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Access and PatientCentricityIs it Achievable?COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.Ginger Biesbrock PA-C MPH MPAS AACCSenior Vice President Consultinggbiesbrock@medaxiom.com904-580-01901

The Challenge Adults in the United States receive onlyabout half of the health care they needwhen they need it150%AF outcomes are subpar due to lack ofguideline adherence2HF guidelines adherence improvesoutcomes but lacking in traditional caremodels31Improving Physician Adherence to Clinical Practice Guidelines, New England Healthcare Institute, February 2008Hendriks et al. "Cost-effectiveness of a specialized atrial fibrillation clinic vs usual care in patients with atrial fibrillation." Europace (2013). Web. 13 July 20153Feitell, S, Hankins, S, Eisen,H, “Adjunctive Therapy and Management of the Transition of Care in Patients with Heart Failure”Cardiology Clinician 20142COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.2

the message was veryclear, which was "stopjust focusing on thewhat you deliver andstart focusing more onthe how you deliver itbecause if you get the'how' part right, then the'what' becomes then somuch more meaningfulfor us.”“Putting the patient first in an open and sustainedengagement of the patient to respectfully andcompassionately achieve the best experience andoutcome for that person and their 20/Defining-patient-centricity.aspxCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Attributes of aHigh PerformingCVSLTRULY PATIENT CENTRICCULTURE OF EXCELLENCETRANSITIONS ARE INTENTIONAL, MANAGEDACCESSIBLE ON ALL FRONTSEffortPROVIDER COMP SYNCS WITH VALUEHIGHLY ENGAGED WITH DATA (REGISTRIES, EMR, FINANCIAL, SERVICE)TEAM IS RECOGNIZED OVER THE INDIVIDUALPURPOSEFUL STANDARDIZATION (CLINICAL, OPERATIONAL)HIGH FUNCTIONING GOVERNANCE & LEADERSHIPWELL DEFINED & ARTICULATED VISIONTransformativeTransformativeCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Industry Standard 5 business daysMarket differentiatorNew PatientAccessCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy. 2 business days Disease specificprograms – AF,Chest Pain Pathway

New Patient Access SolutionsSchedule Management Same Day Access ClinicDefine new patient slotneeds Doc of the Day 248 Clinic Build schedule to suit Disease specific programs Expand when goal is notbeing met Actively Manage ScheduleCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy. AF ClinicChest Pain PathwayWorkingpatients inis NOT anew patientaccessstrategy

Build the schedule based on patient needs.Provider Weekly Schedule BuildTime8:00 EST8:20 AMESTESTESTESTEST8:40 AMESTESTESTESTEST9:00 AMNewNewNewNewNew9:30 AMESTESTESTESTEST9:50 AMESTESTESTESTEST10:10 AMESTESTESTESTEST10:30 AMNewNewNewNewNew11:00 AMESTESTESTESTEST11:20 AMESTESTESTESTEST11:40 AMESTESTESTESTEST12:00 PMLUNCHLUNCHLUNCHLUNCHLUNCH1:00 PMESTESTESTESTEST1:20 PMESTESTESTESTEST1:40 PMESTESTESTESTEST2:00 PMNewNewNewNewNew2:30 PMESTESTESTESTEST2:50 PMESTESTESTESTEST3:10 PMESTESTESTESTEST3:30 PMNewNewNewNewNew4:00 PMESTESTESTESTESTCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.10

Access – Measures of SuccessAd Hoc Feedback “I had to wait .” Frequency of favorrequestsPatient Survey ResultsQ6In the last 12 months, whenyou phoned this provider’soffice to get anappointment for care youneeded right away, howoften did you get anappointment as soon asyou needed?COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.Access Goals % patient offeredvisits within goal % new patient toreturn visits Reschedule rate Market Share

Availability ObjectivesRoutineManagement atRequested IntervalsUrgent NeedManagementCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.Results Follow-upProceduralAvailability

Routine Management SolutionsUnderstand your Capacity vsDemand Patient to Slot Ratio Actively manage changesin physicianroles/responsibilitiesCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.Effective Schedulemanagement and RecallSystem 6 – 12 month schedules Recall matches availability Open and Reliable

Urgent Need SolutionsRN TriageUrgent Clinic Slots Direct Answer Line Specific to care team RN protocols that allowfor appropriateescalation Doc of the DayCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy. Urgent Clinic

Important Procedural AvailabilityStructural Heart Understand yourreferral toproceduretimelineElectrophysiology AF AblationavailabilityInterventional Day of Procedurewait times Market standard2-4 weeks** Average is 4-6weeks**Industry Observation**MedAxiom Community via listservCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Availability – Measures of SuccessAd Hoc PatientFeedbackPatient Survey Results “I had to wait .” “No one returnedmy call .” “I just went to theER” “You told me 6months but it took12”Q8When you made an appointment for a check-upor routine care with this provider, how often didyou get an appointment as soon as you needed?Q10/12When you phoned this provider’s office during orafter regular office hours, how often did you getan answer to your medical question thatsame day?Q22When this provider ordered a blood test, x-ray, orother test for you, how often did someonefrom this provider’s office follow up to giveyou those results?COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.AvailabilityGoals Backlog orWaitlist Volumes Procedure waittimes RN Triage turnaround times

ACCF/AHA Multimodality Imaging“"An appropriate imaging study is one in which the expectedincremental information, combined with clinical judgment, exceeds theexpected negative consequences by a sufficiently wide margin for aspecific indication that the procedure is generally consideredacceptable care and a reasonable approach for the indication.“January 2020 – Ordering providers will be required to consult AUC;furnishing providers will be required to submit documentation about AUCCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Cardiac Intervention AUCRetrospective Review NCDR PCI Data Review Peer to Peer Review – QA Measure #2 – PCI withdocumented abnormalstress imaging studyBlinded, random reviewCath ConferenceCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.Prospective Revascularization criteriaco-developed by IV/CTS Heart Team SharedDecision making

Is there a story behind your data?To the Right – are all PCI’s appropriate?To the Left – Is non-invasive imaging being utilized effectively?COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Guideline Driven Medical TherapyNCDR-PCINCDR-ICDPINNACLE REGISTRY Clinical Indication Clinical Indication Heart Failure DischargeMedications DischargeMedications Atrial Fibrillation Antiplatelet Therapy Reduced LVEFpharmacologictherapy Statin UseCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy. Ischemic HeartDisease

Appropriateness – Measures of SuccessSTSACC - NCDR Cath/PCI TVT CABG ICD DiabeticCollaboration Valve Action Pinnacle Impact LAAO Adult Congenital A FibCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.OtherUNOS/Interqual Criteria

EngagementExperienceSatisfactionIs there such a thing as a noncompliant patient?Maybe not – if we do this right.COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

The Challenges We are not nearly as effective as we intend to be .Rx incorrectHospitalizationsRx not filled p-MI50%33 – 69%24%Causes and solutions are multi-factorial and patient specific We have to get to know our patients – their challenges, questions andconcerns.COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.30

HOW?Make large seem “small”You are the most important thing I needto do right now .Happy teams produce better outcomesPhysician communicationCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Strategic and Aligned Team Based Care Structure**Patient facing functions- Keepteams together 3-5 physicians1 APP3-5 MAs2-3 RNsDefined Groups based on Specialty – NI, IV, EP, CTS,etc. Previous relationships Geography (outreachclinics)**Make large seem small .COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.33

Defining Patient Experienceinteractions, shaped by anculture, that influencepatient perceptionsacross the continuum of careThe sum of allorganization’s-The Beryl InstituteCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.34

1Culture of Service –Incentivize effective patientexperience2Customer Service Trainingfor all team members3Leadership Rounding –Routine and often4Secret Shoppers and OutsideEyes5Patient/Family AdvisoryCommitteeCustomer Service FocusStudorgroup.comCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Employee Engagement1Employee EngagementSurveysEmployee Satisfaction1. Best place to worka. Overall job satisfaction2Physician EngagementSurveysb. Satisfaction with organizationc. Recommend as a good place to workd. Recommend to Friends and Family3Turn over RatesCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.e. Have a best friend at work

The Proven Connections between EmployeeEngagement and Patient SatisfactionEmployeeEngagement A case study using nearly 29,000 healthcare employeeopinion surveys revealed compelling evidence thatemployee engagement has a direct tie to patientsatisfaction. In the survey, it was determined that: 85 percent of engaged employees displayed agenuinely caring attitude toward patients, compared toonly 38 percent of disengaged employees. 91 percent of engaged employees recognize theirworkplace as dedicated to patient care, compared to only42 percent of disengaged employees. 82 percent of engaged employees would want to usethe facility where they work as a healthcare provider,compared to only 22 percent of disengaged RIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

ProviderCommunicationCan be a learned skillPair up high and low andperformers for learningProvide Feedback routinely and oftenSet the physician up for success – rightpatient, right schedule, right informationCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.38

Provider Communication DomainQ14Q15Q17How often did thisprovider explain thingsin a way that was easyto understand?How often did thisprovider listen carefullyto you?How often did thisprovider give you easyto understandinformation aboutthese health questionsor concerns?COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Provider Communication DomainQ18Q19Q20How often did thisprovider seem toknow the importantinformation aboutyour medical history?How often did thisprovider showrespect for what youhad to say?How often did thisprovider spendenough time withyou?COPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

CG-CAHP InterpretationProvider Listened Carefully Top Box100908092.188.8Provider Listened Carefully Percentile 04043403020301020010Provide A Provider B Provider C Provider D Provider E Provider Provider G Provider H Provider er Listened CarefullyPractice (89.3)29242619940Provider Listened Carefully1. Difference between Top Box % and Percentile Rankings2. Watch your Sample SizeCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

Actionable – Measures of SuccessAd Hoc PatientFeedback “I didn’t reallyunderstand” Unnecessaryreadmissions “I just went to the ER”Patient Survey ResultsActionable GoalsOutcome Measures Physician CommunityDomain Likelihood toRecommend MedicationAdherence MIPS outcomemeasures Anticoagulation - TTRCOPYRIGHT 2019 MedAxiom – AN ACC COMPANY. All rights reserved. Terms of Use. Privacy Policy.

1 Improving Physician Adherence to Clinical Practice Guidelines, New England Healthcare Institute, February 2008 2 Hendriks et al. "Cost-effectiveness of a specialized atrial fibrillation clinic vs usual care in patients with atrial fibrillation." Europace (2013). Web. 13 July 2015