D511_Task 2 TPMC Affiliation_LB

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Western Governors University *

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Dec 6, 2023

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Twin Pines Medical Center Affiliation Recommendation Presented to the Twin Pines Medical Center (TPMC) Board of Directors Prepared by LB 10/27/2023 1

A. Goals and Rationale 1. Key goals. Twin Pines Medical Center's (TPMC) primary objective is to provide accessible, affordable, comprehensive, and quality healthcare services to all the community regardless of origin, race, or ability to pay (Profile: Twin Pines Medical Center [TPMC], n.d., pg. 3). TPMC’s affiliation key goals include the ability to provide specialized care to proactively treat diabetic patients, provide a robust program with educational resources to the diabetic population, and develop a telemedicine system to address referrals. (Profile: TPMC, n.d., pg. 1). A candidate must focus on providing patient-centered care that is not only accessible, but affordable, convenient, and effective. The chosen candidate will need to have telehealth services for easy access to Endocrinologists for our diabetic population. A well-established diabetes program that offers visits with health educators and educational resources will be necessary as well. One other explicit goal of TPMC is physician engagement with patients. This ensures that all treatment is based on the best practices and standards of care using evidence-based medicine. Physicians must provide care for all patients regardless of their ability to pay, race, social, or economic status. (Profile: TPMC, n.d., pg. 6). 2. THREE advantages. The TPMC Board of Directors has looked at three candidates for affiliation which include the Mayo Clinic, Intermountain Healthcare, and Ochsner Health. Regardless of which organization Advantages of an affiliation with TPMC would be to gain technical 2

support for advancements, telehealth, communications, and data systems. This will require integrated IT services to facilitate data sharing among facilities. (Profile: TPMC, n.d., pg. 1). 3. Market Segmentation/Population Analysis Twin Pines Medical Center (TPMC), a nonprofit organization, is located in the Pine Parish area in northern Louisiana. Pine Parish has a population of almost 48,000 with 77% living in Urban areas. 33% of the population is uninsured, and 36% is enrolled in Medicaid, and more may qualify due to the Affordable Care Act. In 2012 and 2013, the market segment and population analysis revealed that non-Hispanic Black and Native American individuals were neglected and had a greater prevalence of diabetes. These patients rely on ED services to manage their complex diabetes. Early preventative treatment by specialists in diabetes care, endocrinology, and certified health nutritionists and educators are the most needed practitioners in the community. (Profile: TPMC, n.d., pg. 3). The population’s health needs are aligned with the proposed affiliation. Ochsner has numerous services to implement throughout TPMC if the agreement is finalized. B. Affiliate Recommendation 1. Affiliation recommendation. My recommendation for affiliation is Ochsner Health. Ochsner Health focuses on providing patient-centered care that is not only accessible, but affordable, convenient, and effective. Ochsner has a diabetes program that offers visits with Certified Diabetes Care and 3

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Education Specialists with referrals from Ochsner-affiliated primary care providers (Ochsner Health, n.d.-d). The organization also uses digital health tools to assist in the management of hypertension and diabetes which helps keep more patients out of the ER and reduces wait times (Blackman, 2021). 2. Benefits/Goals Major Benefits of Affiliation Associated TPMC Goal One advantage of establishing an affiliation with an organization will be greater access to a greater range of care for the community. Ochsner Health strives to provide patient- centered care that is not only accessible, but affordable, convenient, and effective. TPMC strives to provide accessible, affordable, comprehensive, and quality healthcare services to all the population regardless of origin, race, or ability to pay. (TPMC, n.d., pg. 3). Ochsner has a diabetes program that offers visits with Certified Diabetes Care and Education Specialists with referrals from Ochsner-affiliated primary care providers (Ochsner Health, n.d.-d A3). The organization also utilizes digital health tools to assist in the management of hypertension and diabetes, which helps to keep more patients out of the ER and reduce wait times (Blackman, 2022). TPMC needs a robust program with educational resources for the diabetic population. Ochsner will integrate its EHR system, telehealth, and digital programs to help TPMC would like to gain technical support for advancements, telehealth, 4

TPMC deliver more personalized care to patients to help manage their chronic diseases. communications, and data systems to access specialty healthcare providers not available at TPMC. 3. Avoided candidates. Candidate Partner Reasons to Avoid Affiliation Mayo Clinic Mayo Clinic is a non-profit healthcare system based out of Rochester, MN with many other facility locations in Florida, Minnesota, and Arizona. Serving approximately 1.3 million patients annually from 130 countries, it is one of the largest not-for-profit, academic healthcare systems in the United States (Mayo Clinic, n.d.-a). As one of the largest non-profit healthcare systems in the U.S., this may cause TPMC’s staff to feel overwhelmed, misplaced, and not up to par with the Mayo Clinic name. I also believe TPMC and Mayo Clinic’s mission statements and vision are misaligned. Mayo Clinic focuses more on clinical practice and education overall (Mayo Clinic, n.d.-b), while TPMC's main priority is providing accessible and affordable healthcare 5

to the community members they serve (Profile: TPMC, n.d., pg. 3). Intermountain Healthcare (IHC) IHC is committed to supporting every community in the regions it serves with hospitals, clinics, and outreach services in rural Idaho, Wyoming, Montana, Kansas, Utah, and Colorado (Intermountain Healthcare [IHC], n.d.-b). IHC has three primary institutes and centers of excellence that the system is well-known for, which are: Intermountain Urological Institute, Intermountain Heart Institute, and Intermountain Spine Institute. (IHC, n.d.-a). I do not believe Intermountain Health would be the best option for affiliation as its focus is expanding its system within the Midwest. IHC hospitals and clinics in Colorado, Montana, Kansas, and Wyoming are Catholic in religion, which may cause conflict with administrators, employees, and the community of TPMC, as everyone does not value the same religious beliefs (IHC, n.d.-b). 6

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C. Affiliation Plan 1. Affiliation structure. TPMC and Ochsner Health will be a clinically integrated network. Spees (2014) stated that organizations can collaborate in developing networks that provide efficient care coordination and facilitate the partners to share the cost of infrastructure necessary to manage population health (pg.3). TPMC will retain their independence and local governance, but will align with Ochsner’s clinical expertise, infrastructure, and IT. Both TPMC and Ochsner will have a member of their administrations along with a healthcare representative to form a committee board. This committee will be responsible for collaborating on strategy, implementation, and data sharing. 2. New organizational, vision, mission, and value statements. Organizational Statement Our mission, vision, and values guide our decisions, inspire our actions, and influence our interactions with our patients, colleagues, and communities. Vision Statement To be the provider of choice for high-quality, comprehensive care and inspiring healthier lives in the communities we serve. Mission Statement Our mission is to help, heal, lead, and educate the communities we serve regardless of race, national origin, or ability to pay. Value Statement Our commitment to “Put People First” ensures that all families can receive quality medical services. (Profile: TPMC, n.d., pg. 3) 3. Leadership Plan. 7

The best-suited management system for this affiliation will be an open system where our front-line employees have more autonomy and feedback from employees is highly valued. The Chief Executive Officer (CEO) will direct the entire project by setting and executing the organization’s strategy, allocating capital, and overseeing the executive team. The Chief Operating Officer (COO) will supervise the day-to-day activities and administrative activities such as legal matters and logistics of the affiliation. The Chief Financial Officer (CFO) is responsible for financial planning, cost monitoring and control, and fiscal management. The Chief Medical Officer (CMO) is responsible for oversight of all the physicians and their credentialing. The Chief Nursing Officer’s primary responsibility is to manage the clinical staff. The project manager will determine and implement a schedule and plan, detailing needs, overseeing resources and teamwork, and controlling costs, modifications, and integration (Figueroa, 2019). To proactively mitigate potential risk points, we must first formulate a SWOT analysis for the affiliation of TPMC and Ochsner to find the strengths, weaknesses, opportunities, and threats. Our target audiences in the development of our communication plan will be the Governing Board members, employees, and the Pine Parish community. To facilitate proper communication of the affiliation to staff, we will be communicating messages through company-wide emails. Our communication with the Pine Parish community will be through both TPMC and Ochsner’s websites. The governance committee, which includes the CEO and COO of both organizations will be responsible for monitoring the progress of the affiliation. This committee will meet at least twice a month to provide timely decision-making and address any barriers to success 8

(Figueroa, 2019). Department managers and clinic managers will meet weekly to discuss issues or concerns that arise, as well as utilize the Plan, Do, Check, Act (PDCA) cycle. Phase I of the plan will span over one year to evaluate the strategic plans of the affiliation. Phase II will be to come to a definitive agreement with approval from both organizations governing bodies, as well as receiving state and federal regulatory approvals. Phase III will be to implement the plan and to integrate TPMC with Ochsner Health. (Harrison Medical Center, 2012). 4. Employee engagement and retention. With both organizations joining in an affiliation, there will be a large cultural shift. Allowing employees to feel heard and empowered will ultimately lead to an increase in job satisfaction thus increasing retention and reducing job turnover. During this change, employees may feel inspired and motivated to contribute during meetings as well as gain more trust in the organization's affiliation. In turn, TPMC will be more competitive in the healthcare market as the workplace becomes more diverse. 5. Opportunities and Challenges. Opportunities Challenges All meetings will be thoroughly documented including dates, times, participants, agenda, discussions, and any action plans formulated. Action plans will be distributed to managers that are involved. One potential challenge throughout the implementation of the affiliation may be inconsistent or untimely communication with TPMC staff. Through the employee survey, we will be able to determine what is going well, and what is It is a great concern that employees may be dissatisfied if they feel their needs are not met 9

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not within the organization. within the organization. 6. Impact of the organizational cultures. With Ochsner Health’s mission to serve, lead, heal, educate, and innovate, employees respect the dignity and needs of patients and guests. The health system must become more innovative while remaining present and having a connection with their communities and patients. It is expected that healthcare members improve medical care by establishing a patient-centered culture and improving patient engagement. (Ochsner Health, 2018). 7. Reasons for termination. Termination of the Ochsner/TPMC affiliation will be declared if outcomes or performance metrics are not up to standards. This could include not adhering to the mission, vision, and values, improper use of funds, inability to decrease the percentage of diabetic patients accessing the ED by the first year, and the patient satisfaction rate below the benchmark for more than 1 year. 8. Exit strategy. The affiliation contract will have performance expectations that must be met along with the identified parties that will be affected, namely the patient population. If termination is imminent, a communication plan will be made along with a termination letter for internal and external audiences. The timing of the implementation of the exit strategy will depend on how long the affiliation has ensued at the time of the decision. A project plan will need to be 10

created to ensure the termination of the affiliation runs smoothly with little effect on employees or patients. (Waymack, 2005). The CEO of either organization is ultimately responsible for the termination of the affiliation. Reallocation of expenses will be determined based on how far along into the affiliation and what resources have been merged at the time of termination. The committee will meet to discuss their desire to terminate and the reasons. They will then schedule another meeting and reconvene to discuss necessary steps and if there is potential for restructuring of the affiliation. 9. Future challenges and opportunities to evolve the community healthcare landscape. If one or both organizations do not retain the affiliation agreement, there could be many challenges including employee dissatisfaction, patient dissatisfaction, and cultural discrimination. Addressing employee and patient concerns promptly to attempt remediation would be indicated. If the organizational cultures differ, this could cause friction in the organizations. Creating a new culture of excellence focused on employee engagement and a culture of safety will help deter and mediate this issue. If the population of Pine Parish’s needs are not being met through this affiliation, a termination of the affiliation may be considered. Clear, concise, and timely communication must be present when any issues arise. Timely remediation will be vital for the organizations to continue an affiliation. Several opportunities for improvement within the affiliation could include improving the payer mix and charity care through improved management of the diabetic patient population. Early diagnosis, health education, and case management of diabetics in the 11

outpatient setting will improve the financial status of TPMC’s ED and the healthcare system overall (Profile: TPMC, n.d., pg. 9). D. APA Sources Blackman, M. (2021). Ochsner's 10-year vision to improve Louisiana’s overall health. Health Leaders. https://www.healthleadersmedia.com/strategy/ochsners-10-year-vision-improve- louisianas-overall-health/ Figueroa, R. (2019, March 21). The 7 key factors for healthcare mergers and affiliations . Hea! Thcare Innovation. https://www.hcinnovationgroup.com/finance-revenue-cycle/mergers- acquisitions/article/21072901/the-7-key-factors-for-healthcare-mergers-and-affiliations Intermountain Healthcare. (n.d.-a). Medical services. Intermountain Health. Retrieved October 20, 2023, from https://intermountainhealthcare.org/services Intermountain Healthcare. (n.d.-b). Who we are. Intermountain Health. Retrieved October 19, 2023 from https://intermountainhealthcare.org/about/who-we-are/ Harrison Medical Center. (2012, October 16). FAQs regarding affiliation [Press Release]. Mayo Clinic. (n.d.-a). About Mayo Clinic. Retrieved October 31, 2023, from https://www.mayoclinic.org/about-mayo-clinic 12

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Mayo Clinic. (n.d.-b). About us- Mayo Clinic's mission and values. Retrieved October 31, 2023, from https://www.mayoclinic.org/about-mayo-clinic/mission-values Ochsner Health. (2018). Ochsner Health receives prestigious 2018 HIMSS Davies Award of Excellence for innovation work. https://news.ochsner.org/news-releases/ochsner-health- system-receives-prestigious-2018-himss-davies-award-of-excel Ochsner Health. (n.d.-a). About Ochsner. Retrieved October 21, 2023, from https://www.ochsner.org/about-ochsner Ochsner Health. (n.d.-b). About our culture. Retrieved October 21, 2023, from https://www.ochsner.org/careers/culture Ochsner Health. (n.d.-c). Community: Who we are. Retrieved October 21, 2023, from https://www.ochsner.org/ochsner-community-impact Ochsner Health. (n.d.-d. Diabetes management. Retrieved October 21, 2023, from https://www.ochsner.org/services/diabetes Ochsner Health. (n.d.-e). Digital medicine programs and chronic disease management. Retrieved October 21, 2023, from https://www.ochsner.org/employer-solutions/chronic-disease- management-programs-digital-medicine Ochsner Health. (n.d.-f). History | Ochsner Health . Retrieved October 20, 2023, from https://www.ochsner.org/about-ochsner/history Ochsner Health. (n.d.-g). Mission, vision, values. Retrieved October 21, 2023, from https://www.ochsner.org/values Ochsner Health. (n.d.-h). Ochsner Health Network leads the way in Value-Based care. Retrieved October 21, 2023, from https://news.ochsner.org/news-releases/ochsner-health-network- leads-the-way-in-value-based-care 13

Ochsner Health. (n.d.-i). Quality & safety. Retrieved October 21, 2023, from https://www.ochsner.org/about-ochsner/quality-safety Profile: Twin Pines Medical Center. (n.d.) Master of Healthcare Administration. Western Governors University . 1-10. Spees, J. (2014, October 9). 2015 AHLA health care transactions: Resource guide. The Camden Group. 1-4. http://cdn2.hubspot.net/hubfs/161605/Choosing_the_Right_Affiliation.pdf? __hssc=48229496.1.1580456635421&__hstc=48229496.dee2e8648587f1ca074a562fa3fb2 096.1580456635419.1580456635419.1580456635419.1&__hsfp=1733251557&hsCtaTrac king=f8ac7eb0-a0b7-4315-9616-33ebf8f1037c%7Ca2b989d1-175f-45da-b4d5- d6b3c72f0ea1 Waymack, P.M. (2005). Exit strategies: planning for contract termination. Healthcare Financial Management: Journal of the Healthcare Financial Management Association, 59( 11), 50- 52. 14

D511_Task 2 TPMC Affiliation_LB

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