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UCSF Clinical Enterprise Strategic Plan Retreat 1 May 6, 2013 1.

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1 UCSF Clinical Enterprise Strategic Plan Retreat 1 May 6,

2 2 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

3 3 UCSFCE Strategic Planning Process – Project Overview May - July August - October February - 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 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 & Distinction 2. 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

5 5 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

6 A Health Plan View of the California Market UCSF Clinical Enterprise Strategic Planning Retreat May 6,

7 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

8 What’s Important Three most important priorities for health plans (and should be for the rest of the healthcare delivery system)… 1) Affordability 2) Affordability 3) Affordability We’ve been discussing this for years, but now it is much, much more serious… 3

9 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

10 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

11 Erosion of Employer Based Coverage 6 Average Premiums 2002 vs % Inflation 2002 vs % Political View: Health insurance inflation is the health plan’s fault Reality: Health insurance inflation is due to health care cost inflation

12 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

13 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. 8

14 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 9

15 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. 10

16 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 11

17 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

18 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

19 Questions?

20 20 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

21 Academic Medicine for the Future May 6, 2013 UCSF Clinical Enterprise Retreat Tom Enders, Managing Director Manatt Health Solutions

22 22 NIH Doubling Health Reform Managed Care and Capitation Despite dire predictions, the last two decades have been excellent for academic medicine NIH Stimulus Innovation in Medicine — Aging of the Population — Specialty Services Boom Growth of the AMC Missions Stock Market Bubble 2003 – 2008 Excellent Clinical Margins Philanthropy Boom

23 23 Erosion! AMC Relentless Forces Defenses

24 24 The AMC Business Model…. Talent 2 x Pricing Power x (Enterprise Costs) AMC Sustainability ∫(Δ)(Technology Introduction - Diffusion) (Regulation)

25 25

26 26 The Challenge of Change  Risk of change perceived as great  Connection to people who succeeded in the old model  Fear of lacking the competence to succeed  Overload  Healthy skepticism about new ideas  The fear of hidden agendas  Feeling of personal threat from the changes  Genuine belief that “next generation” models are a bad idea

27 27 Strategy

28 28 Options 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 support  Clinically 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

29 29 Clinical Strategies of Research Intensive AMCs NIH RANKINSTITUTION 1JOHNS HOPKINS 2UCSF 3U MICHIGAN 4U PENNSYLVANIA 5U WASHINGTON 6U PITTSBURGH 7UCSD 8WASHINGTON UNIVERSITY 9YALE UNIVERSITY 10UNC CHAPEL HILL

30 30 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 partners Increasing integration of clinical services Primary care & ambulatory care expansion Sophisticated analytics and IT infrastructure Maximizing brand value Quality: Measurable, Demonstrable, Superior Some Consistent Themes

31 31 AMC System

32 32 Strategy OrganizationExecution

33 33 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

34 34 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?

35 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 Threat 35

36 Regional leader in select tertiary/quaternary services Research innovator Talent and commitment Capital investment in plant, IT Nascent network development 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 Clinical Enterprise SWOT 36

37 Regional leader in select tertiary/quaternary services Research innovator Talent and commitment Capital investment in plant, IT Nascent network development Cost structure Limited regional primary care Hard to access specialists Limited access to capital Limited population health experience or infrastructure Highly federated governance Provider consolidation and competition Changing insurance models New world challenging to our ‘core’ identity & competencies Strength Weakness Opportunity Threat Clinical Enterprise SWOT 37

38 Regional leader in select tertiary/quaternary services Research innovator Talent and commitment Capital investment in plant, IT Nascent network development Cost structure Limited regional primary care Hard to access specialists Limited access to capital Limited population health experience or infrastructure Highly federated governance 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 Clinical Enterprise SWOT 38

39 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. 39

40 40 Vision: UCSF as the Preeminent High-Value System in Northern California World Class Education Specialist Network Home & Sub-Acute Care Long-Term Care UCSF Cutting Edge Research High-Value, Quality Clinical Care Strong Primary Care Teams Clinical Research Implementation Leading Acute Facilities Regional T/Q Partnerships Strategic Regional Expansion Northern California System of Care

41 41 Strategic Priority 1: Grow Complex Care Referrals Via Innovation & Distinction Patient Outcomes & Breakthrough Research System of Care with Referring Providers Excellent Patient Experience

42 42 Strategic Priority 2: Lead A High Value System of Care UCSF Hospitals / Systems (Marin General, UCSF oncology affiliates etc.) Existing UCSF Distributed Services SCCIPAPediatric SystemKaiser? Other? Physician Groups (Hill, One Medical, etc. ) Existing Relationships On Which To Build Relationships Under Development Potential Transformation of Existing Relationship

43 43 Strategic Priority 3: Build a Culture of Continuous Process Improvement Today: Organization in silos…. Tomorrow: Integrated organization that is high-quality and efficient

44 44 Enablers of UCSF’s Strategic Priorities and Vision Build UCSF Brand Lead in Precision Medicine Align Financial and Administrative Operations Align Financial and Administrative Operations Establish Risk Management Capability Establish Risk Management Capability Apply Research to Clinical Care Apply Research to Clinical Care Train and Recruit The Next Generation Train and Recruit The Next Generation Develop Physician Services

45 45 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 ENABLERS STRATEGIC PRIORITIES

46 46 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

47 47 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 ENABLERS STRATEGIC PRIORITIES

48 48 Imperatives

49 49 UCSF Market Position: Overall Bay Area Market Share - Adults Adult IP Market Share – Bay Area CY 2011; Market Discharges = 524,170 Source: UCSF Data Reports and OSHPD; Excludes MS-DRG 795 Note: Counties included: San Francisco, Marin, Napa, Solano, Sonoma, San Mateo, Santa Clara, Alameda, Contra Costa ?

50 50 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 markets UCSF’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 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 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 Sacramento Close 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 53 Ingredients of a High-Value System of Care UCSF ACO Analytics and Reporting Governance and Partnerships Patient Centered Care Population Health Management Health Information Technology Risk Contracts

54 54 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

55 55 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

56 56 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

57 Clinical Enterprise Financial View UNDERSTAND & PROJECT THE FINANCIAL PERFORMANCE OF THE UCSF CLINICAL ENTERPRISE IN ITS ENTIRETY  Integrate Finance with Strategy  Leverage scale of our Enterprise  Align assumptions, planning, and decision making  Create new financial resources that will be needed for investment in the strategy and our missions of research and education 57

58 UCSF Clinical Enterprise Financial View Clinical Operating Margin Expenses Institutional & Technical Revenue Pro-Fee Revenue 58

59 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 Investments Reserves 59

60 UCSF Clinical Enterprise Key Assumptions FY 2013-FY22 (Medical Center and Medical Group) Volume Inpatient Outpatient 0%-1.5% annually % annually Payor MixFY 2013 Budgeted Payor Mix: 0.5% shift from Commercial to Government; additional 1% shift to Government in FY 2020 (1) Net Revenue Government Commercial 0%-2.5% annually 4.0%-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 % in FY 2015 and beyond Net New Clinical Faculty89 for FY 2013-FY 2023 Increase 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 60

61 61 UCSF Clinical Enterprise FY 2012 Actuals

62 UCSF Clinical Enterprise Consolidated 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. 62

63 Balance Sheet Details UCSF Medical Center 63

64 UCSF Clinical Enterprise Medical Center Net Income - Mitigation Strategies 64

65 UCSF Clinical Enterprise Medical Center Capital Allocation Proposal UCSFCE IS CERTAIN TO NEED MORE!! 65

66 UCSF Clinical Enterprise A. Forecast ChallengesB. 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 66

67 67 UCSF Clinical Enterprise Balancing Sources and Uses Source: Kaufman, Hall & Associates 67

68 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: 68

69 69 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

70 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 & Distinction 2. 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 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 & Distinction 2.Lead a High Value System of Care 3.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 72 Breakout Group Assignments TopicTablesFacilitatorsSupportLocation 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 Norris Main Conference Room 2 B: Lead a High Value System of Care 1, 2 Sam Hawgood & Ron Arenson Jonah Frohlich Main 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 Ingraham Main Conference Room

73 73 Retreat Agenda TimeActivitySpeaker 8:00am – 8:30 Welcome Overview of Opportunities & Challenges Facing UCSFCE Brief Summary of Planning Process Perspectives on the Clinical Strategy Mark Laret Jack Stobo 8:30 – 9:20A Health Plan View of the California Market David Joyner, Hill COO, formerly of Blue Shield 9:20 – 9:45Academic Medicine for the FutureTom Enders, Manatt 9:45 – 10:00Break-- 10:00 – 10:30Emerging UCSFCE Vision & Draft Strategic PrioritiesSam 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 – 11:55 Break Boxed Lunches Break to Tables Tom Enders 11:55 – 1:15pmRetreat Participant Breakout Group SessionsParticipants 1:15 – 2:00 Groups Report Out; Q&A Closing Discussion M Laret, S Hawgood, T Enders

74 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 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 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 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 78 Appendix

79 79 UCSF Clinical Enterprise Consolidated Income Statement Projections based on FY 2013 Budget

80 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 Workgroup 1: Grow Complex Care Referrals Via Innovation & Distinction

81 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

82 82 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


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