2018 Nicolas E. Davies Enterprise Award of ExcellenceHSS Overview

A Legacy of Musculoskeletal Leadership

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Provide the highest quality patient care, improve mobility, and enhance the quality of life for all, and to advance the science of orthopedic surgery, rheumatology, and their related disciplines through research and education. Mission

Vision

Values

Lead the world as the most innovative source of medical care, the premier research institution, and the most trusted educator in the field of orthopedics, rheumatology, and their related disciplines.

Excellence. We set and continually raise the bar on all that we do. Integrity. We take pride in maintaining the highest levels of personal and professional conduct. Teamwork. We participate fully as members of our team, respecting, supporting, and empowering one another. Creativity. We support an environment that fosters new ideas and new approaches in everything we do. Passion. We bring energy, commitment, and enthusiasm to our work everyday

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Dedicated Interdisciplinary Team Cross-Continuum Care

Operative Care Non-Operative Care Rehabilitation

Research and Innovation

Education and Academic

Affairs

Diagnostics and Imaging

World Class Talent Singularly Focused on Musculoskeletal Care

~230

~250 Physicians in related medical specialties:• Rheumatologists• Perioperative Medicine• Radiology• Physiatry• Pain Management• Primary Care Sports Medicine• Anesthesiology• ID, Neurology, Cardiology

Orthopedic faculty, fellows, and residents specialized across 10 service lines

1,000+ PAs, NPs, RNs and PTs also specialized according to service lines

Singular Focus on Musculoskeletal Medicine

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Orthopedics Adult Reconstruction &

Joint Replacement Foot & Ankle Hand & Upper Extremity Hip Preservation Limb Lengthening

Rheumatology Inflammatory Arthritis LupusOsteoarthritis

Related Disciplines Anesthesiology Infectious Disease Neurology Pain Management

Metabolic Bone Disease Pediatrics Spine Sports Trauma

Osteoporosis Pediatric Rheumatology Scleroderma, Vasculitis, Myositis

Pathology & Laboratory Medicine Physiatry Radiology & Imaging Rehabilitation

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Patients from All 50 States and 100+ Countries* Choose HSS

Tri-State Area51%

New York City36%

International2%

Source: 2017 HSS IP & AMS surgical volumePercentages are of surgical volume*Over 3 years

Domestic11%

>150KPatients Cared For

~32KSurgeries Performed

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An Extensive and Growing Delivery System

NYC

Employer ProgramsInclude onsite services and other offerings to deliver greater value and more accessible care

Ambulatory Surgery CentersUpper East Side, Manhattan, NYWest Side, Manhattan, NY (2019)

Stamford CampusStamford, CTHSS Stamford Health Collaboration

NY

NJ

CT

Main CampusUpper East Side, Manhattan, NY

Main Hospital with 39 ORs, 215 beds Research Institute, Education Institute,

Innovation Institute, other leading facilities

Outpatient Centers

Long Island

Paramus, NJ Westchester, NY Stamford, CT

Queens

West Side*

Brooklyn*

Hudson Yards*

*anticipated 2019

Rehab NetworkAffiliated network of rehab centers to facilitate episode of care management

MA

NH

ATT

AN

NYC

MET

RO

Madison Ave.

Florida CampusWest Palm Beach, FL(2019)

FL

Planning 2025 Main Campus Transformation

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Engaging in advisory relationships, management service arrangements, and operating partnerships to create a global network of leading orthopedic providers who bring HSS’s cutting edge knowledge to the world

GLOBAL VENTURES

Extending Value Proposition Beyond NYC

Robust Pipeline

Connecticut

Florida

United BrazilHospital Medical Services

Global Ventures Examples

AcademicCollaborations

AdvisoryServices

Management Services & Collaborations

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Cutting-Edge Research Advances Knowledge and Care

Bone Health

Making bones stronger

Autoimmunity & Inflammation

Improving the immune system

GenomicsInterpreting the body’s blueprint

Precision MedicineStudying disease mechanisms to

personalize treatment for each patient

Soft Tissue & Spine Regeneration

Helping the body to heal itself

BiomechanicsEngineering advances in

orthopedics

Healthcare Research Institute

Using historical data to improve future of patient care

MRI ResearchDiagnosing patients less

invasively and more accurately

$42MM 2017 EXPENDITURES | $66M GRANT SUPPORT | 300+ SCIENTIFIC STAFF 47 REGISTRIES

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Extending Leadership Through Education

Engaged 99,450 individuals in educational

programs in 2017

600+ professional education HSS eAcademyonline modules and onsite

courses

Improvements in population health through

targeted programs in the community

Hosted 427 academicvisitors from around the

world in 2017

State-of-the art training and simulations using Bioskills Education

Laboratory

Affiliated with Weill Cornell Medical College

Pediatric Outreach Program

Screening

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Leading Results

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Hip/Knee all cause

readmissions 31% better than national

average

7 consecutive years of hip replacement

infection rates lower than NY state average

#1 in Nation for Joint Replacement, and in NY State for

Spine Surgery

94%Net Promoter Scorevs. 67% Healthcare

Average

1st in NYS to receive4 consecutive Magnet

Nursing designations#1 in Orthopedics#3 in Rheumatology

#1 Orthopedic Residency for 3rd year in a row

5th consecutive Guardian of

Excellence Award

99%ile ‘Likelihood to Recommend’ for 38 consecutive

quarters among Magnet hospitals

Only hospital rated 5 stars in NY State

CULTURERECOGNITION

QUALITY

PATIENT SATISFACTION

Ranked as a 5 Starhospital for Spine

Surgery

&

7 to 1 ratio of engaged to disengaged employees based on Gallup Employee Engagement Score

Power of Culture

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6727.2%

Healthcare Average.

Netflix 68

Amazon 69

Apple 72

Costco 79

CVS Minute Clinic 84

HSS 92

Source: Press Ganey, NPS Benchmarks 2015

2.0x

4.0x

6.1x

4.7x

4.0x

2015 Gallup

Hospital Database

201620102006

Source: Gallup Hospital Database

Net Promoter ScoreEmployee Engagement

Ratio of Engaged to Actively Disengaged Employees

Actively Engaged Employees contribute to an industry leading Net Promoter Score, a measure of customer/patient satisfaction

94% promoters

Tipping Point where impact of engaged

overpowers disengaged.

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Technology Roadmap to 2020

Build Strong Technology Foundations enabling cost-effective, standardized and agile delivery of services (Core IT).

Establish an Information Security Program with dedicated leadership, active executive team engagement, management of third-party relationships and increased patient confidence in security protections (Risk).

Develop Enterprise-Level Business Intelligence and Data Analytics capabilities enabling new discovery, innovation and value (Knowledge).

Define a Patient Experience Strategy essential for sustaining market position, enhanced care coordination and “Better” (Brand/Value).

Align IT Service Expansion Model to respond to market growth and pending facility changes to existing campus (Growth).

Evolve the IT Governance Process for stakeholders seeking broader engagement and shared decision-making (Shared Leadership).

Create New IT Partnerships supporting Innovation Center, Value Management and Patient Experience initiatives (Alignment).

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Clinical & Operational Advisories

IT Governance

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HSS Executive Leadership

Information Security(CISO)

Patient Journey(CMO)

Inpatient Service Line(CNO & Director Periop Med)

Technology(CTO)

Analytics Advisory(CIO)

Ambulatory Advisory(SVP Rehabilitation)

Legal, Risk, & Compliance(VP Corporate Compliance)

Research Advisory(VP Research Administration)

Physician Advisory(CMIO)

Corporate Systems(CAO)

Revenue Cycle(VP Revenue Cycle)

IT Steering Committee

IT Program Management Office

Working Groups for Content Management, Process Modeling, & Application Development

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IT Enterprise Overview

EMR

MICROSOFT VMWARE AVAYA PALO ALTO JUNIPER

DIGITAL JOURNEY

RESEARCH EDUCATIONANALYTICSERP

Epic Epic

Epic Lawson

SASE-Academy

HalogenEpic

Tableau Lawson

CITRIX

Our portfolio of technology is a key enabler of our strategy

EPIC HOSTING

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1Received an ‘Excellent’ rating from Epic within the first six months of Go-Live, placing HSS in the top 7% of all Epic implementations.2Added two additional Ambulatory waves at the request of HSS surgeons. 3As of last week, HSS is the 15th client ready to attest for Meaningful Use Stage 3.

EMR Successes

2018 Nicolas E. Davies Enterprise Award of ExcellenceCase Study: Optimizing Consumer Access with Technology Improvement

Andi KolodnyDirector, Physician Referral Service

Physician Referral Service (PRS))

Introduction

Overview Summary

Physician Referral Service

Problem

Objective/Solution

Planning and Implementation

Results

Q&A

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Overview: HSS’s Patient Demand Is Complex And Requires A Specialized Approach

HSS believes improved patient outcomes begin with optimized access

Need a scalable and efficient process that provides a better experience for consumers with greater expectations for quality, speed and personalization

A technology solution enabled us to deliver a standard of service to which consumers have become accustomed

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Multiple Patient Types

Demand Access In Several Ways

To HSS Specialists In Many Locations

From 100+ Countries

To Meet Patient Needs, HSS Identified 3 Guiding Objectives

1. Providing the right level of care, in the right place, at the right time, most efficiently

2. Providing highest level patient experience from first point of contact through treatment and recovery

3. Optimizing HSS physician schedule capacity

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HSS’s High Patient Demand is Coordinated By Physician Referral Service

Our challenge is identifying a scalable approach to specialist access

SpecializedPhysicians

PRS Agents

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Discovery

Patient Provider

Hospital

The Problem

PRS workflow was inefficient and redundant. Length of call time was elevatedbecause the legacy system was difficult for PRS staff to navigate.

The PRS legacy system for matching consumers with physicians was inefficient and inadequate to scale in support of strategic expansion of HSS offerings and capacity specifically to HSS regional locations.

The legacy system was difficult to maintain because physician profiles, scope of practice, and insurance participation had to be maintained by our HSS IT department and with the vendor.

Physician referral analytics was substandard as a weekly data drop to an excel database. (Manipulating this data into a presentable format for ~200 physicians on a monthly basis was not realistic.)

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Problem: Navigation Challenges

Criteria for Success

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Criteria for Success – Survey Feedback (Users/Stakeholders) Pre-solution

Ease of Use 4

Match to Provider 6

Match to location 0

Match to distance/zip 0

Match to Surgical Status 5

Match to physicians participating in strategic initiatives NA

Maintenance of provider profiles 2

EPIC integration NA

MRN# tracking NA

PHO integration for insurance participation 0

Integration with PPM files for Office Manager names NA

Data availability 8

Real time data dashboard 0

Score: 1-3(Poor) 4-7(Mediocre) 8-9(Good) 10(Excellent)

Solution Summary

PRS looked for a solution to address guiding objectives and create value

PRS VALUE

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Patient Experience

PRS Operations

Physician Engagement

Referral Accuracy Physician Referral Service is an optional service for patients and physicians. We needed

to provide a value to efficiently get patients to the right level of care, at

the right time, in the right location

PRS VALUE

PRS Objectives

Legacy System Deficiencies

Limited ability to account for patient preferences when matching with providers

No record of past referral data for individual patients, needed CRM tool

Solution SystemObjectives

Ability to search and filter providers based patient preferences to optimize referral match (e.g. insurance, location, language etc.)

CRM tool for patient tracking, and to foster meaningful connections during current and future interactions. CRM tool also reduced duplicate referrals

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Patient Experience:

Provide a best-in-class experience for patients

PRS Objectives

Limited library of clinical concepts specific to surgical and non-surgical conditions made it difficult to identify appropriate condition search

Manual updates required for to make changes in physician profiles caused delayed updates

Extensive library of clinicalconcepts separate from surgical/non-surgical alignment

Smart search functionality to help direct clinical search

Ability to search regional locations to match patients with physicians treating in those locations

Physician profiles updates automatically via data interfaces to maintain referral accuracy

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Referral Accuracy:

Improve referral accuracy based on consumer needs and preferences

Legacy System Deficiencies

Solution SystemObjectives

Manual ad hoc referral reporting in a monthly data drop to excel

Inconsistent referral reporting caused lack of physician trust

Standardize reporting to physicians and service line administrators with 24/7 analytics dashboard

empower physicians to measure and modify their Scope of Practice to optimize consumer referrals

build physician trust

Additional filters to scale with physician participation in strategic initiatives such as Bundle and Employer programs

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Physician Engagement:

Improve and increase physician engagement

Legacy SystemDeficiencies

Solution SystemObjectives

PRS Objectives

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Complicated workflow for PRS staff to navigate

Follow up emails were typed manually. Time consuming and provided room for error

Call center data pulled from monthly excel database; Reports manually updated and provided on an as requested basis

User friendly

Smart search to surface patient conditions in an easy and seamless way

Referral templates for outgoing emails to reduce inefficiency and errors

Access Center metrics for quality and productivity measures in real time.

PRS Operations Improve and scale workflows. Enhance user experience

Legacy SystemDeficiencies

Solution SystemObjectives

PRS Objectives

Kyruus ProviderMatch

Implementation & Rollout

Workgroup Responsibility Members Suggestions

Operational/ PRS

Provide guidance and oversight of vendor workflows and integration strategy for PRS users

Individuals intimately acquainted with call center processes and procedures

Director, PRS Systems

Specialist, PRS

Leadership“Steering”

• Drive overall project vision, direction for engagement and ongoing partnership

• Formal sign off on all project initiatives

1-2 representatives from each of the groups

CMO Director, PRS CMIO OE Leader IT Leader

Technical

• Identify and support the data integration strategy

• Provide technical and data assistance in accordance with project needs

Subject matter experts and decision makers from each data source

IT Leader IT Support

Clinical

• Provide guidance and oversight on provider profile configuration & maintenance

• Define best practices foradjudication of coverage

• Individuals with a strongunderstanding of all clinical specialties andclinical operations

Surgeon-in-Chief Service Chiefs

(Hip/Knee)

CMIO Clinical Quality

Improvement Champion -Physician

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Governance and Steering

Project Stages and Clinical Engagement

Convert/OptimizeMay - July 2016

ConfigureMar – May 2016

PlanJan - Mar 2016

Establish clinical leadership structure• Convene influential stakeholders to set tone

for clinical engagement, communication rollout, review of high level analytics, and to ensure organizational alignment

Define provider scope• Ensure provider inclusion in PRS aligns

with strategic goals. “Rules of Engagement”

Standardize definition for configuration and matching• Ensure standard & clear definition for

Scope of Practice – In Scope vs. Out of Scope

Develop oversight process• Develop a process to validate and maintain

accurate profiles and adjudicate coverage areas

Communication to physicians• Communication plan to engage providers

Scope of Practice configuration• Establish a plan to ensure that all

providers would configure their PRS profile to ensure best match

Validate clinical coverage & referral rules• Employ clinical lineup reports to

identify coverage gaps or oversupply

• Identify clinical & business rules for search-ability (necessary filters)

• Utilize practice guides and term/condition alerts for decision support

24/7 physician analytics• Utilize supply/demand metrics to report

out to providers to enable a drive toward organizational change to improve access

Profile maintenance• Internal access to provider

demographic and scopes of practice to maintain up to date profiles ensuring referral accuracy

PRS Workflow Mapping

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System Integration

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Solution Scenario #1:

Herniated Disc - Surgical

CRM Tool

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Search

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Search Result

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Search ResultLong Island Location

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Solution Scenario #2:

Knee Pain – Non-Surgical

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Condition Alerts

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Referral Resolution

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Email Template

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Solution:

PRS Analytics Dashboard

Physician Analytics Dashboard

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Service Line Analytics Dashboard

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Administrator Real Time Updates

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Call Center Analytics

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Results

Result Summary

Key improvements since engaging with the vendor solution are:

Improved consumer/patient experience

Increased accuracy for referral matching

Increased utilization of HSS and physician capacity

Improved data tracking

Robust data reporting

Immediate actionable decision metrics

Ability to integrate with other hospital EMR systems

Physician engagement leading to improved patient access

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Results

Criteria for Success – Survey Feedback (Users/Stakeholders) Pre-solution Solution

Ease of Use 4 8

Match to Provider 6 8

Match to location 0 10

Match to distance/zip 0 10

Match to Surgical Status 5 10

Match to physicians participating in strategic initiatives NA 10

Maintenance of provider profiles 2 10

EPIC integration NA 10

MRN# tracking NA 10

PHO integration for insurance participation 0 10

Integration with PPM files for Office Manager names NA 10

Data availability 8 8

Real time data dashboard 0 10

Score: 1-3(Poor) 4-7(Mediocre) 8-9(Good) 10(Excellent)

The Percent Of Referrals Directed To Non- Operative Care Has Increased to 54%

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Accurate referrals improves patient value and increases physician satisfaction

NOTE:2015 - 20178.3% increase in overall referrals 2015 – 2017

Results

• +15% referral volume• +27% call volume• +42% email volume• +19% physician profile management

55Note: 1 Jan - April 2017 vs. Jan – April 20182 July 2016 – April 2018

Enhanced Patient Experience1

Increased productivity with same FTE staff , allows PRS to manage increased call/email volume resulting in more patients served in real time;

Physician and Leadership

Engagement 2

• 95% Physician participation in Physician Referral Service• 24/ 7 Data analytics dashboard provided to 200+

physicians and their office staff • Service Line Directors, Physician Practice Management,

Marketing and HSS Leadership

Results

56 Note:July 2016 – April 2018

User Friendly Improved Workflow1

New system allows for efficiency!

Integration with Multiple Systems

and EMR1

• 17% decrease in handle time; created capacity to answer thousands more calls and email requests.

• Training time for new staff on PRS system reduced from two weeks to two days

• System supports FTE ½ day per week. FTE time now spent managing several hundred additional referrals per year

Promising results allows for…

New initiatives to be operationalized and managed through Physician Referral Service (e.g. Spine Triage; Knee Pain Center; Ankle Fracture, Direct Access PT) all resulting in:

Faster access to appointment

Higher conversion to appointment

Improved outcomes for referred patients

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Lessons Learned

Extensive time spent during discovery phase to define the problem and agree upon scope of project ex: Referral matching; CRM; Tracking analytics etc. allowed for smooth build and implementation

Included internal stakeholders early in the process to outline mutual goals that could be solved with new system implementation

Developed robust yet specialized physician scopes of practice by looking at historical referrals to various service lines and building clinical scopes of practice with physician chief oversight

Systematic communication plan encouraged physicians to update their scopes of practice in new system. This included a multi-tier communication plan showing buy in from Surgeon-in-Chief, Physician Chiefs and added support from Physician Practice Management

Identified physician champions to help align physicians on importance of scope of practice submission

Identified physician practice managers to support scope of practice rollout through office manager reminders to physicians

System demo provided to physician referral staff prior to finalizing implementation helped with a smooth rollout

Vendor onsite training support during rollout provided smooth transition to new system

System demos to physicians built trust in new system and referral process

Transparent 24/7 referral data analytics provided physicians with added value for PRS panel participation

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Q&A