University of Utah Medical Group David Bjorkman, M.D., M.S.P.H. Executive Medical Director

Beginnings Independent departments with Physician Billing Office Faculty Practice Organization (FPO) –Minimal unified contracting –Management of Community Clinics UUMG formed with arrival of new SVP –Joint contracting, finance, cash management, clinical operations, quality, IT –Independent billing, collections, recruitment

UUMG Mission Advocates on behalf of UUMG Members Facilitates and promotes integration of clinical practices into a coordinated, and comprehensive, fiscally sound clinical delivery system Ensures accessible, quality, patient oriented health care that is market responsive Works in conjunction with the other components of the health system to further the education, research and service missions of UUHSC

Group Structure Component of the University of Utah Health System Not a separate 501(c)(3) Reports to the Senior Vice President for Health Sciences/CEO of University of Utah Health Care Physician-led committees

UUMG Board Chaired by SVP All clinical chairs Elected non-chair physicians Appointed non-chair physicians and one administrator Hospital CEO Ex officio –Group CEO –Group Executive Medical Director –Others

UUMG Working Committees Executive Committee (elected from Board members) Clinical operations –Practice management (includes quality) Contracting Finance –Revenue cycle –Cash Management –Investments IT –EHR implementation –Finance

UUMG Working Committees Advantages –Broad physician participation and input –Departmental administrator participation –Committees can be changed, formed or discontinued easily –Staff support of all committees Disadvantages –Variable participation of department chairs –Committee leadership can be weak –Participation of physicians inconsistent –Personal agendas can dominate –Must coordinate with other committees and Hospital

Key Decisions EHR and business IT implementation –Funding –Enrollment Contracting strategies Patient experience Operational improvement Capital investment in group initiatives Joint goals with Hospital (quality) Involves physicians in strategic decisions

Funds Flow Revenues flow to departments Billing/collections done by departments Tax to support group (2%) Departments set –Physician salaries based on metrics –Other missions cross-subsidized within departments –65% of SOM budget comes from clinical revenue

Group Development Faced few hurdles because of timing of initial formation Had no effect on chair/faculty retention (dealt with at department level) Chairs are responsible for department finances and ultimately for group budget All are responsible to SVP

What We Are NOT Doing Collaborating, NOT coordinating –Hospital –Departments Joint funds flow – not prepared for global payments Sharing risk Tracking costs of ambulatory care Common financial metrics Common practice operations

The future ain’t what it used to be. Yogi Berra

What Lies Ahead? Healthcare reform –Bundled payments –ACOs New Health Sciences administration