2011 AMGA Annual Conference

Leadership and Governance

Board members, department heads, and other thought leaders will discuss changing cultures, leadership development, and strategic planning.

Friday, 2:00 p.m. - 3:15 p.m. Dealing with Difficult Physicians: Understanding and Addressing Performance Problems
Robert A. Blomberg, M.A., Education Administrator; and Teri Rummans, M.D., Professor of Psychiatry, Mayo Clinic College of Medicine, Chair, Career and Leadership Development Committee, Mayo Clinic Health System

Physician leaders report that addressing performance problems with colleagues is the most difficult and distasteful aspect of the leadership role. This session will describe common causes and consequences of physician distress, and provide a model for addressing problematic performance issues. The session will be interactive, using actual workplace cases.
Upon completion of this activity, participants should be able to describe factors contributing to physician distress; identify workplace and personal consequences of impairment; describe when physician leaders should "coach, counsel or discipline" a colleague; and apply learning to several actual workplace personnel-related cases.

Friday, 2:00 p.m. - 3:15 p.m. From Autonomy to Standardization; Imbedding Best Practices and Care Standards in an Integrated System
Joe Bianco, M.D., Associate Chief - Primary Care Division; and Barbara Possin, M.S., R.N., Vice President, Strategy and Quality, Essentia Health - East Region

Creating a new successful, patient-focused primary care delivery model includes moving the practice of medicine from a "cottage industry" (autonomy) to evidence-based best practices and care standards. This multispecialty group practice has worked 4+ years to efficiently and effectively improve the clinical outcomes of primary care patients with chronic disease through standardized workflows and best practices. The presenters will share theirs experiences and how modifying their implementation of best practices has led to dramatic improvements in clinical measures.
Upon completion of this activity, participants will be able to state the basic elements of the "Accountability Sequence" communication structure and the components of moving from "complyment to complete alignment," as articulated by Roger Connors and Tom Smith in the book How Did That Happen?; discuss common change management failures when the system and structure is not in place, as described in the "Accountability Sequence"; describe the use of tools and processes that support consistent use of care standards for the organization to adopt; and demonstrate processes for creating consistent expectations of accountabilities to successfully accept and adopt best practices throughout a network of primary care clinics.

Friday, 2:00 p.m. - 3:15 p.m. Patient Satisfaction Surveys: The Good, the Bad, and the Ugly
Scott Hayworth, MD, President and CEO; Abe Levy, M.D., Chief Medical Officer and Chief Quality Officer; Thomas J. Lester, M.D., Associate Medical Director, Mount Kisco Medical Group; and Stan Moser, Chief Administrative Officer, Bozeman Deaconess Health System

The Mount Kisco Medical Group has initiated the AMGA Patient Satisfaction Survey within the past three years. The surveys were a valuable learning tool throughout the organization. Improvements in parking, phone service, and patient access were accomplished. However, when these surveys were tied to physician compensation, some physicians were insulted that patients' subjective evaluation of their visit would affect their income. Many physicians questioned the scientific validity of the survey. The presenters will review MKMG's experience with the survey, and describe their efforts to gain group-wide acceptance of this concept and put physicians' compensation at risk for performance goals.
Upon completion of this activity, participants will be able to create a strategic plan that directs compensation and performance goals as a result using data from implemented patient satisfaction surveys.

Friday, 3:45 p.m. - 5:00 p.m. The Brave New World of Integration: A Discussion among Colleagues on Contemporary Models and Lessons Learned
Don Wreden, M.D., President and Chief Executive Officer, Sutter Medical Group; Terrigal Burn, M.D., Chair, Executive Board, Palo Alto Medical Foundation; Michael Rau, M.D., Chairman of the Board, Patients First Health Care; Alan S. Kaplan, M.D., M.M.M., FACPE, FACHE, Vice President and Chief Medical Officer, Iowa Health System; and James W. Lord, Principal, ECG Management Consultants

This presentation will be an interactive seminar between industry leaders of organizations that have recently undergone or are in the midst of significant integration efforts. It will enable comparisons of different market dynamics and the type and speed of integration. Lessons learned and comparisons of each entity specific to cultural, clinical, and financial integration will enable participants to get a broad spectrum of information and understanding of real-time efforts, enablers, and barriers to integration from some of the AMGA's leading group practices.
Upon completion of this activity, participants should be able to describe new methods and tactics for integrating physicians in strategic relationships (e.g., ACO, clinical integration models, group mergers, etc.).

Friday, 3:45 p.m. - 5:00 p.m. Creating Best-in-Class Research Management Systems
Steven C. Smith, M.H.A., Chair of Research Administration, Mayo Clinic

Creating "best-in-class" management systems is critical for successful group practices. This interactive case study will highlight the Mayo Clinic quality management framework and share efforts underway at Mayo to create best-in-class management systems. Participants will be able to learn firsthand from a leader who has been directly involved with quality improvement teams and responsible for creating best-in-class research management systems at Mayo Clinic. Participants also will complete an assessment tool to enhance the likelihood of a successful transformation in their own organization.
Upon completion of this activity, participants will be able to describe the Mayo Clinic quality management framework and how this framework can be applied in their own organizations to improve quality and create ‘best-in-class' business processes; describe the Mayo Clinic Research Management System Model and the six key components of the model necessary to create essential core corporate competencies to operate highly successful research programs, and how this facilitates translation of scientific discoveries to the benefit of patients; and select a change management opportunity of strategic importance in their own organization and complete a brief assessment tool to identify critical action steps to take and common problems to avoid enhancing the likelihood of a successful transformation.

Saturday, 11:00 a.m. - 12:15 p.m. Leveraging Performance Improvement, Business Intelligence and the Group Practice Model to Integrate a Health System
David Bronson, M.D., President of Regional Hospitals; and Brian Harte, M.D., Chief Operating Officer of Hill Crest Hospital, Cleveland Clinic Foundation

Healthcare organizations are under immense pressure to provide low-cost, high-quality care. Cleveland Clinic provides a case study in how a group practice created a comprehensive integrated delivery network to efficiently put the right patient in the right place at the right time, all at the right cost. This presentation will highlight the examples of system integration, including physician alignment/group practice model, ICU integration across 30 ICUs, automated physician-level scorecard, patient experience dashboard, cost and utilization transparency, system-wide centralized hospital transfer and bed placement process, system-wide blood stream infection rate reduction, and improved critical care transport.
Upon completion of this activity, participants should be able to demonstrate ways the Cleveland Clinic has aligned enterprise-wide performance management tools to develop an integrated delivery network; provide examples of how business reviews and monthly balanced scorecards powered by automated business intelligence solutions have been used as transparent tools that drive transformational change and improvement throughout the system; describe how Cleveland Clinic uses standardized processes, electronic medical records, and other tools to reach higher levels of efficiency and performance; explain how Cleveland Clinic is creating specialty care centers throughout the system to reflect the needs of the community and ensure patients receive superior levels of care without creating redundant capability; and explain how an effective group practice model in a patient-centered environment can lead to innovation and uncover opportunities for improving quality of care while increasing safety and lowering costs.

Saturday, 11:00 a.m. - 12:15 p.m. Physician/Hospital Integration: The Carle Foundation Acquisition of the Carle Clinic Association and Health Alliance Medical Plans
R. Bruce Wellman, M.D., Chief Executive Officer, Carle Physician Group and Gary K. Edmiston, Principal and Chair of Board of Directors, ECG Management Consultants, Inc.

On April 1, 2009, Carle Clinic Association and Health Alliance Medical Plans merged with Carle Foundation to create an integrated delivery system serving east central Illinois. The integration is a prime example of the potential for collaboration among physicians and hospitals as these organizations strive to serve their communities and maintain financial stability in today's ever-changing provider landscape. This case study explores issues and lessons learned during this merger, with a specific focus on physician leadership within the integrated organization.
Upon completion of this activity, participants should be able to describe the process used by physician and non-physician leadership to merge a hospital, physician group, and insurance plan into an integrated delivery system; discuss the issues identified and solutions employed by both parties to ensure a successful outcome to the merger process; and identify the strategic motivations and potential future benefits that can be achieved through integration and incentive alignment.

Saturday, 11:00 a.m. - 12:15 p.m. Operational Reorganization and Cultural Change in a Multispecialty Medical Group
Steven A Mitnick, M.D., M.B.A., Medical Director; and Robert Altman, M.D., Chair, Department of OB/GYN, Gould Medical Group

How does a rapidly-growing medical group impart in each member a collective sense of purpose and ownership of the vision and values of the organization? This presentation is a case study of Gould Medical Group and the cultural and geographic challenges they faced as they began to expand aggressively by individual hiring and acquisition of existent community practices within both the historical market areas and surrounding markets. Presenters will describe the process used to explicitly state group values through creation of a compact and the fundamental re-organization of the leadership structure required to improve communication and inspire a feeling of ownership among all the members.
Upon completion of this activity the participants should be able to explain the inter-relationship between medical group structure and culture; discuss strategies for maintaining culture during expansion; and evaluate the use of a compact within their own organization.

Saturday, 2:00 p.m. - 3:15 p.m. The Journey to an ACO: A Firsthand Look at a Commercial ACO Pilot; the Tools, Governance and Care Process Improvements to Success
John E. Jenrette, M.D., Chief Executive Officer, Sharp Community Medical Group

Sharp Community Medical Group has been a successful IPA for the past 20 years. Using the tools, programs, and processes from 20 years as a delegated, coordinated care model in California, the presenters will explore how this experience has translated to one of the first commercial ACO pilots with a major national payer. Specific details regarding attribution models, incentive payment structures, and clinical process changes will be shared.
Upon completion of this activity participants should be able to outline the organizational and program infrastructure that is necessary to achieve a successful Accountable Care Organization; describe the tools that are necessary to effectively contract and implement an ACO with a commercial payer; and discuss the pitfalls and challenges for becoming an ACO and receive important information to avoid these pitfalls.

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