PAN Physicians as Customers Building an Integrated Strategic Plan Thornhill

Physicians as Customers:Building an Integrated Strategic

PlanJane Thornhill, Administrative Director HFMG

Referring Physician Office & Josephine Ford Center for Cancer Surgery

NCI PAN Conference April 24, 2014

Physicians as Customers: Building an Integrated Strategic PlanJane Thornhill

Administrative DirectorHFMG Referring Physician Office & Josephine Ford Center for Cancer

Surgery

Henry Ford Health System – Malcolm Baldrige National Quality Award Recipient

Henry Ford Hospital

Henry Ford Hospital (HFH), founded in 1915 by auto pioneer Henry Ford, is the flagship hospital of Henry Ford Health System

Located in Detroit’s New Center area, it is a 877-bed tertiary/quaternary research and education complex with a Level 1 Trauma Center

Staffed by the Henry Ford Medical Group – 1,200 physicians and researchers in more than 40 specialties in 29 medical centers.

Referring Physician Program 2007 Current structure wasn’t working

– Individual programs had pockets of success Previous healthcare management

organization– HFHS owns Health Alliance Plan

Competition in the local Detroit market was fierce…

Hospitals within 50 Mile Radius of HFH

MONROE

MACOMB

ST. CLAIRSHIAWASSEE GENESEE

LENAWEE

LIVINGSTON

CLINTON

INGHAM

WAYNE

OAKLAND

WASHTENAW

HILLSDALE

JACKSON

LAPEER

Mercy Memorial

Crittenton

Henry Ford Macomb

McClaren Regional Hurley Medical Center

Genesys Regional

Doctor's Hospital of MI

Huron Valley-Sinai

St. Joseph Livingston

St. Joseph AA Oakwood Heritage

Oakwood Southshore

Oakwood Annapolis Oakwood

POH Regional

U of M

St. Joseph Saline

Lapeer Regional

St. John River District

Beaumont GPHenry Ford

BotsfordSt. John Sinai-Grace

Children's of MI

Providence HFMH-WC

St. John Oakland

Garden City

Providence Park

Chelsea Community

St. Mary Mercy

St Joseph Oakland

St Joseph Port Huron

St. John MacombDMC Surgery Center

Mt. Clemens Regional

Beaumont RO

Beaumont Troy

Karmanos

Hutzel Women's Rehab Institute MI

Harper University Detroit Receiving

Henry Ford Wyandotte

HFWBH

Port Huron Hospital

Referring Physician Program Steering Committee

Was formed and charged with…. “Increasing internal & external

physician referrals to Henry Ford Hospital and Medical Group specialists”

Challenges Committee members had competing interests

– HFMG & HFH vs System Hospitals with private practice physicians

Existing services for support were located in a system Call Center along with patient traffic– Lacked dedicated focus– Data collection was non-existent

Internal & external referring physician credibility was very low

We Needed A New Structure We focused on a solid infrastructure

– Data & Analytics– Operations

• Schedules, phones, eConsults

– Service• Concierge

RPO Service Level Guarantees Accept the request 24/7/365 Core hours of operation M-F 7:30 – 5:30 After hours ~ accept the request & follow up next business day Facilitate doc to doc telephone consults Facilitate making the appointment no later than the following business day

• Communicate delays as they occur• Close the loop with you and/or the patient

Assure that the referring physician is attached to the appointment via our database– To increase communication between rendering and referring physicians.

Early Focus Started with the idea of growing external

referrals– Quickly became refocused on supporting

internal referrals and building credibility We were committed to:

– Data collection– Seamless operational function– Best in class service

We had our work cut out for us…HFH draws patients from its “backyard”

Summary Report: Outstate Referral Strategy

Our in state competitor has a substantial “out-state” presence

Discharge Origins

1 to 4950 to 99

100 to 199200 to 299300 to 3000Top 3

0

A New Program Partner Internal physician leadership &

engagement is key– Needed a recognized name with

the skill set to work within complex physician environment

– The individuals that have the recognized name, do not have the time

Dr. Steven Kalkanis has national clinical expertise and was an up and coming physician leader. The perfect partner!

1414Summary Report: OutState Referral Strategy

Study ObjectivesTo Inform Development Of A High Return Referral Strategy

• To understand current and (believed) future referral needs of out-state physicians;

• To understand referral influences among physicians; including the influence of the hospital and system affiliation, the influence of the established relationships, unique worries and concerns of the patient, and the reputation and ease-of-referral for alternative institutions;

• To understand the opportunity to change referral practices by physician / disease / requirement and region;

• To understand the component and activities the would serve to earn new referrals; which may include CME events, local visits, “branding” or “cooperative advertising/promotion”, and/or on site presence, and;

• To build a growth strategy based on that learning

1515Summary Report: OutState Referral Strategy

Study Objectives:To Inform Development Of A High Return Referral Strategy

To understand the component and activities the would serve to earn new referrals; which may include CME events, local visits, “branding” or “cooperative advertising/promotion”, and/or on site presence

To understand the opportunity to change referral practices by physician / disease / requirement and region

To understand referral influences among physicians; including the influence of the hospital and system affiliation, the influence of the established relationships, unique worries and concerns of the patient, and the reputation and ease-of-referral for alternative institutions

To understand current and (believed) future referral needs of out-state physicians

To build a growth strategy based on that

learning

Two-Part Approach

Summary Report: Outstate Referral Strategy 16

Framing The Study HFMG interviews

Key stakeholders (12) To understand market

perspective and believed basis upon which referral should be won

Many false starts Internal credibility to

build was very low

Understanding Drivers Outstate Physician /

Specialists (51) To current practices,

preferences, decision-making, and potential influences

Alumni

Non-Alumni

Referring 13 21

Non-Referring

2 15

1717

Research Format

Broadly representative of out-state Michigan communities/environs

Summary Report: OutState Referral Strategy

1818

HFMG Interviews: What We’ve Learned

• Basis for referral is in most complex levels of care – primarily in surgery• U of M is the only competitor on the most complex cases • A view that we must have a Medical Group consolidated approach

• Many are currently conducting their own referral programs• General view that HF has done a poor job of managing referral in the past• General belief that strength of referral is in strength of personal

relationship• A view that we must build a reputation for leadership – where we have

leadership• Marketing Considerations suggested included

– Dedicated referral center, 24 hr appointment promise, Branded referral Affiliation, CME’s, Life-Flight Transportation


What We’ve Learned: Primary Messages

There is (perhaps significant) opportunity – to win increased referral – for treatment of the most complex diseases

UM and Henry Ford are the clear leaders in presumed referral (KCI is strong 3rd)– West side of State competition grows: Spectrum, Mayo, Chicago

Among those who know Henry Ford the view is generally very positive– Presumed excellence in care– Generally positive protocols and relationships

Henry Ford is not however well known Opportunity is in winning recognized superiority

…presumably in specific set of specialties– Outstanding referral protocols– Strong specialist-to-specialist relationships– Demonstrated quality of service– Demonstrated respect


2020

More complex conditions warrant referral…Referrals come about when physicians find a more complex condition that is

best handled at an advanced care facility… symptoms are defying diagnosis… simply need a 2nd opinion… or participation in clinical trials…

PulmonologyPulmonary hypertension Lung transplantLung reductionTherapeutic bronchoscopic proceduresInterventional pul (airway stents)

ENTOtologic surgeryOncology - head / neckTinnitusEar issues (chrome mastoid bone)Pediatric issues

ONCBone marrowLiver privation carcinomaProstate (robotic surgery)Neuro surgeryLung treatmentResection

GASTROAdvanced liver diseaseInflammatory bowel diseaseLiver hepatitisLiver transplantPancreatic cancerOncology

GP/FAMArthritisCrohn’s diseaseNeuro

COLON/RECTALInteroperational RadiationKock pouch TherapyRectal cancer


NeuroscienceMSEpilepsyTrauma inter cranialCerebral endovascular aneurysm (coiling)Cranial facial reconstructionALS

GYNCervical cancerBladder supportSarcoma/melanoma clinicEndometrial oncology

ORTHOTraumaOncology

Building a Referral Strategy - Five Components


Focus On Select Specialties

Build An Excellent Referral Protocol

Build Geographic Tiers

Build Recognized Excellence – By Communicating Expertise

Build Basis For Extended Preference Through Excellence In Relationship

Building A Team

Physicians who… Receive specialty

referrals Know the importance of

communication & relationships

Committed to outreach & growing the business

Admin/Operations ~– Physician leaders to do

road clearance– Outreach RN’s– Concierges– Insurance Specialist– Communication Coord– Data collection

• CRM reporting

– Service, Service, Service

Metrics

2009 2010 2011 2012 20130

5,00010,00015,00020,00025,00030,000

Phone Volume

2009 2010 2011 2012 20130

2,0004,0006,0008,000

10,000

Online Consults

2010 2011 2012 20130

500

1,000

1,500

2,000

2,500

3,000 Transfers

2010 2011 2012 20130

5001000150020002500

Outpatient Referrals

OaklandOaklandOaklandOaklandOaklandOaklandOaklandOaklandOakland

SchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraft

AlgerAlgerAlgerAlgerAlgerAlgerAlgerAlgerAlger

AlleganAlleganAlleganAlleganAlleganAlleganAlleganAlleganAllegan

AlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAntrimAntrimAntrimAntrimAntrimAntrimAntrimAntrimAntrim

ArenacArenacArenacArenacArenacArenacArenacArenacArenac

BaragaBaragaBaragaBaragaBaragaBaragaBaragaBaragaBaraga

BarryBarryBarryBarryBarryBarryBarryBarryBarry

BayBayBayBayBayBayBayBayBay

BenzieBenzieBenzieBenzieBenzieBenzieBenzieBenzieBenzie

BerrienBerrienBerrienBerrienBerrienBerrienBerrienBerrienBerrienBranchBranchBranchBranchBranchBranchBranchBranchBranch

CalhounCalhounCalhounCalhounCalhounCalhounCalhounCalhounCalhoun

CassCassCassCassCassCassCassCassCass

CharlevoixCharlevoixCharlevoixCharlevoixCharlevoixCharlevoixCharlevoixCharlevoixCharlevoix

CheboyganCheboyganCheboyganCheboyganCheboyganCheboyganCheboyganCheboyganCheboygan

ChippewaChippewaChippewaChippewaChippewaChippewaChippewaChippewaChippewa

ClareClareClareClareClareClareClareClareClare

ClintonClintonClintonClintonClintonClintonClintonClintonClinton

CrawfordCrawfordCrawfordCrawfordCrawfordCrawfordCrawfordCrawfordCrawford

DeltaDeltaDeltaDeltaDeltaDeltaDeltaDeltaDelta

DickinsonDickinsonDickinsonDickinsonDickinsonDickinsonDickinsonDickinsonDickinson

EatonEatonEatonEatonEatonEatonEatonEatonEaton

EmmetEmmetEmmetEmmetEmmetEmmetEmmetEmmetEmmet

GeneseeGeneseeGeneseeGeneseeGeneseeGeneseeGeneseeGeneseeGenesee

GladwinGladwinGladwinGladwinGladwinGladwinGladwinGladwinGladwin

Grand TraverseGrand TraverseGrand TraverseGrand TraverseGrand TraverseGrand TraverseGrand TraverseGrand TraverseGrand Traverse

GratiotGratiotGratiotGratiotGratiotGratiotGratiotGratiotGratiot

HillsdaleHillsdaleHillsdaleHillsdaleHillsdaleHillsdaleHillsdaleHillsdaleHillsdale

HoughtonHoughtonHoughtonHoughtonHoughtonHoughtonHoughtonHoughtonHoughton

HuronHuronHuronHuronHuronHuronHuronHuronHuron

InghamInghamInghamInghamInghamInghamInghamInghamIngham

IoniaIoniaIoniaIoniaIoniaIoniaIoniaIoniaIonia

IoscoIoscoIoscoIoscoIoscoIoscoIoscoIoscoIosco

IronIronIronIronIronIronIronIronIron

IsabellaIsabellaIsabellaIsabellaIsabellaIsabellaIsabellaIsabellaIsabella

JacksonJacksonJacksonJacksonJacksonJacksonJacksonJacksonJacksonKalamazooKalamazooKalamazooKalamazooKalamazooKalamazooKalamazooKalamazooKalamazoo

KentKentKentKentKentKentKentKentKent

LakeLakeLakeLakeLakeLakeLakeLakeLake

LapeerLapeerLapeerLapeerLapeerLapeerLapeerLapeerLapeer

LeelanauLeelanauLeelanauLeelanauLeelanauLeelanauLeelanauLeelanauLeelanau

LenaweeLenaweeLenaweeLenaweeLenaweeLenaweeLenaweeLenaweeLenawee

LivingstonLivingstonLivingstonLivingstonLivingstonLivingstonLivingstonLivingstonLivingston

LuceLuceLuceLuceLuceLuceLuceLuceLuce

MackinacMackinacMackinacMackinacMackinacMackinacMackinacMackinacMackinac

MacombMacombMacombMacombMacombMacombMacombMacombMacomb

ManisteeManisteeManisteeManisteeManisteeManisteeManisteeManisteeManistee

MarquetteMarquetteMarquetteMarquetteMarquetteMarquetteMarquetteMarquetteMarquette

MasonMasonMasonMasonMasonMasonMasonMasonMason

MecostaMecostaMecostaMecostaMecostaMecostaMecostaMecostaMecosta

MenomineeMenomineeMenomineeMenomineeMenomineeMenomineeMenomineeMenomineeMenominee

MidlandMidlandMidlandMidlandMidlandMidlandMidlandMidlandMidland

MissaukeeMissaukeeMissaukeeMissaukeeMissaukeeMissaukeeMissaukeeMissaukeeMissaukee

MonroeMonroeMonroeMonroeMonroeMonroeMonroeMonroeMonroe

MontcalmMontcalmMontcalmMontcalmMontcalmMontcalmMontcalmMontcalmMontcalm

MontmorencyMontmorencyMontmorencyMontmorencyMontmorencyMontmorencyMontmorencyMontmorencyMontmorency

MuskegonMuskegonMuskegonMuskegonMuskegonMuskegonMuskegonMuskegonMuskegon

NewaygoNewaygoNewaygoNewaygoNewaygoNewaygoNewaygoNewaygoNewaygo

OceanaOceanaOceanaOceanaOceanaOceanaOceanaOceanaOceana

OgemawOgemawOgemawOgemawOgemawOgemawOgemawOgemawOgemaw

OsceolaOsceolaOsceolaOsceolaOsceolaOsceolaOsceolaOsceolaOsceola

OscodaOscodaOscodaOscodaOscodaOscodaOscodaOscodaOscoda

OtsegoOtsegoOtsegoOtsegoOtsegoOtsegoOtsegoOtsegoOtsego

OttawaOttawaOttawaOttawaOttawaOttawaOttawaOttawaOttawa

Presque IslePresque IslePresque IslePresque IslePresque IslePresque IslePresque IslePresque IslePresque Isle

SaginawSaginawSaginawSaginawSaginawSaginawSaginawSaginawSaginawSanilacSanilacSanilacSanilacSanilacSanilacSanilacSanilacSanilac

St. ClairSt. ClairSt. ClairSt. ClairSt. ClairSt. ClairSt. ClairSt. ClairSt. Clair

St. JosephSt. JosephSt. JosephSt. JosephSt. JosephSt. JosephSt. JosephSt. JosephSt. Joseph

TuscolaTuscolaTuscolaTuscolaTuscolaTuscolaTuscolaTuscolaTuscola

Van BurenVan BurenVan BurenVan BurenVan BurenVan BurenVan BurenVan BurenVan Buren WashtenawWashtenawWashtenawWashtenawWashtenawWashtenawWashtenawWashtenawWashtenaw WayneWayneWayneWayneWayneWayneWayneWayneWayne

WexfordWexfordWexfordWexfordWexfordWexfordWexfordWexfordWexford

AlconaAlconaAlconaAlconaAlconaAlconaAlconaAlconaAlcona

2013 RNs

31 to 90

11 to 30

4 to 10

1 to 3

2013

RN Outreach Contacts

Total: 1956

(Increase of 37% or 525 since 2012)








































































2013 ASRLs

7 to 10

5 to 6

3 to 4

1 to 2

2013

New Referring Physicians

Total: 253








































































2013 MRNs

7 to 15

4 to 6

2 to 3

1

2013

New Patient MRNs

Total: 751



150 miles

100 miles

50 miles






































































2013 Transfers

71 to 125

21 to 70

4 to 20

1 to 3

2013

Transfers

Total: 1759

(Increase of 20% or 289 since 2012)

Payor Mix

OSGS Return on our efforts (ROI)

DSS – Decision Support Analysis

2009 = $9.6M ICM 2010 = $18.9M ICM 2011 = $34.5M ICM 2012 = $93.3M ICM

Transfers Case Mix Index

2014 Medicine 1.90 2011 Surgical 2.30

2012 OSGS 4.2

YTD 2013 Helicopter CMI Medicine 2.91 Surgical cases 7.67

Preference through Excellence & Relationships Dinners Conferences Executive Outreach Teleconferencing

– Tumor Boards – Case Discussions

Next Phase – Cancer Surgery Data results - 40 percent of all OSGS

business is surgical oncology– Current structure was virtual

• Coordination and dedicated resources were needed

It’s time to build again…

Henry Ford Center for Cancer Surgery

Josephine Ford Cancer Institute

The Opportunity

2011 Cancer DischargesHenry Ford: A regional powerhouse in terms of overall cancer numbers, but…

Henry Ford

Henry Ford Hospital 1965West Bloomfield Hospital 464Macomb - Clinton Twp Hospital 703Wyandotte Hospital 376Macomb - Warren Hospital 19

3527

DMC

Karmanos Cancer Institute 1251Detroit Receiving Hospital 469Sinai-Grace Hospital 614Harper University Hospital 462Children's Hospital of Michigan 1192Hutzel Hospital 32Huron Valley - Sinai Hospital 330

4350

University of Michigan Health System 2964

Beaumont

Beaumont Hospitals - Royal Oak 2360

Beaumont Hospitals - Troy 1003

Beaumont Hospitals - Grosse Pointe 329

3692

Surgical Oncology plays a leading role in our Out-State Growth Strategy

Henry Ford Center for Cancer Surgery:The Case for Surgical Oncology

Henry Ford Health System - POG DSS2010 Cancer Service Line Cases

Cancer_Group Hem Onc Radiation Surgery Hem Onc Radiation SurgeryBone 14% 21% 31% 29% 24% 57%Brain 18% 42% 53% 14% 17% 31%

Breast 4% 13% 19% 5% 4% 5%Colon 9% 17% 17% 5% 3% 7%

GynOnc 13% 17% 21% 5% 2% 7%Head & Neck 16% 26% 45% 8% 6% 29%Lung/Thorax 13% 25% 29% 3% 4% 21%

Malig. Hematology 7% 22% 17% 6% 4% 12%Metastasis 14% 24% 27% 4% 5% 18%

Other GI 19% 30% 41% 9% 5% 17%Other GU 17% 30% 17% 2% 7% 9%

Other Malig. 15% 21% 31% 8% 3% 18%Prostate 9% 12% 55% 5% 4% 44%

Skin 33% 36% 36% 17% 5% 19%

Overall 10% 20% 37% 6% 5% 24%

New MRN for Cancer Resides outside Tri-county

Henry Ford Center for Cancer Surgery: Opportunities

Differentiate our Cancer Institute, fully partner with JFCI

Develop, promote unique capabilities, publish superior outcomes, NCI

Enhance our Customer Experience

Access portal: “if you have cancer, call this number…”, nurse navigation, protocols, multidisciplinary coordination of care, concierge services

Build our Internal Team Identity

Virtual and Physical Space, Signage, Web Presence

Build our External Brand and Public Perception

Referring Physician Office - Organization Chart

Jane Thornhill

Administrative Director

Nancy Long

Concierge Supervisor

11.0 FTEs

RPO Advocate

Lisa Webb

Data & Outreach Director

Liz Knight, RN

Supervisor CCS

3.0 FTEs

Access Coordinator

4.0 FTEs Insurance , Communication

& Data

2.5 FTEs

RN Outreach

Sarita Dickens

Advocate Manager

4.0 FTEs

Concierge5.0 FTEs

Nurse Navigators

Last Modified: 4/15/2014

Dr. Steven Kalkanis

Medical Director

1. FTE

Clerical

5.0 FTEs

Surgical Concierge

Vision,Business Plan,Surgeon and JFCI Buy-In, Gap Analysis

Infrastructure Development:Admin, Nursing, Patient Advocate Support

Website Development

888-777-4167Patient Phone Triage InfrastructureJFCI, RPO, SurgicalDepartments

PR/Marketing Plan,Creative Content Development

Henry Ford Center for Cancer Surgery L

AUNCH

Sept. 24,

2012

May 2012

VisionBusiness PlanSurgeon and

JFCI Buy-In, Gap Analysis

Infrastructure Development:

Admin, Nursing, Patient

Advocate Support

PR/Marketing Plan

Creative Content

Development


LAUNCH

September 24, 2012

Center for Cancer Surgery

2012 20130

200

400

600

800

1000

1200

1400

1600

ReferralsSurgeries

Karmanos Henry Ford Health System

Beaumont U of M St. John Providence DMC Oakwood

2004 0.21 0.09 0.18 0.14 0.07 0.03 0.03

2014 0.2200197 0.1908724 0.1766523 0.1561412 0.076684 0.0672288 0.0231169

3%

8%

13%

18%

23%

Tri-County: CancerPr

efer

ence

Southeast Michigan – System ShareAdult Cancer Discharges

YTD 2012Discharges Market Discharges Market to 2013

Top 10 Hospitals SEM (YTD Change) Hospital Share Hospital Share % ChangeHenry Ford Health System 2149 16.6% 1905 16.2% -12.8%

Beaumont Hospitals 1767 13.6% 1728 14.7% -2.3%

St John Providence Health 1986 15.3% 1689 14.4% -17.6%

DMC Vanguard 1053 8.1% 941 8.0% -11.9%

Oakwood Healthcare 965 7.4% 843 7.2% -14.5%

St Joseph Mercy Health System 847 6.5% 826 7.0% -2.5%

University Michigan Health Sys 627 4.8% 567 4.8% -10.6%

McLaren Health 469 3.6% 427 3.6% -9.8%

Botsford 350 2.7% 310 2.6% -12.9%

All Other 2757 21.3% 2501 21.3% -10.2%

Total 12970 100.0% 11737 100.0% -10.5%

01/2012 - 06/2012 01/2013 - 06/2013

Source: MIDB

Executive Committee:


Executive Committee:

Zane Hammoud Tamer Ghanem Craig Rogers David KwonDavid Nathanson Kellie McFarlin Craig Reickert Melissa TimesChris Steffes Madhu Prasad Tom Buekers Michael MottJack Rock Ian Lee Robert Elkus Srinivas BhandarkarVernon Strand Donna Tepper Rajpal Swarn Shawn WebbJames Peabody Hans Stricker Riad Farah Rabbi HannaStefan Smietana Francis Hall Robert Stachler Marwan KazimiAtsi Yoshida Dean Kim David Sternberg Stephen BartolMichael Simoff Ben Movsas

Steven Kalkanis, Director William Conway John PopovichRobert Chapman Scott Dulchavsky Tom NantaisMarwan Abouljoud Mani Menon Adnan MunkarahTed Parsons Mark RosenblumJane Thornhill, Administrator Elizabeth Knight, Nursing Director

www.henryford.com/cancer

Game on Cancer

Questions?

PAN Physicians as Customers Building an Integrated Strategic Plan Thornhill

Presentations & Public Speaking

henry ford medical group

auto pioneer henry ford

referral practices

referral influences

future referral

state physicians

new referrals

high return referral