Remodeling – Three Alternative Models...remodeling summit, but also to test the alternatives with...

MSMS1

_____________________________________________________________________________________MSMSRemodelingSummit-Facilitation/ConsultationProvidedbyTeckerInternational,LLC

301OxfordValleyRoad,Suite1504B•Yardley,PA19067•(215)493-8120•Fax(215)493-8125•www.tecker.com

Facilitationby:

GlennTecker

ChairmanandCo-CEO

JimMeffert,

SeniorConsultant

www.tecker.com

TeckerInternational,LLC

301OxfordValleyRoad

Suite1504B

Yardley,PA19067

Remodeling–ThreeAlternativeModelsJanuary2017

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TABLEOFCONTENTS

OverviewofTheRemodelingSummit______________________________3

DesignSpecifications___________________________________________4

SummariesofModelsfromtheRemodelingSummit__________________5

RatingoftheModels___________________________________________6

ThreeAlternativeModels

LeastVariationModel__________________________________________7

GreatestVariationModel_______________________________________11

HybridModel________________________________________________15

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OverviewofTheRemodelingSummit

TheMichiganStateMedicalSociety(MSMS)embarkedonaprocesstodevelopanorganizationalstructuretoguidetheenterpriseforthesecond150yearsofitsexistence.TheRemodelingSummitheldinOctoberof2016isanessentialpartofthatprocess.MSMSleadersgatheredtoexaminethecomponentsoftheinfrastructuremodelusedasthebasisforthepreviousassessmentofcurrentstructuresandprocessestocreateseveralmodelsofwhatMSMS’sinfrastructurecouldlooklikeinthefuturegiventhestrategyandassessmentofcurrentinfrastructurewithwhatwillberequiredtoachievetheenvisionedfuture.

Specifically,theRemodelingSummitincludedthefollowingcomponents:

§ ADiscussionofthe“CaseforChange”

§ DiscussionofthehighlightsoftheInfrastructureAnalysisdonepriortothesession.

§ CreatingacommonunderstandingofMSMS’sconditiontodaybyorganizingintosmallgroupswheretheyvisuallyportrayedtheassociationifitwereamodeoftransportation.

§ Groupsestablishedasetofspecificationswhichanyproposedorganizationalmodelneedstobeconsistent.

§ Theyreviewedalternativeorganizationalmodelsfromothersimilaranddissimilarassociationstoprovideacommonformatfor“modelbuilding”.

§ EachofthecrossrepresentativeworkgroupsdevelopedanorganizationalmodelforMSMStopresenttothefullgroup.Modelswillincludedepictionsofkeystructuresincluding,membership,governance,workforce,andfinancial;

§ Participantsassessedtheadvantagesanddisadvantagesofeachofthemodelspresentedbytheirpeers.

§ A“strawpoll”oftheentiregroupascertainedtherelativepopularityofeachofthemodels.

Followingthatmeeting,membersoftheprojecttaskforceconsolidatedthemodelsintothreedistinctalternatives.Thosealternativesweredevelopedtoreflectthemainconceptsidentifiedduringtheremodelingsummit,butalsototestthealternativeswithabroadaudienceofstakeholders.Thesealternativeswillbethefocusofconversationswiththosestakeholdersoverthecomingmonths.TheresultwillbeafurtherrefinementandwillbepresentedtotheMSMSHouseofDelegatesforconsiderationinMay.

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DesignSpecificationsGroupswereaskedtoidentifyqualitiesthattheorganizationmustbeandthosethattheorganizationmustnotbe.Thefollowingquestionwasusedtobeginthediscussion:Whatmustanyorganizationalmodelforthe“XYZ”organization“be”,“belike”or“do”?Whatmustanymodeloforganizationforthe“XYZ”organizationnot“be”,“belike”or“do”?

/-indicatequalitiesidentifiedbymultiplegroups

MustBe

MustNotBe

• Nimble//• Flexible//• Valuableandaffordable//• Forwardthinking/• Relevant/• Proactive/• Transparentandaccountable/• Inclusiveanddiverse/• Supportallphysicians(members)/• Interactivewithmembers/• Patientandcommunityfocused/• Ethical• Adesiredproduct• Leadingchange• Drivinginnovationindeliverymodels• Innovative• Collaborative• Trusted• Youngandexperienced• Conversationstarter• Connectedtospecialtysocieties• Representational(bidirectional)• Unifyingforceinmedicine• Memberengaged• Memberengagingadvocacy• Modeltechnology• Respectfulandresponsiveinpayer

relationships• Atthetable• Recognizedandrecognizable• Partnersinmedicine• Developingfutureleaders

• Rigid,inflexible//• Statusquo//• Self-serving/• Acluborstar-chamber/• Static/• Exclusive• Conversationjoiner• Complacent• Onthetable• Isolated• Onlyreactive• Lessdiverse• Loosecaregivermission• Useonlytraditionalthinking• Toospecialtyfocused• Beunresponsivetotheneedsandchallenges

ofyounger,employedphysicians• Focusedongenerations• Indifferenttopatientneeds• Forgetthecoreattributesofmedicine

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ReviewofMSMSModels

Theparticipantswereplacedintofivegroupsandwereaskedtodevelopmodelsofmembership,governance,workforce/program,andfinance.Thefollowingisasummaryofthemodelsdevelopedbythegroups.Attheendofeachgroup’smodels,youwillfindasummaryoftheadvantagesanddisadvantagesidentifiedbyallparticipantsrelatingtothatgroup’smodels.Thechartbelowhighlightstheuniqueaspectsofthefivemodels:

Group DescriptionA ThemodelsarethemostconsistentwithcurrentMSMSstructures.Thenotabledifferences

arethefollowing:• TheBoardofDirectorsisgivensignificantlymorepowertoestablishpolicybetween

HouseofDelegatesmeetings.• ProfessionalOrganizations(POs)aregivenaseatontheBoard.• Geographicalrepresentationisbaseduponregionratherthancounty.• AsteeringcommitteeisaddedtohelpfocustheHouseofDelegates.

B Themostsignificantcomponentsofthesemodelsarethefollowing:• MembershipandrepresentationareorganizedbyGeographicDistrictsandPhysician

Organizations.• Thereisnodirectrelationshipwithcounties.• LocalphysicianconnectionsalongwithgrassrootsactivitiesareorganizedbyMSMS

directly.• LocalissueactivityisprioritizedbytheMSMSBoard.• MaintainstheHouseofDelegatesasthepolicymakingandagendasettingentity.

C GroupC’smodelscontainthemostsignificantdeparturesfromthecurrentMSMSstructure.

Theoverallconceptwastosimulateanintegratedhealthcaredeliverystructure.Asaresult,thefollowingareuniquecharacteristicsofthemodels:

• Geographywasnotarelevantfactorinanyaspectofthismodel.• Asmallerboardisselectedforperspectiveandexpertiseinadditiontolocationand

background.• Inadditiontoindividualmemberships,groups,specialtysocieties,nurses,andnon-

physicianproviderorganizationswouldhaveamechanismtoparticipateinMSMSactivities.

• TheBoardofDirectorsisthepolicy-makingandgoverningbody.• Thereisanattempttomonetizeandcontractouttheworkdoneonbehalfof

specialtysocietiesandothergroups.D Thisgroupcreatedmodelswiththeunderlyingassumptionofde-unificationfromcounties.

Themostsignificantcharacteristicsinclude:• TheadditionofaGovernanceCounciltoserveinasimilarcapacitytoaNominating

Committee.• PO’s,SpecialtySocieties,Groups,andinstitutionshaverolesontheGovernance

CouncilalongwithpossiblerepresentationattheHouseofDelegatesandontheBoard.

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• A15memberBoard.E GroupEmaintainedmuchoftheexistingMSMSstructurewiththefollowingvariations:

• ThereisspecificandformalSpecialtySocietyrepresentationforthosespecialtiesmeetingasetmembershipthreshold.

• TheBoardisenhancedbyinputfromaCommunityAdvisoryBoardandaCorporationCouncil(externalbusinessinterestswhowouldliketojoinMSMS).

• Geographicrepresentationisorganizedbydistrictsratherthancounties.

RatingtheModelsAttheendofthesession,groupswereaskedtoratethefivemodelsonascaleof1–5asnotedbelow.Thefollowingchartindicatestheselectionsofthegroups.Groupswerenotaskedtoratetheirownmodel.

1. Really like it !2. Like it, but it needs some tweaking.3. Can live with it, but significant modification will be required.4. Really do not like it.5. No way; not ever!

RatingModel

1 2 3 4 5

A XX XX B XX XX C X X X XD X XXX E XXX X

Thefollowingattributesarecommontoatleastfourofthegroups:

• AllofthegroupsidentifyachangeinthegeographicorganizationofMSMSmembershipandgovernance.Thosechangesrangefromorganizinginregionstode-unification.

• ThereisamechanismtospecificallyaddProfessionalOrganizations(POs)totheBoardandHouseofDelegates.

• Thereisadesiretohaveasmaller,more“nimble”Board.• Theroleofspecialtysocietiesisenhanced.• ThereisanattempttomodifytheroleoftheHouseofDelegatesasasourceoffocusedinputon

policyissueswhileallowingtheBoardtogoverntheorganization.

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ReviewofConsolidatedAlternatives

LeastVariationModel

Membership

AregionmayuseastaffedcountyasafirstpointofcontactorseparatestructurecreatedbyMSMStorepresentindividualmemberships

Governance

MSMS

IndividualMembership

Region Student Resident

GroupMembership

Specialty PhysicianOrganizamon

Members

HouseofDelegates BoardofDirectors

ExecumveComminee Officers

CEO Staff

Comminees

Steering/NominamngComminee

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NameofBody HouseofDelegates BoardofDirectors ExecutiveCommitteeNumber 23(oddnumber) 7Composition Representativesselected

frommembershipcategories

12fromRegionsIeachYPSRes/fellowStudentsHospitalspecialtyOutpatientspecialtyPrimarycareMedschoolfacultyPOIndependentGroupHoDofficers

OfficersExOfficioCEO

Responsibilities EstablishMSMSPolicy,ElectofficersandmembersoftheBoardofDirectors

Leadership,Vision,FiduciaryResponsibility,setpolicybaseduponHouseofDelegatesDirection

Internalaffairs,management

MeetingSchedule Annual Quarterly AsneededStaffLiaison CEO CEO CEO

Finance

Duesprocessconsiderationsidentified:

Multi-yearmemberships

Automatedmonthlybilling

MSMS

Dues

Region PhysicianGroups Hospitals Academic

Groups

Non-Dues

Meemngs AssociatedBusiness

ProductsandServices

Co-SponsoredMeemngs

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Program

Model Advantages

• Inclusive • Dues model might have potential for attracting members • Sharing resources • Program structure is appropriate • More nimble • Increased diversity • Geographic / practice type • BOD decisions • Smaller board • Improved contact/ communication • Adds “steering committee” to HOD • Leadership development program • Regional offices -> good improved resource scan • Empowers BOD btw annual HOD mtngs • Board composition is complete • Add # of directors to avoid ties • Composition of HOD and Steering Comm. • Emphasis on social media for communication • Slightly smaller board/ add # • Preserves value and individual members • Current HOD doesn’t represent membership (new model offers improved composition) • Identify diversity of board members • Regional and county • Steering committee

MSMS

Advocacy

Lobbying

Policy

Grassroots

Educamon

CME

EducamonProducts

Leadershipdevelopment

Pracmcemanagement

Operamons

HoD

BoD

Communicamons/PR

Media

MIMedicaid

ElectMedia

SocialMedia

Membership

Students

Sociemes

Districts

Alliance

Secmons

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• Regional representation

Model Disadvantages • Continued financial loss • Boards still large - not nimble • How is regionalization adding to efficiency (it might duplicate a county layer) • It gives the board more authority • Board is missing reps from some sections • Board reps appointed vs. elected • Country/ Region confusion • Leaves holes in country/ region representation • BoD empowered above HoD • Population decrease areas would have proportionately less representation than rural areas • Duplicates much of status quo • “regional” idea is same as district directors • Concerns about BoD above HoD • Cost for region’s staff • Regional representation/ low proportional • Same financial structure

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GreatestVariationModel

Membership

Governance

EmployedPhysicianGroups PhysicianOrganizamons Specialmes IndividualPhysicians

Students Residents AcademicPhysicians

HealthCareOrganizamons• Nurses• Pharmacists• AncilaryProviders

Physician Organizations Independent Physicians Physicians in Training Practice Managers

Sp

ecia

lties

& A

llied

Hea

lth

Employed Physicians

MOA

, MPA

, Adv

ance

Pra

ctic

e Pr

ovid

ers,

RNs

Advisory Council

Board of Directors

ExecutiveCommittee

PhysiciansExecutive CommitteeBoard of DirectorsAdvisory

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BoardofDirectors-21total/ExecutiveCommittee(officers)–7

Memberareelectedbythemembershipafterbeingselectedbyanominatingcommitteefornecessaryattributestogoverntheorganizationincluding:

• Skillsandexpertise • Rural/suburban/urbanbalance• Independent/employedbalance • Diversity• Geographicbalance

AnominatingCommitteeselectsboardcandidatesforelectionbythemembership.

Revenue

Specialty–monetizetheworkcurrentlydoneforspecialties,otherprofessionalassociation).AdvocacybenefittinganentiregroupmaybereimbursedbacktoMSMS(currently,entiregroupsbenefitforthecostofonemembership).Contractsmaybenegotiatedatanytransitionstage

Dues

• Individual• OrganizamonalandaffiliateorganizamonsmaynegomatecontractsatanytransimonstageNon-Dues

Non-Dues

• Sponsorships• Insurancerevenue• PCVS• TenantRent• Educamonalincome• POCouncilRevenue• Quantum• WealthcareAdvisors• Investments• Incubatenewbusinessopportunimes/expandtoangelgroups/Seededfuturebusinessenmmes

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Programs

Model Advantages

• Inclusive • Diversifies Representation • A population health focus • Smaller board • Accounts for MOA specifically • Allowing virtual presence in representation on BOD • Population based • Connects with allied providers • Aims to preserve physician leadership in healthcare despite changes • Competency based board • Inclusion of non-physicians • Possible nominating committee adding MOA is an advantage • Unifies into one healthcare organization • Competency based with constituency situated representation • Less reactionary, more proactive • Virtual participation in meetings • Need to start with those who are ready for change • Adding MOA • Forward thinking • Inclusive of important perspectives • Larger voice • Care delivery model

Model Disadvantages

• Might be received as a threat to physicians/ current members • Does not diversify membership • Will be hard to implement • No clear composition of the board • Additions of apps may complicate decision making within the organization and dilute

physician voice • Changes mission of the organization • Competing legislative intersects

Educamon

• CME• Research• MedicalSchoolModels

Advocacy

• Payer• Regulatory• Purchasers• Legislamve

Communicamons

• Print• Electronic• Virtualcommunimes

PopulamonHealth

• MACRA,MIPS,otherstakeholders• Newmodelsofcommunityhealthandcommunityhealthorganizamons

IntegraPonofAPPs HCTechnology

• HIT• Pamenttools• Telehealth

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• Does not address geographic distribution or representation • No mechanism to decrease BOD seats • Doesn’t address outreach to unstaffed counties • Challenges with non-physician representative • “Optics” of having non-physicians may be viewed as negative • A lot of change at once may decrease existing membership at first • Are we ready? • Effect on counties/ acceptability • How it impacts legitimacy of MSMS in the AMA • Many details are not determined yet • Unsure how rank and file doctors will “buy in” and become new members

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HybridModelThismodelisanattempttounifythecommonelementsfromthefivegroups.Theelementsusedtodevelopthismodelincludethefollowing:

• TheHouseofDelegatesastheprimarysourceofongoinginputintothepublicandphysicianpracticepolicyprioritiesofMSMS.

• AchangeinthegeographicorganizationofMSMSmembershipandgovernance.• RecognitionofmembershipandinputfromProfessionalOrganizations(POs)andSpecialty

SocietyRepresentation.• AsmallerBoardwithincreasedoperationalandpolicy-makingauthority.• TheutilizationofaNominatingCommittee,whichutilizesspecificcriteriatosuggestmembersof

theBoardofDirectorstothemembership.• ThereisanattempttomodifytheroleoftheHouseofDelegatesasasourceoffocusedinputon

policyissueswhileallowingtheBoardtogoverntheorganization.

Membership

Affiliatememberswillbedefinedinthebylawsasindividualsand/orgroupswhomaybenefitfromtheproductsandservicesprovidedbyMSMS.Theywillbenon-votingmemberswithspecificbenefits.

MSMS

IndivicualPhysicians

PhysicianOrganizamons

SpecialtyPhysicians

MedicalSchoolStudents

ResidentPhysicians

PhysicianGroups(hospitalandacademic)

Affiliate(non-vomng)

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Governance

NameofBody HouseofDelegates BoardofDirectors NominatingCommitteeNumber Nolimit 16 6Composition Opentomembersin

goodstanding9membersatlargenominatedbytheNominatingCommitteewiththreememberselectedeachyearfor3-yearterms.7officers

3–OfficersPresidentPresident-ElectSpeaker3–SelectedbytheBoardofDirectors

Responsibilities Theprimarysourceofinputintopublicpolicyandtrendsinphysicianpractice.TheissuesdiscussedbytheHoDaredrivenbyongoingqualitativeandquantitativeresearch.ThedeliberationsdrivetheagendaandprioritiesofMSMS.

OperationalPolicy,Leadership,Vision,FiduciaryResponsibilities,EstablishstrategicprioritiesbaseduponHouseofDelegatesInput.

Nominateaslateofcandidates(officersandatlargeBoardmembers)tothemembershipforelectionattheHouseofDelegatesmeeting.Candidatesareselectedbaseduponapre-establishedsetofcriteriatoinsureabalanceofperspectivesandskills.ThiscriteriashouldbedevelopedbytheBoardandapprovedbytheHouseofDelegates.

MeetingSchedule OnceAnnuallywithan

ongoingmechanismforinput.

Quarterly Asneeded

StaffLiaison CEO CEO

HouseofDelegates/Membership-PublicandHealthcarePolicyInput

BoardofDirectors-Operamonalandongoing

MSMSpolicy

CommiRees/TaskForces

CEO MSMSStaffNominaPngCommiRee

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Revenue

Programs

Programsandrelatedtaskforce/committeeactivitieswouldbedevelopedbytheBoardofDirectorsinordertoachievethegoalsintheMSMSstrategicplan.

Model Advantages

Will be generated through input from stakeholders

Model Disadvantages

Will be generated through input from stakeholders

Dues

• Individualphysicians• Groups• PO• GroupPracmces• AcademicInsmtumons

SpecialtySociemes

• Negomatecontractsforspecificservicesandrepresentamon.Revenuemaybebaseduponaformulaofmembershippenetramonwithinthespecialty,sharingofdata,etc.

Non-Dues

• Sponsorships• Insurancerevenue• PCVS• TenantRent• Educamonalincome• POCouncilRevenue• Quantum• WealthcareAdvisors• Investments• Incubatenewbusinessopportunimes/expandtoangelgroups/Seededfuturebusinessenmmes

AffiliateRevenue

• Affiliateduesmaybecollectedfrominterestednon-physicianssuchasanorneys,pracmcemanagers,grouppracmcemanagers,employergroups,healthplans,etc.Duesinthiscategorymaybehigherthanregularmemberduesbaseduponthevalueofbenefitstotheaffiliategroup.

Advocacy

Lobbying

Policy

Grassroots

Educamon

CME

EducamonProducts

Leadershipdevelopment

Pracmcemanagement

Operamons

HoD

BoD

Communicamons/PR

Media

MIMedicaid

ElectMedia

SocialMedia

Membership

Students

Sociemes

Districts

Alliance

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MSMS19



Trends

ThefollowingisalistoftrendsmosteffectingthefutureofphysiciansinMichiganidentifiedbytheparticipantgroups:

• 8Accesstocare• 19Workforce/Michigan• 30YoungerPhysicians• 20Burnout• 23Life-workbalance• 71TechnologyDriven• 23ChallengeswithPhysicianhealthandwellnesswithlifebalance• 30YoungerPhysicianshavedifferentsenseofmembershipvalue• 88Anincreaseinthenumberofemployedphysicians• 46Mid-levelpractitionerswillseekincreasedscopeofpractice• 71Technologydrivenconsolidationtrendsareleadingtophysicianburnoutanddecreased

physiciancontrol• Decreasingfinancialresourcesforhealthcarewillmeanmorefocusonoutcomesthatpayingfor

procedures.• Socialandeconomicfactorsarelinkedtooverallpatientoutcomes.• Healthcarerelatedtechnologywilldrivethetrendsinmedicineforallstakeholders.• Healthcareconsolidationwillcontinue,basedonmarketforces,sophysicianscannotbe

isolatedorunconnected• Therewillcontinuetobequalityaccessissuesinurbanandruralareaswithincreasetheneed

forclinicalintegrationandexpandedteam-basedmodelsofcare.• Changingpatientexpectationsaboutaccessandconvenience.• Increasedphysicianrecognitionofwork-lifebalancewithpart-timeoptions• 6Decreasingoverallhealthanddecreasedaccesstocare.MSMScanadvocateforlegislative

andregulatorychangestomakeimprovementtopublichealthandaccesstocarebyincreasingphysiciantraining.

• 45/86/70Governmentinfluence,regulatoryburdenandEHRdecreasephysicianautonomy.• 23/30ChangingPhysiciandemographicsandburnout.• 43/38/59Megamergers,healthsystememployment,interferingwithdoctorpatient

relationshipandmovesto“quality”basedcaredecreasephysicianautonomyandsatisfaction.

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SUMMARYOFCURRENT“MODESOFTRANSPORTATION”

ParticipantswereaskedtoidentifyamodeoftransportationwhichbestdescribesthecurrentstateoftheMichiganStateMedicalSociety.Followingisadescriptionofthosemodesidentified.

Bus

• Carriesmixedpopulationstogether• Establishedpoint-to-pointslowtocreatenewpick-upsorstops• Canbestoppedorslowedbyoneorjustafewpassengers• Subjecttotrafficandotherlocalizedforces• Focusedprimarilyinpopulationscenters• Riderslackalternatetransportationoptions

Train

• Progresshasbeenmadebutmoreflexibilityisneeded.• Wecannowonlychangeatcertaintimesandincertainways.• Wetendtostayonthesametrack• Multipleprograms,multiplecarsrepresentedbythetraincars.• Carsareconnectedbutseparatefromeachother• Memberscangetonandoff

Taxi

• Evolvingvs.traditionaltransportationmethods• Forhiretoaspecificdestination• Oldercustomersusetraditionaltaxis• Taxisareusefulbutnobodyknowswheretheygo• Limitedcapacityforthosewhowanttogotoadifferentdestination–onetripmaybetakenata

time.• Technology-Driverlesscars–technologicalcanbeafriendorfoedependinguponperspective• Innovation–TaxisarenotUBER(convenient,easy,technologydriven,anyonecanbeadriverfor

thetimetheydesignate).• Communication–onedirectionaltransaction

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