Strategy Execution with Carilion Clinic

Okay. Good morning, everyone. My name is Jenna Hamilton, and I'm part of the marketing team here at Clearpoint. I'd like to thank you all for joining us to discuss a topic we know and love. Effective strategy execution. The audience will be muted for the duration of this webinar. However, we encourage questions and comments, and we ask that you please submit them at any point in the questions tab. We have two speakers today. Darren Eversole, director of finance for Carilion Clinic, located in Roanoke, Virginia. And interviewing Darren will be our very own Ted Jackson, one of clearpoint's two founders. Without further ado, Ted, I'll turn this over to you.

Thanks, Jenna. So, Darren, thank you so much for joining. I'm very, very excited to have you here with us. Can you tell us a little bit about who Carillion Forum.

Carillion Clinic, for those that are not familiar with, is a health care organization in Southwest Virgin. If you imagine the landscape of Virginia, we are west of Richmond and the largest employer, about 13,000 employees. We have a thousand providers. We do over a million patient visits in a given year. So we're a level one trauma center and a major footprint in Southwest Virginia.

Great.

And how it likes to have one scorecard, one eight or nine measures specific for 40 providers. And then we also have our family medicine doctors. All have individual. It's the same measure, but it's individual results. So they all have the same eight measures, but it's how that provider is performing individually. And one could say one way is better than the other, but that's the chair's discretion and it's up to them. But yes, we do. Currently, I think we have about 300 scorecards through Clearpoint. So it's pretty big. But we have another individual that helps me manage that. And we kind of. And clearpoint's partnership has been great about developing those and helping us create those at the beginning of our fiscal year, which takes a lot of weight off our shoulders. But yes, it does can go down to the individual provider level, which we do see benefits in that because the physician or the provider has individual control of the outcome for their own results.

Okay, good. So if I were to kind of take it out of a healthcare environment and try to make it completely generic, what you said, it sounds like you have kind of divisions down to departments, down to individuals, and you can. This is, I guess, more of a question. And you can roll that information up so that you could say at a division or at a department level, I could see the aggregated information across all these Organizations.

That's right. So using our family medicine platform, we with the individual or family community med, their individual results roll into their location. So look at it from. I'm going to make it easy for those that might have a family practice in a region and there's. Within that region, there's six family practices. That region would be one level up. And all of those providers results are rolling into that layer of this next layer and then that region is rolling into the overall department of the card. So yes, we do link everything up. So everything's aggregated up into a total. So everybody's rowing in the same direction. It's not like a scattered pie chart.

And so we got a question from the audience is how do you develop these compensation bands? What level do you speak with departments and section chairs to determine what an appropriate compensation band is or just how does it work in general?

Yeah, so the compensation structure is set by the cmo. So everybody has the same percent at risk. If that's where the question is. We start the process actually really in February. So our fiscal year rolls from October through September. It takes about, I would say, yeah, a good five months to develop these for the following year. And when I say we're not meeting with the individuals regularly, it's more of a. We give a timeline, so we give a long Runway. Because a lot of what we have found is you have to get the reports built correctly. I mean, if the physician or the provider understands what they're being measured on, we see tremendous success. But if you're just handing out a measure and with no Runway to understand how they can have an impact, we see some failure in that. So we start like March 1st and. And it takes some time now, we're not more meeting every couple months, but we just start rolling that ball slowly. And we ideally like to have everything tied in a bow by August 1st. That gives two months leeway to kind of understand what's being measured and they hit the ground running.

And like, what percentage of comp is tied up in this?

Yeah, so we are probably on the high end. So we have about 20% of our.

And like, what percentage of comp is tied up in this?

Yeah, so we are probably on the high end. So we have about 20% of our 20% is tied to performance management. So we're not talking a very small portion of dollars. With 1,000 providers, there is a lot of dollars at Stay here and we see a lot of success in that. If they understand the cards are presented appropriately monthly, we try to push them out to individuals as much as we can. And I typically, you would think you get a lot of feedback at the end of the year when payouts are done. But I don't get too much feedback, which I look at as a success, is that we've delivered it. Everybody knows what they're getting paid. If that's. If you're presenting it regularly.

Right. And you think this is driving better results for you as a, as an organization like, yes.

We do see success. Now, there's multiple factors in it. If the section chief is, you know, as they have their department meetings, whether it's monthly or quarterly, if they're presenting on this, they see success. But going back to. If it's not in the forefront or they don't see the results, that's not clearpoint's problem. The software is there. We tend to have challenges, but teams and the majority of the teams got a good flow of this. It's on standing agendas, whether they go over it in detail or not. When you tie compensation to it, it drives behavior. And we do see success in that quite a bit now. It took some time too. So we've been with clearpoint for about seven years now and had a great relationship prior to that. We had a clunky system that really was hard to understand. Load data, read the data, there were some errors in it. And when we converted over, we saw a big win there because it's, it's easy to use. Our providers have access to it if they want to go in to see it as a read. Only our operational leaders have ability to go in and input data. So they are familiar with. Varies a little bit on the expertise of how someone can use it and the learning curve. But those that are seasoned, we don't see too many complaints. It's really like this is. This is very good and meets our needs.

So would you say you had, you know, a thousand people all perfectly aligned with their compensation for the last seven years or were there some challenges along the way?

Well, so I would probably look at it a little bit differently is the compensation component is a whole different discussion. So it's really more of, that's, that's the contract that Carillion uses, or that's what we kind of have set up. Whether that's right or wrong, that's not my wheelhouse. It's really more of after the provider signs. This is our current structure. So how do we measure it? I'm not really part of the kind of the negotiation part of the compensation, but the tier one, which is the performance management and tier two is the productivity. How we label it. Those are standard now. They're always up for negotiation from the board and how they could change that. But if they do change it, then we'll just adjust our calculations on our end.

And how many measures is a clinic or a physician looking at? Like, is this complicated or simple?

No. So we. I'll give an example. When I took this role, our clinic scorecard. So we have two cards. We have the clinic, the corporation, and then we also have physician scorecards or provider core. The clinic scorecard had 85 measures on it. And you start thinking through that out of 100%, each measure or metric had 1 2% weight. Very hard to drive behavior. So in the course of three years, we went from 80, 85 metrics down to seven. And we saw tremendous success. We put obviously more weight behind certain measures and, you know, fewer measures gets a little bit more line of focus. And we see that beneficial. You know, one could say you could go up to 8 or 9 or 10 or maybe 13. We were at 13. But then you start thinking we don't see much success or interest in measures valued at 5 points or 5%. Really our sweet spot is that 10 to 20 point weight. So you think about that. That really kind of puts it down to seven measures when it's all said and done. And we find that that works. Another key success that what really helps some of our sections on the physician world will a section chief will assign a provider to each measure, so they're responsible of working with their colleagues and implementing the change. Understanding why a measure is not meeting its goals or has there been a change in environment? There's lots of factors that can drive that, but we find that having a metric champion per metric really helps articulate and keep a pulse on what the outcomes are. We also do that on the clinic scorecard as well. We have a couple champions on the senior level, senior management team that oversee those measures and have work groups that are working on that.

When I hear clinic, I think of a small group, but clinic. So it's like the full executive scorecard. So we have a few questions coming in while you've been talking. So these measures, let's focus on the provider side first. Are they solely based on numbers or how much is qualitative information?

That's a good question. So we have a scorecard committee, so which consists of a few chairs and vice presidents. And that's more of the SNF test. So when a new measure comes through or teams have to submit. And it's more just to validate since there is compensation tied to this. When I started this, we had measures like meeting attendance. Well, meeting attendance is more of your. That's your duty of being an employee. You should show up to meetings. So we kind of steer away from this. But we've also, we have quality measures or safety measures, but we also have research and scholarly activity. We have community involvement. There is value in that, that we find that the providers have to participate in the community or community events, do a presentation to outside providers, just to kind of network to build their referral base. So there are some measures that teams have kind of honed in on that seem to be working. And it's a balance. It's not all driven by patient outcome. It's really a holistic view of what we stand for at Carillion and how we can compensate and make it a meaningful driving factor.

That's great at the, at the executive level, that separate scorecard for what you call the clinic, but at the kind of like the entire level, is it. Is there any qualitative information there? Is it also kind of heavily quant because you have.

Yeah, it's more overarching themes. So the theme this year is employee retention as well as access. So in the healthcare, we want to drive access to across the system. So a lot of the measures are driven on inpatient as well as new patient scheduling lags. So getting patients into our system, getting them the referral process, template management, and then also turnover or retention. Sure. Some of you have experienced a lot of turnover. We've experienced quite a bit. So that costs the institution quite a bit of money. And retaining employees is a high interest of focus. So that's kind of the theme of it. But again, they're more broad topics where there's a lot of work going into that to influence those numbers.

Okay. One of the things we say is, you know, when you're using clearpoint, you, you save time and you get higher quality reports. I know you kind of briefly touched on, you know, a system you were using in the past, but just, just curious about, like, when you look at, you know, using a system like this, do you think about, like the time savings? Have you ever tried to quantify or think about the report quality and things like that as well?

Yeah. So it is, I think there's two parts to this for us is the old system. I'll talk about the service we've received from clearpoint. So one of the, with, with the old system, we had you. There was no support function. So we would send emails off or call and be in a queue and we finally get a response back. Well, that took time. Whether it's right or wrong, some groups would present stuff or going in and they couldn't get the report. So we're like, well we're sorry. That's a big benefit we see is with clearpoint we have actually gotten timely responses. We get things fixed correctly or if there's an issue, we get it done. The results take care of itself very quickly. The data. So now thinking about moving from the old system to this one. The functionality of using the upload function. I know our family medicine. There's a lot of provider scorecards in that department that everything is uploaded and streamlined. Nothing's manually entered. The old system didn't have that. So you think about that. That was a huge deciding factor. We wanted a system that we could utilize that just being able to PDF the scorecard and then or email it out, setting it up where you can just blast it out to a lists serve. I know there's a few departments that utilize that where the. Now that we're more in a virtual world and clinics are everywhere and they have the department meeting, teams can just pull up their own scorecard or the same scorecard that was emailed to them. So there's quite a few functionalities that speed it up and make it very easy. So yes.

Would you say things that roll up like whether it's patient satisfaction or operating margin? Well, let's take those two because one's super tangible and one is more qualitative. Have you seen those change or improve since you've been able to focus everyone using this system?

I think we see the improvement when it's specific to the section. Our patient experience scores for the system were very good two years ago. It's taken a little bit of a dip over the last year and some of that's just because of staffing. And our results have been very good and at a higher percentile than the mean. So you know, you do hit sometimes a ceiling on the patient experience and is is moving up a half a percent. Really? Is that really showing an extreme improvement? I don't know. One could argue yes or no. The operating margin, I mean that's more of just a high level. We do see that especially now there's a high focus in on the operation. So I'm hopeful in the future, like with teams working on efficiencies. Yes. We should see that yield in a favorable direction going forward.

Okay, great. We've Got another question from the audience is what does performance management look like when the results are not what's expected and how do you kind of push for improvement? Like give us, like if you have an example or any anecdote for how.

So that's a good question. So we do have occasionally some sections that do not meet their goals. And that's just natural. It does happen. Some of it is, you know, reflecting back on, well, what drove the change. And I think what we've learned is don't choose metrics or measures that maybe are tied to physician recruitment or retention. So I don't have a specific example off the top of my head, but sometimes if you lose a provider, your scores will suffer because just of natural cause. We don't want to penalize any providers because of that. But on the same lines, we don't change the measure because of that. But when we develop these type of measures, we want to ensure that even if you add a provider or lose a provider, we know that's going to happen over the course of a time frame. We don't want the measures to change or the results change because of some things that can't be controlled up front. So patient experience, that's one is if it's provider communication, just because a provider leaves that doesn't mean the physicians that are there, they can still communicate effectively. That should not drive an outcome.

Yeah, that makes sense. I imagine you also have some kind of ratios in there.

Yeah.

To have people leaving versus coming back.

Exactly. Now. Good. Now you wouldn't pull a question, did I get an appointment in a timely fashion? Because again, if you lose some providers, the answer is going to be no because now the templates are much more full. It's harder to get an appointment. So again, it's that learning curve and thinking through that, there were some challenges up front like when I started this, so. But we've kind of ironed a lot of those out.

So I think I have a technical question. I don't understand it, so I'm going to read it and see if you do. Are we talking about OPPE profiles with provider specific measures and how long did it take to establish that in Clearpoint? To me, I don't, I'm not sure.

O, P, P, E. Is that what it was?

Right.

All right. You made. I, I hope, I, I don't know, can maybe that person type that in and say what's that? Operational performance?

Yeah, I'll see if we can get more details while we're waiting.

Sorry about that.

No, no, I I didn't know what it was. I was just curious. While we're waiting for that, I know we're almost out of time. Can you tell us what, what you have in plans next? Like when you look forward for, you know, performance management at Carilian Clinic, what's kind of in your future? What do you, what do you see as the next steps to, to make your system even better?

So I, you know, I visualize our. We have like our nursing. All of our nursing units have scorecards or some sort of performance management. Now a lot of times that's done in Excel or it's done in these one offs. I visualize in the future that a lot of individuals will start using. When I say individuals departments, I mentioned something back just from an audit perspective. We needed a software to do the provider compensation and stuff. But we have a lot of scorecards that are oft that are done just manually across the system. I see in the future, you know, moving that over. Some groups are actually moving it over our pharmacy team. They don't have compensation tied to their scorecard, but they want a tool or a platform. So I visualize a lot more departments coming now. It takes resources, right. I'm sure we don't have a lot of resources in finance. So as we grow this, we got to find the time to help maintain it and ensure that it's calculating. Right. So it's a balance. But I visualize that taking place over the future because there are some teams starting to use it. Another thing I think that would be very beneficial is, and it's hard to do is clearpoint has this automation process of sending scorecards out to certain users on a certain cadence, whether it's weekly, monthly, however you want to set it up. That would be a big win for us if we could do that to all the providers and have it in the forefront, sent to a monthly. They can look at it on their cell phone computer. At the moment we don't have that because again, physicians are always moving different locations and we want to make sure it's. Someone's got to manage that. So how we get there, I don't know yet, but that's something that I would like to grow this product to make it even more meaningful.

Yeah, that sounds great. The OPPP was ongoing professional practice evaluation. I'm not sure if that's part of the comp model or the seven measures that you typically have.

Yeah, we don't use that. No, but thank you. No, we don't really use that as an indicator.

Right. Okay. Darren, we're out of time. This has been a great conversation. I feel like we could go on for. For another hour, so I greatly appreciate you. You sharing what y' all are doing. We did get questions where people wanted to. To get a visual for what this looks like, and I think we have a generic version of that that I can put up that doesn't share any confidential information, but at least show kind of how you look at kind of that evaluation level.

Thank you very much. Thanks for having me, and happy to answer questions offline if need be. So thank you.

Okay, thanks again.