HEALTHCARE ROUNDTABLE An Informative Q&A with OCs Top Healthcare - - PDF document

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• April 9, 2018

HEALTHCARE ROUNDTABLE

An Informative Q&A with OC’s Top Healthcare Professionals

Barry Arbuckle, PhD President & CEO MemorialCare Scott Aston Senior Vice President & Partner Burnham Benefits Insurance Services Ray Chicoine President Monarch HealthCare Mark E. Costa Senior Vice President Kaiser Permanente Kathleen M. Marcus Shareholder & Co-Chair, Enforcement Defense & Investigations Practice Group Stradling Jennifer Mitzner CEO Hoag Orthopedic Institute Gene Rapisardi Market President, Southern California & Nevada Cigna Richard J. Gannotta Interim CEO UCI Health

Suzanne Richards, RN, MBA, FACHE

CEO of Healthcare Operations KPC Health Will Righeimer CEO Lindora Tonmoy Sharma, M.B.B.S., M.Sc. Founder & CEO Sovereign Health Yasith Weerasuriya President & CEO Stanbridge University Erik G. Wexler Chief Executive Providence St. Joseph Health Southern California Region

B-36 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

Burnham Benefits Insurance Services Burnham Benefits Insurance Services Inc. is a privately held, full-service strategic employee benefits consulting and brokerage firm based in Irvine, CA, with seven offices throughout the state offering comprehensive client-first strategic

• solutions. The closely held nature of Burnham allows its leadership to easily adapt and create customized programs that fit

clients’ best interests – investing in cutting-edge technology, and the tools and resources needed to provide the specialized level of service that today’s rapidly changing business climate demands. Burnham goes Well Beyond Benefits with its cadre

• f highly skilled industry professionals providing unmatched personal service. Retirement Consulting and Wealth

Management services are also offered through our strategic partnership with Burnham Gibson Wealth Advisors Inc. Burnham is a certified Benefits Corporation (B Corp). For more information, visit www.BurnhamBenefits.com. Cigna At Cigna, we’re more than a health insurance company. We’re a global health service company. Cigna works with employers and organizations around the world helping employees stay healthy and on the job. We work closely with brokers and consultants to develop innovative programs, help individuals and families improve their health, well-being and sense of security – and lower their medical costs. And, Cigna provides access to a global network of local physicians and hospitals – as well as 24/7/365 live customer service. Hoag Orthopedic Institute Hoag Orthopedic Institute (HOI) is located in Orange County, CA. It consists of a specialty hospital located in Irvine and two ambulatory surgery centers: Orthopedic Surgery Center of Orange County in Newport Beach and Main Street Specialty Surgery Center in Orange. HOI has more than 300 physicians on staff, including more than 80 orthopedic specialists. HOI physicians were instrumental in establishing Hoag Orthopedics, a nonprofit founded by physicians for the purpose of conducting research, education and identifying leading-edge clinical care improvements. HOI ranks in the 99th percentile for patients’ likelihood to recommend the hospital and 98th percentile for overall hospital rating, according to Press Ganey’s national database of hospitals. HOI focuses in the treatments of the knee, hip and spine disorders, and takes pride in specialty care related to sports medicine, orthopedic trauma and extremities care. Since opening in 2010, HOI’s hospital has been named by U.S. News & World Report and Becker’s Orthopedic, Spine & Pain Management Review as one of the top orthopedic hospitals in the nation. HOI was recognized by the Centers for Medicare & Medicaid Services (CMS) as one

• f 112 hospitals nationwide, and one of 10 in California to earn the highest, five-star rating for overall quality of care. HOI

was also rated a “Best Places to Work” by Modern Healthcare in 2016 and 2017. For more information, visit www.orthopedichospital.com. Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high- quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 11.8 million members in eight states and the District of Columbia. Care for members and patients is focused

• n their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring

medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share. For information about Kaiser Permanente Irvine Medical Center, visit kp.org/orangecounty and follow us on Twitter @KPOCThrive. KPC Health KPC Health and its four award-winning Orange County acute care community hospitals operate on a long-standing tradition

• f serving families throughout the hospitals’ surrounding communities. As the oldest hospital system in Orange County, KPC

Health remains committed to providing high-quality, affordable health care that offers top-level specialty services from physicians, nurses and staff who have decades of experience in health care. KPC Health’s hospitals, consisting of 755 inpatient beds, include Orange County Global Medical Center (Santa Ana), Anaheim Global Medical Center (Anaheim, near Disneyland), South Coast Global Medical Center (Santa Ana, near South Coast Plaza), and Chapman Global Medical Center (Orange). Its flagship hospital, Orange County Global Medical Center, is designated by the County of Orange as one

• f only two Level II Trauma Centers in the county and provides emergency, trauma and burn treatment services for more

than 20,000 patients per year. Lindora Founded in 1971, Lindora is one of the largest, medically supervised weight loss, wellness and consumer products companies in the United States. The nationally recognized brand has helped hundreds of thousands of people lose weight and live happier, healthier lives for nearly 50 years. Lindora’s comprehensive weight management and wellness programs teach patients how to lose weight rapidly and keep it off by eating better, exercising more and managing stress more

• effectively. The company operates a number of brands underneath the Lindora master brand including Lindora Nutrition,

Lindora Fresh, Lindora Wellness and Lindora Clinic. Lindora operates 34 weight loss and wellness clinics in Southern

• California. Lindora’s mission is to transform people’s lives through weight loss and wellness. The company is owned by

Solis Capital Partners and Innovate Partners, both located in Newport Beach, CA. For additional information about Lindora, visit lindora.com. MemorialCare A nonprofit Southern California integrated healthcare delivery system and pioneer in best practice, evidence-based medicine, MemorialCare has more than 200 care sites; 15,000 employees, affiliated physicians and volunteers; five top community and teaching hospitals – MemorialCare Saddleback Medical Center in Laguna Hills, MemorialCare Orange Coast Medical Center in Fountain Valley, MemorialCare Long Beach Medical Center, MemorialCare Miller Children’s & Women’s Hospital Long Beach and MemorialCare Community Medical Center Long Beach; MemorialCare Medical Group; Greater Newport Physicians; Seaside Health Plan; and outpatient ambulatory surgery, medical imaging, kidney dialysis and urgent care centers. Among MemorialCare’s many honors for its healthcare organizations include Best U.S. Health Systems, America’s 50 Best Hospitals, Top Children’s Hospitals in America, Nation’s Top 50 Cardiovascular Hospitals, Best Orthopedic Programs, American Heart Association Gold Plus for cardiac and stroke care, Nation’s Top Places to Work, Best

• f Orange County Hospitals and Medical Groups and the prestigious Magnet status for nursing excellence. To learn more,

visit www.memorialcare.org.

HEALTHCARE

ROUNDTABLE PARTICIPANTS

APRIL 18, 2016 Local breaking news: www.ocbj.com ORANGE COUNTY BUSINESS JOURNAL B-37

B-38 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

HEALTHCARE

ROUNDTABLE PARTICIPANTS

Monarch HealthCare

M o n a rc h H e a lth C a re , p a rt o f O p tu m C a re , is a n In d e p e n d e n t P ra c tic e A s s o c ia tio n (IP A ) c a rin g fo r p a tie n ts s in c e 1 9 9 4 . M o n a rc h is a le a d in g h e a lth c a re d e liv e ry o rg a n iz a tio n th a t is h e lp in g tra n s fo rm h e a lth c a re th ro u g h b e s t-in -c la s s q u a lity c a re a n d a n im p ro v e d e x p e rie n c e th ro u g h a “p a tie n t-firs t” p h ilo s o p h y o f h e a lth c a re . L e d b y m o re th a n 2 ,5 0 0 p riv a te -p ra c tic e p h y s ic ia n s c a rin g fo r o v e r 2 2 5 ,0 0 0 O ra n g e C o u n ty a n d L o n g B e a c h re s id e n ts , M o n a rc h h a s b e e n re c o g n iz e d b y h e a lth p la n s a n d b u s in e s s g ro u p s fo r p ro v id in g h ig h q u a lity c a re a n d e x c e lle n t s e rv ic e . W e a s p ire to b e th e s o lu tio n fo r a ffo rd a b le q u a lity c a re fo r a ll p a tie n ts in th e c o m m u n itie s w e s e rv e . F o r m o re in fo rm a tio n a b o u t M o n a rc h , p le a s e v is it

www.monarchhealthcare.com. Providence St. Joseph Health Southern California

P ro v id e n c e S t. J o s e p h H e a lth S o u th e rn C a lifo rn ia is p a rt o f o n e o f th e n a tio n ’s la rg e s t h e a lth s y s te m s , P ro v id e n c e S t. J o s e p h H e a lth (P S J H ). C o m m itte d to im p ro v in g c o m m u n ity h e a lth w ith s p e c ia l fo c u s o n th e p o o r a n d v u ln e ra b le , P S J H

• p e ra te s a c ro s s s e v e n s ta te s – A la s k a , C a lifo rn ia , M o n ta n a , N e w M e x ic o , O re g o n , Te x a s , a n d W a s h in g to n . W ith 5 0

h o s p ita ls , 8 2 9 p h y s ic ia n c lin ic s , s e n io r s e rv ic e s , s u p p o rtiv e h o u s in g a n d m a n y o th e r h e a lth a n d e d u c a tio n a l s e rv ic e s , th e h e a lth s y s te m a n d its p a rtn e rs e m p lo y m o re th a n 11 0 ,0 0 0 c a re g iv e rs (e m p lo y e e s ). T h e P S J H fa m ily o f o rg a n iz a tio n s is h e a d q u a rte re d in Irv in e , C A a n d R e n to n , W a s h .

Radiant Health Centers

R a d ia n t H e a lth C e n te rs h e lp s m o re th a n 1 ,3 0 0 p e o p le liv in g w ith H IV in O ra n g e C o u n ty e a c h y e a r a n d is e x p a n d in g to a ls o p ro v id e c o m p a s s io n a te a n d c a rin g h e a lth c a re s e rv ic e s to th e 1 2 ,0 0 0 m e m b e rs o f O ra n g e C o u n ty ’s L G B T Q c o m m u n ity w h o fa c e s ig n ific a n t b a rrie rs to c a re . It h a s p ro v id e d c o m p re h e n s iv e s o c ia l s e rv ic e s in th e c o m m u n ity s in c e 1 9 8 5 , a s w e ll a s H IV p re v e n tio n a n d o u tre a c h a n d fre e H IV a n d H e p C te s tin g a t its Irv in e a n d S a n ta A n a lo c a tio n s . A s o f M a rc h 2 0 1 8 , R a d ia n t H e a lth C e n te rs h a s a d d e d m e n ta l h e a lth s e rv ic e s fo r th e b ro a d e r L G B T Q c o m m u n ity in n e e d w ith p la n s to c o n tin u e e x p a n d in g its h e a lth a n d w e lln e s s s e rv ic e s to in c lu d e a n e w L G B T Q h e a lth c e n te r a n d a h e a lth y O ra n g e C o u n ty fo r a ll.

Sovereign Health

S o v e re ig n H e a lth h a s s e rv e d a d u lt a n d a d o le s c e n t p a tie n ts w ith tra u m a , c o g n itiv e d e fic its , e a tin g d is o rd e rs , m e n ta l illn e s s e s a n d s u b s ta n c e u s e d is o rd e rs s in c e 2 0 0 9 . W ith n a tio n a l tre a tm e n t lo c a tio n s , S o v e re ig n ’s h ig h -q u a lity, c o m p re h e n s iv e tre a tm e n t p ro g ra m s in te g ra te in n o v a tiv e , c u ttin g -e d g e c o g n itiv e te s tin g , re h a b ilita tio n te c h n iq u e s a n d e v id e n c e -b a s e d tre a tm e n t m o d a litie s . S o v e re ig n is c o m m itte d to h ig h -q u a lity a n d e ffic a c io u s c a re fo r e v e ry p a tie n t a n d s p e c ia liz e s in re p a irin g c o g n itiv e d e fic its to p ro m o te b ra in w e lln e s s a n d h e lp p a tie n ts a c h ie v e la s tin g re c o v e ry. To in fo rm th e d e c is io n -m a k in g p ro c e s s a n d im p ro v e its c lin ic a l e ffic a c y, S o v e re ig n s y s te m a tic a lly c o lle c ts c lin ic a l o u tc o m e d a ta a n d v a lu a b le p a tie n t fe e d b a c k . S o v e re ig n c o n s is te n tly ra n k s a s a to p p ro v id e r o f b e h a v io ra l h e a lth s e rv ic e s , s u rp a s s in g th e c lin ic a l o u tc o m e s o f 5 0 J o in t C o m m is s io n a c c re d ite d fa c ilitie s , a c c o rd in g to in d e p e n d e n t q u a rte rly re p o rts b y H a rv a rd M e d ic a l S c h o o l a ffilia te M c L e a n H o s p ita l. T h e c o m p a n y e n jo y s th e d is tin c tio n o f p ro v id in g c o n c u rre n t m e n ta l h e a lth a n d s u b s ta n c e u s e tre a tm e n t, a ra rity in th e fie ld . F o r m o re in fo rm a tio n , v is it www.sovhealth.com.

Stanbridge University

S ta n b rid g e U n iv e rs ity is a n a w a rd -w in n in g in s titu tio n o f m o re th a n 1 ,8 0 0 s tu d e n ts th a t fo c u s e s o n p re -lic e n s u re h e a lth c a re p ro g ra m s in N u rs in g , O c c u p a tio n a l T h e ra p y, P h y s ic a l T h e ra p y, a n d V e te rin a ry S c ie n c e . W ith c o re h a llm a rk s o f in n o v a tio n , te c h n o lo g y, a c a d e m ic rig o r a n d s e rv ic e , th e in s titu tio n h a s re c e iv e d n a tio n a l re c o g n itio n fo r its fo c u s o n s e rv ic e a n d s e rv ic e le a rn in g . S ta n b rid g e h o u s e s th e W e s t C o a s t’s firs t S y n th e tic H u m a n C a d a v e r L a b , a s w e ll a s o n e o f th e c o u n try ’s la rg e s t v irtu a l re a lity la b s fo r m e d ic a l tra in in g . S ta n b rid g e g ra d u a te O T s tu d e n ts re c e n tly p re s e n te d a t a s y m p o s iu m fo r N A S A o n th e e ffe c ts o f lo n g -d u ra tio n s p a c e flig h t to M a rs a n d b ro u g h t s c u b a th e ra p y fo r w o u n d e d v e te ra n s to O ra n g e C o u n ty in p a rtn e rs h ip w ith th e W A V E S fo u n d a tio n .

Stradling

S tra d lin g re p re s e n ts c o m p a n ie s a n d e n titie s w h ic h s e e k a s o p h is tic a te d la w firm w ith e x p e rie n c e d c o u n s e l to g u id e c ritic a l tra n s a c tio n s a n d d is p u te s . O rig in a lly fo u n d e d in 1 9 7 5 to re p re s e n t S o u th e rn C a lifo rn ia ’s m o s t in n o v a tiv e e m e rg in g g ro w th c o m p a n ie s , S tra d lin g is k n o w n to d a y a s a le a d in g fu ll-s e rv ic e la w firm re p re s e n tin g h ig h g ro w th a n d e s ta b lis h e d

• rg a n iz a tio n s a c ro s s a w id e ra n g e o f in d u s trie s . T h e firm h a s b u ilt its p ra c tic e a ro u n d its c lie n ts ’ c o re n e e d s . S tra d lin g ’s

s iz e , s tru c tu re a n d c u ltu re a llo w it to p ro v id e b ig -firm re p re s e n ta tio n w ith s m a ll-firm fle x ib ility a n d re s p o n s iv e n e s s . To d a y S tra d lin g s e rv e s e s ta b lis h e d a n d e m e rg in g c o m p a n ie s , m u n ic ip a litie s a n d g lo b a l o rg a n iz a tio n s u s in g th a t v e ry p re m is e .

UCI Health

U C I H e a lth c o m p ris e s th e c lin ic a l, p h y s ic ia n e d u c a tio n a n d m e d ic a l re s e a rc h e n te rp ris e s o f th e U n iv e rs ity o f C a lifo rn ia , Irv in e . P a tie n ts c a n a c c e s s U C I H e a lth a t p h y s ic ia n o ffic e s th ro u g h o u t O ra n g e C o u n ty a n d a t its m a in c a m p u s , U C Irv in e M e d ic a l C e n te r in O ra n g e , C A , a 4 1 7 -b e d a c u te c a re h o s p ita l th a t p ro v id e s te rtia ry a n d q u a te rn a ry c a re , a m b u la to ry a n d s p e c ia lty m e d ic a l c lin ic s , b e h a v io ra l h e a lth a n d re h a b ilita tio n . U .S . N e w s & W o rld R e p o rt h a s lis te d it a m o n g A m e ric a ’s B e s t H o s p ita ls fo r 1 7 c o n s e c u tiv e y e a rs . U C I M e d ic a l C e n te r fe a tu re s O ra n g e C o u n ty ’s o n ly N a tio n a l C a n c e r In s titu te -d e s ig n a te d c o m p re h e n s iv e c a n c e r c e n te r, h ig h -ris k p e rin a ta l/n e o n a ta l p ro g ra m , L e v e l I tra u m a c e n te r a n d L e v e l II p e d ia tric tra u m a c e n te r, c o m p re h e n s iv e d ig e s t d is e a s e c e n te r, a n d is th e p rim a ry te a c h in g h o s p ita l fo r U C I S c h o o l o f M e d ic in e . U C I H e a lth s e rv e s a re g io n o f n e a rly 4 m illio n p e o p le in O ra n g e C o u n ty, w e s te rn R iv e rs id e C o u n ty a n d s o u th e a s t L o s A n g e le s C o u n ty.

APRIL 9, 2018 Local breaking news: www.ocbj.com ORANGE COUNTY BUSINESS JOURNAL B-39

B-40 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

With the removal of the ‘individual mandate’ as part of the recent Tax Reform, I expect to see an increase in the number of individuals going uninsured and upward pressure on those premiums. Burnham works closely with its employer plan sponsor clients to stay vigilant to ensure compliance in their offer, pricing and reporting of coverage to their employees. Scott Aston Senior Vice President & Partner Burnham Benefits Insurance Services

The Affordable Care Act and the myriad of changes to healthcare from Washington, D.C. has affected many healthcare

• stakeholders. What do you feel will be the

ultimate fate for the Affordable Care Act? Will there be a cap for price increases with insurance or deductibles in 2018 and beyond following the passing of the new Healthcare Act? How have you been impacted and how has it affected enrollment? Scott Aston, Burnham Benefits: I think that it’s safe to assume the ACA is here to stay, for at least the next several years. The Trump administration discovered this is a complicated and interconnected knot that will be difficult to untangle. You can’t just flip a switch and turn it off. However, with the removal of the “individual mandate” as part of the recent Tax Reform, I expect to see an increase in the number of individuals going uninsured and upward pressure on those

• premiums. Burnham works closely with its

employer plan sponsor clients to stay vigilant to ensure compliance in their offer, pricing and reporting of coverage to their employees. Suzanne Richards, KPC Health: The Affordable Care Act (ACA) has presented both benefits and challenges for providers, such as hospitals, within the healthcare system. On

• ne hand, providers experienced insurance

coverage expansion for individuals giving hospital operators a greater ability to recover some cost reimbursement compared to none at all. However, ACA also created a significant financial risk by penalizing hospitals for Medicare patient readmissions occurring within 30 days from prior discharge from any hospital, which involves factors beyond a hospital’s control such as an acute ailment unrelated to the previous diagnosis and

• treatment. Hopefully, the ultimate fate of ACA

includes comprehensive reforms that encourage greater participation and price competition amongst insurers to stabilize premiums for families, provide more appropriate payments to providers for services, and incentivize preventive care. These principles will certainly foster an environment that promotes efficient delivery of high-quality care for patients. Most employers have seen their medical insurance premiums raise by more than 150% over the past 10 years, what steps can be taken to “bend the cost curve” and reverse this hyper-inflationary trend? Gene Rapisardi, Cigna: Cigna is doing a number of things to bend the cost curve, which seem to be working because we have the best medical cost trend among all of the national insurers. First, we have been very aggressive in developing value-based arrangements that reward medical groups for their performance. The top-performing groups active for at least one year have saved 3.2% in total medical cost. This is driven by a number of factors, including better use of generic medications, lower hospital readmission rates and lower use of the emergency room for non-emergencies. Another approach is to create high-performing networks – subsets of our full network that include only those providers that deliver the best quality at the best cost. We also make quality and cost information available online and via mobile app so our customers can see the cost of care and prescription medications at different facilities so they can make better informed decisions about how to spend their healthcare dollars. Mark Costa, Kaiser Permanente Orange County: Healthcare costs continue to rise well above inflation, and as a result, many employers are making changes to their benefit strategies. The bulk of these changes work by shifting financial responsibility from the employer, and placing the burden onto the employee(s). While this may lower an employer’s short-term costs, it doesn’t address one of the modifiable factors behind this upward trend — the health of the employee(s). According to a Kaiser Health News article, “Largely preventable, and highly manageable chronic diseases and conditions such as diabetes and obesity account for 75 cents of every dollar spent on healthcare in the United States.” We also know, that this cost can be better managed through employee behavior change. That’s where building an effective workforce health strategy comes into the picture. By encouraging employees to make long-term behavior changes, employers can help decease costs attributed to healthcare coverage. As I have shared here before, and share publicly in numerous business leadership circles, a healthy and engaged workforce is a productive workforce. If employers encourage a healthier workforce, they should begin to experience a reduction to the risk that poor health has on safety, disability, workers’ comp and healthcare premiums. Employers should also see an increase in productivity and a reduction in absenteeism. If fully supported, a healthier, more engaged workforce, are key steps to bending the cost curve and will lead to a healthier bottom line for all involved. Erik G. Wexler, Providence St. Joseph Health: As healthcare providers committed to meeting the needs of our communities, we’re focused on solutions that contribute to long- term employee health and disease

• management. Experts agree there is a direct

correlation between improved employee health and bottom-line outcomes like lower costs, better performance and employee retention and satisfaction. Through our employer relations program, we partner with employers to develop comprehensive employee wellness strategies that focus on effective illness prevention and lifestyle

• changes. We provide on-site programs for

high-risk individuals that reduce hospital readmissions and emergency visits, and we make care accessible via health coaching and telemonitoring. We also bring the medical

• ffice to the employer with Wellness Corners

that are close to local businesses and onsite wellness centers which focus on healthy lifestyle choices. Scott Aston, Burnham Benefits: Employers are getting creative in addressing how to structure their plans to help mitigate year-

• ver-year cost increases. We’ve seen an

increased focus on self-funding benefit plans and leveraging available data to custom design plans to address areas of opportunity and drive behavior. Burnham works with its clients to identify low hanging fruit that can be as simple as looking to carve out pharmacy vendors (PBM’s) to improve pricing. We’ve consistently been able to achieve 10-20% continued on page B-42

Hopefully, the ultimate fate of ACA includes comprehensive reforms that encourage greater participation and price competition amongst insurers to stabilize premiums for families, provide more appropriate payments to providers for services, and incentivize preventive care. These principles will certainly foster an environment that promotes efficient delivery of high-quality care for patients. Suzanne Richards, RN, MBA, FACHE CEO of Healthcare Operations KPC Health

HEALTHCARE ROUNDTABLE

B-42 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

It has become harder to find qualified healthcare workers. That said, [Lindora has] been fortunate in that we’ve still been able to attract high- quality nurses because of the work environment we can offer. At Lindora, they’ve found satisfaction in seeing a complete transformation of our patients; from pre-program patients who are overweight, unhappy and at high risk of disease to those who complete the program, find a new lease on life through their weight loss, and reduce their risk of disease and dependency on medications. Will Righeimer CEO Lindora

s a v in g s o n o u r c lie n ts ’ p h a rm a c y c o s ts , ju s t b y ru n n in g th a t d a ta th ro u g h o u r p ric in g m o d e l a n d im p ro v in g c o n tra c ts . W e a ls o lo o k to in s ta ll c o s t tra n s p a re n c y s o lu tio n s to d riv e u tiliz a tio n to w a rd s lo w e r c o s t/h ig h e r o u tc o m e p ro v id e rs a n d fa c ilitie s .

There is concern that the economic recovery will exacerbate an already predicted shortage for RN and other healthcare workers. Do you see trending data to support this theory? Will Righeimer, Lindora: T h e re ’s n o q u e s tio n

th a t it h a s b e c o m e h a rd e r to fin d q u a lifie d h e a lth c a re w o rk e rs . T h a t s a id , w e ’v e b e e n fo rtu n a te in th a t w e ’v e s till b e e n a b le to a ttra c t h ig h -q u a lity n u rs e s b e c a u s e o f th e w o rk e n v iro n m e n t w e c a n o ffe r. W e ’v e s e e n a lo t o f c a n d id a te s w h o h a v e c o m e fro m h o s p ita ls a n d s k ille d n u rs in g fa c ilitie s w h e re 1 2 -h o u r s h ifts , o v e rtim e a n d w e e k e n d s a re e x p e c te d a n d n u rs e s p u t th e m s e lv e s a t ris k o f in fe c tio n . O u r c a n d id a te s a re th rille d to le a rn th a t th e y c a n w o rk in a s a fe e n v iro n m e n t, g e t w e e k e n d s o ff a n d ra re ly w o rk o v e rtim e , a llo w in g th e m m o re b a la n c e in th e ir liv e s . A n o th e r a d v a n ta g e fo r u s is th a t m a n y o f o u r re c ru its h a d b e e n in s itu a tio n s w h e re th e y h a d b e e n tre a tin g c h ro n ic c o n d itio n s fo r p a tie n ts w h o w e re n o t g e ttin g b e tte r. A t L in d o ra , th e y ’v e fo u n d s a tis fa c tio n in s e e in g a c o m p le te tra n s fo rm a tio n o f o u r p a tie n ts ; fro m p re -p ro g ra m p a tie n ts w h o a re o v e rw e ig h t, u n h a p p y a n d a t h ig h ris k o f d is e a s e to th o s e w h o c o m p le te th e p ro g ra m , fin d a n e w le a s e

• n life th ro u g h th e ir w e ig h t lo s s , a n d re d u c e

th e ir ris k o f d is e a s e a n d d e p e n d e n c y o n m e d ic a tio n s .

Yasith Weerasuriya, Stanbridge University:

In s p e a k in g w ith S ta n b rid g e U n iv e rs ity c lin ic a l h e a lth c a re p a rtn e rs , in c lu d in g C -S u ite E x e c u tiv e s a t a n u m b e r o f h o s p ita ls , th e re tu rn to th e 2 0 0 7 d a y s o f b o n u s e s fo r n e w h ire R N s is b e g in n in g to fu lfill th e p ro p h e c y th a t th e a g in g C a lifo rn ia n u rs in g w o rk fo rc e a n d th e im p e n d in g s u rg e o f re tire m e n ts is c o m in g to p a s s a s p re d ic te d . C a lifo rn ia h a s th e fifth lo w e s t ra tio o f R N s p e r 1 0 0 ,0 0 0 p o p u la tio n in th e U n ite d S ta te s , w ith o n ly 8 0 9 p e r 1 0 0 ,0 0 0 in 2 0 1 5 . A d d itio n a lly, re c e n t s u rv e y s e s tim a te d th a t 2 8 1 ,2 3 2 fu ll-tim e p o s itio n s n e e d e d to b e fille d in 2 0 1 7 , in d ic a tin g a s h o rta g e o f a v a ila b le R N s to m e e t th e in flu x o f re tire e s .

It has been said healthcare should prepare for a year of continued policy changes and

• uncertainty. We’re most likely also looking

at a rise in the rate of uninsured. How does this affect your strategic planning for

• perations and growth? How does a health

provider continue to serve its community in this environment? Ray Chicoine, Monarch HealthCare: It’s o u r

b e lie f th a t, re g a rd le s s o f w h a t p o lic y m a k e rs d e c id e , a s lo n g a s M o n a rc h a n d its p h y s ic ia n s c o n tin u e to fo c u s o n h ig h -q u a lity p a tie n t c a re a n d e x c e lle n t o u tc o m e s , w e w ill p ro v id e v a lu e a n d th riv e in a n y h e a lth c a re c lim a te . A t th e e n d o f th e d a y, o u r g ro w th c o m e s fro m p o s itiv e w o rd o f m o u th , a n d o u r p a tie n ts e n d o rs in g M o n a rc h a n d its p h y s ic ia n s to frie n d s , fa m ily a n d o th e rs b e c a u s e o f fa v o ra b le e x p e rie n c e s . W h ile w e s till m o n ito r h e a lth c a re p o lic y, o u r fo c u s is w o rk in g to im p ro v e th e o v e ra ll h e a lth a n d th e h e a lth c a re e x p e rie n c e w e o ffe r o u r p a tie n ts a n d

continued on page B-44

p h y s ic ia n p a rtn e rs . T h e s e e le m e n ts a re w ith in

• u r c o n tro l, a n d g u id e s o u r s tra te g ie s a n d
• p e ra tio n s .

Phil Yaeger, Radiant Health Centers:

In a d e q u a te o r n o h e a lth in s u ra n c e is a b a rrie r to c a re th a t w e h e lp p e o p le o v e rc o m e w ith tw o c e rtifie d C o v e re d C a lifo rn ia e n ro llm e n t c o u n s e lo rs o n o u r s ta ff a n d a th ird in th e w o rk s . T h e y h e lp g e t e lig ib le p a tie n ts e n ro lle d in th e C a lifo rn ia H e a lth E x c h a n g e a n d a re a p a rt o f a la rg e r c o o rd in a te d te a m . O u r m e d ic a l c a s e m a n a g e rs th e n c o n n e c t th e m w ith m e d ic a l c a re a n d m e d ic a tio n a s s is ta n c e th ro u g h re g io n a l, s ta te a n d fe d e ra l p ro g ra m s . E x p a n d in g a c c e s s to h e a lth c a re fo r th e p o p u la tio n w e s e rv e is n o w c e n tra l to o u r s tra te g ic p la n w h ic h c a lls fo r th e e s ta b lis h m e n t o f a n L G B T Q h e a lth c e n te r. T h is fa c ility w o u ld p ro v id e c o m p a s s io n a te a n d c u ltu ra lly c o m p e te n t c a re d ire c tly to o u r c o m m u n ity o n a s lid in g s c a le . W e ’v e a lre a d y b e g u n p ro v id in g m e n ta l h e a lth s e rv ic e s o n th is b a s is , a n d s e e th e s e s e rv ic e s a s v ita l to re a c h in g o u r g o a l o f e ra d ic a tin g H IV /A ID S in O ra n g e C o u n ty a n d a c h ie v in g a h e a lth y O ra n g e C o u n ty fo r a ll.

How should companies use the new Department of Justice and the Office of Inspector General compliance tools to improve their compliance programs? Kathleen M. Marcus, Stradling: T h e D O J ’s

in te rn a l g u id a n c e d o c u m e n t e n title d “E v a lu a tio n o f C o rp o ra te C o m p lia n c e P ro g ra m s ” p ro v id e s a lis t o f q u e s tio n s fo r u s e in a s s e s s in g a c o m p lia n c e p ro g ra m in th e c o n te x t o f c rim in a l lia b ility. T h e lis t c o v e rs M & A d ilig e n c e a s w e ll a s ris k s s u rro u n d in g th ird -p a rty re la tio n s h ip s , a n d s h o u ld b e c o n s u lte d in b o th c o n te x ts . T h e O IG ’s d o c u m e n t, “M e a s u rin g C o m p lia n c e P ro g ra m E ffe c tiv e n e s s : A R e s o u rc e G u id e ,” a ro s e fro m a ro u n d ta b le o f c o m p lia n c e p ro fe s s io n a ls in c o n ju n c tio n w ith th e H e a lth C a re C o m p lia n c e A s s o c ia tio n , a n d is fa r m o re c o m p re h e n s iv e . R a th e r th a n p ro v id e a c h e c k lis t, th e ro u n d ta b le c o m p ile d a n e x te n s iv e lis t o f m e a s u re m e n ts fo r p ro g ra m s o f a ll s iz e s a n d c o m p le x itie s . T h e re s u ltin g R e s o u rc e G u id e in c lu d e s h u n d re d s o f to p ic s w h ic h ro u g h ly fo llo w th e s ta n d a rd “s e v e n e le m e n ts .” It s h o u ld b e u s e d to id e n tify c u rre n t b e s t p ra c tic e s , a n d a ls o a s a m e a n s o f a s s e s s in g h o w to b u ild a s c a la b le c o m p lia n c e p ro g ra m th a t b e s t fits a c o m p a n y ’s c u rre n t a n d a n tic ip a te d p ro file .

How will the Department of Justice’s “Brand Memo” change enforcement actions in the healthcare space? Kathleen M. Marcus, Stradling: T h e

J a n u a ry 2 0 1 8 “B ra n d M e m o ” d ire c te d th a t D O J C iv il D iv is io n a tto rn e y s “m a y n o t u s e n o n c o m p lia n c e w ith a g e n c y g u id a n c e d o c u m e n ts a s a b a s is fo r p ro v in g v io la tio n s o f a p p lic a b le la w .” In o th e r w o rd s , n o n c o m p lia n c e w ith a g e n c y g u id a n c e d o c u m e n ts d o e s n o t e q u a te to a v io la tio n o f u n d e rly in g re g u la to ry o r s ta tu to ry re q u ire m e n ts . P re v io u s ly, th e D O J fre q u e n tly u s e d n o n c o m p lia n c e w ith s u b -re g u la to ry g u id a n c e to d e m o n s tra te v io la tio n s o f la w , in c lu d in g th e e s ta b lis h m e n t o f k n o w le d g e ,

• v e rp a y m e n t o r fa ls ity in F a ls e C la im s A c t

(F C A ) c a s e s . A d e p a rtu re fro m th is p a s t p ra c tic e is p a rtic u la rly re le v a n t in th e

HEALTHCARE ROUNDTABLE

Expanding access to healthcare for the population we serve is now central to our strategic plan which calls for the establishment of an LGBTQ health center. This facility would provide compassionate and culturally competent care directly to

• ur community on a sliding scale.

Phil Yaeger CEO Radiant Health Centers

APRIL 18, 2016 Local breaking news: www.ocbj.com ORANGE COUNTY BUSINESS JOURNAL B-43

B-44 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

healthcare space where the OIG, CMS, FDA and other agencies frequently issue substantive guidance to help navigate complex healthcare regulations. DOJ attorneys will now be limited in their use of fraud alerts, manuals, bulletins, interpretive guidance, advisory opinions or coverage decisions to establish liability. Thus, the Brand Memo will likely be a win for healthcare and medical device companies in curtailing FCA cases. Mergers and consolidation of the healthcare industry in Orange County continue to reshape local brands and established healthcare systems. How have you been affected with the consolidation? How has this trend impacted Orange County’s healthcare systems and what results do you see coming from such deals? How effective are these partnerships, and what do they mean to patients? Suzanne Richards, KPC Health: The mergers and consolidation in the healthcare industry in Orange County from a hospital perspective has proven beneficial with regards to streamlining overhead and sharing of administrative costs over a greater number of facilities and programs. Furthermore, it presents an opportunity for each provider to expand specialty services for consumers by establishing Centers of Excellence and offering patients greater access to specialty physicians, as well as a higher level of care. The greatest challenge to attaining these benefits for the community is ensuring our healthcare system offers competitive health plans in our local marketplace. Barry Arbuckle, MemorialCare: Patients want convenient access to healthcare close to home or work, so leading healthcare providers are forging strong partnerships, whether through consolidation or other innovative affiliations. MemorialCare partners with many outstanding healthcare

• rganizations, including Cedars Sinai, UCLA

and UC Irvine Health in innovative, value- based, exclusive programs and health plan

• fferings. Our partnership with Boeing

provides a customized health plan option at lower cost. A joint venture with RadNet

• ffers Southern California’s most extensive
• utpatient imaging network. Academic

partnerships with scores of colleges and universities increase availability of highly trained physicians, nurses and other

• clinicians. With UCI, UCLA and USC, for

example, we provide physician residency and fellowship programs at MemorialCare Long Beach Medical Center and MemorialCare Miller Children’s & Women’s Hospital Long Beach. And an affiliation between Miller Children’s & Women’s Hospital and UCLA Mattel Children’s Hospital enhances access to highly trained specialists and children’s healthcare services in Southern California. Ray Chicoine, Monarch HealthCare: Healthcare is evolving at an incredible pace and this is creating pressure on providers, medical groups and hospitals, which is driving mergers and consolidation. Monarch’s track record in innovative care solutions and desire to make an impact on improving care set the stage for our partnership with Optum, which has allowed us to thrive. We’re able to be competitive in attracting new physicians, even in light of the well documented shortage of physicians in the U.S. We’ve also been able to add technology which lets our physicians improve care for patients and, more importantly, greatly improve access to primary and specialty care across our service area. We believe our model is transformational in our ability to improve the health status of the communities we serve. Value-based care is a hot issue for many providers, including many in Orange

• County. How has your organization

adopted value-based care initiatives? What are the benefits of the emerging value- based healthcare initiatives and how will it affect healthcare providers and patients in OC? Jennifer Mitzner, Hoag Orthopedic Institute: Everyone, including Orange County employers, wants more value out of their healthcare dollar. Hoag Orthopedic Institute was organized by our physician founders to be a pioneer as a value-based model, a model that used by Harvard Business School to teach others about value. For employers, as an example, we have seen our bundled payment program grow in volume in the last several years as more employers seek direct contracts with value-based providers, such as HOI for hip and knee replacements. We also actively participate in Medicare program’s joint replacement model or CJR, which on a federal level is testing bundled payments for joint replacement surgeries. As a physician-owned entity, HOI has been at the forefront of innovative payment models that leverage our nationally recognized outcomes and value. Last year, more Californians selected HOI for their joint replacement surgery than any other facility in the state, a testament to our value- based focus. Barry Arbuckle, MemorialCare: MemorialCare is the region’s leader in value- based healthcare – delivering high-quality care and a superb patient experience at a reduced

• cost. Hundreds of thousands of patients

participate in our value-based plans, including innovative HMOs, like Vivity that includes

• ther top healthcare systems; tailored PPOs

like Aetna Whole Health; and our preferred partnership direct contract with Boeing. Employers and patients actively seek out our innovative accountable care offerings because

• f our ability to improve quality, increase

access to care and reduce costs. We tailor programs to meet the needs of each population of employees, use data to improve

• utcomes and reach out to patients with risk

factors to help manage their chronic conditions and achieve optimal health. With hospitals and

• utpatient locations stretching from South

Orange County to the South Bay, we are uniquely positioned to provide consumers, employers and health plans with high value healthcare in the right location, with the right services and at the right price. Erik G. Wexler, Providence St. Joseph Health: Value-based care is our mantra because it aligns with our strategy to transform how healthcare is delivered. Benefits for pursuing value over the old volume-based model include better care, as well as lower

• cost. But the real work for us is establishing

programs to ensure continued value, such as continued on page B-46

HEALTHCARE ROUNDTABLE

Patients want convenient access to healthcare close to home or work, so leading healthcare providers are forging strong partnerships, whether through consolidation or other innovative affiliations. MemorialCare partners with many outstanding healthcare organizations, including Cedars Sinai, UCLA and UC Irvine Health in innovative, value-based, exclusive programs and health plan

• fferings.

Barry Arbuckle, PhD President & CEO MemorialCare Value-based care is our mantra because it aligns with our strategy to transform how healthcare is

• delivered. Benefits for pursuing value
• ver the old volume-based model

include better care, as well as lower cost. Erik G. Wexler Chief Executive Providence St. Joseph Health Southern California Region

B-46 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

le v e ra g in g d a ta to p ro v id e re a l-tim e q u a lity a n d c o s t in fo rm a tio n fo r p h y s ic ia n s ; u s in g d a ta to a s s e s s o u r o u tc o m e s s o w e c a n b e tte r in v e s t in k e e p in g p e o p le h e a lth ie r; a n d , in c re a s in g tra n s p a re n c y s o p a tie n ts h a v e m o re d a ta , e n a b lin g th e m to w o rk w ith th e ir d o c to rs to h e lp d e te rm in e th e c a re p la n th a t’s b e s t fo r th e m . T h ro u g h o u r n e w C irc le a p p (c o m in g th is fa ll) e x p e c ta n t p a re n ts c a n s h a re d a ta w ith th e ir p ro v id e r to h e lp e n s u re a s a fe a n d h e a lth y p re g n a n c y.

Tonmoy Sharma, Sovereign Health: In o u r

c o m m itm e n t to q u a lity, S o v e r e ig n H e a lth h a s a d o p te d m e a s u r e m e n t- b a s e d p r o to c o l to a s s e s s a n d m o n ito r p a tie n ts th r o u g h o u t tr e a tm e n t to e n s u r e tr e a tm e n t is e ffic a c io u s a n d p r o v id e p a tie n ts w ith th e b e s t c a r e p o s s ib le . O u r c lin ic ia n s im p le m e n t e v id e n c e - b a s e d p r a c tic e s a n d s y s te m a tic a lly c o lle c t c lin ic a l o u tc o m e d a ta a n d v a lu a b le p a tie n t fe e d b a c k a b o u t th e ir s y m p to m s , c o g n itiv e fu n c tio n in g , s a tis fa c tio n w ith life a n d r e a d in e s s to c h a n g e to in fo r m d e c is io n - m a k in g . H a r v a r d M e d ic a l S c h o o l a ffilia te M c L e a n H o s p ita l’s in d e p e n d e n t q u a r te r ly r e p o r ts s h o w th a t o u r p a tie n ts c o m e in m u c h s ic k e r, b u t le a v e tr e a tm e n t w ith m u c h g r e a te r im p r o v e m e n ts in th e ir s y m p to m s a n d fu n c tio n in g c o m p a r e d to 5 0 J o in t C o m m is s io n a c c r e d ite d o r g a n iz a tio n s n a tio n w id e . W e v ie w p a tie n ts h o lis tic a lly a n d

• u r c o g n itiv e e n h a n c e m e n t p r o g r a m s

in te g r a te n e u r o s c ie n c e , d e v e lo p m e n ta l p s y c h o lo g y a n d s o ftw a r e in fr a s tr u c tu r e a p p lic a tio n s to im p r o v e b r a in fitn e s s a n d h e a lth . W e k n o w r o u tin e o u tc o m e m o n ito r in g e n h a n c e s tr e a tm e n t e ffic a c y a n d o u tc o m e s , a n d s tr o n g e v id e n c e s u p p o r ts its u s e in c lin ic a l p r a c tic e – th e r e s u lts : h e a lth ie r p a tie n ts , h ig h e r q u a lity tr e a tm e n t a n d g r e a te r a c c o u n ta b ility.

Yasith Weerasuriya, Stanbridge University: S ta n b r id g e U n iv e r s ity is

in tim a te ly a w a r e o f th e a c u te n e e d fo r n e w g r a d u a te s to b e c o n s c io u s o f th e in s titu tio n a l b u s in e s s n e e d s o f th e o r g a n iz a tio n s th a t th e y w ill b e jo in in g . A c c o r d in g ly, H C A H P S ( th e H o s p ita l C o n s u m e r A s s e s s m e n t o f H e a lth c a r e P r o v id e r s a n d S y s te m s ) a n d th e im p o r ta n c e o f th e u n d e r ly in g c u s to m e r s e r v ic e tr a in in g fo r a ll h e a lth c a r e s tu d e n ts is a m p lifie d in a n a lr e a d y in te g r a te d c u r r ic u lu m u s in g a v a r ie ty o f te c h n iq u e s , in c lu d in g v ir tu a l r e a lity. W ith th is fo c u s , w e c a n p e r p e tu a te im p r o v e d p a tie n t c a r e a n d c o m m u n ic a tio n , b e n e fitin g b o th p r o v id e r s a s w e ll a s p a tie n ts a n d th e ir fa m ilie s .

Gene Rapisardi, Cigna: C ig n a h a s e n te r e d

in to a n a llia n c e w ith S t. J o s e p h H o a g H e a lth to jo in tly b r in g v a lu e - b a s e d h e a lth p la n s to O r a n g e C o u n ty. W e a ls o h a v e c o m p a n io n a llia n c e s w ith S c r ip p s in S a n D ie g o C o u n ty a n d H e a lth C a r e P a r tn e r s in L o s A n g e le s C o u n ty. T h e s e lo c a l p r o d u c ts a r e b u ilt e x c lu s iv e ly a r o u n d th e c a p a b ilitie s o f e a c h o f th e s e d e liv e r y s y s te m s w ith a fo c u s o n im p r o v e d q u a lity, b e tte r a ffo r d a b ility a n d a n e n h a n c e d p a tie n t e x p e r ie n c e . O n e o f th e m o s t s ig n ific a n t fe a tu r e s o f th e s e a llia n c e s is th a t th e d e liv e r y s y s te m p a r tn e r s h a v e a s e a t a t th e ta b le in o u r c o n v e r s a tio n w ith e m p lo y e r s . W e a r e fu n d a m e n ta lly c h a n g in g th e r e la tio n s h ip b e tw e e n h e a lth c a r e d e liv e r y s y s te m s a n d p a y e r s , b e c a u s e w e g o to m a r k e t to g e th e r u n d e r a c o m m o n b r a n d w ith a u n ifie d p u r p o s e – to d o w h a t’s b e s t fo r th e p e o p le w e jo in tly s e r v e . T h is c r e a te s g r e a te r tr a n s p a r e n c y a n d o u ts ta n d in g c o m m u n ic a tio n b e tw e e n a ll s ta k e h o ld e r s .

Ray Chicoine, Monarch HealthCare: W e

c o n tin u e to a s p ire to tra n s fo rm h e a lth c a re in th e c o m m u n itie s w e s e rv e th ro u g h a fo c u s o n th e q u a d ru p le a im : b e s t-in -c la s s q u a lity c a re , a n im p ro v e d p a tie n t e x p e rie n c e , re d u c in g th e c o s t o f c a re a n d b e in g th e g ro u p o f c h o ic e fo r p h y s ic ia n s w h o w a n t to p ro v id e e x c e lle n t c a re fo r p a tie n ts . W e h a v e b e e n d o in g th is s in c e w e w e re fo u n d e d a lm o s t 2 5 y e a rs a g o a s a n in d e p e n d e n t p h y s ic ia n g ro u p . E v e ry d a y, h u n d re d s o f p a tie n ts ta lk to o u r d o c to rs a b o u t th e ir h e a lth in a d d itio n to c o n c e rn s a b o u t h e a lth c a re c o s ts . A s O ra n g e C o u n ty b u s in e s s e s c o n tin u e to fa c e ris in g c o s ts fo r e m p lo y e e s , th e y ’ll c h o o s e p ro v id e r g ro u p s w h ic h e m b ra c e a c o m m itm e n t to q u a lity c a re th a t o ffe rs v a lu e . V a lu e -b a s e d in itia tiv e s re q u ire u s to h e lp o u r p h y s ic ia n s c re a te b e tte r e ffic ie n c ie s in th e d e liv e ry o f h e a lth c a re w h ile im p ro v in g q u a lity, w ith th e e n d re s u lt o f m o re a ffo rd a b le c a re fo r o u r p a tie n ts .

Hospitals and other healthcare facilities have been ramping up on customer service training as a result of value-based purchasing and other patient satisfaction based federal initiates. Can you comment

• n how important this is at your

institution? Yasith Weerasuriya, Stanbridge University: T h e im p o rta n c e o f c u s to m e r

s e rv ic e in a s e rv ic e -d e liv e ry m o d e l is b e in g p u t to th e te s t w ith V a lu e -B a s e d P u rc h a s in g a n d w ill re q u ire a n e m p h a s is o n s o ft s k ills , c o m m e n s u ra te w ith lic e n s u re p re p a ra tio n a n d c o re c lin ic a l s k ills , a s p a rt o f th e fa b ric o f a ll h e a lth c a re tra in in g .

Suzanne Richards, KPC Health: K P C

H e a lth ’s m o tto is “E n jo y L ife In G re a t H e a lth ” b e c a u s e o u r n u m b e r o n e jo b is to p ro v id e p a tie n ts w ith th e b e s t h e a lth c a re a n d g e t th e m o n a p a th to w e lln e s s , s o th e y c a n re tu rn to th e ir d a ily liv e s . G e n e ra lly, p e o p le d o n o t g o to th e h o s p ita l o u t o f d e s ire , b u t o u t

• f n e c e s s ity. B e y o n d v a lu e -b a s e d p u rc h a s in g

a n d re g u la to ry re q u ire m e n ts , w e h a v e p u t a s ig n ific a n t e m p h a s is o n c u s to m e r e x p e rie n c e in o u r s e rv ic e d e liv e ry a n d e m p lo y e e tra in in g p ro g ra m s . R e g a rd le s s o f th e fa c t th e re a re fe w e r c h o ic e s in h e a lth c a re th e s e d a y s , c o n s u m e rs s till fo rm o p in io n s a b o u t th e ir u n p la n n e d v is it to th e h o s p ita l a n d w ill ju d g e w h e th e r th e y s e le c t th a t h o s p ita l fo r e le c tiv e s e rv ic e s in th e fu tu re b a s e d u p o n th e ir p re v io u s e x p e rie n c e .

How is the behavioral health industry transitioning from volume- to value-based care, and how is this bringing standards to the behavioral health treatment industry? Erik G. Wexler, Providence St. Joseph Health: It is e n c o u ra g in g th a t b e h a v io ra l

h e a lth is m o v in g to v a lu e -b a s e d m o d e ls th a t fo c u s o n b e tte r o u tc o m e s a n d re d u c e d c o s t. To e n s u re s u c c e s s , a ll e n titie s im p a c tin g b e h a v io ra l h e a lth – h o s p ita ls , d o c to rs , p a tie n ts , g o v e rn m e n t in s titu tio n s , e tc . – m u s t im p ro v e a n d s ta n d a rd iz e d a ta c o lle c tio n . T h is is v ita l fo r m o re e ffe c tiv e ly a d d re s s in g o u r n a tio n a l m e n ta l h e a lth c ris is . P ro v id e n c e S t. J o s e p h H e a lth h a s c o m m itte d $ 3 0 m illio n to im p ro v in g a c c e s s to m e n ta l h e a lth s e rv ic e s in

continued on page B-48

Cigna has entered into an alliance with St. Joseph Hoag Health to jointly bring value-based health plans to Orange County. We also have companion alliances with Scripps in San Diego County and HealthCare Partners in Los Angeles

• County. These local products are

built exclusively around the capabilities of each of these delivery systems with a focus on improved quality, better affordability and an enhanced patient experience. Gene Rapisardi Market President, Southern California and Nevada Cigna

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B-48 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

• California. We’ve also developed a Mental

Health Hub database – one of the largest data assessments of its kind – to create an extensive gap analysis for each region in our seven-state service area. In Orange County, we’re partnering with other health systems, the Health Care Agency, faith communities and others to create a world-class system of mental healthcare. Tonmoy Sharma, Sovereign Health: Insurance companies like the Centers for Medicare and Medicaid Services (CMS) as well as private insurance companies are transitioning from volume (fee-for-service) to value-based (fee-for-performance) payment

• structures. Providers are challenged with the

task of measuring clinical outcomes and developing standards of care to ensure the public, consumers, insurance companies and

• ther payers that treatment is effective and

high quality. Measurement-based care is aligned with value-based programs and involves systematically collecting patient- reported outcome data to inform clinical decision-making to improve the quality of care delivered to patients with mental and substance use disorders. Clinicians are beginning to use standardized outcome measures – brief structured instruments with good psychometric properties – to provide valuable feedback about patients’ psychiatric symptoms, symptom severity and other factors to help determine if treatment is

• working. It can empower patients to better

understand and overcome their illness and inform third-party payers about the value of behavioral health treatment services. Suzanne Richards, KPC Health: As a prominent county provider for behavioral health in Orange County, KPC Health is proud to be an industry leader amongst a community that is working with the Health Care Agency and other stakeholders to establish Crisis Stabilization Units and Hope Centers that

• ffer treatment in the outpatient setting. As the

Orange County healthcare community is working together to reform its behavioral healthcare system, providers are focused on a continuum of care that supports keeping patients out of Emergency Rooms and away from long term hospital stays, which is inspired by prevention, coordination and

• integration. Over time, these principles will

result in better outcomes for patients. Advances in medicine and technology, market forces, an emphasis on wellness and health reform are moving patients out

• f the hospital into outpatient and

community settings. How has the growth

• f outpatient care affected your institution

and how have you integrated outpatient care into your delivery system? How has this impacted the role of the traditional inpatient hospital? Barry Arbuckle, MemorialCare: MemorialCare embraces the move from hospital-based care to outpatient, community-based care. Over the past several years we have expanded and diversified our health system into more than 200 outpatient sites offering primary and specialty care, surgery, imaging, urgent care and dialysis centers throughout Orange County, Long Beach and the South Bay complementing our great hospitals. These community sites are intentionally not

• perating as Hospital-Based Outpatient

Departments which receive higher reimbursement, but instead as high quality, lower priced Ambulatory Care Centers. We’re unveiling more healthcare centers, innovative programs, progressive partnerships and comprehensive services where consumers live and work. We’re able to offer the best in health, wellness, prevention, disease management and treatment in the right location with the right services at the right price – with substantial savings for employers, health plans and

• patients. Technological advances, for

example, mean many surgical patients spending days in a hospital can now receive care in convenient, lower cost outpatient centers without overnight hospital stays. Richard J. Gannotta, UCI Health: As home to Orange County’s only Level 1 trauma center, regional burn center, National Cancer Institute-designated comprehensive cancer and other leading tertiary/quaternary care services, UCI Health believes its inpatient hospital will continue to play a vital role in providing complex care unavailable anywhere

• else. However, modern healthcare

increasingly demands that patients be treated in less-costly, high-quality outpatient settings. We continue to expand access to world-class multidisciplinary care and medical advances, many pioneered at UCI, at outpatient facilities like the H.H. Chao Comprehensive Digestive Disease Center. This standalone specialty center, along with our Tustin and Newport- area satellite offices, is a blueprint for our commitment to seamless integration between inpatient and outpatient care. Jennifer Mitzner, Hoag Orthopedic Institute: The Hoag Orthopedic Institute model purposely includes both an inpatient hospital in Irvine as well as two ambulatory surgery centers, one in Newport Beach and

• ne in Orange. The trend toward more
• utpatient medical and surgical care

continues to grow in Orange County as more and more orthopedic procedures – surgeries that were just a few short years ago where performed in the hospital setting, such as hip replacement – are being successfully performed in the outpatient

• setting. Today, we have implemented

Enhanced Recovery Program after surgery, which seeks to get patients home same day, thus avoiding inpatient hospitalization. Our strategic plan calls for the building of more ambulatory surgery centers throughout Orange County and greater Southern California, greatly increasing access to

• utpatient orthopedic care in more
• communities. Furthermore, we are

committed to building new orthopedic “Super Centers” that offer physician medical and surgical services, ambulatory surgery and rehabilitation in a single location so that patients do not need to travel all over to get the best orthopedic surgical or medical care. Ray Chicoine, Monarch HealthCare: The acceleration toward using outpatient resources, where appropriate, continues to reduce healthcare costs for everyone. At Monarch, we have accelerated our commitment to more ambulatory healthcare services, as evidenced by our partnership and integration with Surgical Care Affiliates, a leading network of outpatient surgery continued on page B-50

As home to Orange County’s only Level 1 trauma center, regional burn center, National Cancer Institute- designated comprehensive cancer and other leading tertiary/quaternary care services, UCI Health believes its inpatient hospital will continue to play a vital role in providing complex care unavailable anywhere else. However, modern healthcare increasingly demands that patients be treated in less-costly, high- quality outpatient settings. We continue to expand access to world- class multidisciplinary care and medical advances, many pioneered at UCI, at outpatient facilities like the H.H. Chao Comprehensive Digestive Disease Center. Richard J. Gannotta Interim CEO UCI Health

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B-50 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

c e n te r s in O r a n g e C o u n ty. If w e c a n p r o v id e th e s a m e o r b e tte r c a r e in a n o u tp a tie n t s e ttin g – o r e v e n a t h o m e – w e c a n r e d u c e c o s ts a n d im p r o v e a c c e s s to c a r e fo r o u r p a tie n ts . M o r e o v e r, s tu d ie s h a v e d e te r m in e d th a t if w e c a n k e e p p a tie n ts o u t o f th e h o s p ita l s e ttin g , th e y a r e a t le s s a t r is k fo r in fe c tio n . T h a t’s w h y w e ’v e a d d e d m o r e r e s o u r c e s to o u r in - h o m e c a r e a n d h o u s e c a lls p r o g r a m s , w h ic h to d a y in c lu d e n o t o n ly m e d ic a l c a r e b u t s o c ia l w o r k e r s , p h a r m a c is ts , n u tr itio n c o u n s e lin g a n d c a r e c o o r d in a tio n . T h a t is n o t to s a y th a t h o s p ita ls a r e n o t c r u c ia l to o u r h e a lth c a r e d e liv e r y s y s te m . T h e y a r e in d e e d a n d w e h a v e fo r m e d s tr a te g ic a llia n c e s a n d jo in t v e n tu r e s in c o n ju n c tio n w ith o u r p h y s ic ia n s w ith fo r w a r d - th in k in g h o s p ita ls to m o r e e ffe c tiv e ly in te g r a te s e r v ic e s in to a s e a m le s s d e liv e r y s y s te m .

The opioid crisis sweeping Americans is another hot healthcare issue. Has your

• rganization and its physicians

addressed this issue and/or implemented policies or actions to stem the risks associated with these pain medications? What is the best way for healthcare providers and city/county agencies to work together against the opioid epidemic across America? Mark Costa, Kaiser Permanente Orange County: K a is e r P e r m a n e n te c o n tin u e s a s a

n a tio n a l le a d e r in c o n fr o n tin g th e o p io id e p id e m ic a n d w a s e a r ly to r e c o g n iz e th e c r is is y e a r s a g o b y im p le m e n tin g K a is e r P e r m a n e n te ’s S a fe a n d A p p r o p r ia te O p io id P r e s c r ib in g P r o g r a m in 2 0 1 0 . K a is e r P e r m a n e n te e n lis te d th e h e lp o f a p r o g r a m c a lle d P A C E ( P h y s ic ia n A s s e s s m e n t a n d C lin ic a l E d u c a tio n P r o g r a m ) . W e r e q u ir e a ll

• u r p h y s ic ia n s to a tte n d a m a n d a to r y fo u r -

h o u r e d u c a tio n a l p r o g r a m o n o p io id r is k , p r e s c r ib in g a n d m a n a g e m e n t o f p a in . W e lo o k e d w ith in fo r o u r s tr e n g th , w h ic h w a s le v e r a g in g o u r b e lie f in e v id e n c e - b a s e d c a r e a n d p u ttin g p a tie n ts a t th e c e n te r. A s s u c h , e v e r y m e d ic a l c e n te r c r e a te d a C o n tr o lle d S u b s ta n c e R e v ie w Ta s k F o r c e th a t id e n tifie d p a tie n ts o n u n s a fe le v e ls o f o p io id s . T h e p a tie n t’s c a r e a n d e le c tr o n ic m e d ic a l r e c o r d a r e th o r o u g h ly e v a lu a te d a n d a s e t o f r e c o m m e n d a tio n s a r e m a d e to h e lp m a n a g e th e ir p a in fr o m a n o n - o p io id p e r s p e c tiv e . F u r th e r m o r e , o u r p h a r m a c is ts e n g a g e d e a r ly

• n to d e v e lo p a n e s c a la tio n p r o to c o l. A n y

c o n c e r n s a b o u t th e m e d ic a tio n , th e d o s e , fr e q u e n c y o r a m o u n t th a t is p r e s c r ib e d is e s c a la te d b a c k to th e p r e s c r ib e r, a n d th e n to th e c h ie f o f th e d e p a r tm e n t if r e s o lu tio n o f th e c o n c e r n is n o t a c h ie v e d a fte r th e p r e s c r ib e r is c o n ta c te d . A n d g iv e n th e fu n c tio n a lity o f o u r e le c tr o n ic m e d ic a l r e c o r d s , w e h a v e lin k e d to th e s ta te s C o n tr o lle d S u b s ta n c e D a ta B a s e , c a lle d C U R E S to p r e v e n t d o c to r s h o p p in g . L a s tly, w e h a v e c r e a te d b e s t p r a c tic e g u id e lin e s a r o u n d h o w lo n g , a n d h o w m a n y p ills s h o u ld b e p r e s c r ib e d to a p a tie n t w h o h a s a c u te p a in , v e r s u s p a in p o s t- o p e r a tiv e ly. C o lla b o r a tiv e te a c h in g a n d le a r n in g is k e y fo r lo n g te r m r e m e d ia tio n . A s s u c h , w e a r e p r e p a r e d , to e d u c a te n o n - K a is e r P e r m a n e n te p h y s ic ia n s a b o u t w h a t is p r o p e r p a in m a n a g e m e n t, if th e y d o n o t h a v e th e in te r n a l s u p p o r t a n d r e s o u r c e s th a t K a is e r P e r m a n e n te h a s . S tu d ie s s h o w th a t p a tie n ts w ith m e n ta l h e a lth d ia g n o s is a r e th e o n e s m o s t lik e ly to b e p r e s c r ib e d a n o p ia te . W e n e e d to c r e a te b e tte r m e n ta l h e a lth a n d s u b s ta n c e a b u s e r e s o u r c e s fo r th o s e a fflic te d w ith p a in .

Richard J. Gannotta, UCI Health: A s th e

r e g io n ’s o n ly a c a d e m ic m e d ic a l c e n te r a n d a v ita l c o m p o n e n t o f th e c o m m u n ity ’s tr u s t, U C I H e a lth h a s th e e x p e r tis e a n d o b lig a tio n to c o n fr o n t th is e p id e m ic a n d le a d a c o lla b o r a tio n o f c o m m u n ity p a r tn e r s in d e v e lo p in g s o lu tio n s . T h r o u g h th e S a fe R x O C c o a litio n o f h e a lth c a r e p r o v id e r s , p h a r m a c is ts , p h y s ic ia n g r o u p s a n d c o u n ty h e a lth a n d la w e n fo r c e m e n t o ffic ia ls , w e ’r e e d u c a tin g p r o v id e r s w h o p r e s c r ib e o p io id m e d ic a tio n s to e n s u r e s u r e th e y h a v e th e r ig h t in fo r m a tio n to p r e s c r ib e th e r ig h t p a in m e d s . W e ’v e d e v e lo p e d E m e r g e n c y D e p a r tm e n t S a fe r P r e s c r ib in g G u id e lin e s , w h ic h h a v e b e e n a d o p te d in h o s p ita ls a c r o s s th e c o u n ty, a n d a r e r e fin in g o u tp a tie n t p r e s c r ib in g g u id e lin e s .

Jennifer Mitzner, Hoag Orthopedic Institute: O u r m is s io n a t H o a g O r th o p e d ic

In s titu te is to g e t p a tie n ts o u t o f p a in a n d b a c k to th e ir p r o d u c tiv e life , in c lu d in g g e ttin g b a c k to a c tiv itie s th e y lo v e a n d e n jo y. T h e m a n a g e m e n t o f p a in is a m a jo r fo c u s fo r a ll

• u r p h y s ic ia n s a n d s u r g e o n s , in c lu d in g p r e -
• p , p o s t- o p a n d a d d r e s s in g p a tie n ts w h o

e x p e r ie n c e c h r o n ic p a in . H O I p h y s ic ia n s h a v e le d a n e ffo r t to a d d r e s s th e o p io id is s u e d ir e c tly th r o u g h s e v e r a l m e a s u r e s : o n e is d e v e lo p in g n e w a n e s th e s ia te c h n iq u e s th a t c a n h e lp in p o s t- o p p a in m a n a g e m e n t, w h ic h w o u ld le s s e n th e n e e d fo r p a in m e d ic a tio n s fo llo w in g s u r g e r y. M o r e o v e r, o u r p h y s ic ia n s h a v e b e e n p r o a c tiv e ly m in d fu l a b o u t p r e s c r ib in g o p io id m e d ic a tio n s to th e ir p a tie n ts a n d h a v e a d o p te d m o r e c o n s e r v a tiv e m e th o d s fir s t a n d fo r e m o s t. L a s tly, fr o m a n e n te r p r is e p e r s p e c tiv e , H O I is e n g a g in g in r e s e a r c h p r o g r a m s th r o u g h

• u r H o a g O r th o p e d ic s r e s e a r c h a r m th a t is

s tu d y in g p a in m a n a g e m e n t th r o u g h s e v e r a l in n o v a tiv e p r o je c ts . H O I p h y s ic ia n s a r e r ig o r o u s ly e n g a g e d in b e in g a p a r t o f th e s o lu tio n to r e d u c e o p io id u s a g e a n d d e v e lo p b e tte r, a n d m o r e im p o r ta n tly, s a fe r p a in m a n a g e m e n t th e r a p ie s .

What is the Department of Justice’s current appetite for pursing cases alleging off-label promotional activities? Kathleen M. Marcus, Stradling: T h e D O J

c o n tin u e s to a c tiv e ly p u r s u e o ff- la b e l c a s e s . In fa c t, th e D O J is in c r e a s in g its h e a lth c a r e - fo c u s e d r e s o u r c e s in th e w a k e o f th e o p io id e p id e m ic . T r u th fu ln e s s r e m a in s a c o r e c o n s id e r a tio n in o ff- la b e l m a tte r s , a n d th e D O J c o n s id e r s th e p r e s e n c e o f o th e r m is c o n d u c t o r “ p lu s fa c to r s ” in its c h a r g in g d e c is io n s . In a F e b r u a r y 2 0 1 8 s p e e c h , D A A G E th a n D a v is v o w e d to “ v ig o r o u s ly in v e s tig a te a n d p r o s e c u te fir m s th a t m a k e fa ls e o r m is le a d in g s ta te m e n ts ” a n d ta r g e t p r a c tic e s th a t “ th r e a te n p a tie n t h e a lth o r s a fe ty.” C o n s is te n t w ith th a t p o lic y, th e D O J lo o k s to w h e th e r : ( 1 ) a c o m p a n y m is le d d o c to r s , p a tie n ts o r th e F D A ; ( 2 ) th e c o n d u c t in v o lv e d im p r o p e r in d u c e m e n ts ; o r ( 3 ) p e o p le w e r e h a r m e d . In c o n tr a s t, w e a r e n o t s e e in g th e s a m e le v e l o f e n fo r c e m e n t a c tiv ity fr o m th e F D A . T h e r e is s till n o fin a l F D A o ff- la b e l p r o m o tio n p o lic y, a n d th e F D A ’s O ffic e o f P r e s c r ip tio n D r u g P r o m o tio n is s u e d th e fe w e s t d is c ip lin a r y le tte r s o n r e c o r d in 2 0 1 7 .

continued on page B-52

The DOJ continues to actively pursue off-label cases. In fact, the DOJ is increasing its healthcare- focused resources in the wake of the

• pioid epidemic. Truthfulness

remains a core consideration in off- label matters, and the DOJ considers the presence of other misconduct or ‘plus factors’ in its charging decisions. Kathleen M. Marcus Shareholder & Co-Chair, Enforcement Defense & Investigations Practice Group Stradling

HEALTHCARE ROUNDTABLE

B-52 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

Warren Buffett and other business leaders have announced a new healthcare initiative that will seek to reduce costs and improve quality for employers through direct contracting or through employer networks. How has your organization addressed the employer healthcare marketplace in Orange County, and what can other employers do to yield similar change, transparency and cost mitigation? What will be the impact of these types of alliances on employers, families and consumers, as well as traditional healthcare providers? Barry Arbuckle, MemorialCare: Employers are seeking better value in the care employees receive and health benefits they

• ffer. MemorialCare is in an ideal position to

provide high-quality care at lower costs to employers and their employees. These include direct-to-employer customized contracts and accepting responsibility for healthcare cost trend and quality

• expectations. MemorialCare was chosen by

Boeing as its preferred partner for California’s first-of-its-kind customized health plan option for many of its Southern California employees. A 20% enrollment growth in just its second year indicates high satisfaction by Boeing

• employees. MemorialCare also partners with

health plans in value-based models. Aetna Whole Health PPO model provides many similar benefits as the Boeing customized model and Vivity’s HMO product with Anthem and six other top healthcare systems offers patients access to top physicians and hospitals with a single patient health record, thus maximizing care coordination and minimizing duplication. We also offer solutions to counter unhealthy lifestyles by engaging employers, schools and community

• rganizations in healthy living partnerships.

Will Righeimer, Lindora: We know that

• besity often leads to a myriad of chronic

diseases including heart disease and stroke, diabetes, hypertension, pulmonary disease and many cancers. We also know that, according to a recent article in Forbes magazine, obesity is costing American companies more than $70 billion annually. Lindora’s solution is to work directly with corporations and organizations to help employees lose weight and improve their

• verall health. By doing so, companies can

improve employee health and happiness, reduce absenteeism and healthcare costs, and improve worker productivity. Lindora works with local businesses and offers them special employee pricing, in-clinic or on-site programs, and customized wellness

• programs. Programs cost between $1-$3 a

day per patient. Jennifer Mitzner, Hoag Orthopedic Institute: Hoag Orthopedic Institute was an early leader in the development of commercial bundled payments, the concept of one fixed cost for an episode of care such as a knee or hip replacement with a warranty pledge. Patients who are with employer-based direct contracting programs come to HOI from all

• ver the U.S., have surgery and recover

initially here before returning home. They usually come with a family member and all of the costs for this are bundled into a fixed fee. HOI engages a patient navigator to manage all of the details of each corporate travel patient, which makes the process seamless. Our bundled corporate patients – and their employers – report a high degree of satisfaction with this program. Orange County is a great destination for travel medicine. Scott Aston, Burnham Benefits: The Berkshire/Chase/Amazon model is actually not that new of an approach. Employers have looked to leverage their employee membership in specific geographies to negotiate exclusive deals with providers/facilities that can undercut traditional network discounts. I think the new twist on this will be leveraging transparency and technology on the purchasing end and arming the end user employees with technology to get the right care, at the right place, at the right time and at the right price. The ACA paved the way by incentivizing hospital systems to re-think how they contract through its promotion of Accountable Care Organizations (ACOs). The Berkshire/Chase/Amazon model will further define and create a new healthcare economy, which we’ll all hopefully be able to benefit from in the future. Collaboration with physicians is critical to ensuring excellence in healthcare and

• rganizational success. How are you

building, maintaining and sustaining relationships with physicians? Erik G. Wexler, Providence St. Joseph Health: Providence St. Joseph Health works hard to ensure we’re the partner of choice for

• ur doctors. Over the years, we’ve formed

strong alliances through our medical groups, Clinical Institutes (which provide advanced care by using best practices and protocols) and other arrangements. Through focused collaboration with exceptional clinicians, we’re identifying best practices and standardizing processes that ensure

• utstanding healthcare delivery. In addition,

we recognize the importance of expanding the digital landscape with our physician

• partners. We’re enhancing our use of

telehealth, digital patient engagement, and more through technologies such as our Circle app for expectant parents (coming this fall) and our online patient portal, which enables patients to view their health records, schedule appointments and communicate directly with their doctor in a secure environment. Gene Rapisardi, Cigna: Cigna has developed multiple approaches to collaborating with physicians. Our Cigna Collaborative Care arrangements throughout Southern California (and nationally) are ACO- like arrangements with primary care medical groups that reward the groups for meeting certain quality and cost goals. Our alliances with St. Joseph Hoag Health, Scripps and HealthCare Partners are even deeper collaborations that create a “healthcare ecosystem” in which all aspects of an individual’s care are carefully integrated. We are also on a journey to develop patient- centered medical “neighborhoods” in which there is better care coordination, navigation and an overall improved patient and physician experience. Will Righeimer, Lindora: This is something that our Chief Medical Officer, Dr. Amy Lee, takes very seriously. Dr. Lee is constantly meeting with medical colleagues and industry experts who specialize in obesity medicine, continued on page B-54

Hoag Orthopedic Institute was an early leader in the development of commercial bundled payments, the concept of one fixed cost for an episode of care such as a knee or hip replacement with a warranty

• pledge. Patients who are with

employer-based direct contracting programs come to HOI from all over the U.S., have surgery and recover initially here before returning home. Jennifer Mitzner CEO Hoag Orthopedic Institute

HEALTHCARE ROUNDTABLE

APRIL 9, 2018 Local breaking news: www.ocbj.com ORANGE COUNTY BUSINESS JOURNAL B-53

B-54 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

a s w e ll a s g e n e r a l p r a c titio n e r s w h o a r e s tr u g g lin g to d e d ic a te th e tim e a n d e x p e r tis e n e e d e d to p r o p e r ly s e r v e o b e s e p a tie n ts . D ia lo g u e b e tw e e n th e s e g r o u p s a llo w s u s to r e m a in a t th e fo r e fr o n t o f m e d ic a l w e ig h t lo s s , to u n d e r s ta n d th e c h a lle n g e s o f b o th p h y s ic ia n s a n d p a tie n ts , a n d to a c t a s a n

• u ts o u r c e e x p e r t fo r th e p h y s ic ia n c o m m u n ity.

O u r te a m h a s a ls o e s ta b lis h e d s tr o n g r e la tio n s h ip s w ith p r o v id e r s w ith in m e d ic a l g r o u p s , o u tp a tie n t s u r g ic a l c e n te r s , p a y e r n e tw o r k s , b e n e fit p r o v id e r s , c o r p o r a te w e lln e s s a n d p r iv a te in d u s tr y to s h a r e b e s t p r a c tic e s a n d o ffe r o u r p a tie n t s e r v ic e s .

Jennifer Mitzner, Hoag Orthopedic Institute: A s a p h y s ic ia n - o w n e d a n d le d

e n te r p r is e , H o a g O r th o p e d ic In s titu te ’s m o d e l is c e n te r e d a r o u n d p h y s ic ia n e n g a g e m e n t. W e h a v e fo u n d th a t w h e n p h y s ic ia n s a n d s u r g e o n s h a v e “ s k in in th e g a m e ,” it c h a n g e s th e m o d e l d y n a m ic a lly in m a n y p o s itiv e w a y s . H O I p h y s ic ia n s s h a r e a u n iq u e p a s s io n fo r p a tie n t c a r e in n o v a tio n a n d r e s e a r c h , o n e th a t h a s c o m e to e p ito m iz e o u r b r a n d a c r o s s th e n a tio n . O u r c lin ic a l o u tc o m e s a r e s o m e o f th e b e s t in th e c o u n tr y a n d e a c h a n d e v e r y o n e o f

• u r p h y s ic ia n s p la y s a n a c tiv e r o le in o u r

c o m m itm e n t to e x c e lle n c e .

Ray Chicoine, Monarch HealthCare:

M o n a r c h d o e s n ’t ju s t c o lla b o r a te w ith p h y s ic ia n s ; w e a r e p h y s ic ia n s . A s a p h y s ic ia n - le d o r g a n iz a tio n fo u n d e d b y p r a c tic in g d o c to r s , w e th r iv e u n d e r o u r m o d e l o f c o o r d in a te d m e d ic a l c a r e . W ith o u r p a r tn e r O p tu m , w e ’v e w o r k e d tir e le s s ly to b r in g n e w d o c to r s in to o u r n e tw o r k w h ile e n s u r in g th a t o u r e x is tin g p h y s ic ia n s h a v e th e s u p p o r t th e y n e e d to m o r e e ffe c tiv e ly c a r e fo r p a tie n ts . It’s n o s e c r e t th a t m a n y p h y s ic ia n s to d a y fa c e b u r n o u t a n d r e p o r t th a t th e y a r e s p e n d in g m o r e tim e th a n e v e r o n a d m in is tr a tiv e w o r k a n d s a tis fy in g fe d e r a l a n d s ta te r e g u la to r y r e q u ir e m e n ts . B u t a s a le a d e r in o u r in d u s tr y, w e h a v e w o r k e d to m in im iz e th o s e b u r d e n s s o o u r p h y s ic ia n s c a n fo c u s o n p a tie n t c a r e . W e h a v e o n g o in g in v e s tm e n ts in r e s o u r c e s , w o r k s h o p s a n d te c h n o lo g y to h e lp o u r d o c to r s m e e t g r o w in g d e m a n d s a n d im p r o v e w o r k flo w . O u r a lig n e d p h y s ic ia n s a p p r e c ia te o u r s u p p o r t in h e lp in g im p r o v e th e h e a lth o f th e c o m m u n itie s th e y s e r v e a n d th e y r e c o g n iz e th e w o r k w e ’v e d o n e to b e p h y s ic ia n fr ie n d ly.

Why is it necessary for healthcare

• rganizations to provide patients with a full

continuum of care, and what is being done to address this need? Tonmoy Sharma, Sovereign Health: P a tie n ts

w ith c h r o n ic illn e s s e s lik e d ia b e te s a n d h e a r t d is e a s e a r e v u ln e r a b le to r e la p s e a n d r e c u r r e n c e ; th o s e w ith b e h a v io r a l h e a lth d is o r d e r s s h o u ld n ’t b e v ie w e d o r tr e a te d a n y d iffe r e n tly. S u c h c o n d itio n s c a n b e e ffe c tiv e ly tr e a te d a n d m a n a g e d w ith a fu ll c o n tin u u m o f in te g r a te d , r e c o v e r y - o r ie n te d c a r e fo c u s in g o n lo n g - te r m m o n ito r in g , n o t ju s t s ta b iliz a tio n . A u n ifie d s y s te m e n s u r e s p a tie n ts r e c e iv e th e s e r v ic e s n e e d e d , r e g a r d le s s o f th e s e ttin g th e y ’r e in , p r o m o te s w e lln e s s a n d e m p o w e r s p a tie n ts to ta k e r e s p o n s ib ility fo r th e ir liv e s . It’s th e p r o v id e r s ’ r e s p o n s ib ility to te a c h p a tie n ts h o w to m a n a g e th e ir s y m p to m s a n d m a k e h e a lth y c h o ic e s th a t s u p p o r t th e ir o v e r a ll h e a lth . A s p a tie n ts w ith c o m o r b id a d d ic tio n a n d m e n ta l illn e s s ty p ic a lly h a v e p o o r e r

• u tc o m e s a n d h ig h e r u tiliz a tio n r a te s th a n th e

g e n e r a l p a tie n t p o p u la tio n , m o v in g to w a r d a n in te g r a te d , p a tie n t- o r ie n te d s y s te m o f c a r e a llo w s o r g a n iz a tio n s to in c o r p o r a te h o lis tic s e r v ic e s a n d a d d r e s s a ll o f th e p a tie n t’s n e e d s , w h ile w o r k in g to a c h ie v e b e tte r c a r e , h e a lth ie r p a tie n ts a n d lo w e r c o s ts .

Mark Costa, Kaiser Permanente Orange County: W ith th e h ig h in c id e n c e o f c h ro n ic

d is e a s e a n d th e g ro w th in o u r e ld e rly p o p u la tio n a s tro n g c o n tin u u m o f c a re is e s s e n tia l. W ith in K a is e r P e rm a n e n te w e c o n tin u e to d e v e lo p n e w c o m p o n e n ts o f o u r c o n tin u u m o f c a re a n d to s tre n g th e n e x is tin g P rim a ry C a re , M e n ta l H e a lth , H o m e C a re , L o n g Te rm C a re a n d H o s p ic e /P a llia tiv e C a re S e rv ic e b a s e d o n th e c h a n g in g n e e d s o f th o s e w e s e rv e . W e a ls o s e e g re a t o p p o rtu n ity in d e v e lo p in g s tro n g e r re la tio n s h ip s w ith e x is tin g

• r n e w c o m m u n ity p ro v id e rs o f h e a lth a n d

s o c ia l s e rv ic e s . In re s p o n s e to o u r g ro w in g e ld e rly p o p u la tio n , th is m a y b e s u p p o rtiv e s e rv ic e s re la te d to d a ily m e a ls , tra n s p o rta tio n , d a y c a re a n d s u p p o rt fo r d e m e n tia . F o r o th e r re fe rra ls to c o m m u n ity re s o u rc e s p ro v id in g d is e a s e s p e c ific s u p p o rt, h e a lth e d u c a tio n a n d fitn e s s m a y b e a re a s o f o p p o rtu n ity. T h e b o tto m lin e is th a t th a t n o h e a lth c a re p ro v id e r c a n a lo n e m e e t a ll th e h e a lth c a re n e e d s o f in d iv id u a ls . T w o e x a m p le s o f h o w h e a lth c a re s y s te m s a n d o th e r p riv a te a n d p u b lic e n titie s a re c o m in g to a d d re s s h e a lth c a re g a p s w ith in O ra n g e C o u n ty is th e w o rk le d b y th e U n ite d W a y to e n d h o m e le s s n e s s (U n ite d to E n d H o m e le s s n e s s ) a n d th e w o rk o f th e O ra n g e C o u n ty C o m m u n ity C o a litio n fo r B e h a v io ra l H e a lth . K a is e r P e rm a n e n te v ie w s e ffo rts s u c h a s th e s e to b e e s s e n tia l a s w e w o rk to im p ro v e th e h e a lth o f a ll O ra n g e C o u n ty C o m m u n itie s .

Will Righeimer, Lindora: W e ’v e fo u n d th a t

th e r e a n u m b e r o f fa c to r s a t p la y w h e n it c o m e s to o b e s ity. M o s t w e ig h t lo s s c o m p a n ie s w ill fo c u s s o le ly o n th e n u tr itio n a l a s p e c ts o f o b e s ity. L in d o r a g o e s b e y o n d th a t to u n d e r s ta n d th e p s y c h o lo g ic a l a n d e n v ir o n m e n ta l fa c to r s th a t d r iv e a n o b e s e p e r s o n ’s b e h a v io r. W e a r e a ls o ta k in g a lo n g - te r m v ie w – to d r iv e b e h a v io r a l c h a n g e fo r life lo n g s u c c e s s . W h ile th e w e ig h t lo s s p o r tio n o f o u r p r o g r a m is ty p ic a lly te n w e e k s ,

• u r p a tie n ts a r e w ith u s fo r a m in im u m o f o n e

y e a r. T h a t w a y w e c a n te a c h h e a lth y h a b its a n d in s till life lo n g c h a n g e . M a n y o f o u r p a tie n ts w ill s ta y w ith u s fo r y e a r s b e y o n d th a t in o r d e r to m a in ta in a h e a lth y w e ig h t a n d w e llb e in g . T h a t c o n tin u u m o f c a r e is c r itic a l to e s ta b lis h in g th a t lo n g - te r m b e h a v io r a l c h a n g e a n d o v e r a ll p a tie n t w e lln e s s .

Gene Rapisardi, Cigna: C ig n a ’s m is s io n is

to h e lp p e o p le g e t a n d s ta y h e a lth y, n o m a tte r w h e r e th e y fa ll o n th e h e a lth c a r e c o n tin u u m . T h r o u g h o u r h e a lth c o a c h in g a n d o th e r c lin ic a l p r o g r a m s , w e h e lp h e a lth y p e o p le s ta y h e a lth y ; h e lp p e o p le w h o a r e a t r is k fo r h e a lth d e te r io r a tio n to r e v e r s e th a t tr e n d ; a n d h e lp p e o p le m a n a g e th e ir c h r o n ic c o n d itio n s , m in im iz e h e a lth c o m p lic a tio n s a n d s ta y a s h e a lth y a s p o s s ib le . O u r r o le is to c o n n e c t o u r c u s to m e r s to c o o r d in a te d , e v id e n c e - b a s e d c a r e th a t’s a p p r o p r ia te to th e ir c ir c u m s ta n c e s , a n d to s u p p o r t th e m w ith s p e c ia liz e d p r o g r a m s th a t h e lp th e m m a n a g e c h r o n ic c o n d itio n s lik e d ia b e te s , h e a r t d is e a s e a n d d e p r e s s io n . O u r v a lu e - b a s e d p r o g r a m s a n d

• u r a llia n c e s w ith le a d in g d e liv e r y s y s te m

p a r tn e r s lik e S t. J o s e p h H o a g H e a lth a r e fo c u s e d o n h e lp in g o u r c u s to m e r s g e t th e r ig h t c a r e a t th e r ig h t tim e a n d in th e r ig h t s e ttin g .

continued on page B-56

Monarch doesn’t just collaborate with physicians; we are physicians. As a physician-led organization founded by practicing doctors, we thrive under our model of coordinated medical care. With our partner Optum, we’ve worked tirelessly to bring new doctors into

• ur network while ensuring that our

existing physicians have the support they need to more effectively care for patients. Ray Chicoine President Monarch HealthCare

HEALTHCARE ROUNDTABLE

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B-56 ORANGE COUNTY BUSINESS JOURNAL Healthcare Roundtable APRIL 9, 2018

In the public exchanges, we saw the selection of lower-premium products with restricted provider choice by consumers. Do you think Americans are more willing to trade off choice for affordability? Suzanne Richards, KPC Health: A m e ric a n s

h a v e s h o w n tim e a n d a g a in th a t th e y a lw a y s p re fe r h a v in g c h o ic e s . H o w e v e r, o u r h e a lth c a re s y s te m h a s e n a b le d s k y ro c k e tin g p re m iu m s

• fte n le a v in g w o rk in g fa m ilie s w ith v e ry fe w
• p tio n s a n d fo rc in g th e m to s e le c t a ffo rd a b ility
• v e r c h o ic e . T h a t is w h y it is s o c ritic a lly

im p o rta n t th a t th e n e x t ro u n d o f re fo rm s to o u r h e a lth c a re s y s te m fo s te r g re a te r p a rtic ip a tio n a n d p ric e c o m p e titio n a m o n g s t in s u re rs to s ta b iliz e p re m iu m s fo r fa m ilie s , p ro v id e m o re a p p ro p ria te p a y m e n ts to p ro v id e rs fo r s e rv ic e s , a n d p ro m o te g re a te r a c c e s s to p re v e n tiv e c a re .

Scott Aston, Burnham Benefits: T h ro u g h o u t

th e 8 0 s , 9 0 s a n d e a rly 2 0 0 0 s , A m e ric a n s g re w v e ry a c c u s to m e d to h a v in g lo w -n o c o s t h e a lth in s u ra n c e , w ith v e ry little o u t o f p o c k e t c o s ts a n d la rg e p ro v id e r n e tw o rk s . M o s t d id n ’t e v e n re a liz e h o w g o o d th e y h a d it o r g a v e m u c h th o u g h t to w h e th e r th e y n e e d e d th a t ric h o f a p la n . G iv e n th e h e a lth c a re c o s t c ris is , th a t m o d e l is n o lo n g e r s u s ta in a b le . S tu d ie s h a v e c o n tin u e d to p ro v e o u t a n d th e E x c h a n g e e n ro llm e n t n u m b e rs d e m o n s tra te th a t w h e n g iv e n a c h o ic e m o s t in d iv id u a ls p re fe r to p a y lo w e r p re m iu m s in e x c h a n g e fo r h ig h e r o u t o f p o c k e t c o s ts a n d /o r re d u c e d n e tw o rk s iz e ...w ith in re a s o n . T h e m a rk e t is s till try in g to fin d b a la n c e fo r th a t s w e e t s p o t.

The pace of change in medicine is rapid. We now understand that social factors – education, transportation, housing, etc. – can affect care utilization patterns. How does your organization view its involvement in social interventions? How are you preparing healthcare providers of the future to adapt to changes and improve care in an increasingly diverse community? Phil Yaeger, Radiant Health Centers: R a d ia n t

H e a lth C e n te rs is a t th e fo re fro n t o f th e s e is s u e s . A ll o f o u r s y s te m s a re s e t u p to re d u c e b a rrie rs a n d g e t p e o p le re ta in e d in p ro p e r m e d ic a l c a re a n d o n th e ir w a y to b e c o m in g h e a lth y a n d s e lf-s u ffic ie n t. O u r s e rv ic e s s ta rt b y a d d re s s in g u n d e rly in g s o c ia l fa c to rs lik e p ro v id in g fo o d w h e n th e y h a v e n o n e , tra n s itio n a l h o u s in g w h e n th e y a re h o m e le s s , a w e lc o m in g p la c e fo r th e ir c h ild re n to p la y a n d m a k e frie n d s h ip s , a rid e to m e d ic a l a p p o in tm e n ts . T h e s o o n e r th a t th e s e s o c ia l is s u e s c a n b e a d d re s s e d , th e s o o n e r w e c a n h e lp o u r p a tie n ts s ta b iliz e th e ir H e p C , H IV o r a b e h a v io ra l o r m e n ta l h e a lth c o n d itio n s . F ra n k ly, th e p o p u la tio n w e s e rv e is o fte n in d ire s tra its a n d th e ir h e a lth is ju s t o n e o f m a n y c ris e s to b e fa c e d . W ith th e c o o p e ra tio n o f o u r m a n y c o m m u n ity p a rtn e rs in b o th s o c ia l a n d m e d ic a l s e rv ic e s , fo rtu n a te ly, w e h a v e b e e n a b le to h e lp m o re th a n 1 ,3 0 0 p e o p le a n n u a lly.

Yasith Weerasuriya, Stanbridge University:

S ta n b rid g e U n iv e rs ity is a c u te ly a w a re o f th e c o n tin u in g tre n d to w a rd s c o m m u n ity -b a s e d h e a lth c a re a n d p re v e n ta tiv e m e d ic in e . T h e e x tra o rd in a rily d iv e rs e n a tu re o f S o u th e rn C a lifo rn ia w ill re q u ire h e a lth c a re g ra d u a te s to h a v e a s tro n g e d u c a tio n in c u ltu ra l, re lig io u s , a n d e th n ic d iv e rs ity. S ta n b rid g e is in c re a s in g th e u tiliz a tio n o f v irtu a l p a tie n t ro o m s w ith s im u la te d s c e n a rio s th a t p re p a re g ra d u a te s to s u c c e s s fu lly s e rv e th e d iv e rs e p o p u la tio n o f S o u th e rn C a lifo rn ia .

The multi-cycle baby boomer retirements have seen an increase in the need for geriatric care. Where do you see the most acute geriatric healthcare staffing needs in the future for Orange County? Richard J. Gannotta, UCI Health: U C I

H e a lth is le v e r a g in g its a c a d e m ic a n d c lin ic a l e x p e r tis e to m e e t th is c h a lle n g e . W e p r o v id e c o m p r e h e n s iv e c lin ic a l c a r e n o t o fte n s e e n in th is p o p u la tio n th r o u g h th e U C I H e a lth S e n io r H e a lth C e n te r, c o n s is te n tly r a te d a m o n g b e s t b y U .S . N e w s & W o r ld R e p o r t a n d o n e o f th e c o u n tr y ’s fir s t c e r tifie d P a tie n t C e n te r e d M e d ic a l H o m e s fo r c o o r d in a te d g e r ia tr ic c a r e . W e p r o v id e p r e v e n tio n , w e lln e s s a n d h ig h e r le v e ls o f c a r e fo r c h r o n ic c o n d itio n s to e m p o w e r o ld e r p a tie n ts to m a n a g e th e ir o w n h e a lth . W e a r e s h a r in g th a t e x p e r tis e w ith th e c o m m u n ity, th r o u g h a c a d e m ic in itia tiv e s s u c h a s C u ltiv a tin g a C u ltu r e o f C a r e fo r O ld e r A d u lts , w h ic h w ill in c r e a s e th e n u m b e r o f h e a lth c a r e p r o fe s s io n a ls tr a in e d to m e e t th e n e e d s o f

• ld e r a d u lts . T h is e ffo r t, le d b y U C I e x p e r ts in

g e r ia tr ic s a n d n u r s in g , a n d c o m m u n ity p a r tn e r s lik e th e A lz h e im e r ’s A s s o c ia tio n o f O r a n g e C o u n ty, V ie tn a m e s e C o m m u n ity o f O C - S o u th la n d H e a lth C e n te r a n d th e c o u n ty ’s s o c ia l s e r v ic e s a g e n c y, w ill d r iv e in n o v a tio n s in c o o r d in a tin g c a r e fo r s u s ta in e d a n d m e a n in g fu l im p r o v e m e n t fo r

• ld e r a d u lts .

Mark Costa, Kaiser Permanente Orange County: S e le c tin g th e r ig h t te a m a n d c o r r e c t

s ta ffin g is c r u c ia l to m e e t th e n e e d s o f th e a g in g p o p u la tio n in O r a n g e C o u n ty. It is c r itic a l th a t a p a s s io n fo r th e s e n io r a d u lt is c o n s id e r e d w h e n p r o v id in g e ld e r c a r e . T w o e x a m p le s o f o u r e ffo r ts in tr e a tin g O r a n g e C o u n ty ’s s e n io r p o p u la tio n r e v o lv e a r o u n d

• u r N IC H E u n it a n d ( IQ M ) In te g r a te d Q u a lity

M a n a g e m e n t. B o th in itia tiv e s fo c u s o n m e e tin g th e u n iq u e n e e d s o f o u r s e n io r p o p u la tio n in th e a c u te c a r e s e ttin g a n d th r o u g h o u t th e c o n tin u u m o f c a r e . T h e s e in itia tiv e s r e q u ir e h ig h ly s k ille d p r o fe s s io n a ls , m a n y o f w h o m h a v e a g e r ia tr ic c e r tific a tio n . A c c o r d in g to th e 2 0 1 7 U .S D e p a r tm e n t o f L a b o r B lo g , b y 2 0 2 4 , n e a r ly 7 0 m illio n p e o p le w ill b e b e tw e e n th e a g e s o f 6 0 a n d 7 8 . A s a r e s u lt, o c c u p a tio n s r e la te d to e ld e r c a r e a r e p r o je c te d to b e a m o n g th e fa s te s t g r o w in g in th e e c o n o m y o v e r th e n e x t d e c a d e . In fa c t, h o m e h e a lth a id e s , p e r s o n a l c a r e a id e s , r e g is te r e d n u r s e s , n u r s in g a s s is ta n ts a n d L P N s /LV N s a r e p r o je c te d to a d d m o r e th a n 1 .6 m illio n n e w jo b s n a tio n w id e b y 2 0 2 4 , o r a b o u t o n e in s ix n e w jo b s a d d e d to th e e c o n o m y. W ith in O r a n g e C o u n ty, K a is e r P e r m a n e n te is r e d e s ig n in g H o m e C a r e to m e e t th e n e e d s o f o u r m e m b e r s a s c a r e m o v e s fr o m a c u te c a r e in to th e h o m e e n v ir o n m e n t. M o r e r e s o u r c e s w ill b e n e e d e d to a d d r e s s th e d e m a n d fo r p r iv a te d u ty c a r e ( n o n - s k ille d c a r e ) s u c h a s h o m e h e a lth a n d p e r s o n a l a id e s w h ic h a r e n o t c o v e r e d b y a n y in s u r a n c e c a r r ie r. T h is is e s p e c ia lly n e e d e d w h e n a d d r e s s in g A lz h e im e r ’s d is e a s e a n d r e la te d d e m e n tia s .

Yasith Weerasuriya, Stanbridge University: T h r e e w a v e s o f r e tir in g b a b y

b o o m e r s w ill p la c e a n e x tr a o r d in a r y a m o u n t

• f s tr e s s o n th e g e r ia tr ic a b s o r p tio n

c a p a b ilitie s o f S o u th e r n C a lifo r n ia . W e c o n tin u e to e d u c a te o u r s tu d e n ts o n a ll o f th e r e la te d d im e n s io n s in th e n u r s in g a n d th e r a p y fie ld s , in c lu d in g in c r e a s e d tr a in in g in

continued on page B-58

Stanbridge University is acutely aware of the continuing trend towards community-based healthcare and preventative

• medicine. The extraordinarily diverse

nature of Southern California will require healthcare graduates to have a strong education in cultural, religious, and ethnic diversity. Yasith Weerasuriya President & CEO Stanbridge University

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dementia, stroke rehabilitation, and other critical needs for the burgeoning geriatric population. How is the “Yates Memo” impacting internal investigations and interactions with the government under the current administration? Kathleen M. Marcus, Stradling: The 2015 “Yates Memo” articulated principles for enhancing enforcement against individuals involved in corporate wrongdoing, including the requirement that companies provide all relevant facts concerning individual conduct to the DOJ as a condition of receiving any corporate cooperation credit. In October 2017, DAG Rosenstein pronounced the Yates Memo “under review,” but indicated that modifications will reflect a “resolve to hold individuals accountable for corporate wrongdoing.” The Yates Memo thus remains DOJ policy and its effects are observable in the aggressive pursuit of individuals in recent enforcement actions. As a result, internal investigations should be managed at the

• utset to be sensitive to the prickly issues of

separate counsel and related employment questions (which adds expense and can disrupt information flow). Investigating attorneys must also consider the sufficiency

• f UpJohn warnings and the strategy for

protecting privileges when the company intends to offer transparency and cooperate with a government investigation. How significant will the January 2018 “Cranston Memo” be in curtailing False Claims Act litigation? Kathleen M. Marcus, Stradling: The “Cranston Memo” should become a significant tool for defense counsel in False Claims Act

• cases. DOJ attorneys can now assume a

gatekeeper function and proactively consider dismissal of qui tam complaints when the government declines to intervene. On average, the government intervenes in just 20% of cases, but continues to monitor the remaining 80%. Based on a desire to preserve resources and advance the government’s interests, the Cranston Memo lays out seven factors for evaluation of cases for dismissal. Armed with this framework, defense lawyers now have a roadmap to advocate beyond non-intervention and for complete dismissal. To gain this advantage, companies facing a False Claims Act case should consider a swift internal investigation to gather evidence to present to the DOJ early in the process. This will allow defense counsel to persuasively advocate for each applicable factor. How is your health system leveraging advances in technology and data to improve the health and wellbeing of the patients you serve? What innovations are likely in the next three to five years and how do you think these changes will impact healthcare? How can the healthcare industry improve its ability to innovate? Tonmoy Sharma, Sovereign Health: Sovereign Health strives to be leaders of

• innovation. We’ve created and adopted new

technologies and implemented measurement- based care protocol to provide clinicians with patient feedback and evaluate symptoms, cognitive functioning and personality variables

• f patients throughout the treatment course

to improve the delivery of care and patients’ clinical outcomes. We have also created an internal workflow system that leverages in- house software capabilities to improve the process of working with patients we serve. The Patient Information Management System captures real-time information about patients and allows us to manage multiple users involved in patient care. We leverage telehealth and smartphone apps to reach those who cannot physically attend treatment, involve family members in treatment and provide ongoing case management and care to patients after they return home. As relapse rates tend to be high in the first year after treatment, ongoing involvement can help to improve treatment

• utcomes and recovery.

Barry Arbuckle, MemorialCare: MemorialCare’s commitment to nurturing and advancing innovation drives efficiency, accuracy, time-to-treatment and patient

• utcomes – saving time, resources, costs –

and most importantly lives. Systematic measurements using metrics that matter to patients produce remarkable results. Decades ago, MemorialCare began performing extensive clinical outcome assessments deploying best-practice, evidence-based medicine in our hospitals,

• utpatient centers and physicians’ offices.

Sophisticated information systems providing timely, trusted analytics for fact-based decision-making improve quality, patient experiences and communications, while decreasing hospitalizations and duplication. Near-instantaneous analytics with billions of data points allow physicians to analyze results with extraordinary improvements in care and overall health. And MemorialCare’s strategic investment partnership with Cedars- Sinai – Summation Health Ventures – speeds innovation, improves outcomes and decreases cost by helping entrepreneurs accelerate product development, ensuring communities early access to emerging products, devices, information and other

• technologies. Recent MemorialCare

innovative partnerships have resulted in technologies that better treat strokes, monitor surgical blood loss in real-time, prevent surgical infections, and identify the most effective medications at the best price. Erik G. Wexler, Providence St. Joseph Health: Health systems are getting serious about population health, focusing on preventive care and disease management

• utside the hospital. To do population health

right, collecting and efficiently employing large amounts of data is imperative – and we’re doing that as we’re making significant investments in health data coordination, advanced analytics and predictive modeling. When it comes to digital technology, we’re laser focused, thanks to leadership with expertise in that industry. We’re excited to introduce innovations such as Express Care,

• n-demand healthcare services delivered via

retail clinics, virtual video visits, an “uber- like” home visit option and the Circle app. We also established the Innovation Institute and Providence Ventures, which invest in customized solutions to our most pressing health problems. Scott Aston, Burnham Benefits: Burnham has worked with its customers to embrace continued on page B-60

Sovereign Health strives to be leaders of innovation. We’ve created and adopted new technologies and implemented measurement-based care protocol to provide clinicians with patient feedback and evaluate symptoms, cognitive functioning and personality variables of patients throughout the treatment course to improve the delivery of care and patients’ clinical outcomes. Tonmoy Sharma, M.B.B.S., M.Sc. Founder & CEO Sovereign Health

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a v a ila b le d a ta to h e lp d r iv e c o s ts o n its e m p lo y e r s p o n s o r h e a lth p la n s . M a n y o f o u r c u s to m e r s a r e s e lf- fu n d e d , w h ic h a llo w s fo r th e g r e a te s t tr a n s p a r e n c y a n d a c c e s s to d a ta . W e c a n le v e r a g e th a t d a ta to ta ilo r p la n d e s ig n s , id e n tify h ig h c la im a n ts o fte n b e fo r e th e y h a p p e n , a n d h e lp to d r iv e m e m b e r s in to g e ttin g th e r ig h t tr e a tm e n ts b e fo r e little c la im s tu r n in to b ig o n e s . W e h a v e a ls o s e e n a s u r g e in v ir tu a l p r o v id e r v is its a n d n o w o n - d e m a n d h o u s e c a ll v is its , th in k U b e r m e e ts p r im a r y c a r e .

Gene Rapisardi, Cigna: U s in g te c h n o lo g y to

s u p p o r t o u r c u s to m e r s s o th e y c a n b e tte r u n d e r s ta n d th e ir h e a lth c a r e c h o ic e s is a s ig n ific a n t p r io r ity fo r u s . F o r e x a m p le , w e h a v e in tr o d u c e d C ig n a O n e G u id e , a n in te g r a te d h i- te c h /h i- to u c h a p p r o a c h to c u s to m e r d e c is io n s u p p o r t a n d s e r v ic e . O n e G u id e h e lp s p e o p le n a v ig a te th r o u g h th e ir c r itic a l d e c is io n p o in ts , s u c h a s s e le c tin g a h e a lth p la n , c h o o s in g a p r im a r y c a r e p h y s ic ia n , r e c e iv in g p r e v e n tiv e s e r v ic e s , b e n e fitin g fr o m h e a lth im p r o v e m e n t p r o g r a m s a n d r e c e iv in g a v a ila b le c a s h r e w a r d s . O n e G u id e d e liv e r s c le a r, p e r s o n a liz e d g u id a n c e n o t o n ly w h e n e v e r a c u s to m e r n e e d s it, b u t e v e n w h e n th e y m a y n o t r e a liz e th e y d o . O n e G u id e is a v a ila b le to m illio n s o f c u s to m e r s n a tio n a lly, in c lu d in g h e r e in S o u th e r n C a lifo r n ia .

Will Righeimer, Lindora: T h e a b ility fo r

p a tie n ts to tr a c k p e r s o n a l d a ta in r e a l tim e w ill c o n tin u e to h a v e a s ig n ific a n t im p a c t o n p a tie n t o u tc o m e s . W e ’r e a lr e a d y s e e in g th e im p a c t o f w e a r a b le s a n d h o w v a lu a b le th o s e to o ls a r e fo r th e p a tie n t/n u r s e d ia lo g u e . L in d o r a , a s a p a r tn e r, c a n u s e th a t d a ta to a d v is e o u r p a tie n ts o n h o w to im p r o v e d ie t,

• p tim iz e e x e r c is e a n d fin d w a y s to r e d u c e

s tr e s s . W e a ls o b e lie v e th a t th e g r o w th o f te le m e d ic in e w ill m a k e m e d ic a l a n d w e lln e s s c o n s u lta tio n s m o r e c o n v e n ie n t a n d a c c e s s ib le . L in d o r a w ill b e la u n c h in g Lindora Anywhere la te r th is y e a r w h ic h , th r o u g h a n o n lin e p la tfo r m , w ill a llo w p a tie n ts m o r e o p p o r tu n itie s to h a v e th o s e in te r a c tio n s w ith n u r s e s a n d c o a c h e s a t th e ir o w n c o n v e n ie n c e . L a s tly, w e b e lie v e th a t te c h n o lo g y - d r iv e n p a tie n t e n g a g e m e n t to o ls th a t a llo w th e p a tie n t to r e c o r d p e r s o n a liz e d in fo r m a tio n a n d g e t b a c k r e le v a n t g u id a n c e a n d r e c o m m e n d a tio n s w ill fu r th e r e m p o w e r p a tie n ts a n d in c r e a s e th e ir c h a n c e s o f s u c c e s s .

In Orange County, there are still five to six new HIV infections per week. There has been a recent Hepatitis A outbreak and a rise in other healthcare-associated

• infections. How is your health system

protecting patients and improving the health of the community against these and

• ther public health issues?

Richard J. Gannotta, UCI Health: U C I H e a lth

e p id e m io lo g is ts a n d in fe c tio n p r e v e n tio n e x p e r ts p la y a k e y, u n d u p lic a te d r o le w ith O r a n g e C o u n ty p u b lic h e a lth o ffic ia ls in c o n fr o n tin g th e r is e o f h e a lth c a r e - a s s o c ia te d in fe c tio n s a n d a n tib io tic - r e s is ta n t b a c te r ia th a t a r e n o w a m o n g th e g r e a te s t c h a lle n g e s fa c in g h e a lth c a r e p r o v id e r s . N a tio n a lly - r e c o g n iz e d U C I H e a lth e x p e r ts a r e le a d in g c r itic a l m u lti- y e a r r e s e a r c h fu n d e d b y th e C e n te r s fo r D is e a s e C o n tr o l a n d P r e v e n tio n to c o m b a t th e s p r e a d o f th e s e in fe c tio n s in h o s p ita ls a n d n u r s in g h o m e s r ig h t h e r e in O r a n g e C o u n ty. T h o s e e ffo r ts w ill b e a m o d e l fo r k e e p in g p a tie n ts s a fe h e r e a n d a c r o s s th e c o u n tr y.

There has been an increased focus on the need for mental health services in the last few years. Is there a need for more mental health services now than before in Orange County, and if so, what is being done to address this need? Why is it important to treat mental illness at the same time as a substance use disorder, and how does integrated behavioral health treatment help to address both conditions?

Phil Yaeger, Radiant Health Centers: I w o u ld

a rg u e th a t w e a re ju s t b e c o m in g m o re a w a re o f th e n e e d a n d le ttin g g o o f s o m e o f th e s tig m a th a t h a s k e p t m e n ta l h e a lth in a s ilo . T h a t s a id , it is c ritic a lly im p o rta n t to c o n tin u e e x p a n d in g a c c e s s to m e n ta l h e a lth s e rv ic e s in O ra n g e C o u n ty. W e ty p ic a lly s e e p e o p le w h o h a v e h a d a life tim e o f tra u m a s w h e re it is e s s e n tia l to tre a t th e m in d a n d b o d y to g e th e r. U ltim a te ly, a d d re s s in g th e ir m e n ta l h e a lth is ju s t a s c ritic a l a s m a n a g in g th e ir in s u lin

• r h ig h b lo o d p re s s u re . N e a rly h a lf o f a ll

A m e ric a n s w ith a m e n ta l h e a lth c o n d itio n h a v e a c o -o c c u rrin g s u b s ta n c e a b u s e d is o rd e r b e c a u s e p e o p le w ill o fte n s e lf-m e d ic a te th ro u g h s u b s ta n c e a b u s e to tre a t th e ir u n d e rly in g s y m p to m s . A n in te g ra te d tre a tm e n t a p p ro a c h is e s s e n tia l to tre a t th e ro o t is s u e , a s w e ll a s th e a d d ic tio n a n d to h e lp w h e n s o b rie ty b rin g s o th e r life is s u e s to th e s u rfa c e .

Tonmoy Sharma, Sovereign Health: T ra d itio n a l

v o lu m e -b a s e d c a re m o d e ls e m p h a s iz in g q u a n tity ra th e r th a n q u a lity la c k in c e n tiv e s fo r p ro v id e rs to im p le m e n t in te g ra tiv e h e a lth c a re s y s te m s fo r p a tie n ts w ith m e n ta l a n d s u b s ta n c e u s e d is o rd e rs . F o r th is re a s o n , a d d ic tio n a n d m e n ta l illn e s s a re o fte n tre a te d a s s e p a ra te , u n re la te d c o n d itio n s . F a ilin g to a d d re s s b o th c o n d itio n s a t th e s a m e tim e c a n g e t p a tie n ts s tu c k in a “re v o lv in g d o o r,” w h e re th e y re p e a te d ly re la p s e a n d re tu rn to tre a tm e n t, b u t n e v e r g e t b e tte r. F o rth c o m in g p o lic y a n d s y s te m c h a n g e s w ill u ltim a te ly a d d re s s th e n e e d fo r in te g ra te d c a re a n d c h a n g e h o w th e s e c o n d itio n s a re tre a te d . T h e o n ly e ffe c tiv e w a y to tre a t in d iv id u a ls w ith c o -

• c c u rrin g m e n ta l a n d s u b s ta n c e u s e d is o rd e rs is

to tre a t b o th c o n d itio n s a t th e s a m e tim e . A t S o v e re ig n H e a lth , w e ’re lic e n s e d to tre a t b o th m e n ta l d is o rd e rs a n d s u b s ta n c e u s e d is o rd e rs , a n d o u r c lin ic ia n s a re h ig h ly q u a lifie d a n d w e ll- tra in e d to a s s e s s , d ia g n o s e a n d tre a t s u b s ta n c e u s e d is o rd e rs a n d m e n ta l illn e s s a t th e s a m e tim e .

Mark Costa, Kaiser Permanente Orange County: S tu d ie s fo c u s e d o n th e m e n ta l h e a lth

n e e d s o f O ra n g e C o u n ty re s id e n ts a re s h o w in g a fa s t-g ro w in g d e m a n d . S tu d ie s re la te d to c h ild re n , a d o le s c e n ts , a n d th e e ld e rly a ll s h o w g ro w in g ra te s o f d e p re s s io n a n d a n x ie ty. In s o m e o f th e s e s tu d ie s , th e in c id e n c e o f m e n ta l h e a lth illn e s s e s is g re a te r th a n th a t o f o u r s ta te a n d o th e r c o u n tie s . L ik e o th e r a s p e c ts o f q u a lity h e a lth c a re n o o n e h e a lth c a re p ro v id e r c a n a d d re s s a ll n e e d s . C o m m u n ity w id e e ffo rts w h ic h a s s e s s th e g a p s o f n e e d e d s e rv ic e s a n d m o re e ffe c tiv e ly c o m m u n ic a te to re s id e n ts th e a v a ila b ility o f e x is tin g s e rv ic e s is w o rk th a t m u s t b e d o n e . E ffo rts s u c h a s th o s e o f th e O ra n g e C o u n ty C o m m u n ity C o a litio n fo r B e h a v io ra l H e a lth a re e x a m p le s o f h o w p u b lic a n d p riv a te e n titie s a re c o m in g to g e th e r to b u ild c a p a c ity a n d o p tim iz e e x is tin g s e rv ic e s . A s w e c o n tin u e to b e tte r u n d e rs ta n d th e m e n ta l h e a lth n e e d s o f o u r O ra n g e C o u n ty re s id e n ts , w e w ill c e rta in ly fin d th a t m e n ta l illn e s s w ill m a n y tim e s a ffe c t a n in d iv id u a l’s p h y s ic a l h e a lth , a s w e ll a s , ris k fo r a d d ic tio n o r s u b s ta n c e a b u s e . K a is e r P e rm a n e n te c o n tin u e s its b e lie f th a t h e a lth is m o re th a n fre e d o m fro m p h y s ic a l a fflic tio n – it’s a b o u t M in d , B o d y a n d S p irit.

Studies focused on the mental health needs of Orange County residents are showing a fast-growing demand…As we continue to better understand the mental health needs

• f our Orange County residents, we

will certainly find that mental illness will many times affect an individual’s physical health, as well as, risk for addiction or substance abuse. Kaiser Permanente continues its belief that health is more than freedom from physical affliction – it’s about Mind, Body and Spirit. Mark E. Costa Senior Vice President Kaiser Permanente

HEALTHCARE ROUNDTABLE

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