michael j. dowling, president & ceo, north shore

Pursuing Success – Lessons Learned

October 9, 2014

West/North West Hospitals Group Conference

Michael J. DowlingPresident & Chief Executive Officer

North Shore-LIJ Health System

PROPRIETARY AND CONFIDENTIAL INFORMATION. DO NOT DISTRIBUTE 2

North Shore-LIJ Health System


Insurance Enterprise

Educational

Enterprise

Research Enterprise

Community Health Enterpris

e

Community benefit

Access and education programs

Veterans’ programs

Children’s programs

CareConnect

Risk

Capitation- bundled payments

Product offerings

Joint product offerings

Employer products

Population health

Bioelectronic medicine

Clinical research management

Health services/ outcomes research

GME/CME

Medical School/ Elmezzi

CLI

Clinical Enterprise

Inpatient facilities

Ambulatory/ outpatient

Long Term/ Home Care

Hospice

Joint ventures

Medical transport

Medical Group

North Shore

Ventures

New businesses

Consulting

Partnerships

Shar

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uppo

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ervi

ces

A

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inis

trat

ive

serv

ices

Cli

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Support Structure

Health System Enterprises

Services supporting the health system enterprises:

Partnerships

The System Today


• Largest provider of health care in NY State – one of the largest employers• Major academic teaching center• Major commitment to research – The Feinstein Institute• Single governance – not just a collection of distinct, individual entities• Administratively and clinically integrated; Service Line approach to care delivery• Single system-wide management – clinical and administrative• Densely populated; competitive and diverse environment• Provides full continuum of care• Possesses insurance license and capabilities to take risk and sell products

An Integrated System


Health System Growth & Integration


• First organization in the region to form a health system and subsequently grew into the region’s largest integrated health system

• In 2002, established the industry’s first corporate university – The Center for Learning and Innovation

• Opened the first allopathic medical school in New York State since 1963 – Hofstra North Shore-LIJ School of Medicine

• First healthcare provider in New York State to create a wholly-owned health insurance company – North Shore-LIJ CareConnect Insurance Company, Inc.

• Opened the first freestanding emergency center in Manhattan – Lenox Hill HealthPlex

• Opened the first freestanding laboratory in New York State in 1998 and now has the largest health system-based integrated laboratory operation in the northeast

• Established a first of its kind collaboration with the U.S. Department of Veterans Affairs to provide coordinated behavioral health care to veterans and their families under one roof

• First private hospital system in New York State to post its hospitals’ quality performance data on its website

• First health system in the New York metropolitan area to receive the National Quality Healthcare Award from the National Quality Forum in 2010

• First health system to receive The Joint Commission’s Codman Award in 1999 for achievement in the use of process and outcomes measures to improve organizational performance

A History of Firsts


Source: 2013 SPARCS, Based on discharges & patient origin

*Service Area-Manhattan, Richmond, Queens, Nassau & Suffolk

27% Share – 15 points greater than closest competitor

27% Share – 15 points greater than closest competitor

2010 Market Share 29% Share – 17 points

greater than closest competitor 29% Share – 17 points

greater than closest competitor

2013 Market Share

Source: 2010 SPARCS, Based on discharges & patient origin

NS-LIJ27%

NY-Presby

12%Mt Sinai/

Continuum11%

CHS-LI10%

HHC9%

Winthrop / S. Nassau

6%

All Other25% NS-LIJ

29%

NY-Presby

12%Mt Sinai/

Continuum12%

CHS-LI9%

HHC9%

Winthrop / S. Nassau

6%

All Other23%

Service Area Market Share


• New businesses• Consulting• Partnerships

• Taking risk• Treating illness & promoting health • Innovative partnerships

• Expanding geography• Creating alignment• Innovative relationships

• Promotion of interdisciplinary learning• Pioneering discoveries• Innovative educational programs

• New markets• Joint ventures• Innovative delivery models

• Consolidations• Conversions• Centers of Excellence

• Quality and patient safety• Efficiency and productivity• Employee/patient engagement

• Physician leadership• Succession planning• Continuous learning

Health System Strategy


Management CapabilitiesInformation Technology

•Meaningful Use Consulting•ICD-10 Consulting•Patient Portal Development

Compliance/Risk Management

Strategic Planning

Human Resources

Emergency Management

Real Estate & Facility Services

Payer Relations

Centralized Services

Purchasing •NSLIJ Alliance GPO•Accounts Payable Management Services•Supply Chain Management & Advisory Services

•Warehousing Management & Advisory Services•Integrated Distribution Center •Customer Contact Center Management & Advisory Services

•Contract Development Consulting•Risk Advisory Services•Provider Owned Health Plan Advisory Services

•Property Management Advisory Services•Capital Project Business Planning & Management•Construction Management Advisory Services

•Training & Consulting•Disaster Management & Advisory Services•Security/Investigations

•Site Management

•Payroll Management & Advisory Services•Talent Acquisition Management & Advisory Services•Compensation Strategy Advisory Services

•Certificate of Need Advisory Services•Program Planning

•Compliance Advisory Services•Risk Advisory Services

•Security/Audit Consulting

•Bundled Payment Advisory Services•ACO Advisory Services

•Leasing Advisory Services•Maintenance & Engineering Services•Design/Architectural Advisory Services

•Biomedical Engineering•Safety/Regulatory Compliance Advisory Services

•Staffing Services•Benefits Advisory Services


NetworkDevelopment

Clinical Capabilities•Post Acute Acquisition/Integration Advisory Services

•Hospital Acquisition/Integration Advisory Services

•Voluntary Physician Integration & Alignment

Pharmacy Services

Perioperative Services

CoreLaboratory

Education/Training

•Krasnoff Quality Management Institute

•Dashboards/Performance Improvement Tools

•Telehealth Management & Advisory Services

•The Center for Learning & Innovation

•The Patient Safety Institute

•Bioskills Education Center

•Laboratory Cooperative Services

•Reference Testing Services

•Laboratory Management & Advisory Services

•Perioperative Management & Advisory Services

•Synergy Health True North Central Sterile

•Vivo Health Pharmacy (Retail)

•Repackaging Services

•Compounding Services

•Skilled Nursing Facility Advisory Services

•Hospice Care Management & Advisory Services

•Home Care Management & Advisory Services

•Inpatient/Ambulatory Rehabilitation Management & Advisory Services

•RegionCare Home Infusion Services

•Health Home Management & Advisory Services

•Root Cause Advisory Services

•Regulatory Advisory Services

•QI Advisory Services

Patient Transport

•Dispatch & Ambulance Operations & Advisory Services

•Air Medical Transport Management & Advisory Services

•Institute for Nursing

•Academic Advisory Services

Clinical Transformation & Quality Management

•Clinical Pathway/Protocol Development

•eICU Management & Advisory Services

•Advanced Illness Advisory Services

•Laboratory Information Systems Advisory Services

Post Acute Services


• Collection of entities or an “integrated system”• The philosophy of one• Understand what’s not negotiable

1. Clarity of Purpose: What’s the Goal


• Outside versus inside-out• Changes perspective on access; service; convenience;

engagement; employee authority; etc.• Challenges tradition of provider-centric

2. Create a Customer-Focused Organization


• Creates broader perspective: modifies strategy• Medical intervention only one component of health

3. Think Health – Not Just Medical Care


• Build outpatient/ambulatory network• Care outside hospital walls

4. Avoid Being Hospital Centric Only


• Governance of the whole: not just under parts• Be clear of Board’s role vs. management’s role

5. Avoid Constituency Governance


• Administrative and clinical• Authority to make tough decisions on programs;

consolidations; personnel; etc.

6. Create Single “System” Leadership


• Quality• Service• Access• Financial

7. Standardized System-Wide Metrics


• Leadership at all levels• Builds culture• Matrix organization: managing paradox

8. Choose Leadership Carefully


• Bureaucracy• Empire building• Keeping “wrong” people• Silos: lack of teamwork

9. Avoid Self-Inflicted Wounds


• Leadership development: all disciplines• Succession planning• Respond to needs of “new” workforce

10. Invest in Talent Management


• Create healthy “internal” competition• Promote face to face communication at all staff levels

11. Emphasize Transparency and Communication


• Government must give maximum “freedom” to operate and meet regional needs

• Align financial incentives• Reduce/eliminate unnecessary rules and regulations

12. Promote Changes in Role of Government

michael j. dowling, president & ceo, north shore

Health & Medicine

integrated health system

confidential information

behavioral health care

partnershipsthe system

new york state

private hospital system

new york metropolitan

ny state