Women & Children’s InstituteTrina Jellison, GVPSeptember 28, 2021

Physician Leads: Mike Barsotti, MD & Kevin Pieper, MDSystem Leadership: Trina Jellison, Group VP & Courtney Jackson, Director

Clinical Program Services (CPS)

Councils SharePoint page

Providence System Council Structure

7

Alaska Region❑ AL: Cathy

Heckenlively*

Oregon Region

❑ AL: Kristine Bell*

❑ AL: Laurel Durham

NorCal Region❑ PL: Greg Sacher*

SoCal Region❑ AL: Jean Millar*❑ PL: Dave Lagrew❑ AL: Kristy O'Fallon

WA/MT Region

Montana

❑ AL: Tracy Hartzell

Northwest Washington

❑ AL: Laawna Murchison

Providence Health Care

❑ PL: Mark Schemmel*

❑ AL: Valerie Higginbotham

❑ PL: Nate Miller

❑ AL: Deanna Higgins

South East Washington

❑ AL: Kelly Harper*

South West Washington

❑ AL: Annette Stier

❑ PL: Lorie Sorensen

W&C Institute Dyad Leads▪ Kevin Pieper, MD*▪ Mike Barsotti, MD*

Clinical Program Services▪ Trina Jellison*▪ Courtney Jackson▪ Samantha Branch▪ Rishele Carlin

System Support▪ Epic (Peds): Debbie Van Soest & James

Reggin, MD▪ Epic (NICU): Holly Hunt, MD▪ Epic (OB): Neil Rawlins, MD▪ Epic (Women): Robin Cothrell-Tubbs▪ Clinical Analytics: Rocky Ramo & Funi Chen▪ REH: Kirsten Nelson▪ Finance: Brian Babcock▪ Pharmacy: Sophia Humphrey, Rx & Adam

Corson, Rx

* = Executive (voting) Members

Women and Children’s Institute2021 Leadership Council

TX/NM Region

Texas

❑ PL: David Gray*❑ AL: Marybeth Moran

Murphy❑ AL: Gina Smith

Swedish Region

Washington

❑ AL: Melissa Short*

❑ PL: Tanya Sorenson

❑ AL: Cindy Rose

PL = Physician Lead

AL = Admin Lead

KEY

Rishele CarlinSr. Project Manager

Samantha BranchProgram Manager

Courtney JacksonDirector

Trina JellisonGroup Vice President

Mike Barsotti, MDCo-Medical Director

Kevin Pieper, MDCo-Medical Director

Women'sService Line

Children'sService Line

Leadership Council

Women’s Health

Maternal Health / OB

Maternal Fetal Medicine

Focus Groups

Sub-Groups

• Maternal Sepsis

Newborn / NICU Acute Care Pediatrics

• Peds Suicide• Peds DKA• Peds Vascular Access

Other Commitments

▪ COVID – Pregnancy and Pediatric Coordination, Response and Communication

▪ Quantitative Blood Loss▪ Institute Redesigns: 1) Pediatric

2) Antepartum▪ Women's Heart Health▪ PeriGen/OBIX Steering Committee▪ Prov Breastfeeding Certification

Review BoardCircle / Wildflower

Click HERE to view the W&C Institute Meeting Schedule

Click HERE to view the Executive Metrics & Operating Commitments

W&C Institute (2021)P

artn

ers Finance

Clinical Analytics / Healthcare Intelligence

Epic; Information Services

Supply Chain; Pharmacy

Click HERE to view the W&C Institute Portfolio/Projects

2021 Women & Children’s Institute Focus Groups/Subgroups

2021 Completed Projects:✓ Acute Care Peds – ED Sepsis✓ Acute Care Peds – NAS to NOWS✓ Acute Care Peds – DKA Pathway✓ MFM – Cord GasVisit SharePoint for full list of completed project and additional details (LINK)

2021 Ongoing Collaboration Projects:▪ Zero Suicide and Acute Care Peds – Pediatric Suicide

Screening Tools▪ W&C and Heart Institute - Women's Heart Health▪ Maternal Health/OB and MFM – Postpartum Hypertension▪ MFM – Vigilance & OBIX▪ W&C and Circle – Circle App (Wildflower)

2021 Monitored Work:▪ Executive Metrics (LINK)▪ Maternal Health/OB - Quantitative Blood Loss▪ Providence Breastfeeding Certification

2021 Upcoming Projects:❑ Acute Care Peds – Peds ED Readiness❑ Acute Care Peds – Abuse Screening Tools❑ Maternal Health/OB – Teambirth❑ Maternal Health/OB – Telehealth❑ MFM - Consultation and Transfer GuidelinesTo participate in this work (LINK), please contact Rishele.Carlin@providence.org

Maternal Fetal Medicine

Focus Group

Acute Care Peds –

Vascular Access

Maternal Health/OB -

Maternal Sepsis

MFM –PeriGenSteering

Committee

Acute Care Pediatrics

Focus Group

Maternal Health/OB

Focus Group

Newborn & NICU Focus

Group

InstituteRedesigns: 1) Pediatric

2) Antepartum

Women's Health Focus

Group

David Lagrew, MD &Laurel Durham, RN

Courtney Jackson

Samantha Branch & Rishele CarlinMike Barsotti, MD

Lead(s) - TBD

Nam Hong &Trina Jellison, MHA, RN

David Gray, MD &Cathy Heckenlively, RN

Tanya Sorensen, MD &Dale Reisner, MD

Greg Sacher, MD &Sarah Myers, RN

Title & IntentTarget

(System)Current

Baseline

(System)

Data

Source

Target Setting Methodology &

Connection to StrategyCurrent Status

Ex

ec

uti

ve

Me

tric

s

Circle (Wildflower):

Increase the number of users per

month

14,964 new

users

System: 16,188 new users as of 9/7/21

Swedish Region: 1823

0 Marketing &

Wildflower

• Target set in alignment with

Providence system marketing team.

• Digitally enabling care management.

Moving towards Health 2.0 -

proactive healthcare

Working on

setting/aligning

metrics and

exploring

opportunities for

VBC

Postpartum Opioid Prescribing:

Reducing amount of pills

prescribed after vaginal birth (n = 0

tablets prescribed) and C-section

birth (n ≤ 20 tablets prescribed)

• ERAS

C-section:75%

Vaginal: 94%

Aug20 – July21

C-section System: 83.3% | C-section Region:

77.8%

Vaginal System: 95.7% | Vaginal Region:

94.5%

2017

Vaginal: 66.6%

C-section: 34.5%

2020

Vaginal: 94.6%

C-section: 76.2%

System

Clinical

Analytics

• PSJH response to ACOG

recommendation of tablet amount.

The percentage target was based on

Swedish pilot

• Preventing care & population health.

Community benefit

On target

VOA:

• Low Risk Delivery

• Hysterectomy

≤.97 OE Rolling 12mo–Jul21All System: 1.02 | All Region: 96.5

Delivery System: 1.01 | Delivery Region: 94.8

Hysterectomy System: 1.06 | Hysterectomy

Region: 1.03

2020

1 OE

System

Clinical

Analytics

• Institute roll up but measurement is

taken at the region & facility level

• Moving us towards a value-based

organization instead of fee for service

In progress

2021 W&C Institute Metrics | Swedish

On

go

ing

Pro

jects

Title & Intent

Maternal Health / OB – Teambirth

MFM – Vigilance & OBIXQuantitative Blood Loss Calculation MethodologyAcute Care Peds – NAS to NOWS

Acute Care Peds – Suicide Screening Tools

Acute Care Peds – DKA Pathway

Acute Care Peds – Abuse Screening Tools

Acute Care Peds – Peds ED Readiness

Maternal Sepsis – Two step process for diagnosis/screening & develop toolkit

Op

era

tin

g

Co

mm

itm

en

ts Continuous quality improvement:

• Acute Care Pediatrics• Maternal

• Newborn• Women's Health

Ins

titu

te

Red

esig

n Antepartum: Efficient, timely, and consistent high-quality care for any patient that is

experiencing a complicated pregnancy

Pediatric Redesign: Provide easily accessible pediatric sub-specialty care to all

pediatric patients across our Providence communities

Op

era

tin

g

Sta

nd

ard

s

Partner with the below groups to drive alignment and accountability to system

approach:• Clinical Analytics• Clinical Decision Teams• Epic• Information Technology• Healthcare Intelligence • Resource Engineering and Hospitality

Last Updated: Sept 2021

P&L by Discharge Year

2021Q1 2018 2019 2020 2021Q1

Facility Statistics

ADC 957.3 936.7 898.5 850.5

CMI 0.86 0.89 0.91 0.95

ALOS 3.1 3.1 3.1 3.2

% Commercial 51% 53% 53% 49%

Inpatient Cases 113,169 111,023 105,278 23,945

Outpatient Cases 328,673 313,856 244,484 63,312

Combined P&L

Facility Direct:

Net Service Revenue 1,236,489,609$ 1,272,866,041$ 1,246,985,011$ 302,623,021$

Top Side Revenue 33,147,436$ 39,865,840$ 38,398,499$ 9,457,150$

Total Revenue 1,269,637,045$ 1,312,731,881$ 1,285,275,803$ 312,080,171$

Supply (75,410,526)$ (76,085,935)$ -$ (18,868,626)$

Labor (518,960,584)$ (517,647,307)$ -$ (135,183,240)$

Pharm (19,917,466)$ (18,129,717)$ -$ (4,287,507)$

Professional Fee (33,452,205)$ (38,598,166)$ -$ (11,436,320)$

Purchased Services (40,014,661)$ (42,133,976)$ -$ (10,513,386)$

Other (12,361,280)$ (12,320,541)$ -$ (3,402,341)$

Total Facility Direct Expenses (700,116,722)$ (704,915,642)$ -$ (183,691,420)$

Professional Investment (33,125,429)$ (29,296,115)$ -$ (5,963,087)$

Program Subtotal 536,394,894.00$ 578,520,124$ 122,425,664$

Program Subtotal Margin (% of NOR) 43% 45% 40%

Medical Group Primary Care Investment (45,076,658)$ (41,448,914)$ (11,539,295)$

Facility Indirect Expense (232,032,267)$ (227,769,144)$ (56,473,243)$

Regional & System Overhead (177,465,056)$ (186,959,384)$ (51,409,036)$

Net Operating Income (Fully Loaded) 81,820,913$ 122,342,682$ 3,004,090$

Net Operating Income Margin (% of NOR) 7% 10% 1%

P&L by Region

2021Q1 Alaska OregonSouthern

CaliforniaSwedish

Washington/

MontanaGrand Total

Facility Statistics

ADC 73.7 129.9 188.2 190.3 268.4 850.5

CMI 1.07 0.87 0.82 1.08 0.99 0.95

ALOS 5.6 3.0 2.8 3.5 3.2 3.2

% Commercial 30% 55% 46% 62% 46% 49%

Inpatient Cases 1,191 3,942 6,040 5,030 7,742 23,945

Outpatient Cases 3,079 17,430 7,501 11,787 23,515 63,312

Combined P&L

Facility Direct:

Net Service Revenue 29,993,583$ 55,281,873$ 49,703,642$ 77,292,017$ 90,351,906$ 302,623,021$

Top Side Revenue 398,991$ (59,807)$ 3,370,369$ 2,003,939$ 3,743,659$ 9,457,150$

Total Revenue 30,392,575$ 55,222,066$ 53,074,011$ 79,295,955$ 94,095,564$ 312,080,171$

Supply (1,592,159)$ (3,720,610)$ (3,461,358)$ (3,207,525)$ (6,886,975)$ (18,868,626)$

Labor (10,905,252)$ (24,044,957)$ (31,180,930)$ (29,484,396)$ (39,567,705)$ (135,183,240)$

Pharm (379,421)$ (745,412)$ (903,312)$ (864,735)$ (1,394,627)$ (4,287,507)$

Professional Fee (1,627,086)$ (1,898,829)$ (2,994,722)$ (2,373,386)$ (2,542,298)$ (11,436,320)$

Purchased Services (322,825)$ (1,393,150)$ (1,049,904)$ (5,204,679)$ (2,542,827)$ (10,513,386)$

Other (231,989)$ (66,902)$ (725,302)$ (1,530,815)$ (847,333)$ (3,402,341)$

Total Facility Direct Expenses (15,058,732)$ (31,869,860)$ (40,315,528)$ (42,665,536)$ (53,781,765)$ (183,691,420)$

Professional Investment (175,508)$ (633,902)$ (1,183,833)$ (1,065,624)$ (2,904,219)$ (5,963,087)$

Program Subtotal 15,158,335.00$ 22,718,304$ 11,574,650$ 35,564,795$ 37,409,580$ 122,425,664$

Program Subtotal Margin (% of NOR) 51% 41% 23% 46% 41% 40%

Medical Group Primary Care Investment (424,206)$ (3,577,333)$ (1,245,174)$ (3,434,053)$ (2,858,529)$ (11,539,295)$

Facility Indirect Expense (6,233,965)$ (8,214,820)$ (14,167,371)$ (10,075,791)$ (17,781,297)$ (56,473,243)$

Regional & System Overhead (3,989,878)$ (10,388,076)$ (10,547,115)$ (13,717,689)$ (12,766,278)$ (51,409,036)$

Net Operating Income (Fully Loaded) 4,510,286$ 538,075$ (14,385,010)$ 8,337,262$ 4,003,476$ 3,004,090$

Net Operating Income Margin (% of NOR) 15% 1% -29% 11% 4% 1%

2021Q1 Gynecology Antepartum Delivery Postpartum NeonatologyWomen &

Children's ED

Women &

Children's OP

Imaging

Grand Total

Facility Statistics

ADC 16.8 34.9 310.0 10.4 478.3 0.0 0.0 850.5

CMI 1.42 0.79 0.81 0.96 1.08 0.00 0.00 0.95

ALOS 3.0 4.0 2.6 3.3 3.8 0.0 0.0 3.2

% Commercial 59% 41% 57% 58% 42% 34% 59% 49%

Inpatient Cases 509 786 10,862 285 11,503 0 0 23,945

Outpatient Cases 12,203 30,574 0 5,874 0 8,862 5,799 63,312

Combined P&L

Facility Direct:

Net Service Revenue 52,923,820$ 16,761,799$ 107,356,765$ 4,975,500$ 111,126,912$ 7,338,355$ 2,139,871$ 302,623,021$

Top Side Revenue 917,384$ 641,910$ 2,714,058$ 155,472$ 4,463,915$ 540,804$ 23,609$ 9,457,150$

Total Revenue 53,841,204$ 17,403,709$ 110,070,822$ 5,130,971$ 115,590,827$ 7,879,158$ 2,163,479$ 312,080,171$

Supply (8,114,518)$ (1,059,042)$ (4,130,526)$ (224,610)$ (4,881,445)$ (420,531)$ (37,953)$ (18,868,626)$

Labor (12,955,837)$ (11,781,929)$ (50,346,979)$ (2,555,726)$ (53,079,359)$ (3,555,987)$ (907,423)$ (135,183,240)$

Pharm (970,945)$ (274,858)$ (1,421,985)$ (159,743)$ (1,339,784)$ (107,059)$ (13,133)$ (4,287,507)$

Professional Fee (1,395,824)$ (873,527)$ (3,877,121)$ (120,602)$ (4,537,911)$ (622,702)$ (8,633)$ (11,436,320)$

Purchased Services (1,629,741)$ (985,612)$ (1,642,161)$ (168,618)$ (5,612,332)$ (394,113)$ (80,809)$ (10,513,386)$

Other (1,299,389)$ (396,512)$ (499,370)$ (89,905)$ (894,479)$ (121,643)$ (101,042)$ (3,402,341)$

Total Facility Direct Expenses (26,366,254)$ (15,371,480)$ (61,918,142)$ (3,319,204)$ (70,345,310)$ (5,222,035)$ (1,148,993)$ (183,691,420)$

Professional Investment (1,539,340)$ (817,357)$ (1,409,305)$ (176,284)$ (1,895,467)$ (94,786)$ (30,547)$ (5,963,087)$

Program Subtotal 25,935,610.00$ 1,214,872$ 46,743,375$ 1,635,483$ 43,350,050$ 2,562,337$ 983,939$ 122,425,664$

Program Subtotal Margin (% of NOR) 49% 7% 44% 33% 39% 35% 46% 40%

Medical Group Primary Care Investment (1,771,516)$ (963,100)$ (3,982,202)$ (223,296)$ (4,160,505)$ (351,868)$ (86,808)$ (11,539,295)$

Facility Indirect Expense (8,020,340)$ (5,219,621)$ (21,136,223)$ (986,075)$ (19,050,841)$ (1,729,366)$ (330,777)$ (56,473,243)$

Regional & System Overhead (7,758,396)$ (4,597,178)$ (17,700,104)$ (999,017)$ (18,267,370)$ (1,672,750)$ (414,221)$ (51,409,036)$

Net Operating Income (Fully Loaded) 8,385,358$ (9,565,027)$ 3,924,846$ (572,905)$ 1,871,334$ (1,191,647)$ 152,133$ 3,004,090$

Net Operating Income Margin (% of NOR) 16% -57% 4% -12% 2% -16% 7% 1%

P&L by Program

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