1. Harbor Performance Initiative Presentation prepared for the National Association of Psychiatric Health Systems (NAPHS) “Hot Topic” Conference Call Monday, November 4, 2013

2. Harbor Performance Initiative  Dennis King, CEO, Spring Harbor Hospital  Jim Kupel, Managing Principal, Crescendo Consulting Group  Scott Good, Senior Consultant, Crescendo Consulting Group

3. Agenda  Welcome and Introduction  Background of the Harbor Performance Initiative  Goals of the HPI  Composition of the Initiative and Activities  Knowledge Sharing and Learning Segments  Strategies and Next Steps

4. The Idea Behind The Initiative “ From time to time, we all seem to struggle with ways to compare ourselves with similar facilities in an effort to improve our performance. We thought it an especially good time to reach out to a few of our mental health colleagues to examine a limited number of common performance measures on a “blinded” basis.”

5. Background and Pilot Study Original purpose – identify a select list of core measures that drive performance and establish benchmarks to identify best practices within relevant peer organizations A four-part approach was used:  Best Practice and Peer Group Baseline Research  Identification of Key Measures and Metrics used by Peer organizations  Internal Interviews and Development Measures  Benchmarking – Performance Relative to the Peer Group

6. Pilot Study Lessons Learned  Good management teams develop a wide number of “ad hoc” performance improvement processes that may or may not be comparable to other organizations.  Measures with good comparability (e.g., HBIPS) are not current.  Data variations (especially if consistent over time) can help identify learning opportunities  Identification of best practice leaders can help start productive conversations and exchange of operational strategies that may lead to lower costs, and more effective and efficient care  In response, the Harbor Performance Initiative (HPI) established – A group of leading behavioral health organizations to create a Best Practices and Benchmarking initiative

7. Method and Approach  Crescendo aggregated and “de-duped” a list of 75+ key measures collected in peer group institutions.  Refined and standardized metric definitions.  Identified a common set of core measures to be collected quarterly.  Executed participant agreements.  The group refuses to let the perfect become the enemy of the good.  The focus is upon ideas and actions that can be operationalized  We are all “leaders” and “learners.”

8. Composition and Goals of the HPI  HPI participants include a dozen select peer organizations across the country.  The overarching goal was, and is, to enable organizations to improve patient care and operate more effectively in the changing healthcare environment, e.g. bundled payments, ACOs, value-based contracting.  Participants are using key benchmarks as a tool for an on-going learning community that tracks and shares performance on key metrics.  The group believes that sharing our individual performance, knowledge and expertise in a candid and collegial environment can improves performance for all members.

9. HPI Activities  Quarterly data requests for a select group of measures  Data benchmarks and trends are compiled  Participate in Quarterly 90-minute webinars – Share Data (blinded) and benchmarks – “Learning Segments” – Participant Q&A – Engagement  Follow-up calls to each organization  Ongoing facilitation of participant to participant dialogue (1:1 and 1:many)

10. Sample Webinar – Data Benchmarks Secure Participation  Very high rate of participation  Organizational data and reports are individually password protected and being held on an encrypted server Time based trends  Most data ranges are reasonably similar – 2012Q1 and 2012Q4 Internal consistency  Organizations that were leaders (or learners) in 2012Q1 tend to still maintain that role  There are lots of high value opportunities for everyone

11. Sample Webinar – Selected Measures Measures 2012Q1 Median 2012Q4 Median 2013Q1 Median 2013Q1 Min 2013Q1 Max Occupancy rates X% Readmission rates X% Denials to inpatient care facilities X% HBIPS X% a. Admission screening X% b. Hours of physical restraint used 0.yy c. Hours of seclusion use by unit 0.yy d. Patients discharged on multiple antipsychotic medications X% e. Patients discharged on multiple antipsychotic medications with justification X% f. Post discharge continuing care plan created X% g. Post discharge continuing care plan transmitted to next level of care provider X%

12. Sample Webinar – Learning Segment HPI-Member led discussion: Cost Reduction Strategies  Overview of core cost drivers  Approach and Strategies to Reduce Costs

13. Learning Segment Sample continued Description of the impact of each major factor  Staff hourly rate – Rates for each staffing category – Medical staff paid at 75 th percentile but are at 90 th percentile in productivity  Staff ratios (details)  Wages and Benefits equates to 68% of total direct expenses  The impact of different units – C&A and Older Adult have significantly higher incidents of 1:1 patients – Higher staff numbers due to …  Nursing Turnover – reasons, impact, strategies to reduce

14. Participant Engagement  This is the “secret sauce”  Engagement support includes individual calls with each participant  In addition, participants regularly contact Crescendo and their colleagues – To provide a question to the peer group – To identify a participants who may have particular expert in an area targeted for improvement – To ask questions based on Crescendo’s interaction with the aggregated group – Others

15. Strategies and Next Steps Expansion strategies being considered include the following:  Psychiatric units within acute care hospital settings  Regional “pods” or groups based on geography or affinity

16. Contact Information  Dennis King, 207.761.2206; kingd@memhp.org kingd@memhp.org  Jim Kupel, 207.774.2345 ext-11; jimk@crescendocg.com jimk@crescendocg.com  Scott Good, 207.774.2345 ext-15; scottg@crescendocg.com scottg@crescendocg.com