PAN Physicians as Customers Building an Integrated Strategic Plan Thornhill

Physicians as Customers:
Building an Integrated Strategic
Plan
Jane 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 Plan
Jane Thornhill
Administrative Director
HFMG 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 GP
Henry Ford
Botsford
St. JohnSinai-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 Macomb
DMC 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 49
50 to 99
100 to 199
200 to 299
300 to 3000
Top 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 Objectives
To 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…
Pulmonology
Pulmonary hypertension
Lung transplant
Lung reduction
Therapeutic bronchoscopic procedures
Interventional pul (airway stents)
ENT
Otologic surgery
Oncology - head / neck
Tinnitus
Ear issues (chrome mastoid bone)
Pediatric issues
ONC
Bone marrow
Liver privation carcinoma
Prostate (robotic surgery)
Neuro surgery
Lung treatment
Resection
GASTRO
Advanced liver disease
Inflammatory bowel disease
Liver hepatitis
Liver transplant
Pancreatic cancer
Oncology
GP/FAM
Arthritis
Crohn’s disease
Neuro
COLON/RECTAL
Interoperational Radiation
Kock pouch
Therapy
Rectal cancer
Neuroscience
MS
Epilepsy
Trauma inter cranial
Cerebral endovascular aneurysm (coiling)
Cranial facial reconstruction
ALS
GYN
Cervical cancer
Bladder support
Sarcoma/melanoma clinic
Endometrial oncology
ORTHO
Trauma
Oncology

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
0
5,000
10,000
15,000
20,000
25,000
30,000
2009 2010 2011 2012 2013
Phone Volume
0
2,000
4,000
6,000
8,000
10,000
2009 2010 2011 2012 2013
Online Consults
0
500
1,000
1,500
2,000
2,500
3,000
2010 2011 2012 2013
Transfers
0
500
1000
1500
2000
2500
2010 2011 2012 2013
Outpatient Referrals

OaklandOaklandOaklandOaklandOaklandOaklandOaklandOaklandOakland
SchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraftSchoolcraft
AlgerAlgerAlgerAlgerAlgerAlgerAlgerAlgerAlger
AlleganAlleganAlleganAlleganAlleganAlleganAlleganAlleganAllegan
AlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAlpenaAntrimAntrimAntrimAntrimAntrimAntrimAntrimAntrimAntrim
ArenacArenacArenacArenacArenacArenacArenacArenacArenac
BarryBarryBarryBarryBarryBarryBarryBarryBarry
BayBayBayBayBayBayBayBayBay
BenzieBenzieBenzieBenzieBenzieBenzieBenzieBenzieBenzie
BerrienBerrienBerrienBerrienBerrienBerrienBerrienBerrienBerrien
BranchBranchBranchBranchBranchBranchBranchBranchBranch
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
HuronHuronHuronHuronHuronHuronHuronHuronHuron
InghamInghamInghamInghamInghamInghamInghamInghamIngham
IoniaIoniaIoniaIoniaIoniaIoniaIoniaIoniaIonia
IoscoIoscoIoscoIoscoIoscoIoscoIoscoIoscoIosco
nnnnnnnnn
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
SaginawSaginawSaginawSaginawSaginawSaginawSaginawSaginawSaginaw
SanilacSanilacSanilacSanilacSanilacSanilacSanilacSanilacSanilac
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)

nnnnnnnnn
2013 ASRLs
7 to 10
5 to 6
3 to 4
1 to 2
2013
New Referring Physicians
Total: 253

nnnnnnnnn
2013 MRNs
7 to 15
4 to 6
2 to 3
1
2013
New Patient MRNs
Total: 751

150 miles
100 miles
50 miles
nnnnnnnnn
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)

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

2011 Cancer Discharges
Henry Ford:
A regional powerhouse in
terms of overall cancer
numbers, but…
Henry Ford
Henry Ford Hospital 1965
West Bloomfield Hospital 464
Macomb - Clinton Twp Hospital 703
Wyandotte Hospital 376
Macomb - Warren Hospital 19
3527
DMC
Karmanos Cancer Institute 1251
Detroit Receiving Hospital 469
Sinai-Grace Hospital 614
Harper University Hospital 462
Children's Hospital of Michigan 1192
Hutzel Hospital 32
Huron 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 DSS
2010 Cancer Service Line Cases
Cancer_Group Hem Onc Radiation Surgery Hem Onc Radiation Surgery
Bone 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
Concierge
5.0 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, Patie
nt Advocate Support
Website
Development
888-777-4167
Patient Phone Triage
Infrastructure
JFCI, RPO,
Surgical
Departments
PR/Marketing
Plan,Creative
Content
Development
L
A
U
N
C
H
Sept. 24,
2012
May
2012

Vision
Business Plan
Surgeon and JFCI
Buy-In, Gap
Analysis
Infrastructure
Development:
Admin, Nursing, Patient
Advocate Support
Website
Development
henryford.com/
cancer
888-777-4167
Patient Phone
Triage
Infrastructure:
JFCI, RPO, Surgica
l Departments
PR/Marketing
Plan
Creative Content
Development
L
A
U
N
C
H
September 24, 2012

Center for Cancer Surgery
0
200
400
600
800
1000
1200
1400
1600
2012 2013
Referrals
Surgeries

Karmanos
Henry Ford Health
System
Beaumont U of M St. John Providence DMC Oakwood
2004 21% 9% 18% 14% 7% 3% 3%
2014 22% 19% 18% 16% 8% 7% 2%
0%
5%
10%
15%
20%
25%
Preference
Tri-County: Cancer

Southeast Michigan – System Share
Adult Cancer Discharges
YTD 2012
Discharges Market Discharges Market to 2013
Top 10 Hospitals SEM (YTD Change) Hospital Share Hospital Share % Change
Henry 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 Kwon
David Nathanson Kellie McFarlin Craig Reickert Melissa Times
Chris Steffes Madhu Prasad Tom Buekers Michael Mott
Jack Rock Ian Lee Robert Elkus Srinivas Bhandarkar
Vernon Strand Donna Tepper Rajpal Swarn Shawn Webb
James Peabody Hans Stricker Riad Farah Rabbi Hanna
Stefan Smietana Francis Hall Robert Stachler Marwan Kazimi
Atsi Yoshida Dean Kim David Sternberg Stephen Bartol
Michael Simoff Ben Movsas
Steven Kalkanis, Director William Conway John Popovich
Robert Chapman Scott Dulchavsky Tom Nantais
Marwan Abouljoud Mani Menon Adnan Munkarah
Ted Parsons Mark Rosenblum
Jane Thornhill, Administrator Elizabeth Knight, Nursing Director

PAN Physicians as Customers Building an Integrated Strategic Plan Thornhill

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