1. 1 | VHA Inc. Confidential information. Engaging Physicians in the Transition from the Volume to Value-based Care Model Lani Berman VHA Vice President Performance Services Richard D. Parker, MD Professor of Surgery, CCLCM Chairman, Department of Orthopaedic Surgery Orthopaedic Rheumatologic Institute Cleveland Clinic Foundation

2. 2 | VHA Inc. Confidential information. Lani Berman, MBA, MPH, VP, VHA has nothing to disclose I, Richard D. Parker, MD have relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation as follows: Smith & Nephew: Consultant/Education Zimmer: Consultant/Royalties Cleveland Clinic: Chairman, Orthopaedics Disclosures

3. 3 | VHA Inc. Confidential information. Member-based, national network of 5,100 not-for-profit health systems and affiliates—representing both traditional acute-care hospitals and a diverse mix of providers that operate as extensions of the health system Help hospitals reduce costs through group purchasing contracting across their hospital or health system Highly focused on clinical improvement and Member collaboration Leader in consulting in the areas of clinical, operational, supply chain and financial performance for health systems About VHA

4. Department of Orthopaedic Surgery About Cleveland Clinic Became a hospital system in 1990s –Mantra is “Patients First” –“To Act as a Unit” and “All for One” –Physician-led –Culture of leadership 60% employed physicians and 40% private practice physicians Physician employment contract is for one year –Annual Professional Review –Each Staff has a different “formula” Patient Care – Research - Education –Salary is adjusted each year 4

5. Department of Orthopaedic Surgery Cleveland Clinic Foundation: Department of Orthopaedics Ranked #3 for Orthopaedics by U.S. News & World Report magazine 5

6. Department of Orthopaedic Surgery CCF Department of Orthopaedics: Patient Care/Research/Education Two Orthopaedic Residencies –Allopathic –Osteopathic One Podiatry Residency Eight Clinical Fellowships –Hand/UE –Adult Reconstruction –Sports & Exercise Medicine –Sports Ortho –Spine Ortho/NS –Pediatric Ortho –Foot/Ankle –Shoulder Research Fellows CCLCM (32 Medical Students/year) 6

7. Department of Orthopaedic Surgery Orthopaedic Locations “More than Main Campus” 24 Locations in Northeast Ohio CCF Florida CCF Canada 7

8. Department of Orthopaedic Surgery Reality of Being An Orthopaedist: “It doesn’t suck to be us!” We improve quality of life We provide “Episodic Care” Baby Boomers Orthopaedics is fun! Innovation We make a great living 8

9. 9 | VHA Inc. Confidential information. Bridging the Divide Between Physician Alignment and Clinical Integration

10. 10 | VHA Inc. Confidential information. The New Era of Health Care Volume – Based ► Value Based Payment Fee-for-ServiceOutcome Based Incentive Volume Outcome/Cost (Value) Focus Acute EpisodesPopulations Role of the Provider Single EpisodesCare Continuum Information Retro/ProspectiveReal-time & Predictive

11. 11 | VHA Inc. Confidential information. Three Areas of Critical Focus for Health Systems During Transition to Value Based Care Model Optimize cost and quality to remain competitive in current acute care model Engage and align physicians to new value-based care model Assess and stage the transformation to integrated care across the continuum

12. Department of Orthopaedic Surgery Value = Quality (Outcomes) Cost Quality (Outcomes) We are here Where we need to be Physicians Equation for a Value-Based Model 12

13. Department of Orthopaedic Surgery Value = Quality (Outcomes) Cost x Engagement How Will Physicians be Valued in the Equation? 13

14. Department of Orthopaedic Surgery Components of Physician Engagement Track Outcomes (OrthoMiDas) Cost Effective (Care Path) Appropriateness of Care Comparative Effectiveness Professionalism Efficiency Skill Lifelong Learner Malleable (Cooperation) Participation Leadership 14

15. Department of Orthopaedic Surgery Components of Physician Alignment Communication –Financial ROI –Dashboards (SSI, SCIP, HCAPS, etc.) EMR/Outcomes (OrthoMiDas) Care Path (TKRA and THRA) Physician meetings with Supply Chain –EMB driven –PPI (Physician Preference Items) –Quality & Patient Focus –Transparency (COI) –Vetted –Examples: (Total joint/Spine/Trauma/Bone Graft) RFP (ACT AS A UNIT) with Vendors 15

16. VHA Inc. Confidential information. Summary: Achieving Physician Engagement and Alignment Requires… 16 | Open communication Shared goals Transparent data sharing Adaptability Ongoing education

17. This VHA Inc. information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law. Copyright 2014 VHA Inc. All rights reserved. VHA Inc. Confidential information. Contact Lani Berman (lberman@vha.com) or Dr. Richard Parker (pparkerr@ccf.com) for more informationlberman@vha.compparkerr@ccf.com 17 |