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