As the federal government and private payers move swiftly toward value-based care, hospitals and health systems are increasingly looking to clinical integration strategies as a way to coordinate care more easily across settings, manage the health of populations and take advantage of emerging payment models. Join us as we explore strategies for integrating physician practices and ambulatory care facilities. Our panel of experts will outline proven practices—and pitfalls to avoid—when it comes to growing your network and bringing new docs into the fold.

1. Welcome...
Today’s topic
Integrating Physician Practices Into Your Network
During today’s discussion, feel free to submit questions at any time
by using the questions box. A follow-up e-mail will be sent to all
attendees with links to the presentation materials online.
Patricia Richesin
Vice president,
Physician Strategies
and Services,
VHA,
Irving, Texas
Christopher Lloyd
CEO,
Memorial Hermann
Physician Network,
Houston
Dr. Charles Kelly
President and CEO,
Henry Ford Physician
Network,
Detroit

2. HousekeepingHousekeeping
1. Viewer Window 2. Control Panel

3. Maureen McKinney
Editorial programs manager,
Modern Healthcare
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

4. Patricia Richesin
VP, Physician Strategies and Services
VHA
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

5. ************************************THE PATIENT****************************
Creating a Community of Care
Fundamentals of Integrated System Risk Management
Employers • Payers • Providers • Hospitals
Right Providers Right Specialties Right Access Right Services
Optimal Outcomes Optimal Utilization Optimal Cost
Big Data Effective Networks New Knowledge New Expertise
1 |

6. Value-based care is forcing more hospitals and health
systems to explore clinical and physician integration
strategies
2 |

7. Assessment
Acculturation
Alignment
Assimilation
Creating a Community of Care
Key steps to successful integration
3 |

8. Assessment
Acculturation
Alignment
Assimilation
Creating a Community of Care
Key steps to successful integration
Lack of due diligence
to ensure a match
between hospitals
and physician
networks can derail
long-term strategy
Assess demand for
services across
continuum, primary
care and specialists,
as well as places of
service
4 |

9. Assessment
Acculturation
Alignment
Assimilation
Creating a Community of Care
Key steps to successful integration
Not being aligned upon
entering an agreement
might lead to
misunderstanding of
value proposition and
expectations for the
relationship
Align incentives for
clinical quality, patient
access, financial
outcomes; create
structures that fit
including employment
models
5 |

10. Assessment
Acculturation
Alignment
Assimilation
Creating a Community of Care
Key steps to successful integration
Resistance to change
may ultimately result
in conflict and
misalignment of long-
term vision/goals
Decide if you’re going
to build or adopt a
culture; share best
practices while
moving from a team
of individuals to
individuals on a team
6 |

11. Assessment
Acculturation
Alignment
Assimilation
Creating a Community of Care
Key steps to successful integration
Without strong network
and physician
leadership, systems
break down and
progress is slowed
Need a team approach
to care – not only
across providers
(primary, specialists,
hospitalists), but within
a practice (providers,
nurses, techs)
7 |

12. Assessment
Acculturation
Alignment
Assimilation
Creating a Community of Care
Key steps to successful integration
Successful
Integration
8 |

13. Physician Integration Strategies
Appendix

14. 7 keys to creating an efficient onboarding process
As new physicians and practice groups join your organization, a thoughtful,
standardized approach can make onboarding and orientation go more
quickly and efficiently.
Below are seven keys to creating an efficient onboarding process that
enables a smooth transition for physicians and staff joining the new
organization and assimilating into the new culture.
1. Due diligence: Create a check list of items typically required for due
diligence such as by-laws, articles of incorporation, shareholder or
partnership agreements, real estate documents, an asset list, all
contracts, insurance documentation, pending litigation, financial
documents, employee roster and regulatory compliance documents.
2. Document exceptions: Develop a template to document exceptions to
the standard agreement. These might include medical directorships,
additional assets or monetary arrangements or anything that is not
typically part of the standard agreement.
10 |

15. 7 keys to creating an efficient onboarding process
3. Develop a master onboarding list with a timeline. Identify responsible
staff for each section and tie together sequential processes. Provide
central access to the list so that each department can access it as
needed.
4. Communicate. Communication and coordination is the key to ensuring
that all items are completed prior to the provider beginning employment.
Missing key deadlines can be costly to the organization. Setting up a
realistic timeline, which is minimally 60 to 90 days is essential.
5. Appoint a project manager/owner. The project manager/owner serves
as the key contact for administrators and practitioners to ensure the
process goes smoothly and remains on schedule. Regularly scheduled
meetings with key players helps keep the project moving and holds
people accountable.
11 |

16. 7 keys to creating an efficient onboarding process
6. Establish an orientation plan. During the first year of employment,
assign a physician mentor and hold regular meetings with the medical
director to ensure engagement and integration into the new group and
culture.
7. Continually review the process. Create a physician survey related to
the onboarding process as part of the master plan to help identify areas
for improvement.
In our rapidly-changing environment, a well-planned onboarding process
that serves as a structural compass before, during and after the partnership
deal is done is critical to success. When a plan is in place, the organization
as a whole benefits through improved employee morale and a vibrant
culture that works together to put the needs of the patient first.
12 |

17. Dr. Charles Kelly
President and CEO,
Henry Ford Physician Network
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

18. Henry Ford Physician Network
• Clinically integrated as defined by FTC
• Operational April 2010
• Approximately 1700 physicians total
– 1100 member Henry Ford Medical Group
– 100 non-HFMG, regionally employed physicians
– 500 private practice physicians
– Footprint in 3 county market, SE Michigan, 7 competitive Health
Systems.
• Marketing as Narrow Network/Population Manager
– Provider-owned Health Plan
– Direct to employer
• Application pending for CMS MSSP for 2015

19. On-boarding Process
• Practice Interest and Application completion
• 120 day period of pre-Qualification
membership
• Achieving Qualified membership
• Practice Orientation

20. Application period
• Clinical Integration is hard work and not for
everyone
• Initial contact regarding “interest” generally
triggered by news of peer receiving incentives
or desire to participate in a premium contract
• Little knowledge of the extra work and
commitment required of a CI Citizen

21. Application Period
• Following our notification, application and
copy of participation agreement forwarded
• If completed and returned within 2 weeks the
provider and practice enter a 120 day pre-
Qualification phase.
• We follow up with the practices in 2 weeks if
we have not received any information
• Status change to “ declined” and process ends

22. 120 day pre-Qualification
• All the following elements must take place within
120 days or our agreement is void
– Establish data connectivity and continuous reporting
– W9 on file
– Approved credentials
– Executed participation agreement
• Your worst case scenario is having providers enter
into patient assignments without commitment to
CI process thus leading to beneficiary disruptions

23. Qualified Membership
• Orientation scheduled-designed for Office Mgr and key staff- helpful if
physician attends
– Actually begins during installment of data aggregator tool
– Physician portal registration/userID and password
– Metrics toolkits provided for appropriate specialty
– Contract summaries provided
– MSO offerings explained and process to acquire
– General overview of value of the Network and Clinical Integration
– Assist with practice workflow solutions
– Description of required coding and integrating with billing practices
– Leadership review, ie. Board members, Regional Medical Director and HFPN
team.
• Physicians enrolled in all contracts
• Physicians achieve eligibility for incentives and benefits
• Office Manager Forum schedules and invitations

24. Metric Toolkits
• Essentially designed to inform participant on what they will
be measured, what the source of data will be, how they will
be informed of the outcomes and frequency of reports.
– Press Ganey satisfaction surveys distribution by PN
– Data collection across ALL patients, not just contracted
beneficiaries
• It also links these measures to our “Value Campaign” which
also describes eligibility and scoring for earning incentives
• Introduction to the data dashboard that allows individual
and specialty specific and regional comparisons.
• Choosing Wisely Campaign outline and requirements for
members

25. MSO Offerings
• Subsidized IT offerings- supported by training,
install and ongoing maintenance.
• Access to Group Purchasing discounts
• Affordable Malpractice coverage
• Privacy and security compliance for the practice
• Ford X Plan and other employee discounts
offered to HFHS workforce
• Revenue cycle assistance with private vendor that
generates robocalls and securely stores credit
info

26. Christopher Lloyd
CEO,
Memorial Hermann Physician Network
Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator

27. Complexion of the Physician
Network
• MHMD
– 4000 practicing physicians
• 1950 CI physicians in MHACO (single signature
representation)
• 300 Advanced Primary Care Practices (PCMH)
• 250 additional PCPs
• Evolving High Performance Specialty Physicians (500)
• 200 are employed (MHMG)
• University of Texas Physicians
– 800 physicians
– CI and ACO affiliates
– Some UT faculty participate in advanced and high performance
practices

28. Memorial Hermann Corporate
Structure
Memorial
Hermann Health
System
Children’s
Governance
Audit
System Quality
Finance
Physician Council
Corporate
Members
Memorial
Hermann
Foundation
MHMDHePIC
MH Medical
Group
MH Health
Solutions, Inc.
MH Community
Benefit Corp.
MH Accountable
Care
Organization
MH Information
Exchange

29. CPCs: Connecting to the System Board
and the Hospital Medical Staffs/MECs
MH Hospital Board
System Quality Committee
MHMD Board of
Directors
Clinical Programs
Committee
H&V Neuro
Woman/
Child
Surgery
Medicine Oncology
Path/Rad Primary Care
Nursing
Councils
Operating
Councils
Executive
Liaisons
Service Lines
HOSPITAL
MECs
Katy MEC MC MEC
NE MEC NW MEC
SE MEC SW MEC
SL MEC TMC MEC
TWL MEC
MH Medical Staffs (MHMD Members)

30. MHMD Clinical Programs Committees
Physician Governance of Quality and Safety
MHMD Board of Directors
Clinical Programs Committee
H&V
Cardiology
CV
Surgery
Neuro
Neurology
Neurosurgery
Woman/Child
Neonatal
OB/Gyn
Surgery
Anesthesia
Bariatrics
Orthopedics
ENT
Allergy
Medicine
Critical
Care
Emergency
Ad hoc
Hospital
Medicine
Post
Acute
Oncology
Oncology
Contract
Imaging
Pathology
Primary
Care
Adult PCP
Peds
Peer Review
Clinical Ethics &
Palliative Care
Order Set
Editorial Board
Informatics
Acute Surgery
DVT/PE JOC
End of Life Care JOC
Pediatric Head CT JOC
Surgical Home JOC
4

31. Memorial Hermann
Regional Medical Home Structure
Central Region
• Hospitals - 4 (CMHH, TMC, TIRR, NW)
• ASC - 3
• MHDL PSC - 6
204 PCPs
•51 APCP (11 MHMD, 7 MHMG/Phytex, 33 UT)
•9 APP (5 MHMD, 4 MHMG/Phytex)
•144 CI PCPs (inc UT)
757 Specialists
• 21 MHMG/Phytex
• 736 CI Specialists (inc UT)
• OPID - 7
• SMR - 4
Northeast Region
• Hospitals - 1 (NE)
• ASC - 2
• CCC - 1
33 PCPs
•20 APCP (15 MHMD, 4 MHMG/Phytex, 1 UT)
•0 APP
•13 CI PCPs (inc UT)
73 Specialists
• 4 MHMG/Phytex
• 69 CI Specialists (inc UT)
• MHDL PSC - 1
• OPID - 3
• SMR - 2
North Region
• Hospitals - 1 (TWL)
• ASC - 4
• FSER - 1
91 PCPs
•47 APCP (36 MHMD, 11 MHMG/Phytex, 0 UT)
•0 APP
•44 CI PCPs (inc UT)
229 Specialists
• 9 MHMG/Phytex
• 220 CI Specialists (inc UT)
• MHDL PSC - 3
• OPID - 3
• SMR - 6
West Region
• Hospitals - 3 (KT, KT Rehab, MC)
• ASC - 4
• MHDL PSC - 6
163 PCPs
•64 APCP (48 MHMD, 15 MHMG/Phytex, 1 UT)
•2 APP (2 MHMD, 0 MHMG/Phytex)
•97 CI PCPs (inc UT)
283 Specialists
• 15 MHMG/Phytex
• 268 CI Specialists (inc UT)
• OPID - 8
• SMR - 5
Southeast Region
• Hospitals - 1 (SE)
• ASC – 2
• MHDL PSC – 3
97 PCPs
•38 APCP (15 MHMD, 16 MHMG/Phytex, 7 UT)
•0 APP
•59 CI PCPs (inc UT)
141 Specialists
• 7 MHMG/Phytex
• 134 CI Specialists (inc UT)
•OPID - 6
• SMR – 8
Counts as of 7/22/2014
Physician counts do not include physician extenders *Includes UT Pediatricians,
some specialty Pediatricians, and some IM and FP’s with a secondary subspecialty
Southwest Region
• Hospitals - 2 (SL & SW)
• ASC - 4
• MHDL PSC - 6
174 PCPs
•73 APCP (34 MHMD, 33 MHMG/Phytex, 6 UT)
•4 APP (0 MHMD, 4 MHMG/Phytex)
•97 CI PCPs (inc UT)
277 Specialists
• 38 MHMG/Phytex
• 239 CI Specialists (inc UT)
• OPID - 5
• SMR – 8 (add’l 1
pending)
1 Additional SMR in Nederland
3 Additional MDs in Bay City: 1 MHMG PCP, 1 MHMG
Specialist, 1 CI Specialist.
5

32. PCP Regional Leaders
Dr. Jeff
Sweeney
Medical School
at USC and
residency at
Kaiser
Permanente
Captain in
medical corps
Board certified in
family medicine
North Northeast West Southwest Southeast Central
Dr. Tejas
Mehta
Temple
University School
of Medicine
Residency at
Penn State
College of Med
Board certified in
Internal
medicine and
primary care
Dr. Ankur
Doshi
University of
Texas Medical
Branch Med
School
Board certified in
Internal
Medicine
Founder of Prime
Care Medical
Group
Dr. John
Vanderzyl
University of
Texas Health
Center – Houston
Board certified in
family medicine
Named “Top
Doctors in
America”
Dr. Adnan
Rafiq
St. George
University
Medical School
and University of
Medicine – New
Jersey
Board Certified
in internal
medicine
Physician of the
Year 2012
Dr. Kevin
Giglio
UT Health
Houston medical
school
Residency at MH
Family medicine
program
Board certified
family medicine

33. The MHACO
Shared Savings and Aligned Incentives
More flexibility in ACO “related” quality,
safety and efficiency program incentives
MHMD contracting capability
MHACO
Promoting Evidence Based Medicine
Promoting Beneficiary Engagement
Internally Reporting On Quality And Cost Metrics
Promoting Care Coordination
POPULATION MANAGEMENT
Quality Assurance And Improvement Program Processes
Commercial Medicare
7

34. DocbookMD App
1. Go to the App Store or Google Play from your mobile device
2. Search for and download “DocbookMD”
3. Tap “Create Account” and complete the registration process
iOS
• Create Account – select to
register for 1st time
• Existing users
• Enter email and
password setup during
registration
• Click Log in - app will
store details
• Forgot Password – select to
receive email link to reset
• Help icon (?)
Android
• Create Account – select to
register for 1st time
• Existing users
• Enter email and
password setup
during registration
• Click Log in – app will
store details
• Forgot Password – select to
receive email link to reset
• Help icon (:)

35. Today’s panelists...
Integrating Physician Practices Into Your Network
During today’s discussion, feel free to submit questions at any time by using the questions box.
Maureen McKinney
Editorial programs
manager,
Modern Healthcare
Christopher Lloyd
CEO,
Memorial Hermann
Physician Network,
Houston
Dr. Charles Kelly
President and CEO,
Henry Ford Physician
Network,
Detroit
Patricia Richesin
Vice president,
Physician Strategies
and Services,
VHA,
Irving, Texas
TODAY’S MODERATOR

36. Thank you...
... for attending today’s editorial webinar on integrating physician practices into your provider network.
We also thank our panelists, Dr. Charles Kelly, president and CEO of Henry Ford Physician Network, Detroit;
Christopher Lloyd, CEO of Memorial Hermann Physician Network, Houston;
and Patricia Richesin, vice president of physician strategies and services, VHA, Irving, Texas.
Expect a follow-up e-mail within two weeks. For more information,
send an e-mail to webinars@modernhealthcare.com
Our next editorial webinar,“Patient Engagement: A Key Strategy for Population Health Management,”
is set for Wednesday, Sept. 17. For more information, please visit modernhealthcare.com/webinars