Faculty Group PracticeClinical Strategy

2010-2015

FGP Board July 09, 2009

Attachment D

Brief Background of Faculty Group Practice

• 1970’s Departmental practice plans created within the medical school

• 1984 Clinics and ancillary services become hospital based• 1995 Medical Center Clinicians Group formed to improve

the delivery of clinical care• 1996 Faculty Group Practice created• 2008 FGP Board reorganized to include all chairs, faculty

representatives, and health system executives• 2008 FGP assumes responsibility for Ambulatory Care Services

FGP Board July 09, 2009

University of Michigan Medical School Faculty Group Practice (FGP) Organizational Structure

Dean (Chair of Board)Board of Directors

Sr. Associate Dean for Clinical Affairs

CommitteesBudget & Finance CommitteeClinical Practice CommitteeExecutive CommitteeNominating & Bylaws Committee

Professional Compliance

Compliance ProgramQ.A.TrainingEducation

Contracting

Executive HospitalDirector

Director of Billing

Customer ServiceIDXMCAPayor RelationsPBACTraining

Chief Administrative Officer

QualityManagement

Center

BCBSM PGIPComplex CareDisease Mgt.CMS Demo Kids ConnectionOutcomes AnalysisProject Mgt.

Health System Finance Support

BudgetingCapitation Funds ManagementFinancial PlanningFinancial ReportingModelingVenture Funds Management

Administrator,Ambulatory Care

Services

ACOCAmbulatory SurgeryBODTJCAHOProgramsPropertySystems

FGP Board July 09, 2009

FGP Board of Directors

FGP Board July 09, 2009

Goals of Reorganization/HHC-FGP Agreement of 2008

• Improve clarity of management of clinical practice, clinics and ancillary support

• Promote local problem solving• Increase faculty compensation to benchmark• Improve coordinated planning and decision

making• Enhance implementation of initiatives• Improve strategic planning

FGP Board July 09, 2009

Elements of HHC-FGP Agreement/Board Reorganization

• FGP assumes responsibility for managing ambulatory services on behalf of HHC

• FGP assumes financial risk, shares margin improvement 50:50 with HHC

• HHC provides $17 million/year for faculty salary support

• HHC funds capital• Clinical chairs, 5 at-large faculty, hospital and

medical school leadership – comprise Board

FGP Board July 09, 2009

Results to Date

• Faculty salary gap reduced from $29 million to $14 million FY09• Patient satisfaction up to 87.6 (90 goal)• Medical directors appointed for each clinic and ancillary area (ACU)• Margin improvement YTD (May) - $8.5 million• Incentives created for patient access, patient satisfaction, improved

coordination• Medical directors/managers – professional development• Monthly management information provided to each Ambulatory

Care Unit (ACU)• Increased transparency

FGP Board July 09, 2009

Medical School Faculty Satisfaction Survey – Clinical Activities, Fall 2008

Patient Care and Clinical Activities 2006 2008

Clerical Support in the clinic 60.5 66.5Nursing support in clinical activities 65.5 70.0Support provided by medical assistants 67.7

71.6Timeliness of diagnostic tests & procedures 62.3

69.0Timeliness of the transcriptions 79.7

82.8Patient scheduling in clinic 55.5

62.0FGP Board July 09, 2009

Faculty Group Practice Strategic Planning

• Began in Fall 2008

• FGP defines clinical strategy• Based on 2008 Harvard Business Review

article – Can You Say What Your Strategy Is? By David Collis and Michael Rukstad

FGP Board July 09, 2009

Components of Clinical Strategy

• Competitive Advantage – Excellent faculty• Scope or Focus – Nationally recognized faculty

and clinical programs• 5 year goal

– Double Clinical Research (number of patients accrued to clinical trials)

– Patient satisfaction greater than 90 in all areas– Referring physician satisfaction > 90– National leader in quality and safety

FGP Board July 09, 2009

Mission

The mission of the FGP is to manage the clinical enterprise of the medical school clinical faculty for the benefit of education, research and patient care programs of the University of Michigan.

FGP Board July 09, 2009

Vision

The national leader in clinical quality, safety and innovation.

FGP Board July 09, 2009

Clinical Strategy Statement of the FGP

• The focus of the FGP will be to provide exemplary clinical care and service to our patients, develop nationally recognized faculty and clinical programs and increase clinical research, doubling clinical research by 2015.

FGP Board July 09, 2009

Goal 1: Exemplary Clinical Care and Service

A. Engage medical directors, Clinical Practice Committee, faculty, nursing, and clinic staff to improve clinical care and service with the following goals

• Improve patient satisfaction >90 in all clinics• Improve referring satisfaction >90 in all departments• Improve access for new patients >80% in <4 weeks• Improve coordination of care between dependent services

B. Improve Efficiency• Train medical directors and managers in techniques to solve problems,

streamline processes (Lean)• Provide central resources to facilitate problem solving (Coaches)• Strive for 5% productivity gain each year for the period 2010-2015

FGP Board July 09, 2009

Goal 1 – continuedExemplary Clinical Care and Service

C. Improve Quality of Care• Develop and measure process and outcomes in all service areas• Implement E-Prescribing• Implementation of disease management/preventative software• Complex Care Management Program will focus on high cost at risk

populations• Incorporate outside lab tests into CareWeb – improve continuity• Measure the quality of our care in all disciplines• Continue Guideline Development for problem areas (pain

management, imaging utilization)• Display our quality measures for public viewing

FGP Board July 09, 2009

Goal 2: Develop Nationally Recognized

Faculty and Clinical Programs A. Utilize destination program process to focus our resources

• Implement current approved programs using existing operations• Proceed with second round of programs• Utilize lean techniques to streamline processes

B. Improve faculty mentorship and supportB. Improve clinical research infrastructure support• Close salary gaps in departments• Streamline IRB process

C. Targeted recruitment to support destination program development and research strategic plan (under development)

FGP Board July 09, 2009

Goal 3: Double Clinical Research by 2015

• Engage research and regulatory/compliance office to streamline processes (billing calendar, IRB process, clinical design support)

• Engage departments to understand barriers to increasing clinical research

• FGP – margin will support clinical research

FGP Board July 09, 2009

Next Steps

• Chairs discuss with faculty

• Faculty representative discuss with cohort

• FGP leadership will work with ACU leadership to develop 2-3 goals for 2010

• Track progress in FGP Board quarterly

FGP Board July 09, 2009

Measures for FGP Board

• Measure for clinical research

• Access report card

• Patient satisfaction

• National reputation?

FGP Board July 09, 2009