense of urgency (51.8% fav) are flat from August

• Most favorable: “I think our vision, if realized, will make us more competitive” (76.3% fav)

• Least favorable: “We couldn’t have remained competitive without merging.” (40.8% fav)

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Lessons Learned

• Naming leadership early is key. For example; delay in naming chief human resources officer resulted in challenges meeting targeted timelines.

• Never underestimate the impact of Culture• Never underestimate the value of Communication• Geography continues to be a challenge.• Complexities involved in re-branding facilities• Employees want the new brand!

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Population Health Management

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Circle of Care

Vision for the Future of Health Care

•BSWH is integrating care delivery by implementing a population health strategy: • Better health. • Better health care.• Lower per capita costs.

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Strategies for Accountable Care

Strategy 1:

• PATIENT-CENTERED MEDICAL HOME• One of the largest PCMH networks in the

nation.• Enhances preventive health services and

disease management.

Strategy 2:

• CHRONIC DISEASE MANAGEMENTTHROUGH DATA ANALYTICS • Identification in the top 5%.• Risk stratification matches appropriate

resources to patient’s need.

Strategies for Accountable Care

• COORDINATION ACROSS

THE CONTINUUM OF CARE • Helps patients follow physician's plan of care.• Supports transitions and disease management

and closes gaps in care.

Strategies for Accountable Care

Strategy 3:

Baylor Scott & White Quality AllianceFocused on patient-centered clinical integration across all points of care

Entry Point Redesign:

Primary Care strength, PCP PCMH; physician-designed best care and quality improvement processes, access & capacity challenge.

Care Integration/Specialty Alignment:

Standardized order sets, clinical protocols, care redesign. Large scale physician partnering, EHR adoption, and connectivity via HIE challenges.

Population Health Infrastructure:

Predictive analytics, comparative effectiveness, care coordination and population health management.

Financing: New innovative payment models, product & benefit redesign, data repository and control.

Entry Point

Redesign

CI/ Specialty Alignme

nt

Population Health Infrastruc

ture

Financing

Intended consequences: QualityImprovement, patient satisfaction and

cost reduction – otherwise unachievable

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Population Health Management Baylor Scott & White Quality Alliance

• Baylor Quality Alliance became Baylor Scott & White Quality Alliance and expands into CTX.

• Physician members grew from 2,346 to 4,018.• Covered lives increased from 42,300 to

248,004.• Clinical Integration Care Protocols expanded

from 86 to 120.

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• Care Coordination & Data Analytics programs continue to mature.

• Point of Care Delivery Program (PODs) expanded from six (NTX) to eleven (five in CTX).

• Linking of BSWQA to Scott & White Health Plan to establish an enhanced value proposition is underway.

Population Health Management Baylor Scott & White Quality Alliance, cont’d.

BSWQA/SWHP Value Proposition

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Employer

Member

A SWHP/BSWQA collaboration results in economies of scale by offering a system approach to the delivery and financing of care. The outcome of these efficiencies is:

Plan sustainability • Premium predictability • Trendability (lower than national plans) • Data sharability • Performance Measurability • Improved employee well-being and productivity

A SWHP/BSWQA collaboration establishes a financing/delivery model under a unified structure capable of delivering a seamless and personalized member experience.

A common corporate mission, vision, aligned focus, and resources allows for permeating boundaries typically found between payors and providers operating separately.

PR

IVIL

EG

ED

AN

D C

ON

FID

EN

TIA

L

dbMotion(implementation)

BSWQA’s Health Information Exchange Solution• EHRs and data

repositories at other sites are queried for usable information to help complete the patient record.

• Clinical information comes directly to HER.

CPO and EpicCrimson Real TimeOptum One

Data and Analytics Tools

Overall data aggregator of BSWH comprehensive data:• Clinical • Financial • BSWQA

independent physician members

ExplorysLibrary of comprehensive analytic reports for specific cohorts • Identify

actionable clinical opportunities for care coordinators

• Develop patient "hot lists"

Risk stratification and predictive modeling for our individual patients and patient populations.

Enables identification of at-risk patients earlier, preserves patient health, reduces costs and prevents complications.

EHR platform to support management throughout the continuum, including:• Inpatient care

coordination• Post-acute care• Payer-based case

management

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Results – First Two Years• Hospital admissions among the member population

of 34,000 employees and beneficiaries is down an impressive 9%.

• Hospital readmissions (30 days) are down 10%.• Total cost of providing health care to the group is

down $24 million – a 7% savings.• Rise in prescribing rate for less expensive generic

medications – 4.6%.• These exciting results show we are providing the

right care, in the right way, at the right time, in the right place, at the right price and we are able to prove it.

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The alliance between BSWH and the Cleveland Clinic brings high-quality cardiovascular careto the Southwest and offers exclusive providers for Texas and Oklahoma cardiac patient referrals.

Cleveland Clinic Alliance

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BSWH/TGEN Personalized Medicine

Consortium

BSWH and the Dallas Cowboys

Joining with the Dallas Cowboys, BSWH will construct a center of excellence in Sports Medicine at the Star in Frisco.•Ambulatory surgery center, diagnostic imaging center, physical therapy and more.

BSWH & Walgreen’s Coming Together

• Recent collaboration with Walgreen’s gives BSWQA members increased access to quality, after-hours care.

—HTPN physicians oversee nurse practitioners and physician assistants delivering care.

– 11 healthcare clinics at select Walgreen’s are open and fully operational.

Coming Together for Better Health

Through a joint venture with Tenet Healthcare, BSWH will partner on providing care through five North Texas hospitals.

— Will deliver value-based care to Rockwall, Collin and Dallas counties.

— Four hospitals will enter BSWQA.— All hospitals will operate under BSWH brand.

Training Expert Health Companions

BSWH & Canine Companions for Independence are bringing premier service dogs to the Southwest.

— Building the first training center in Irving.

— First dog training schoolin the nation connected with a health care system.

Joint Venture Partnerships - Mission

To provide first-class surgical services for the local community in a safe, comfortable and welcoming environment; one in which we would be happy to treat our own families.

To provide an exceptional patient care experience that promotes healing and recovery in a compassionate environment.

To provide patients with easy access to the same compassionate, high-quality, efficient acute medical care we would want for our families.

To offer patients and physicians the highest quality outpatient imaging services and to support them with a deeply instilled work ethic of personal service and integrity.

(JV formed 1998)

(JV formed 04/2011)

(JV formed 06/2012)

(JV formed 07/2013)

Opportunities and Challenges Going Forward

1. Capital formation/constraints

2. Increasing primary care network across System

3. Growth of Baylor Scott & White Quality Alliance and Scott & White Health Plan as an integrated delivery network

4. Complete integration of HR

5. Preserve 1115 Medicaid Waiver

6. Develop state-wide network

7. Pricing of pharmaceuticals

The Way Forward – Four Focus Priorities

1. Operational Excellence centered around the Circle of Care 

2. Population Health/Growth – Create statewide network

3. People and Culture

4. Digital Patient Experience

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“You can’t list your iPhone as your primary care physician.”

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Each hospital/system has to make a decision of where they

want to play.

New Roles for the Journey

“The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty and we must rise with the occasion. As our case is new, so we must think anew and act anew.”

Abraham Lincoln

Vision 2020 (Video)

Thoughts on Leadership

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Leadership Traits

• Integrity

• Vision

• Compassion

• Passion

• Communication Skills/ Listening Skills

• Risk-taker

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Leadership Traits

• Relationship-builder

• Innovative/creative

• Servant-leader

• Humorist

• Competent

• Inspiring

• Principled

• Trust

Principle-Centered Leadership

• Be continually learning• Be service-oriented• Radiate positive energy• Believe in others• Lead a charmed life• See life as an adventure• Be synergistic – be a change catalyst• Exercise for self-renewal: spiritual,

physical, mental and emotional

Mentors/Advisors

• Appreciate the importance of mentors.

• Have a strong network.

• Have several close, trusted advisors.

What Leadership Skills are Necessary for Future Success?

•Strategic thinking•Team building•Communication•Creativity

1. I am aware of the way I am perceived by various groups.

2. I have complete control over my calendar.

3. I invest two-thirds of my time to relationship improvement.

4. I invest more time in the future than the present or the past.

5. I know the capabilities and capacity of the talent needed to be successful.

Leadership Quick Test

6. Coaching and professional development are a big part of my daily work.

7. I am a servant leader.

8. I routinely use active listening techniques.

9. I deal with difficult behaviors, problems and conflicts quickly and effectively.

10.I am trusted throughout the organization.

Leadership Quick Test, cont’d.

“Leadership is all about people. It is not about organizations. It is not about plans. It is all about people -- motivating people to get the job done. You have to be people-centered.” Colin Powell

Questions/Discussion

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