ELDER MEDICAL

A DIVISION OF IPC HEALTHCARE

DIRECTOR OF BUSINESS DEVELOPMENT

WEST CENTRAL NEW YORK REGION

TONY FANELLI

“The task of the leader is to get his people from where

they are to where they have not been.”

- Henry Kissinger

The Patient Comes First: Commitment to the “Voice of the Customer”

“A customer is the most important visitor on our premises; he is not dependent on us. We are dependent on him. He is not an interruption to our work. He is the purpose of it. He is not an outsider in our business. He is part of it. We are not doing him a favor by serving him. He is doing us a favor by giving us the opportunity to do so.”

- Mahatma Gandhi

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Continuum of Care, Elder Medical &

Personalized Medicine Personalized Medicine Is…

Personalized medicine is a multi-faceted approach to patient care that not only improves our ability to diagnose and treat disease, but offers the potential to detect disease at an earlier stage, when it is easier to treat effectively. Health Information Technology is a key enabler and potential accelerator of the successful adoption of personalized medicine. The full implementation of personalized medicine encompasses the 7 phases of the Continuum of Care denoted below:

Risk Assessment: Genetic testing to reveal predisposition to disease.

Prevention: Behavior/Lifestyle/Treatment intervention to prevent disease.

Detection: Early detection of disease at the molecular level.

Diagnosis: Accurate disease diagnosis enabling individualized treatment strategy.

Treatment: Improved outcomes through targeted treatments and reduced side effects.

Management: Active monitoring of treatment response and disease progression.

Integration of Information:

Seamless and rapid flow of digital information, including genomic, clinical outcome, and claims data.

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Elder Medicine: Improving Patient Care Strategically Positioned to Focus on the Most Critical, Expensive Part of Healthcare Delivery

• SOLVING Critical Needs Across the Continuum

of Care

• QUALITY Care in Acute and Post Acute

Facilities

• PROVEN Network and Diverse Referral Sources

• GROWTH Through Organic Hiring,

Acquisitions, & Hospital Contracts

• SCALABLE Business Infrastructure

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Attractive Market for: Elder Medicine’s Services • Aging population, growth & longer life expectancies – 65 and older population

will double to 70M by 2025.

• Alzheimer's disease and other dementias will grow each year as the U.S. population age 65+ continue to increase. By 2025, the number of people age 65 and older with Alzheimer's disease is estimated to reach 7.1 million — a 40 percent increase from the 5.1 million age 65+ affected in 2015.

• Chronic disease growth rates – cancer, diabetes, CVD, and COPD.

• Post-acute care industry expansion.

• Healthcare Reform, Value-Based Care, Triple AIM Roadmaps, PCMH, CMS requirements, and DSRIP Waivers.

• Without changes to how primary care is delivered, the growth in primary care physician supply will not be adequate to meet demand in 2020.

• Full service, “one stop shop.”

• Key managed care relationships.

• Population Health Management & HIT adaptation.

• Advances in genomics, personalized medicine, and pharmacogenomics / companion diagnostics.

• Significant market share growth potential with ~ 15,000 Post-Acute Facilities.

• Cost pressures will reward lower cost and more efficient providers.

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Significant Growth Opportunities: Elder Medicine & Chronic Diseases • Four chronic diseases account for more than half of the

global healthcare spend: $3.5 trillion!

• Annual Growth Rates:

Cancer – 10%

Diabetes – 5%

CVD – 6%

COPD – 7%

• Expanding its focus on Facility-Based Care in Skilled Nursing Facilities, Nursing Homes and ALFs where these diseases are most endemic.

• By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple, from 5.1 million to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure the disease.

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Elder Medicine: The Future of Geriatric Medicine Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. Maintaining the status quo will mean falling further and further behind. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons:

• To ensure that every older person receives high-quality, patient-centered health care.

• To expand the geriatrics knowledge base.

• To increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons.

• To recruit physicians and other healthcare professionals into careers in geriatric medicine.

• To unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors.

The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population. By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics.

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Integrated Delivery Networks: The Ultimate Delivery Model Objectives of Integrated Delivery Networks Quality Improvement and Cost Reduction:

• Reducing administrative/overhead costs

• Sharing risk

• Eliminating cost-shifting

• Outcomes management and continuous quality improvement

• Reducing inappropriate and unnecessary resource use

• Efficient use of capital and technology

Consumer Responsiveness:

• Seamless continuum of care from “Womb to Tomb”

• Focus on health of enrollees

• Expand footprint and increase access to providers and services

Community Benefit:

• Improvement of community health status

• Addressing the prevention of social issues which affect community health – HIV, substance abuse, infant mortality, child abuse, aging & high risk populations

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Current Trends of Integrated Delivery Networks • Purchasing PCPs to capture patients in order to increase revenue and utilization of primary

and ancillary service lines.

• Shortage of primary care physicians leading to increased care from PAs and NPs.

• PCMH accreditations and Health Home Case Management Programs to address the “frequent flyers” or patients that drain the system of scarce and costly resources.

• Implementing technology like Medication Therapy Management and other Population Health Analytics tools to proactively manage high-risk patients and to reduce hospital stay and readmissions with improved outcomes.

• Re-entering the health insurance market ; heightened relationships with MCOs.

• Adopting and implementing EMR systems per the ARRA of 2009. Also upgrading HIS/LIS to achieve a plug-in model for seamless integration with practice workflow and future HIT and Telemedicine applications.

• Interfacing EHRs with RHIOs / SHINS per the ARRA of 2009 to facilitate a secure electronic exchange of clinical information among providers. Goal is to achieve true Connected Communities of Health Interoperability.

• Migrating specialists to the EMR.

• Incentivized to provide personalized medicine and evidence-based preventive medicine across the Health Care Continuum.

• Patient Protection and Affordable Care Act to have a positive impact on PCP patient access in 2015 with a focus on the rural Medicaid populations. However, higher annual deductibles and co-payments will cause hospitals and other providers to intensify efforts to collect directly from patients.

• Shifting non-critical care patients from inpatient beds and EDs to outpatient and home care.

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Integrated Delivery Networks: My View From The Inside

• Seeking products or services that will make their network best of breed and emulated throughout the region.

• Seamless network for the treatment of pain management, addiction medicine, agonist therapy, inpatient / outpatient care, and primary and behavioral health care integration initiatives.

• PCP as the hub of all relevant activity and responsible for the coordination of value-based and patient-centric care.

• Pursuing strategic partnerships to mutually penetrate new markets, increase revenue and transform patient care through the adaptation of cutting-edge technologies.

• Looking for ease of use in terms of time and hassle saved as well as the highest quality and most compelling value.

• A “Patient First” approach through community focus groups and commitment to the “Voice of the Customer.”

• Direct to consumer marketing to expand footprint and provide the convenience of one-stop-shopping throughout the network’s continuum of health care services and providers.

• Offers a wide range of Health Resources for the community from wellness programs to support groups to clinical trials in order to increase patient access and engagement.

• Shared service and purchase service agreements within and out of network to increase efficiencies and reduce redundancies and costs.

• Taking a proactive approach to HealthCare Reform; preparing for new Part D requirements, ICD-10 conversions, and future CMS metrics and policies.

• Ongoing FTE reductions are adversely affecting patient care.

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Integrated Delivery Networks: My View From The Inside, Cont.

Integrated Delivery Networks: Partnerships = Pull Through Over the years, I have partnered with numerous IDNs:

• BayCare Health System

• Lee Memorial Health System

• HCA Healthcare

• IASIS Healthcare

• USF Health

• VA Sunshine Health

• Florida Rural Health Association

• Community Health Systems

• Tampa General Health

• Sarasota Memorial Healthcare System

• Lee Memorial Healthcare System

• NCH Healthcare System

• Orlando Health

• Florida Hospital Healthcare System

• Ocala Health

• Shands Healthcare

• Central Florida Health Alliance

• Health First

• University Community Health

• Rochester Health

• Catholic Health

• Kaleida Health

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Unique Needs of Post-Acute Care Facilities Within an Integrated Delivery Network Community (IDNC):

Elder Medicine’s Crucial Role An IDNC is a living, breathing and evolving healthcare delivery system. All providers within an IDNC

have unique roles, but are dependent upon each other. In concert, they comprise a seamless,

comprehensive and evidence-based care continuums from “Womb to Tomb.” Providers who

ingrain their brands, imbed & expand their footprints, foster strategic partnerships, and increase

access to its services will prosper in the IDNC’s perpetual care cycle. Most importantly, the goal of care

coordination within an IDNC is to make the primary care physician the hub of all relevant activity. Care

must be coordinated not only within the practice, but between it and community settings, labs,

specialists and hospitals.

Partnering with Elder Medicine enables you to concentrate on running and growing your center or

community while we manage and administer the medical director and mid-level provider

responsibilities and relieve you of what is often a financial and managerial burden.

Effective Medical Management • Elder Medicine has established effective medical management and medical director programs

for post-acute care centers, to include skilled nursing, rehabilitation and long-term care centers, assisted living ,and continuing care retirement communities.

• Each Elder Medicine partnership is unique and each program is tailored to meet the specific needs of clinical and operational goals of our post-acute care partners.

• Providers are supplied based on your center’s census and patient care needs. All staff members are measured against productivity and quality standards as well as benchmarks, proven to result in better outcomes, reduced readmissions and overall operational efficiency for your center and your patients.

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Unique Needs of Post-Acute Care Facilities Within an Integrated Delivery Network Community (IDNC):

Elder Medicine’s Crucial Role, Continued

The Elder Medicine’s team provides the complete spectrum of care to the patient and focuses

on proper charting, medication management, advanced directives, and communication with the

family and center staff. This provides a seamless and consistent approach to care, as reflected in stellar

patient satisfaction results for our partner centers. Our collaborative approach brings advances to your

community:

• We deliver a higher level of care coordination and preventative measures to reduce readmissions between post-acute care centers and hospitals. Elder Medicine’s providers collaborate with both the hospital and post-acute care staff to provide the safe and efficient transition of care necessary to positively impact readmissions as well as costs.

Collaborating with Administrators • We provide post-acute care centers with a board-eligible or board-certified medical director to

manage patients, collaborate with each center's administration, case management and clinical staff to meet or exceed quality and compliance.

Experienced Medical Directors and Providers • We provide medical staff for skilled nursing and rehabilitation centers, assisted living

communities, and long term care facilities.

• Elder Medicine should consider providing on-site outpatient medical clinics for continuing care retirement communities. This provides residents with convenient medical care for drop-in visits, minor health issues and first aid services without the need to secure a future appointment with a physician outside the community.

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Post-Acute Care Facilities (PACFs):

Partnerships = Pull Through Over the years, I have partnered with many PACFs:

• Arbors

• Beverly Health

• Bon Secours

• Freedom Square

• Glen Oaks Healthcare

• Green Briar

• Harborside Healthcare

• Heritage Health Care

• Home Health Agencies

• Hospice Centers

• John Knox Village

• Kindred Healthcare

• Lakeshore Villas

• Long Term Acute Care Hospitals

• Manor Care

• Palm Garden

• Retirement Communities

• VA Medical Centers

• An excellent search engine is CareLookup.com. The site provides Continuing Care Facility State Directories by Site Type & Nationwide Continuing Care Providers by Facility Type.

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Five Step Pipeline Model: Build a Robust & Sustainable Pipeline

• PROSPECT & ENGAGE: Identify prospects, diagram

organizational chart, qualify prospects and secure appointments. Never be more than one step from your clients.

• DIFFERENTIATE & ENTICE: Differentiate, develop right

needs and inspire emotion. Align yourself with early adopters and thought leaders.

• BUILD VALUE: Permeate account, present solution and gain

technical win or added value.

• CONFIRM & CLOSE: Sell decision makers and influencers,

prove capabilities and secure the contract.

• MAKE REFERENCEABLE: Deliver value, make

referenceable and discover new needs. Leverage current clients and deliver patient-centric care according to the “Voice of the Customer.” Expand and develop new managed care relationships.

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Managed Care Organizations: Broaden Relationships With Managed Care Managed Care Experience • Aetna

• Amerigroup

• AvMed

• Beech Street

• Blue Cross Blue Shield

• Choice Managed Care (Workers’ Comp)

• Cigna

• Commercial

• CorVel (Workers’ Comp)

• Coventry Health Care

• Empire – NYS Employees

• Fidelis

• First Health (Workers’ Comp & Medical)

• First Service Administrators

• Focus (Workers’ Comp)

• Freedom Health

• Health First

• Health Options

• Health Choice

• Healthy Kids Florida

• Health Now

Managed Care Experience • Hernando County Government

• Hillsborough County Government

• Humana

• Independent Health

• Magellan

• Manatee Health Network*

• Medicaid

• Medicare

• Memorial Employee Health Plans*

• Pasco County Government*

• Pinellas County Schools*

• Rockport (Workers’ Comp)

• TRICARE

• UnitedHealthcare

• Univera

• WellCare

• Wellpoint

• NUMEROUS OTHERS

*denotes plans that I negotiated . The other

plans I have experience with, helped to set-up, implement

& manage compliance / leakage issues

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Health Care Reform = Opportunity Increased Access, Parity, Integration and Prevention

Health Reform Basics • The American Recovery & Reinvestment Act of 2009

• The Affordable Care Act of 2010

• Mental Health Parity and Addiction Equity Act of 2008

• Primary and Behavioral Health Care Integration

• Grants

• Health Homes

• Patient-Centered Medical Homes

• Eligibility & Enrollment – Medicaid and ACA Health Insurance Exchanges

• National Prevention Strategy

• Preventive Task Force

• Community Transformation Grants

• Prevention and Public Health Fund

• Prevention Services Covered Under the ACA

• Medicare Preventive Services Coverage

• Medicaid Preventive Services Financing

• Employer Wellness Programs

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Leadership That Gets Results: Proactive Solutions

• My Value To Elder Medicine:

Track Record & Experience

• Leadership:

Unite, Lead and Deliver

• Leadership Tools & Strategies:

The Path To Success

• Growth & Retention Tools:

Continuously Expand Footprint

• 30-60-90 Day Plan:

Dedicated, Self-Driven, Focused & Results Oriented 18

My Value to Elder Medicine: Track Record & Experience • Almost 30-years of progressive experience in physician, hospital,

post acute, and IDN settings with 20 years served in positions of leadership.

• Alignment of goals, strengths and cultures. • P & L and territory management acumen. • Ability to build and motivate diverse, high-performance teams. • Proven producer and winner! • Superb networking and business development skills. • IT and connectivity solutions acumen. • Unsurpassed work ethic and integrity. • Extremely loyal and dedicated. • Cross-functional leadership • Industry insight and technical knowledge. • Leadership Tools • Growth and Retention Tools • Business Development Strategies – 5 Step Pipeline Model • Proactive approach to Health Care Reform. • Commitment to the “Voice of the Customer” • Excel in rapidly evolving systems and priorities.

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Leadership: Unite, Lead and Deliver • Embrace role as a PROACTIVE LEADER with a passion –

provides an honest, open and encouraging environment that fosters communication and creativity.

• Proactively builds bench-strength.

• Liaison between clients, sales and operations.

• Provide tools for success

• Cross-functional ingenuity

• Hands-on management style – work in the “trenches” with my team.

• Never more than one step from the customer.

• Leads by example

• Visionary and out-of-the-box strategist

• Team player and persuading conductor

• Bottom-line and big picture oriented

• Always one step ahead of the challenge and two steps ahead of the competition!

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The Eleven Critical Qualities of Leadership: My Daily Mission!

1. Unwavering Courage

2. Self-Control

3. A keen sense of justice

4. Definiteness of decision

5. Definiteness of plans

6. The habit of doing more than paid for

7. A pleasing personality

8. Sympathy and understanding

9. Mastery of detail

10. Willingness to assume full responsibility

11. Cooperation

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Leadership Tools & Strategies: The Path To Success • Liaison between sales and operations per the “Voice of the

Customer”

• Customer and associate satisfaction surveys

• Continuous cross-functional process improvements to differentiate brand and eliminate silos

• 5 Step Pipeline Model

• Weekly conference calls and quarterly meetings

• Provide tools for success

• Business unit recognition programs

• Field Work Contact Review Form

• Personal Development Program

• Mentoring Partnerships - utilize your stars

• Team-building and development – Rembrandt Advantage and Myers-Briggs Type Indicators

• Active role in industry-related organizations

• ACOUNTABILITY! URGENCY! EVOLUTION!

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Growth and Retention Tools: Continuously Expand Footprint • Territory Management Reports • Sales Force Automation • Microsoft Excel/Access Upsell Report • Internal Account Manager “Mining” Program • Internal Account Manager support efforts • Attrition, leakage and variance reports • Account-specific pipeline developments strategies • Brainstorm for non-traditional opportunities • Strategic account stability plans • Accordion Sales Presentation Tool • Adopt-A-Customer Program • Direct to consumer marketing and branding • Population growth-targeted PODs • Maximize under-performing POD volumes • Centralized CEUs and other added value programs • Evaluate local market production schedules • Always be in the center of health care delivery! • Keep your competitors on the defensive!

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30-Day Preliminary Action Plan: Identify Prerequisites & Actions Needed for Successful Execution

• Attend appropriate training, compliance standards and orientation; get to know key corporate hierarchy and associates.

• Maintain the Elder Medicine POD as my base of business and daily operations.

• Fully understand products, services, business models, ROI templates, and administrative reports.

• Determine the scope of the Buffalo POD network. Leverage its relationships to organically grow the business, proactively resolve service issues, and identify at-risk clients.

• Respond to clients on an ad hoc reporting and informational requests.

• Communicate effectively with staff, other professionals, families and the public; convey patience, tact and a positive attitude when dealing with others.

• Initiate, develop and maintain relationships with key Buffalo POD key market business partners in SNF, LTC and ALF facilities; consider expanding into retirement communities.

• Enhance the visibility of Elder Medicine in the community through participation in industry-related professional organizations; provide information and education to facilities.

• Identify/understand competitors and industry trends.

• Provide day-to-day physician practice management administrative support.

• Effectively manage all territory and POD network expenses.

• Adjust action plan according to the feedback of Amy Hillock, Dr. Steve Evans, Ed Metzger, NP & “The Voice of the Customer.”

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60-Day Preliminary Action Plan: Work Cross-Functionally to Formulate Action Plans Designed to Qualify, Quantify & Measure Performance • Develop and implement marketing strategies that will generate patients for the

practice groups; design account-specific business plans.

• Handle crisis and stress in a constructive manner.

• Wear both sales and operations hats depending on the situation. Effectively prioritize activities and simultaneously work on multiple projects in order to maximize time management and productivity.

• Establish a regular call cycle that utilizes the Five Step Pipeline Model.

• Leverage current relationships and develop prospects to build a robust and sustainable organic sales pipeline; conduct sales presentations to healthcare providers.

• Quantify total available market share by Elder Medicine’s service line, facility and competitor; work with finance & utilize third party and corporate data bases.

• Works with Program Director to maintain positive and effective relationships with agency partnerships in SNFs, ALFs and community.

• Oversees and coordinates the process for a thorough and timely orientation for contracted physicians.

• Participates in scheduling and on-call as needed.

• Participates in agency outreach activities, educational symposia, workshops and courses.

• Performs telephonic or electronic validation of daily census for facilities; reviews monthly actual financial data to budgeted data and present monthly financial review.

• Complete and deliver high-quality & accurate administrative reports on time, all the time.

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90-Day Preliminary Action Plan: Implement Account/Geographic-Specific Strategies Designed to Deliver Results, Grow the Pipeline & Differentiate Elder Medicine’s Products and Services • Conduct regular conference calls to review sales pipeline, new and upsell business, at-

risk clients, competitive intelligence, compliance issues, census, etc.

• Lead monthly or quarterly meetings . Key focus will always stress census, organic growth, at-risk clients and areas for improvement. Meeting agendas will be flexible to accommodate national and local initiatives & priorities as well as key associates.

• Follow performance standard guidelines with set baselines to measure organic growth and maximize new business opportunities. Embrace change and be adaptable. Discipline and self-control are crucial. “There is no elevator to success. You have to take the stairs.” – Zig Ziglar

• Convert early adopters and 30-day prospects; leverage referenceable client base.

• Implement an Internal Account Manager “mining tool” that will generate daily qualified leads and act as an internal resource.

• Identify, establish and foster strategic partnerships within each geographic POD. Collaborate with strategic partners to mutually transform patient care through the adaptation of cutting-edge technologies of the highest quality and most compelling value.

• Focus on short-term and long-term expansion plans that involve feedback from physicians, managed care organizations, and senior level executives within the medical community. The patient always comes first! Treat everyone with respect and be humble. Always control your emotions and foster harmony. “A house divided against itself cannot stand.” – Abraham Lincoln.

• Provide knowledge to optimize decision making, improve health outcomes, reduce treatment costs, and establish IPC Healthcare as the dominant player in the post-acute care services arena.

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