iHT² Health IT Summit San Francisco – Case Study “MLK 2.0: Building Value Based Care from the Group Up” with Sajid Ahmed, Chief Information and Innovations Officer, Martin Luther King Jr. Community Hospital

1. Martin Luther King, Jr. Community Hospital Page 1 3/28/2013
The New Martin Luther King Jr. Community Hospital
(MLK2.0): Building Value Based Care from the Ground Up
by Sajid Ahmed, CIIO
IHT2, San Francisco
March 25, 2014

2. Martin Luther King, Jr. Community Hospital Page 2 3/28/2013
Martin Luther King, Jr. Community Hospital
“Transforming Healthcare Delivery through Care
Coordination”
A Hospital Overview
Sajid Ahmed, Chief Information and Innovations Officer

3. Martin Luther King, Jr. Community Hospital Page 3 3/28/2013
History
• August 2007: Martin Luther King, Jr. Harbor (formally MLK/Drew)
was closed
• April 2010: LA County and UC jointly sponsored Assembly Bill 2599
(AB 2599) to ensure long-term financial viability of the
new Hospital
• July 2010: County and UC sign Coordination Agreement; UC will
assist with:
• Hospital’s Graduate Medical Education program
• Hospital-based physician services
• Hospital’s quality and performance improvement
programs
• Pre-opening activities that require physician
expertise
• August 2010: MLK-LA formed as a new nonprofit entity; Board
members are appointed by the County and UC
• October 2012: CEO, Dr. Batchlor hired.
• February 2013: Employee number 2 hired, Sajid Ahmed

4. Martin Luther King, Jr. Community Hospital Page 4 3/28/2013
The New Public/Private Partnership
Governance:
County Board of Supervisors
Governance:
Board of Regents
MLKCH Foundation
Coordination
Agreement
IGT and Indigent Care Funds
MLK, Jr. Community Hospital
Governance:
Community Board
Non-Profit 5013c
Building Lease
LA County
UC, UCLA
Fundraising

5. Martin Luther King, Jr. Community Hospital Page 5 3/28/2013
A private, non-profit, safety net hospital providing
high quality, collaborative care for South Los
Angeles and surrounding communities in
partnership with the County of Los Angeles,
University of California and other community
providers
Identity Statement

6. Martin Luther King, Jr. Community Hospital Page 6 3/28/2013
Vision
To be a leading model of innovative, collaborative
community healthcare
Mission
To provide compassionate, collaborative, quality care
and improve the health of our community
Values
• Caring
• Respect
• Collaboration
• Excellence
• Accountability
Vision, Mission and Values

7. Martin Luther King, Jr. Community Hospital Page 7 3/28/2013
Hospital Service Area
• Population
– 1.2 million residents
• Socioeconomic
– 67% of household incomes less than $50,000
• Payer Mix
– Predominately Medicaid; 14% Medicare
• Access to Healthcare
– Federally Qualified Health Centers (FQHC)
– County multispecialty outpatient center on MLK campus
– Private providers and IPAs
– Physician shortages across all medical and surgical specialties
– High need for adult medicine providers
– Lack of organized managed care medical groups

8. Martin Luther King, Jr. Community Hospital Page 8 3/28/2013
Access to Health Care in South Los Angeles
• Health Professional Shortage & Medically Underserved
Areas
• High need for adult medicine providers
• Lack of organized medical groups
• One hospital
• 90% of residents travel outside area for health care

9. Martin Luther King, Jr. Community Hospital Page 9 3/28/2013
Projected Payer Mix – 2015*
Medicare
10%
Medi-Cal FFS
24%
Medi-Cal managed care
39%
Medicare dual-eligible
2%
Uninsured
23%
Commercial
2%
*Based on ADC

10. Martin Luther King, Jr. Community Hospital Page 10 3/28/2013
Hospital Service Area
• Large portions designated as a Health
Professional Shortage Area and/or a Medically
Underserved Area
• Physician shortages exist across almost all medical
and surgical specialties

11. Martin Luther King, Jr. Community Hospital Page 11 3/28/2013
Hospital Service Area
• Significant Health Disparities
⁻ Mortality rates for diabetes, coronary heart disease,
stroke and lung cancer among the worse
⁻ High incidence rates of AIDS among adolescents and
adults
⁻ Low birth rates

12. Martin Luther King, Jr. Community Hospital Page 12 3/28/2013
MLKCH Medical Staff
Hospital-Based Specialties Provider
Anesthesiology UCLA
Emergency Medicine VEP
Hospitalists VEP
Intensivists VEP
Laborists Eisner
Pathology UCLA
Radiology
UCLA
Surgery (ENT, Neurosurgery, Oral,
Ortho, Plastics)
Under
discussion
Total Estimated FTEs 55
Specialty
Consultants
Primary Care

13. Martin Luther King, Jr. Community Hospital Page 13 3/28/2013
Dr. Elaine Batchlor, MD. MPH
Chief Executive Officer
Sajid Ahmed
Chief Information and
Innovations Officer
Dr. John Fisher, MD, MBA
Chief Medical Officer
Keith Bradkowski, RN, MS
Chief Operating Officer/
Nursing Officer
Kellie Todd
Director, Community Affairs
and Marketing
Dr. Medell Briggs
Malonson, MD, MPH
Medical Director, Quality
Danielle Sreenivasan
Interim Chief of Staff
Blair Contratto
Interim Vice President,
Network and Business
Development
Rebecca Bales
Interim Chief Financial
Officer
Melayne Yocum
Interim Chief Administrative
Officer
Tim Fyffe
Interim Vice President,
Facilities
Peggy Crabtree
Vice President, Ancillary
Services
Phyllis Nelson
Interim Director, General
Services
Dyan Sublett
President, MLK Community
Health Foundation
Pre-Opening Organization Chart
Indicates permanent staff
Indicates actively recruiting position; currently filled by
consultant
Indicates position currently filled by a consultant;
recruitment will begin in future when applicable
Manager, Community
Relations
(OPEN)
Susan Burrows
Vice President, HR

14. Martin Luther King, Jr. Community Hospital Page 14 3/28/2013
• Clinical Excellence
– Workforce
– Protocols and performance
• Care Delivery Innovation
– Connected continuum of care
– Population health management
• Operational Effectiveness and Efficiency
– Structure, systems and tools
• Stable Financial Position
• Collaboration and Community Engagement
MLKCH Strategic Objectives

15. Martin Luther King, Jr. Community Hospital Page 15 3/28/2013
MLKCH Clinical Services
Licensed Bed Type Total
Medical/Surgical 93
Intensive Care 20
Obstetrics 18
Total Licensed Beds 131
Other Total
Nursery - Bassinets 11
Emergency Department 21
Fast Track Stations 8
Operating Rooms 4
C-Section Rooms 1
Post-Anesthesia Care Unit 12

16. Martin Luther King, Jr. Community Hospital Page 16 3/28/2013
MLKCH Clinical Services
Scope of Inpatient Services to be Provided by the Hospital
 Anesthesiology
 Cardiology
 Emergency
Services
 Endocrinology
 Gastroenterology
 General Medicine
 General Surgery
 Neurology
 Obstetrics &
Gynecology
 Ophthalmology
 Orthopedics
 Otolaryngology
 Pathology
 Radiology
 Plastic Surgery
 Pulmonary
Medicine
 Urology

17. Martin Luther King, Jr. Community Hospital Page 17 3/28/2013
The MLKCH Brand Values
Innovation
Caring
MLK Community
Hospital Key
Attributes

18. Martin Luther King, Jr. Community Hospital Page 18 3/28/2013
MLKCH Brand: Caring
• Behavioral interviews to employ diverse, multilingual
workforce that embraces our values
• Family-centered hospital rooms with sleepover beds
• Patient interactive systems for education,
entertainment, and interaction with staff
• Healing art collection
• Customer service coordinators
• Press Ganey and HCAHPS satisfaction surveys to
measure and improve satisfaction

19. Martin Luther King, Jr. Community Hospital Page 19 3/28/2013
MLKCH Brand: Quality
• High quality physicians
• Evidenced-based medicine and performance
transparency
• Team-based care
• Coordination with care partners across continuum
• Patient education and engagement
• High quality, high touch, high tech patient centered
care

20. Martin Luther King, Jr. Community Hospital Page 20 3/28/2013
MLKCH Brand: New
• New hospital leadership and organization
• Recruiting and training high caliber staff
• New state-of-the-art building
• Installing new furniture, fixtures and equipment
• State-of-the-art information and biomedical
technology

21. Martin Luther King, Jr. Community Hospital Page 21 3/28/2013
MLKCH Brand: Collaboration
Area of Collaboration Partner
Care Coordination
• LAC-DHS
• Southside Coalition of Community
Health Centers
• Referral hospitals
• Other community providers
Clinical Oversight • UCLA
Construction of New Building • Department of Public Works
Emergency services • EMS and referral hospitals
Funding
• Los Angeles County
• California DHS
• MLK Community Health
Foundation
Inpatient Providers
• UCLA
• Valley Emergency Physicians
• Eisner Medical Group
• Others

22. Martin Luther King, Jr. Community Hospital Page 22 3/28/2013
MLKCH Brand: Innovation
• New approaches to care delivery
– Telehealth to expand access to specialty care
– Patient interactive system and smartphone applications to
educate and engage patients
– Mobile solutions for providers
– Connectivity to care partners
– Use of auxiliary health care workers
• Community Learning and Resource Center
• Innovation Hub

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Health Care Transformation &
Population Health Management

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The Campus Master Plan Positions MLKCH to
be an Innovative Provider of Coordinated Care
Innovation center, Medical office space, Urgent care, Mental health, Homeless
recuperative care, Assisted living, Skilled nursing facility, Rehabilitative care,
Senior housing
Source: Initiative for a Competitive Inner City

25. Martin Luther King, Jr. Community Hospital Page 25 3/28/2013
MLKCH Care Partners
MLKCH
Dignity
California
Hospital
St. Francis
Hospital
LAC DHS
Rancho
Harbor
LAC USC
UCLA
Clinical
Leadership
Quality
Telehealth
Hospital
Partners
DMH
Hawkins
Community
Partners
Physician
Partners
Alta Med
SSC
8 FQHCs
Omnicare
IPA
IPA
Other
HCLA IPA
Alta Med
IPA
MedPoint
MSO
Social
Services
Home
Health,
DME, Rx
Payor Partners
LA Care
Health-
Net
Medi-
care
Covered
CA
Comm-
erical
MediCal
Medical
Groups
SPA 6
MLK
Campus
Public
Health
Centinela
Hospital
Outside
SPA 6
Outside
SPA 6
LA County
Kaiser
Indep.
Physicians
DHS
MACC
Long-Term
Care
Other
Community
Partners1
Associ-
ations
CBOs
Govn’t
Agen-
cies
1Other Community Partner Examples:
• CBOs – Shields for Families, Black Women for Wellness, Urban League, Community Health Council
• Associations – American Heart Association, American Diabetes Association
• Government Agencies – DMV, 311, Parks and Recs

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Strategy to Manage Population Health
• FQHCs and Community-based Clinics
• Community Providers
• Affiliated Medical Groups
• High Risk Clinic
Primary and Specialty Care Partnerships
• Multi-Disciplinary Transition Teams
• Post-Discharge Clinic
Care Coordination
• Home Visits
• Sub-Acute Care Providers
Post Acute Providers

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Strategy to Manage Population Health
• Remote Patient Monitoring
• Learning and Resource Center
• Smart Phone Apps for Disease Management and Health Promotion
• Peer Support Groups
Prevention, Education, and Wellness
• Shared Risk Payments
• Value Based
Alignment of Payment Incentives

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Inpatient
Care
• EHR secures past
visit data & real-
time patient info
feeding
important data
into the clinician
workflow
• Cerner Smart
Registries
provide top
opportunities
according to
patient
information,
prioritizing
interventions
• Patient’s health
record issues
alerts providers
of possible
health risks or
care gaps based
on trends in the
patient’s record
Pre-
Hospitalizatio
n
• Pre-admit
screening via
eConsult
• Planned
admissions using
risk profiles
• In-home medical
monitoring to
detect necessary
admissions
• TCC helps high
risk patients
avoid
unnecessary
admissions
• Health system
navigation
education to
avoid
unnecessary
admissions
Post-
Discharge
• Discharge
instructions
over-the-phone
to PCP and/or
caretakers
• Securing
transitional care:
TCC, PCMH,
Home Health
Agency
• Assess patient’s
needs and
connect him or
her with
resources for
continued care:
In-home medical
monitoring and
mobile apps

29. Martin Luther King, Jr. Community Hospital Page 29 3/28/2013
Hig
h
Ris
k
5%
Mediu
m Risk
15-35%
Low
Risk
60-80%
Community
Activities
E-Letters, Texts,
Mailings
Awareness/Educati
on Campaigns
Primary Care
Medical Home
In Home Medical
Monitoring
Transitional Care
Clinic
Group Classes
Learni
ng
Center
Targeting Risk
Factors
eConsult

30. Martin Luther King, Jr. Community Hospital Page 30 3/28/2013
Utilization by Health Status
Healthy
50%
Stable
20%
At Risk for
Multiple
Chronic
onditions
PERCENTA
GE]
Multiple
Chronic
Conditions
8%
Catastrophi
c
Conditions
2%
0%
5%
10%
15%
20%
25%
30%
35%
Health Status
Percentage of Costs
Healthy: 6%
Stable: 10%
At Risk for Multiple Chronic
Conditions: 24%
Multiple Chronic Conditions: 28%
Catastrophic Conditions: 32%
Percentage of
Population

31. Martin Luther King, Jr. Community Hospital Page 31 3/28/2013
1.4 Utilize group classes to educate rising-risk patients on how to
manage their condition
Low
Risk
Mediu
m
Risk
Implementation Tactics
1.1 Educate residents about the how to navigate the local
healthcare system through the Learning Center
1.3 Refer appropriate patients to existing Primary Care Medical
Homes with which MLKCH has direct lines of communications
1.2 Connect local PCPs to MLKCH hospitalists through E-Consult
to determine if hospital admission is the appropriate course
1.6 Refer highest risk patients to the Transitional Care Clinic
1.5 Utilize in-home medical monitoring devices to provide 24/7
care and recognize warning signs as they’re occurring

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1.4 Communicate directly with patient’s Primary Care Medical
Homes on admissions as well as with discharge instructions
Low
Risk
Mediu
m
Risk
Implementation Tactics
1.3 Coordinate planned admissions using E-Consult
1.2 Use Electronic Medical Records to standardize and centrally
store patient information and share it across the organization
1.6 Refer highest risk patients to the Transitional Care Clinic
1.5 Utilize in-home medical monitoring devices to supervise
post-discharge care and plan necessary admissions
1.6 Initiate quality reporting to track clinical performance on key
measures and identify weaknesses in care coordination
1.1 Connect patients with telehealth tools
including mobile apps

33. Martin Luther King, Jr. Community Hospital Page 33 3/28/2013
1.4 Utilize group classes to educate rising-risk patients on how to
manage their condition
Low
Risk
Mediu
m
Risk
Implementation Tactics
1.1 Promote healthy behaviors and increase awareness through
e-letters, texts, and mailings
1.3 Institute a series of community activities geared at engaging
the community in health promotion
1.2 Provide a series of tools and classes at The Learning Center
to increase patient’s ability to manage their health
1.5 Increase patient engagement through e-health tools and
platforms

34. Martin Luther King, Jr. Community Hospital Page 34 3/28/2013
MLK Health Transformation Center
A program to
identify, pilot
and adopt new
technologies,
processes and
workforce
development
initiatives,
designed to
enhance the care
within Martin
Luther King, Jr.
Community
Hospital and the
health of the
entire South Los
Angeles
Community.

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Where are we Today?

36. Martin Luther King, Jr. Community Hospital Page 36 3/28/2013
Key Accomplishments
• Completed Environmental, Physician Needs and Clinic
Needs Assessments
• Created strategic plan, operations plan and 5 year
budget/pro forma
• Developed physician staffing plan
• Hired C-Suite executives
• Selected medical equipment and furnishings
• Completed IT strategy and selected health information
systems
• Engaged with South Los Angeles community and other
key stakeholders

37. Martin Luther King, Jr. Community Hospital Page 37 3/28/2013
Where We Are Today
• Los Angeles County completing construction of new
facility
• MLKCH will complete the following before opening in
2015
– Install equipment and information technology
– Implement electronic health record system
– Test all equipment and the new IT system
– Develop policies, procedures and work flows
– Stock the facility
– Hire and train staff (approximately 700 FTEs)
– Obtain licensures, certifications, and accreditations

38. Martin Luther King, Jr. Community Hospital Page 38 3/28/2013
Key Activities Underway
• Hiring hospital management team
• Developing
– Community engagement and marketing programs
– Human resources infrastructure
– Policies and procedures
• Selecting key partners for revenue cycle, general
services, pharmacy, and clinical technology
• Securing hospital equipment
• Designing and building health information systems
• Developing care coordination protocols and resources

39. Martin Luther King, Jr. Community Hospital Page 39 3/28/2013
Key Challenges
• New public-private partnership
• Local market dynamics
– Poor health status and payer mix
– Recruitment and retention of qualified staff
• Development of an integrated, coordinated system of
patient care
• Opening a hospital during an era of healthcare
reform and significant market change

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Questions?

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Martin Luther King, Jr. Community Hospital

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Thank You!