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

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

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

Kaiser Permanente NCAL An integrated healthcare delivery 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

Kaiser Permanente NCAL – An integrated healthcare delivery system Core Business Concepts Drive governance, clinical approaches and operational design Integration Exclusivity Capitated Prepayment Strategic Integration of Non-MD Providers – October 2017, James Chang MD

Kaiser Permanente NCAL – An integrated healthcare delivery system Integration Kaiser Health Plan, Kaiser Foundation Hospital System and The Permanente Medical Group Anatomy is not Physiology Integration in multiple functional interlocking processes: Rate Setting Capital Generation Hospital Capacity Planning Medical Group Expenditures IT Systems Unified Purchasing Strategic Integration of Non-MD Providers – October 2017, James Chang MD

Kaiser Permanente NCAL – An integrated healthcare delivery system Integration Kaiser Health Plan, Kaiser Foundation Hospital System and The Permanente Medical Group Collaborative and matched leadership between entities Functional linkages: Labor-Management Partnership Primary Care-Specialties-Diagnostic Care Technology enabled geographic connection and care delivery MD-RN-PA-staff team based care Strategic Integration of Non-MD Providers – October 2017, James Chang MD

Kaiser Permanente NCAL – An integrated healthcare delivery system Exclusivity Unique exclusive contractual relationship between one Health Plan and one Medical Group 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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