This is CNE | 2016 Annual Report by Women & Infants Hospital of Rhode Island

THIS IS CNE 2016 ANNUAL

REPORT

MIS SION: to be your PARTN ER in HEALTH

V ISIO N: to create a COMMU N ITY of HEALTHIER PEO P LE

VALU ES: Care New Englandâ&#x20AC;&#x2122;s organizational values emphasize IN DIVIDUA L C O N T R I B U T IO N S and a TEAM APPROA CH that foster AC C OU N TAB ILITY, CARIN G and TEAMWORK

2 4

from the CEO and President and Chairman of the Board

CNE

MESSAGE

CNE WORKING FOR YOU

Outreach in action

Reading, writing, and counseling sessions

Seeking more options

for recovery 10

Delivering a great start Helping to keep the heart beating Creating a quality experience for outcomes for

Noteworthy moments

CARING FOR YOU

Probing the influence of environment on child behavior 36

Research highlights

T REAT MEN T S

Achieving healthier the community

CNE

a glance 34

SEEKING NEW

the community

Research at

12 14

healthy and stronger 26

Sharing personal experiences to serve others

Losing weight, loving life

Quick facts and figures

Board of directors

Management team

Board committee structure

Operating margin

Strategic framework

NEW

NURTURING LEADERS AND STUDENTS

Educating the next generation of home care nurses

CNE

Combining technology with human connection 25 Keeping the heart

Learning to lead 45

THIS IS

CARE

NEW ENGLAND

ACCOUNTABILITY

AND

FINANCES

Balanced scorecard 66

MESSAGE FROM THE

CEO AND

CHAIRMAN OF THE

BOARD

s you read this annual report for fiscal year 2016, we hope you do so with an eye toward the rapid pace of change we are experiencing in health care and more specifically, here at

Care New England (CNE).

A major initiative in fiscal year 2016 for us and just about everyone in health care was the ongoing shift to population health. What does that mean? Under this new model, institutions like ours are reimbursed a fixed amount to care for each patient, which has redirected our focus to keeping patients well and receiving care in the community whenever possible. This includes streamlining the continuum of care, minimizing hospital readmissions and better coordinating care through primary care physicians.

It would be easy to share this snapshot in time in the absence of greater context, but given the fast-paced changes in health care it is essential we reflect on the past year with an understanding of where it fits into the broader landscape. That landscape today finds us in the midst of partnership negotiations with Prime Healthcare Foundation and Partners HealthCare as they pertain to Memorial Hospital and the broader CNE system respectively.

In response to this dramatic transition, clinical teams redesigned the way we care for our patients across the varied settings at Care New England, training our collective sights on what is referred to as the Triple Aimâ&#x20AC;&#x201D;improving the patient experience, improving the health of populations, and reducing health care costs.

To better understand the present, it is important to briefly revisit 2016, a year marked by significant change, challenge and opportunity. Despite the challenges, we have been able to stay true to our mission, vision and values, ensuring we provide the high-quality health care our patients and communities deserve.

Creating and adapting to a new model of care was just one of the hurdles CNE faced in the past fiscal year. Other challenges included increased competition from non-profit and for-profit health care organizations in the area, highly restrictive commercial reimbursement rates, reduced inpatient volume, shifts to lower paying health plans, and new technology requirements including electronic medical record upgrades.

With this in mind, we still achieved many notable accomplishments: • Growth of Integra, our accountable care organization, as a more efficient, effective care model increasing from 300 members to more than 125,000 and a staff of nearly 50. • Formation of Care New England Medical Group employing more than 350 physicians and more than 135 non-physician providers across an array of general medicine practices to specialties and sub-specialties. • Refinement of a system-wide balanced scorecard which serves as the roadmap for our strategic direction. • Consolidation of the system’s laboratory services. • Institution of a system talent acquisition team to organize recruitment for key positions and to cultivate volunteer services as a feeder program. • Right-sizing resources to volume at Memorial Hospital. • Installation of Epic information technology in all ambulatory locations across the system. • Establishment of new partnerships with The Providence Center and Rhode Island Primary Care Physicians Corporation. • Payment reform with Blue Cross Blue Shield of Rhode Island. In the midst of all of this change, CNE worked to restructure our corporate debt covenants while retiring loans when possible. Through the wide-reaching Transforming Together Today (T3) initiative, we have examined a multitude of ways to reduce costs, increase revenue generation, maximize care retention, and improve revenue cycle and supply chain functions.

Despite the challenges, we have been able to stay true to our mission, vision and values, ensuring we provide the highquality health care our patients and communities deserve.

T3 is an aggressive plan that has systematically examined every aspect of health care strategy and operations, while targeting major improvements in our physician enterprise, clinical operations, human resources, labor, purchased services, revenue cycle, and 340 B/pharmacy. With this, by the end of fiscal year 2016, T3 initiatives had tallied: • $64.4 million in confirmed savings. • $81.6 million in reoccuring savings through implemented initiatives. The tremendous impact of this system-wide recovery plan was recognized by our lenders and prompted Standard & Poors Global to elevate our rating from “negative” to “stable” by the end of the fiscal year. Their report gives a nod to our efforts to create a more efficient organization, noting that our senior management team “focuses on continued development of its primary care base in Rhode Island and on securing its mental health presence regionally. It is also committed to acting as a local leader in accountable care design and the management of patient-centered medical homes. We believe CNE’s care management strategies overall are prudent and that they follow national industry trends...” We know that the changes of 2016 were just the beginning of an aggressive and critical plan for our sustainability and future growth. The work undertaken this year is a start, but we must be realistic and focused on what is ahead. We firmly believe in the opportunities before us and the close of 2016 simply presents the chance to do more in the year ahead for the long-term health of our system. It will not be easy, but we stand ready for what is ahead, and with those challenges will come tremendous potential and opportunity for the future.

Charles R. Reppucci Chairman of the Board

Dennis D. Keefe President and Chief Executive Officer

CNE WORKING FOR YOU

There’s an old expression which says, “The more

things change, the more they stay

the same.” In the field of today,

change

health care

has become the norm. The

focus of the industry

is to

redirect

care from more costly specialty treatments to wellness and prevention to keep people out of the hospital .

UNCOMPENSATED CARE BY OPERATING UNIT $7,625,130

$7,500,000

developed partnerships and programming

that encompass this broader spectrum of needs, which

to the lingering effects of a concussion.

$6,000,000 $5,376,983

$5,500,000 $5,000,000 $4,500,000

IN W

2016 COMMUNITY BENEFIT $118.3 MILLION Outreach programs $1.3M/1% Subsidized health services $16.4M/14%

Medicaid shortfall $46.5M/39%

Education $42.4M/36%

Financial assistance $9.6M/8% Research $2.1M/2%

Care New England 2014 Schedule H Form 990

WORKING FOR YOU

These strides are happening from the very top of the organization. In September 2016, our Board of Directors approved a targeted, three-year strategy for supporting a myriad of community health improvement efforts, a move that coincided with the release of the Hospital Association of Rhode Island’s Community Health Needs Assessment. The list of objectives—culled from an 18-month evaluation directed by the Board’s Public and Community Health Committee of public health data and conversations with community and government health leaders—identified the community’s top three areas of concern as:

FA N

IAL OR EM

$4,087,882

VNA and The Providence Center reported zero.

and Care New England has mindfully

addictions, and from pediatric learning disorders

$6,500,000

$4,000,000

concept of caring for the whole person,

can range from obsessive compulsive disorder to

$7,038,007

$7,000,000

he medical community embraces the

• Behavioral health. • Chronic disease, including diabetes and heart disease. • Maternal and child health. Using this list as guidance, our Board refined Care New England’s specific areas of focus even further to opioid-related deaths, pre-diabetes, and prenatal care and infant mortality. A system champion for each area was assigned to direct our efforts on behalf of the community. Parallel to these steps, CNE, as a system, continues to invest in innovative ideas that provide the care and guidance people in our region need to keep their bodies and minds as healthy as possible. This includes the roll out of Butler Hospital’s Healing Arts Residency and Training Program, which provided healing arts services such as movement and music therapy to more than 800 patients, 75 staff members and 60 caregivers throughout the year. as well as Women & Infants Hospital’s new Menopause Program for women whose quality of life is affected by mid-life hormonal changes. We’ve also secured federal grant monies to implement Improving Transitions of Care for Vulnerable Elderly Palliative Care Patients in Rhode Island, a project orchestrated through the Care New England Palliative Care Service. Efforts such as these have not gone unnoticed. In August, Michael Botticelli, director of National Drug Control Policy at The White House, visited The Providence Center’s Anchor Recovery Community Center in Pawtucket to see how Care New England is shifting the mindset from “getting people well” to “keeping people well.” The Center, which provides a safe place during the day for people grappling with substance

abuse, as well as social activities at night and on weekends, is a perfect example of our ongoing efforts to care for the body and mind, and in ways that support patients in the community. We’re proud to have the opportunity to share it with a national audience. “Reversing opioid overdoses with naloxone is keeping people alive,” Botticelli said at the end of his visit, “but we can’t stop there—we have to connect people with

treatment from an overdose. (This) innovative approach is bringing the community together to help people access treatment and reach recovery. By increasing access to evidence-based treatment options, we can save lives and help move Rhode Island—and our country—from crisis to recovery.” It’s a progressive way of viewing community health care, but we believe that such a holistic approach is not only logical but compassionate.

OUTREACH IN ACTION

These figures reflect a subset of the $1.3 million in outreach programs that CNE members provided in our region. $21,232 $3,729

$20,000 $15,000

$13,608

$4,757

$4,636

$12,556

$10,000

$8,268 $2,321

$8,972 $5,000

$9,564

$5,947

new parents, breastfeeding classes and support groups

diabetes education, screening and support groups

depression screening and mental health education

$171,002

$100,000

$4,947

$14,321

cancer awareness and screenings

$177,292

$114,056

$75,000 $50,000

$56,389

$54,608

$53,526

$49,600 $19,558*

$25,000 $557

fitness, nutrition and school physicals

health fairs, community lectures and advocacy *includes $312 from the VNA of Care New England

BUTLER

KENT

MEMORIAL

WOMEN & INFANTS

READING, WRITING, AND COUNSELING SESSIONS

atty Donahue walks through the hallways at George J. West Elementary School in Providence feeling like a rock star as students she knows and others she does

not call out greetings to her and ask if they can come down to her basement office to play a game of Uno or to color. Donahue (pictured far left) is a licensed clinical social worker who is the on-site face of the School Counseling and Support Program, a privatepublic partnership of The Providence Center (TPC), Providence schools, and Behavioral Health Solutions. West is one of five elementary and middle schools hosting the program, with more in the planning stages, according to program coordinator Linda Tavares. Donahue and other clinical staff field referrals for students or families who may need behavioral health intervention, a service the schools are not equipped to provide, according to Superintendent Chris Mahar. “The traditional school district model wasn’t designed to meet the socialemotional needs of every child. With this partnership, we can offer our students the mental health and social services support they need to overcome obstacles that are holding back their ability to be fully engaged and ready to learn,” he says. Students at West, which is located in the city’s Mount Pleasant neighborhood, are diverse and many come from violent neighborhoods or difficult homes. “People don’t understand how many of these little ones undergo trauma. Many can’t leave the house because they live in a bad neighborhood, or they have parents who are depressed or incarcerated,” Donahue explains. These challenges manifest as behavioral issues ranging from hyperactivity to sullenness to anxiousness, or severe absenteeism. Any of these signs can prompt a teacher, the school nurse, or another staff person to reach out to a parent about the School Counseling and Support Program, which then often leads to an intake meeting with Donahue either at the school or in the family home. In just months, she has amassed a caseload of 45 active participants, including many siblings, with almost 10 more children’s cases pending.

WORKING FOR YOU

She sees them regularly, calling them down during recess, lunch or a non-academic period to talk. Sometimes, the parents visit the school to provide them with support as well, noting that “anxious kids usually have anxious parents.” “Thank God we have her!” exclaims school nurse Nora Thurber. “Her being here has really made a difference. Kids who had a bad year last year are doing so much better this year. She’s working on skills like anger and conflict management with them, teaching them long-term skills. If they’ve experienced trauma, she’ll do relaxation exercises with them.” As if on cue, Donahue and a quiet third-grader named Serenity (pictured above) stand and together strike the “tree” yoga posture. Donahue wobbles a bit on one leg but Serenity smiles, standing straight and motionless. She’s learning and practicing yoga with her younger sister and mother in a weekly class at the local library that Donahue recommended for them. “I borrow some yoga books and try some moves at home,” Serenity says shyly.

“

People don’t understand how many of these little ones undergo trauma. Many can’t leave the house because they live in a bad neighborhood, or they have parents who are depressed or incarcerated.

” 9

SEEKING MORE OPTIONS FOR RECOVERY

ark spent three years drinking heavily to compensate for worsening anxiety and depression. His many attempts to stop the pattern failed,

but he was willing to try again with the new Outpatient Detoxification Program at Butler Hospital. The program was designed by Medical Chief for Alcohol and Drug Addictions Alan Gordon, MD, to medically manage withdrawal from substances including heroin, opioids and prescription medications, as well as alcohol. “For many patients, an inpatient hospital stay is too intensive, while immediately stopping the intake of a drug or alcohol may be medically dangerous or set people up for failure due to managing the side effects of detox,” said Gordon. “Offering this service provides another option for recovery that we are finding is very empowering for people.” For Mark*, it was the at-home monitoring and accountability the outpatient program demanded that proved helpful to his successful detox. He was responsible for monitoring himself with a breathalyzer that uses face recognition software, and a blood pressure cuff and pulse monitor to track vital signs under the supervision of a program staff member. This both empowered him and helped him stay focused on sobriety. Also key to his long-term success is the transition from the ambulatory detoxification program to Butler’s partial hospital rehabilitation program, also innovative when it started. Through that program he developed a sober support network, improved his coping skills, and developed an optimistic outlook about his sobriety. He is currently maintaining his sobriety with outpatient treatment. Conversely, it wasn’t alcohol use that brought Joe* to Butler’s outpatient detoxification program. It was Percocet. After a back injury caused him constant pain, Joe found relief with the prescription opioid, which he used for five years. He worried that stopping the medication would cause his pain to return, but Butler’s program has a specific protocol for medically converting people like Joe from strong narcotic pain medications to a

WORKING FOR YOU

safer form of treatment. During his outpatient detox, Joe was given doses of Suboxone to help control his pain while safely coming off of Percocet. After finishing detox, Joe also transferred to the partial program as a step down in care and to retain ongoing support and education. Today, he is living without chronic pain—and more able to enjoy life with his wife. The Outpatient Detoxification Program is not appropriate for all people, some do require a hospital stay rather than daily visits to a clinic. But for people like Mark and Joe, who have reliable transportation, adequate support at home, and no unstable psychiatric illness or medical conditions that could impair their care, the ambulatory clinic provides a safe way to withdraw from opioids or alcohol at home. *Names have been changed to protect the patients’ privacy.

“

For many patients, an inpatient hospital stay is too intensive, while immediately stopping the intake of a drug or alcohol may be medically dangerous or set people up for failure due to managing the side effects of detox.

”

DELIVERING A GREAT START

ringing a baby into this world is one of the most jubilant times for a woman and those she considers family.

Until recently, three of Care New England’s hospitals—Kent and Memorial, community-based facilities, and Women & Infants, one of the top women’s specialty hospitals in the country—offered obstetrical services based in two counties covering almost three quarters of the state. In fact, Women & Infants serves as the birthplace for more than 79 percent of babies born in Rhode Island in an average year. With a significantly fewer number of deliveries happening at Memorial than the other two hospitals, CNE sought—and received—state approval to transition Memorial’s small number of patients to Women & Infants and Kent in August 2016.

“

They let me and my husband go through this alone, which was what we wanted. When you are going through a natural birth, especially, you need to trust in your body and that everything will be okay.

”

WORKING FOR YOU

Since then many of the physicians and nurses have become involved with efforts to ensure that mothers with low risk pregnancies are afforded low intervention services at Women & Infants as well as Kent, including the addition of family medicine physicians to the obstetrics team at Women & Infants. It’s also a time when women are empowered to assert themselves even more as they make decisions that affect their bodies and their babies. Care New England has taken great care to encourage such passionate participation, accommodate requests, and provide tailored birth experiences. To that end, Kent’s Women’s Care Center received prestigious international recognition as a Baby-Friendly® Designated birth facility. The designation, held by Women & Infants since 2015, is sponsored by the World Health Organization and United Nation’s Children’s Fund to recognize hospitals promoting the best evidence-based feeding practices for babies. Likewise, Women & Infants continues to provide choices for mothers. Tammy Kerr-Gaudette had very definite ideas about what she wanted her experience birthing her first child to be like—she envisioned laboring in a tub, with her husband Jason and a few others beside her. She wanted the guidance of a midwife and as little intervention as possible.

“I wanted to have my own birth requests met, with my input, so the birth would go the way I wanted with the opportunity to make decisions as I went along,” she explains.

As the time to push got closer, she was helped out of the tub and into a nearby bed for the final stages of delivery.

Working with a midwife from Women’s Care, Tammy and Jason (pictured below left) chose to deliver at the Alternative Birthing Center (ABC) at Women & Infants, arriving on Tuesday, May 24, 2016 in active labor. Once her vital signs and those of her baby were approved for an ABC delivery, Tammy says “they unhooked me from the monitors and let my body do what it knows to do naturally.”

“My midwife told me to reach down and touch the baby’s head. I felt this massive head of hair and said, ‘Let’s get this baby out!’”

She sat in the birthing tub for a bit, which she found helpful in relieving the pains of labor, while her midwife and labor nurse monitored her vital signs and the baby’s heart rate periodically. “They weren’t on top of us the whole time. They let me and my husband go through this alone, which was what we wanted,” Tammy says, adding, “When you are going through a natural birth, especially, you need to trust in your body and that everything will be okay. Fear is the worst thing for labor. I kept reminding myself that every contraction was bringing me one step closer to my baby. I didn’t keep looking at the clock. I just took it as it came.”

A few pushes later and a beautiful, healthy Julia Grace Gaudette was born. Weighing 6 pounds 14 ounces, and measuring 18-1/2 inches long, she was put immediately skin-to-skin with Tammy and cord clamping was delayed at the parents’ request. “It was a very calm, relaxed, wonderful birth. I wouldn’t have changed a thing,” Tammy says. “I was able to write my own story and it was awesome to see it all play out.”

Care New England has taken great care to encourage such passionate participation, accommodate requests and provide tailored birth experiences. 13

HELPING TO KEEP THE HEART BEATING

t was a bitterly cold day when Louis Miller went out to help his son and grandson clear snow from the driveway.

There wasn’t much snow and he didn’t overexert himself, but when he came back inside, the 6-foot, 3-inch man “went down,” unconscious on the kitchen floor in front of his startled family. By the time the rescue squad pulled up, Miller (pictured left) was sitting up in a chair, thanks to the implantable cardioverter defibrillator (ICD) he had implanted in his chest a few months earlier. When the cold air caused his heart, weakened by mitral valve prolapse and heart failure, to stop, the ICD shocked it back to life. “Without this, I probably wouldn’t be here right now,” the Cumberland software support technician says simply. Miller says he learned several years ago that he suffered from heart failure and his CNE cardiologist Thomas Noonan, MD (pictured far right), conducted an echocardiogram every year to monitor it. Last year, the exam showed he had atrial fibrillation (AFib), meaning his heart wasn’t beating normally. It also showed he was at risk for “sudden death” because his ejection fraction was at 35 percent. A round of blood thinners and two cardioversion treatments, in which Dr. Noonan stopped and restarted his heart, didn’t fix the problem. Miller was referred to Bruce Koplan, MD, MPH, director of the Cardiac Arrhythmia Service for CNE and a member of Brigham and Women’s Cardiovascular Associates at Care New England. Dr. Koplan started implanting ICDs, called a breakthrough treatment in the prevention of sudden cardiac deaths, at Kent Hospital in 2012. “Dr. Koplan said I was definitely a candidate for an ICD implant because it’s a good solution for a younger patient,” Miller says. While initially unsure he should have such a drastic treatment, he says he’s happy to know that his ICD worked for his heart. “The device read what was going on with my heart and shocked my heart back into normal sinus rhythm,” Miller says. “It saved my life!”

WORKING FOR YOU

CREATING A QUALITY EXPERIENCE FOR THE COMMUNITY

are New England’s stated goal is to be the clear choice for quality and value in health care for the people of our region.

During fiscal year 2016, CNE implemented multiple initiatives designed to ensure that goal is met. The areas of focus were to: • Eliminate the risk of health care-acquired infections (HAIs). • Communicate effectively with our patients and their families. • Provide the “right care in the right place at the right time.” To facilitate this, our hospital teams have standardized several best practices including: Value-Based Care Meetings – A systematic process for reviewing data regarding care planning and coordination processes, timeliness of patient discharges, and patients’ length of stay in the hospital. This focus helps us improve patient progression from the time of admission through discharge by identifying and eliminating barriers. Monthly Quality Committee Meetings – A place to review data and outcomes, share best practices, and identify barriers and changes needed, thus creating a key accountability structure. Weekly Patient Safety Steering Committee Meetings – Team gatherings to review events reported through the online safety reporting system. The focus is on sharing details that have been learned about each event, identifying problems that need to be addressed, and discussing follow-up actions that have already been addressed. Meetings also provide learning opportunities by creating a communication feedback loop through which managers can share safety lessons learned with staff. Daily Interdisciplinary Care Rounds – A standardized process for care team members to discuss every patient, including his/her care goals, clinical concerns, treatment plans, and anticipated discharge needs. This allows all members of the team to have a shared vision for patients’ needs, which helps to deliver care more effectively and efficiently. Daily Safety Huddles – Brief, hospital-wide meetings at which participants report any safety incidents or concerns. This proactive approach helps identify issues for quick communication, problem solving and, if needed, mobilization of resources. It also provides an opportunity to recognize staff for things that are going well.

WORKING FOR YOU

Hourly Rounding – A process for clinical staff to check in on every patient to ensure that necessary safety measures are in place. The team also confirms patients are comfortable and have everything they need within easy reach. Infection Prevention Bundles – Evidence-based best practices that, when done together, are consistently proven to prevent HAIs. Examples of these practices include: limiting the use of invasive devices such as urinary catheters and central line catheters; a consistent focus on hand cleaning before and after patient contact; use of personal protective equipment; specialized environmental cleaning methods including use of UV robots; and appropriate use of antibiotics. During the same period, we also launched a system-wide safety campaign called “Safer Care Together,” which focuses on preventing harm to our patients and colleagues. This ongoing work requires that all care team members are taught best practices to prevent harm through consistent focus on the details necessary to proactively respond to any risks. To ensure that our patients’ experience meets or exceeds their needs and expectations, our care team members have focused on enhancing systems and processes that support a patient- and family-centered experience. This includes improving how and when we communicate by setting service standards for our interactions with every patient, every time; consistently using care communication boards that allow for sharing and receiving information; hourly rounding by clinical staff; and daily rounding by leaders. In addition, there has been a significant focus on improving the environment of care to promote healing. We think of population health as ensuring that the right care is provided at the right time, so we have done substantial work to make sure our patients don’t spend more time in the hospital than needed. Our community care teams—including those at the VNA of Care New England, Care New England Medical Group and The Providence Center—collaborate to provide needed services for patients to receive timely care and prevent the need for hospitalization. All of this work highlights our commitment to patient safety and experience, and helps us achieve the quality goals we have set: getting to zero HAIs; providing a caring, healing environment for our patients and their families to have the best experience possible; and making sure our patients get the care they need in the right place at the right time.

To ensure that our patients’ experience meets or exceeds their needs and expectations, our care team members have focused on enhancing systems and processes that support a patientand family-centered experience.

2016 BY THE NUMBERS

serious blood stream infections avoided in babies in the Women & Infants Carter Family Neonatal Intensive Care Unit.

35%

56%

fewer C. difficile infections occurring at Memorial Hospital.*

6,900 extra hospital patient days avoided due to improved efficiency.*

19,266

65%

patients and clients provided valuable feedback on their care experience.

more clients enrolled in Current Care at The Providence Center, allowing for improved care coordination.*

53%

fewer one-to-one observations needed at Butler Hospital due to program and staffing changes.*

fewer catheter-associated urinary tract infections occurring at Kent Hospital.*

80%

VNA patients demonstrating functional improvement after receiving care.

*in comparison to 2015 data 17

ACHIEVING HEALTHIER OUTCOMES FOR THE COMMUNITY

ntegra Community Care Network, an accountable care organization, is a partnership of Care New England Health System, Rhode Island Primary Care Physicians Corporation (RIPCPC), and South County Health. After

its second year of operation, it continues to lead in developing new ways to provide a better patient experience, reduce costs, and—most importantly—better health. This is often called the Triple Aim of health care reform, and it is the foundation of all current payment and care delivery reforms. Accountable care organizations (ACOs) differ from traditional, fee for service health care providers in that they are responsible for the whole health, and total cost of care, for patients assigned to them. Instead of focusing on appointments made, procedures performed, tests administered—the traditional definition of fee for service medicine—an ACO aims to achieve better health through prevention, care coordination, chronic disease management, and more. In many ways, ACOs take the “big picture” view of patient care our health care system has long needed, finding efficiency and improved health in the process. To achieve these ambitious goals, Integra has continued to build a team of high-quality health care providers, including primary care physicians, specialists, urgent care and after hours providers, labs, clinics, and inpatient facilities across Rhode Island. Integra has grown to a staff of 46 and now covers approximately 125,000 patients. More than 1,200 individuals are currently enrolled in Complex Care Management for medical conditions. More than 2,500 individuals receive specialized care management through The Providence Center for serious behavioral health conditions.

WORKING FOR YOU

Highlights from this past year include: Reached an agreement with Blue Cross & Blue Shield of Rhode Island (BCBSRI) to provide accountable care to more than 55,000 BCBSRI members. Launched Rhode Island’s first Medicaid Accountable Entity (AE), part of Governor Gina M. Raimondo’s Reinventing Medicaid Act of 2015. More than 40,000 individuals are enrolled in the AE under Integra’s contracts with United Healthcare and Neighborhood Health Plan. Received approval from the Centers for Medicare & Medicaid Services (CMS) to participate in the Next Generation Accountable Care Organization (NextGen ACO) Model. NextGen builds on the MSSP model with additional flexibility for care and a risk-based financial model where Integra will participate in savings without needing to meet a minimum savings threshold. In partnership with BCBSRI, launched a Patient Referral Hub to coordinate patient care, including scheduling specialist visits, providing support in accessing health care resources, and identifying and addressing preventive care needs. Created a network of eight primary care access centers, strategically located across the state, to provide same-day, after hours care for urgent health issues to ensure members have immediate access to primary care and reduce unnecessary use of higher cost emergency rooms while dramatically improving the patient experience. Integra’s Medicare Shared Savings Program (MSSP) reported positive results for the 2015 program year. On total spending of more than $152 million, Integra achieved a savings just short of $4 million, reducing spending compared to the benchmark and strengthening the quality of care being delivered. Integra scored higher than the national average in 22 of 34 quality measures. Elected Albert Puerini, MD, president and CEO of RIPCPC, as chairman of the board of Integra Community Care Network, LLC. Dr. Puerini retains his role as a medical director for Integra. Dr. Puerini has served as a clinical assistant professor of family medicine in The Warren Alpert Medical School of Brown University since 1990.

Instead of focusing on appointments made, procedures performed, tests administeredâ&#x20AC;&#x201D; the traditional definition of fee for service medicineâ&#x20AC;&#x201D;an ACO aims to achieve better health through prevention, care coordination, chronic disease management, and more.

2016 NOTEWORTHY MOMENTS

Jennifer Gass, MD, surgeon-in-chief at Women & Infants and co-director of its Breast Health Center, in her role as president of the National Consortium of Breast Centers, organized a three-day School of Oncoplastic Surgery to give surgeons the opportunity to develop new skills they can use when performing breast conserving surgery (lumpectomy) on breast cancer patients. The goal is to improve surgical outcomes, decrease complications, and reduce the number of procedures breast cancer patients must undergo. In November, Women & Infants was recognized as a 2014 Top Performer on Key Quality Measures® by The Joint Commission, the leading accreditor of health care organizations in the country. The hospital was just one of two in Rhode Island and 1,043 out of more than 3,300 eligible hospitals in the country to achieve this distinction, which recognizes facilities for improving performance on evidence-based interventions that increase the chances of healthy outcomes for patients with certain conditions. The performance measures included in the recognition program are heart attack, heart failure, pneumonia, surgical care, children’s asthma, inpatient psychiatric services, stroke, venous thromboembolism, perinatal care, immunization, tobacco treatment, and substance abuse. Rhode Island Foundation awarded CNE a $520,000 grant to develop a Medicaid Accountable Care Organization (ACO) to more effectively manage the physical and behavioral health of 15,000 Medicaid patients statewide. Working with Integra Community

WORKING FOR YOU

Care Network, CNE will establish this Medicaid ACO in partnership with Rhode Island Primary Care Physicians Corporation, South County Hospital, federally-qualified Thundermist Health Center, the Rhode Island Medicaid office, The Warren Alpert Medical School of Brown University, and other partners. The Rhode Island Foundation awarded $200,000 to Blackstone Valley Community Health Care to develop a community health record program in partnership with Memorial Hospital, Tri-Town Health Center, and Women’s Care, a member of the Women & Infants Health Care Alliance. The goal is to assemble a medical neighborhood team that will benefit from enhanced data sharing on patients common to several area practices to improve population health, improve the quality of health care, and reduce the overall cost of care, especially for high-risk patients. The Center for Surgical Weight Loss at CNE was accredited in January under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a joint program of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. MBSAQIP standards ensure that bariatric surgery patients receive a multidisciplinary program, not just a surgical procedure, to improve patient outcomes and long-term success. Chosen from more than 1,000 nominees The Providence Center (TPC) won the Excellence in Behavioral Healthcare Management Award from the National Council for

Behavioral Health in January. The award was the result of TPC’s commitment to developing new ways to engage and involve individuals in their own treatment. The nomination highlighted TPC’s programs that aim to engage hard-toreach individuals and those from underserved populations, including Anchor Recovery Community Center and the new Intensive Outpatient Program and Community Support Team for Spanish-speaking individuals. The VNA of Care New England achieved a four-star rating for home health patient experience measures from Medicare which made the agency available on the Centers for Medicare & Medicaid Services Home Health Compare website. To achieve the rating, the VNA adapted the systemwide initiative Every Patient, Every Time and added patient rounding. Strong team efforts and practice changes led to improvement with results over the 70th percentile in patient experience measures. As one patient wrote, “Without exception, all nurses, physical and occupational therapies, and home health aides were wonderful. They were always informed, thoughtful, interested, knowledgeable, and prompt. They listened.” The Women & Infants Breast Health Center earned a three-year accreditation as a Breast Imaging Center of Excellence from the American College of Radiology (ACR) after a survey of the hospital’s diagnostic imaging facilities. Women & Infants first achieved this designation in 2009 based on the hospital’s accreditation in mammography, stereotactic breast biopsy and breast ultrasound. In 2016, the ACR refined the

qualifications for the designation by adding accreditation in breast MRI. Women & Infants is one of only a few sites in the region to achieve accreditation in all four modalities and breast imaging.

and 2013. In that timeframe, Dr. Keller had either been lead or co-author for 147 journal publications, 15 journal supplements, 15 books, chapters or monographs, and four editorials, letters and book reviews.

For the second year in a row, Women & Infants received a Women’s Choice Award® as one of America’s Best Hospitals for Cancer Care This evidence-based designation—given to just 366 hospitals in the nation accredited by the American College of Surgeons’ Commission on Cancer—is the only cancer care award that identifies the country’s best health care institutions based on robust criteria that consider female patient satisfaction, clinical excellence, and what women say they want from a hospital. The announcement followed a separate one naming Women & Infants one of America’s Best Hospitals for Obstetrics.

The Scattergood Foundation named The Providence Center’s Anchor Recovery Services—which includes Anchor Recovery Community Center, Anchor ED emergency room program and the Anchor MORE community outreach initiative—as winner of a 2016 Scattergood Innovation Award for programs that advance behavioral health policy and practice. The award includes a $25,000 prize, which will be used to provide training for recovery coaches. Later in the fiscal year, The Providence Business News named The Providence Center one of the 10 most innovative companies in the region for its Anchor ED program connecting peer recovery specialists with overdose survivors in local emergency departments.

Joseph Diaz, MD, chief of medicine at Memorial Hospital, was named chair of a new task force for diversity for the American Medical Society (AMS) at Brown. The task force—made up of students, residents, faculty, and alumni—is charged with drafting an AMS-specific plan. Martin B. Keller, MD, director of strategic academic planning at Butler Hospital, was named to the list of “The World’s Most Influential Scientific Minds 2015.” It was the second consecutive year Dr. Keller was named to the list, which includes highly-cited researchers in 21 science and social science fields as created by Thomson Reuters and generated by compiling researchers with “highly-cited papers” published between 2003

Cornelius “Skip” Granai III, MD, director of the Program in Women’s Oncology at Women & Infants, was presented with the Arnold P. Gold Foundation Humanism in Medicine Award in May at the annual meeting of the American College of Obstetrics and Gynecology. “Humanistic medical care is not simply compassion,” the group’s website notes. “It is the best of medicine. When skilled physicians build caring, trusting and collaborative relationships with patients, studies reveal more appropriate medical decisions, better patient adherence with treatment plans and less costly health care outcomes.”

Care New England President and CEO Dennis Keefe was named the March of Dimes 2016 Citizen of the Year, reflecting his dedication and commitment to superior health care delivery at all of the system’s partner facilities. Justin Nash, PhD, director of behavioral health at Memorial Hospital, was named president-elect of the Society for Health Psychology. The announcement came on the heels of a grant award from the Care Transformation Collaborative of Rhode Island’s Integrated Behavioral Health Pilot Program to develop a population health approach to improving the behavioral and overall health of patients at Memorial’s Family Care Center. With the grant, Dr. Nash’s research is implementing an approach to standardizing screening for depression, anxiety, and substance abuse. In addition, he is creating a registry to understand how patients access and use the behavioral health services available through the Family Care Center. Joseph Spinale, DO, SVP and chief medical officer at Kent Hospital, was named to the Board of Examiners for the 2016 Malcolm Baldrige National Quality Award for the third consecutive time. The award is the nation’s highest honor for organizational innovation and performance excellence. Appointed by the National Institute of Standards and Technology director, examiners are responsible for reviewing and evaluating applications submitted for the Baldrige Award, as well as other assessment-related tasks.

CNE

CARING FOR YOU

The

needs and goals of health care

consumers have expanded

exponentially in

the past few decades. The community now looks to

their care provider to monitor

their

basic physical needs such as high blood pressure, blood sugar levels, or the border on a mole as well as emergent

needs such as

abdominal pain, a strained muscle, or an inability to get pregnant. They are also

seeking help

addressing emotional well-being.

he health care industry’s transition from “sick care” to “well care” is not new at Care New England, where the collective mission of our operating units has always been focused on keeping the people in

our communities healthy.

Even in the shadow of changes taking place at the national level, our vision has broadened. We look at health care in more expansive ways, imagining and reimagining programs that can meet the varied needs of patients of all ages, collaborating with partners—old and new—to deliver care where and when it is needed most, and refining our services to provide the type of care people in our communities need and deserve. While government officials have altered health care regulations and the expectations placed on providers and hospitals, fiscal year 2016 at CNE included the expansion of clinical services for Parkinson’s patients in their homes with visits by skilled VNA of Care New England clinicians, a broader scope of outpatient mental health care for

CARING FOR YOU

Latinos at Butler Hospital, and the first program offering palliative care in a clinical setting at the Program in Women’s Oncology at Women & Infants Hospital. We have brought these services and more to the community in thoughtful ways. Knowing that time is precious and reliable transportation is often a luxury to many people in our communities, we pay special attention to our communities’ demographic profile as we develop and expand programs. We employ novel ways of making needed care or health information available in convenient locations and use language that is most accessible to the patients in need. We take the care to the community, offering talks about a variety of health-related topics—in multiple languages—at community centers, toting blood pressure cuffs and diabetes kits to baseball stadiums and road races to conduct screenings, and teaming with community physicians to augment the services they provide in their offices. Caring for our diverse community takes many forms at CNE, but it is always the driving force behind decision-making at every level. Even in the midst of a challenging 2016, as we worked diligently to address the evolving demands of the health care industry and the multiple financial constraints that resulted, we continued to support an everexpanding constellation of services with a keen eye on ensuring they meet or exceed our rigid quality expectations.

“

Patients come into the hospital daily to check in with our medical staff. When they go home each day, they use the Soberlink monitoring device that collects blood alcohol content, heart rate and blood pressure measurements and reports that data to our staff in real time.

”

COMBINING TECHNOLOGY WITH HUMAN CONNECTION

rowing up, Michael Chan was introduced to alcohol at a young age, beginning his battle with alcoholism when he was a pre-teen. Despite his continuous struggle with alcohol addiction, Michael

established a career as a carpenter, married a woman he loves, and built a seemingly successful life. For decades, he went to work each day, and upon returning home he would most often drink heavily, either alone or with friends. “It was just my way of life; it was how I was taught growing up. I worked hard and played hard, like many of the other people in my life,” says Chan, now in his forties. In the past 20 years, Chan has entered two addiction treatment programs, but could not achieve long-term sobriety. However, late in 2016, after experiencing health issues which he refers to as seizure-like events, Chan went to Butler Hospital in seeking help.

With support from his wife, he entered Butler’s Outpatient Detoxification Program which helped him detox from alcohol using a protocol that included daily visits to Butler, but no overnight stays. Program Chief Alan Gordon, MD, says, “Patients come into the hospital daily to check in with our medical staff. When they go home each day, they use the Soberlink monitoring device that collects blood alcohol content, heart rate and blood pressure measurements, and reports that data to our staff in real time.” With the additional support of his wife at home, Chan completed the Outpatient Detox Program and went on to Butler’s Alcohol and Drug Partial Hospital Program, which helped him further understand addiction and develop helpful coping skills and strategies. Chan’s wife, Rebecca, says the Outpatient Detox Program made her feel included in her husband’s treatment, which she and Chan both believe was an essential part of his success. “I went to every visit with him the week of the program,” she says, explaining that the clinical team made both her and her husband feel empowered and accountable during the entire process. Unlike with previous treatment programs he attempted, Chan says, “I have felt supported the whole way, and I know now that if I ever feel I need extra help, all I have to do is come back to Butler, and the people are here for me.”

KEEPING THE HEART HEALTHY AND STRONGER

teve Starger didn’t feel any different or have a complaint to tell his primary care doctor when he went in for a physical last year, but the doctor heard something he didn’t like when he listened to Starger’s

heartbeat. He did a quick EKG exam and sent Starger to a cardiologist for a more in-depth examination, thus beginning what the 75-year-old Warwick man calls his “odyssey.”

“He found that my left ventricle was operating at just 30 percent!” Starger (pictured above right) says while taking a break in his regular cardiac maintenance exercise session at the Care New England Wellness Center. “No one knew about any of this up to that point!” he exclaims incredulously.

CARING FOR YOU

What followed his physician’s office visit was the implantation of a defibrillator and an angioplasty that uncovered three clogged arteries in Starger’s heart. He was given stents to open the arteries. “It’s really working, too. The doctor has been able to take me off a few of my medications, and my cardio-pulmonary function has improved significantly,” he says. He then entered the cardiac maintenance program, which is offered for two-hour sessions five days a week under the supervision of clinical exercise physiologist Stacie McCarthy (pictured above left). The program is part of Starger’s long-term hearthealthy lifestyle. McCarthy helps participants like Starger use the cardio and weight training equipment in the medical fitness program, checking blood pressure and heart rate during the sessions before sending them home. New participants exercise on cardiac telemetry so she can monitor the effect the workout is having on their heart. She can print strips from the monitors and send to the participants’ doctors if needed.

Starger and his fitness friends—many of whom are up to 15 years older than he—are committed to the consistency and accountability of the cardiac maintenance program.

“By attending three or more times a week, it helps them meet the 150 minutes of moderate intensity aerobic exercise suggested by the Centers for Disease Control’s Physical Activity Guidelines for Americans,” McCarthy notes. In addition, she says the American College of Sports Medicine reports that cardiac patients who exercise often report: • Increased self-confidence, especially in performing physical tasks. • An improved sense of well-being. • Less depression, stress, anxiety, and social isolation. Starger and his fitness friends—many of whom are up to 15 years older than he—are committed to the consistency and accountability of the cardiac maintenance program, which is open for enrollment.

SHARING PERSONAL EXPERIENCES TO SERVE OTHERS

ecovery from addiction is a process, and no one knows that better than Roxxanne Newman. The 32-year-old bounces her seven-month-old daughter Grace on her lap and talks frankly about her life

before recovery—six years living on the streets of Providence snorting and shooting cocaine and heroin, prostituting herself

to pay for her habit, and eating a diet of junk food. “My whole life revolved around getting high, and it was hell on earth, just knowing you can’t stop,” she says, noting that she tried stopping several times but always returned to the drugs. “I had no hope for anything.” Shortly after giving her mother’s phone number to a detective because she was convinced he’d find her dead and would need to notify someone, Newman did walk away from her $500-a-day habit and found support in recovery through the Anchor Recovery Community Center in downtown Pawtucket.

CARING FOR YOU

“I was tired of running and willing to do whatever it took, including going back to prison,” she says. Newman has seen and experienced too much. A decade of abusing cocaine gave her grand mal seizures. Heroin use caused four overdoses. She’s been raped, abused, knifed. She’s jumped from a moving car to get away from someone, and danced in strip clubs. She started using drugs because she suffered from emotional problems as a teen and the lines she’d snort would instantly wipe away the pain, at least at first. These are the characteristics and experiences that make her the ideal recovery coach, says Michelle Harter, associate director of Anchor Recovery Community Center. “All of our staff, like Roxxanne, are in recovery. It’s very important in peer to peer work,” Harter says. The introduction of recovery coaches to a person’s care team has become a powerful initiative introduced by Anchor, a part of The Providence Center. It operates community centers in Pawtucket and in Warwick on the campus of the YMCA; recovery support programs in all of the units of the Adult Correctional Institution; recovery support

“

I tell people I don’t want to hear their excuses. I had a warrant. I had no food, not even a toothbrush.

”

programs in collaboration with Thundermist Health Center in West Warwick; and Anchor MORE, a mobile community outreach team. All of these are staffed and led by people who have battled addiction. As part of its Anchor ED program, Newman and the other coaches are sent to hospital emergency rooms when someone experiences an opioid overdose. Dispatched 24 hours a day, seven days a week, the coaches offer hope and support in whatever sort of recovery the person may be ready to start. Through Newman’s experiences and her bluntness she tries to push people to be honest with themselves. “I tell people I don’t want to hear their excuses. I had a warrant. I had no food, not even a toothbrush. I show them pictures of me when I was using or in the ACI and I tell them that whatever I have, they can have,” she says, adding that, “as a coach, I’m there to plant a seed, to tell them that recovery is possible.” Sober almost five years, Newman is married to a police officer, raising Grace, and in college full time. She’s working toward dual degrees in chemical dependency and psychology to advance a career in “helping people” or doing research. In the meantime, she coaches others who are in the same dark place where she once lived. “I ask for the tough ones—the prostitutes, the street people. I want to support them so when they take the terrifying step into recovery and learn to let go of their bad behaviors, they have someone helping them,” she says.

29 29

LOSING WEIGHT, LOVING LIFE

rankie B. Washington grew up in a family that was overweight and thought that’s “how life is.” When his own weight climbed to more than 400 pounds and he started dealing with different health problems,

including high blood pressure, his doctor suggested he go to a seminar on weight loss surgery through Care New England. “He said it might give me the help I needed to lose weight and get healthy,” says the professional illustrator. His girlfriend, Jess (picured above left with Frankie), who had also struggled with her weight, decided to go, too. “The first thing that struck me was how kind Dr. (Jeannine) Giovanni (pictured upper right in center) and her team were— compassionate and really genuine. We felt this was someone we could trust.”

CARING FOR YOU

What struck the couple as they sat there in the audience at the informational seminar was Dr. Giovanni’s comments about overeating being an addiction. “We could exercise all we wanted, but we were eating too many calories,” Frankie says. “I realized that I’m addicted to food and the surgery was a way to help curb that addiction. When we walked out of that seminar, we knew that weight loss surgery was for us. There was finally a tool to help us lose weight.” Weight loss for Frankie and Jess started before their surgery, with him losing about 40 pounds and Jess losing around 20. Since surgery, Frankie lost a total of 170 pounds and Jess a total of 140, and they’ve noticed many health benefits as a result. “We’re exercising and eating much better. My blood pressure is lower and I’ve got a lot more energy. We both do power walking, yoga, weight lifting, and jogging,” Frankie says. “The way I see it, my body is like a car. If you have a car and you don’t take care of it, it’s going to break down. So I’d tell anybody to take care of your body like you would a car.”

“

The way I see it, my body is like a car. If you have a car and you don’t take care of it, it’s going to break down. So I’d tell anybody to take care of your body like you would a car.

”

Weight loss surgery has been an amazing tool in fighting his addiction to food, but Frankie says he didn’t always think that way. “For years, I thought surgery was for people who couldn’t do it themselves and I thought I could do this myself,” he says simply. “But then I realized I couldn’t—I needed help. The thing is that the surgery isn’t instantaneous. You have to work at it—eat healthy and exercise. Both Jess and I feel that we’ve never been so healthy and happy.” They’re also enjoying some perks of being a healthier size like being able to “pop right into” the seat at the movies and sharing tips with others at CNE’s monthly support group meetings with people Frankie says “know exactly how it feels.” “Surgical weight loss is the best decision we’ve ever made,” he says. “All together, we’ve lost more than 310 pounds, but we’ve gained a whole lot more—more energy, better health, and a new lease on life. Weight loss surgery isn’t the end, it’s a brand new beginning.”

31 31

CNE

SEEKING NEW TR E ATMENT S

Research, defined in Merriam-Webster, is â&#x20AC;&#x153;studious

inquiry or examination; especially investigation or experimentation aimed at the discovery and interpretation

facts, revision of accepted theories or laws in the light of new facts , or practical application of such new or revised of

theories or laws.â&#x20AC;? At Care New England our researchers bring passion to this process to continuously transform the

understanding and the

treatment

practice of medical

locally, nationally, and globally.

hen Paul DiSilvestro, MD, digs into the statistics his team has collected about the genetic mutations linked to ovarian cancer, he sees the faces

of the women who come into his office each week as part of their own grim journey with the disease. It is the hope of identifying which women are more likely to develop the potentially deadly disease through more biological signals that compels Dr. DiSilvestro (pictured left). He continues to pursue new angles, develop more hypotheses, and corral test results into charts in search of an important connection that might prove fruitful in the fight against ovarian cancer. At CNE, Dr. DiSilvestro is not alone. Our research teams toil in labs and at bedsides with one common goal: improving the life and health of the people in this community and across the world. As life-long learners, they are plugged into the latest advancements in various specialties in order to provide the highest level of care to their patients. Our researchers, most of whom see patients in clinical and surgical settings as well, stay abreast of new discoveries in the diagnosis and treatment of diseases and conditions. There are labs dedicated to uncovering the causes of preterm labor— including researchers who keep vigil 24 hours a day, awaiting the onset of labor—and others examining the possibility that something like human papillomavirus can manifest itself in various diseases in the body, prompting more extensive and expansive screenings in certain patients. Our researchers are interested in the entire disease cycle—prevention, detection and treatment—and in uncovering ways to preserve, prolong and improve life. In the past fiscal year, the work of a cadre of our researchers generated extensive local, national and international media attention for their discoveries and hypotheses. Time magazine featured an extensive article on research co-authored by Stephen Salloway, MD, MS, director of Butler Hospital’s Memory and Aging Program, on the efficacy of a novel drug for Alzheimer’s disease. Science Daily promoted the revelation by Barry Lester, PhD, director of the Brown Center for the Study of Children at-risk, that the single-family room environment in the Women & Infants Neonatal Intensive Care Unit best promotes long-term neurobehavioral development in preterm infants. MedPage Today was just one of dozens of websites promoting the work of Charles Eaton, MD, of the Center for Primary Care and Prevention at Memorial Hospital, showing that red meat is harmful for women in danger of heart disease. Research continues in these areas, as well as dozens of others, through the support of federal, local and industry grants. To keep the wheels of innovation and discovery turning teams collaborate with other facilities.

SEEKING NEW TREATMENTS

RESEARCH AT A GLANCE

Care New England researchers earned a total of $23,136,988 in research funding in fiscal year 2016. Primary Care $731,582

General medicine $1,006,746*

Behavioral health $5,076,028**

Ob/gyn $5,145,578***

Addictions $3,532,404 Ob/med $430,149 Other $6,135

Pediatrics $4,525,953

Memory and aging/ movement disorders $2,318,968

Infectious disease $185,829 Cardiology $119,568 Cancer $58,048****

* Includes family medicine, internal medicine, pathology, and emergency medicine. ** Includes obsessive compulsive disorder, psychosocial, womenâ&#x20AC;&#x2122;s mental health, anxiety disorders and mood disorders. *** Includes maternal-fetal medicine, urogynecology and pelvic floor disorders, reproductive endocrinology and infertility, gynecologic oncology and general ob/gyn. **** Includes research at Memorial only. Gyn oncology research at Women & Infants is included under Ob/gyn.

TOTAL SPONSORED RESEARCH EXPENDITURES CNE TOTAL = $23,522,774

$11M

$11,316,280

$10,458,587

$1.5M

$1,625,298

$1M $500K $100K

As life-long learners, they are plugged into the latest advancements in various specialties in order to provide the highest level of care to their patients.

FA N

IAL

NT KE

$122,609

PROBING THE INFLUENCE OF ENVIRONMENT ON CHILD BEHAVIOR

wo Care New England hospitals—Memorial and Women & Infants—were selected in 2016 to participate in a translational, National Institutes of Health (NIH) research study called

Environmental Influences on Child Health Outcomes (ECHO) that has real-life implications for children and families, including helping to shape national policy, health care trends, and educational policy.

“With the data of all the cohorts, the sky is really the limit on what we can do for advancing child health,” summarizes Sean Deoni, PhD (pictured above center), a neuroimaging physicist at the University of Colorado and adjunct professor at the School of Engineering at Brown University, who is working with Memorial’s Pediatrician-in-Chief Viren D’Sa, MD (pictured above right), the hospital’s principal investigator on ECHO. “This is an exciting and unprecedented opportunity to make a major and lasting impact.”

SEEKING NEW TREATMENTS

The seven-year initiative has 35 pediatric cohorts that will together enroll more than 50,000 children to study the early environmental origins of health outcomes. The initial award to Memorial is a two-year grant of $6.2 million, and $4.9 million over two years to Women & Infants. Pending successful completion of this feasibility phase, an additional five years of funding is expected to be available. The study aims to help medical professionals better understand how the various environmental, genetic and nutritional influences interact to shape early brain development from the prenatal stage through childhood and to puberty. This will start with investigating how factors such as the in utero environment, starting as early as 22 weeks gestation, breastfeeding and early nutrition, lead exposure, parent interaction, sleep and daytime activity, pollution, and specific genes influence brain structure and function. The research will track the children’s performance in many functional domains including the classroom. “By understanding how and when this diverse array of influences impact brain growth and, ultimately, childhood outcomes such as their performance in school or their chance of developing a medical, developmental or behavioral disorder, we hope to identify predictors of such outcomes and learn how

interventions can be optimized for a particular child to maximize his/her individual potential,” explains Dr. D’Sa, who is also director of the New England Pediatric Institute of Neurodevelopment at Memorial. Principal investigators for ECHO at Women & Infants are Barry M. Lester, PhD (pictured far upper left), director of the hospital’s Brown Center for the Study of Children at Risk, and Carmen Marsit, PhD (not shown), formerly of Women & Infants and Brown University and now a professor at Emory University. They will use the NIH monies to enhance the existing study “Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI),” which is investigating how early detection of neurobehavior can identify which individual infants are most likely to suffer later developmental impairment and advance interventions to combat those developmental deficits. “ECHO will enable us to study the development of these infants in the broader environmental context in which they develop, including a range of exposures from air pollution and chemicals in our neighborhoods to societal factors such as stress and parenting,” Dr. Lester says. “At the same time, NOVI will contribute a unique population of very low birthweight infants to the pooled ECHO sample and study how the effects of the kind and timing of early exposures can be detected amongst these diverse populations. This is a win-win study, with children and their families as the ultimate winners.”

The study aims to help medical professionals better understand how the various environmental, genetic and nutritional influences interact to shape early brain development from the prenatal stage through childhood and to puberty.

2016 RESEARCH HIGHLIGHTS

A research team from the Center for Primary Care and Prevention (CPCP) at Memorial Hospital—including Charles Eaton, MD; Patrick Koo, MD; F. Dennis McCool, MD; Lauren Hale, PhD; and Katie Stone, PhD— published the results of “Association of Obstructive Sleep Apnea Risk Factors With Nocturnal Enuresis in Postmenopausal Women” in Menopause: The Journal of the North American Menopause Society. The team mined data made available through the landmark national Women’s Health Initiative, which maintained a clinical presence at Memorial from 1993 to 2005, and created a cohort of 2,789 women aged 50 to 79 years of age for the study. They found that a history of nighttime urination, including leakage, in postmenopausal women places them at increased risk of obstructive sleep apnea. Later in the year, Dr. Eaton, head of Memorial’s Center for Primary Care and Prevention, also earned a $2.6-million grant from the National Heart, Lung and Blood Institute to launch the first and largest community-based primary prevention trial on the effects exercise and strength training have on heart failure in elderly women. The five-year Women’s Health Initiative Strong and Healthy (WHISH)-2 Prevent Heart Failure Study is an extension of the Women’s Health Initiative. It will also examine the effect physical activity has on the prevention of heart failure as well as the burden of the disease on women who were previously diagnosed with it. Dr. Eaton will also analyze the type, intensity, and frequency of physical activity, including skeletal muscle strengthening, to see if there’s a related reduction in the risk of heart failure and heart failure burden in the study participants.

SEEKING NEW TREATMENTS

Teams at Care New England’s Butler, Memorial and Women & Infants hospital are on the vanguard of the latest discoveries and treatments to advance medicine. The investigators are affiliated with The Warren Alpert Medical School of Brown University and work collaboratively with research institutions from around the world to change the face of health care for future generations.

Roberta Goldman, PhD, director of Community Participatory Research for the CPCP at Memorial, earned a subcontract from Southern California University to help her pursue qualitative research into the different ways pain is recorded. This includes investigating which methods for measuring and reporting pain impact patients’ experiences of pain, and which are most important for their physicians to understand. She and other researchers will develop a set of indices representing new ways to consider pain experiences that will involve gauging various measurements of pain intensity, environmental setting, and timerelated components. Care New England is part of a new statewide consortium, the first statewide effort in the nation, formed to work jointly on unlocking many mysteries of the brain. Other partners include Lifespan, Brown University, the University of Rhode Island, and Providence VA Medical Center. Focuses in neuroscience will include Alzheimer’s disease, epilepsy, stroke, traumatic brain injury, and autism. To the consortium, Care New England adds the psychiatry research being done at Butler and autism work at Women & Infants. A Women & Infants research team published a study suggesting that low-dose aspirin should be given prophylactically to all women at high risk for preeclampsia (those with diabetes or chronic hypertension) and any woman with two or more moderate risk factors (including obesity, multiple gestation, and advanced maternal age). The team—Erika Werner, MD; Dwight Rouse, MD; and Alisse Hausperg, MD, of the Division of MaternalFetal Medicine—published the research,

entitled “A Cost-Benefit Analysis of LowDose Aspirin Prophylaxis for the Prevention of Preeclampsia in the United States,” in Obstetrics & Gynecology, a publication of the American College of Obstetricians and Gynecologists. Later in the year, Dr. Rouse was part of a national team through the Eunice Kennedy Shriver National Institute of Child and Human Development Maternal Fetal Medicine Units Network that published research showing that steroids reduce the risk of neonatal respiratory distress. Recommendations had dictated that women who go into labor before 34 weeks gestation be given antenatal corticosteroids to help the baby’s lungs mature. It was unknown if this approach would help in babies born in the late preterm period of 34 to 36 weeks, but Dr. Rouse notes that the recent research, published in the New England Journal of Medicine, will help even more babies get the healthiest start at life. Butler was one of six institutions supporting the efforts of a new partnership between the Global Alzheimer’s Platform Foundation and the Brain Health Registry at the University of California at San Francisco to grow its global registry of potential Alzheimer’s clinical trial candidates. This, according to Stephen Salloway, MD, MS, director of Butler’s Memory and Aging Program, is essential in order to find a cure for Alzheimer’s by 2025. He is currently enrolling participants in 11 Alzheimer’s trials at Butler. Dr. Salloway received world-wide recognition for research he co-published in Nature that outlined the efficacy of a novel therapy

for Alzheimer’s. The study results showed that, in patients with the disease, the drug aducanumab successfully reduced the amount of amyloid plaque in the brain and slowed cognitive decline, two major markers of the progression of Alzheimer’s. The data was derived from a Phase 1b clinical trial and must be replicated in two Phase III trials, one of which is currently ongoing at Butler’s Memory and Aging Program. Paul DiSilvestro, MD, interim director of the Program in Women’s Oncology at Women & Infants and head of the program’s research arm, was part of a team announcing the discovery of new inherited mutations linked to ovarian cancer. Previous research had established a link between genetic mutations in the BRCA1 and BRCA2 genes to an increased risk of developing ovarian, fallopian tube or peritoneal cancer in women. The new finding—“Inherited Mutations in Women with Ovarian Carcinoma” published in the Journal of the American Medical Society—documents the efforts to determine other inherited genetic mutations that can also put women at risk of developing these diseases. The research, Dr. DiSilvestro explains, brought the total of suspected inherited mutations to 11, which can direct genetic testing and screening going forward. Research led by Katina Robison, MD, of the Program in Women’s Oncology at Women & Infants, revealed a connection between the human papillomavirus (HPV) and anal cancer. The study—entitled “Anal Cytology and Human Papillomavirus Genotyping in Women with a History of Lower Genital Tract Neoplasia Compared with Low-Risk Women”—was

published in Obstetrics & Gynecology. The publication extended Dr. Robison’s research, who had presented in 2014 that there was an increased likelihood that the two diseases would coexist in some women. Butler researchers were able to demonstrate the benefits of screenings for suicide in the emergency department in research published in the American Journal of Preventive Medicine. The researchers—Sara Arias, PhD, and Van Miller, PhD, leader of the Psychosocial Research Group—found that using a universal suicide risk screening was feasible and led to a nearly two-fold increase in risk detection when applied in an emergency room setting. A manuscript entitled “Influential Forces in Breast Cancer Surgical Decision-Making and Impact on Body Image and Sexual Function” revealed that women trust their own instincts in choosing the type of surgery to have after a breast cancer diagnosis. The research, published in the Annals of Surgical Oncology and presented at the New England Association of Gynecologic Oncologists annual meeting, was produced by a team at Women & Infants’ Breast Health Center led by former Breast Health Fellow Rebecca M. Kwait, MD. The team also included Sarah Pesek, MD, Michaela Onstad, MD; David Edmonson, MD; Melissa Clark, PhD; Christina Raker, ScD; Ashley Stuckey, MD; and Jennifer Gass, MD, surgeon-in-chief and co-director of the Breast Health Center. Of the women surveyed for the study, 56.6 percent having a mastectomy with reconstruction identified themselves as the most important influence on their surgical decision.

James Padbury, MD, pediatrician-in-chief at Women & Infants and William and Mary-Oh and William and Elsa Zopfi Professor of Pediatrics for Perinatal Research, received a five-year, $19.5-million grant for the Rhode Island Center for Clinical Translational Science (RICCTS). This will allow the RI-CCTS “to create the educational and technical infrastructure needed to spur Rhode Island researchers to design, conduct and analyze more medical studies, including treatment trials that build on basic research. Dr. Padbury explains that it enables the research community to move studies from the bench to the bedside to the community and to the population. Barry Lester, PhD, director of the Brown Center for the Study of Children at Risk, which celebrated its 10th anniversary in 2016, released research showing the benefits of singlefamily room neonatal intensive care units. In evaluating 18 months of neurobehavioral outcomes in the single-family room neonatal intensive care unit (NICU) at Women & Infants, Dr. Lester deduced that the single greatest contributor to long-term neurobehavioral development in preterm infants is maternal involvement and that a single-family room NICU environment allows for the greatest and most immediate opportunities for mothers to become involved with their babies. The research—entitled “18-Month Follow-Up of Infants Cared for in a SingleFamily Room Neonatal Intensive Care Unit”— was published in The Journal of Pediatrics. The Providence Center (TPC) was selected to participate in a Dartmouth Medical School research study that explores the use of tablets to monitor mental health conditions.

2016 RESEARCH HIGHLIGHTS

The study, called “Using Automated Telehealth to Improve Psychiatric Illness Management,” uses tablets with specifically tailored content to monitor and connect with clients who suffer from severe mental illness. The project targets TPC clients who have experienced significant recent psychiatric instability, defined as at least two or more psychiatric hospitalizations or emergency room visits, multiple calls to the crisis line during the past 12 months, and diagnosis of major depressive disorder, schizophrenia, schizoaffective disorder, bipolar disorder, or post-traumatic stress disorder. The psychiatric content on the tablets offers a library of support so, if a certain problem is triggered, clients receive an immediate response that helps them manage the symptoms in a concrete and clinically effective way. The clients and tablet responses are monitored by a clinician who regularly checks

SEEKING NEW TREATMENTS

in with clients and provides immediate support if a critical problem is identified on the tablet. Lynae Brayboy, MD, and Carol Wheeler, MD, of the Fertility Center at Women & Infants, were part of a research team that released study results showing that using a smartphone application versus traditional methods of education can potentially connect teenage girls to more information about sexual health. The study—entitled “Girl Talk: A Smartphone Application to Teach Sexual Health Education to Adolescent Girls”—was published in the Journal of Pediatric and Adolescent Gynecology. The team is seeking opportunities to perform additional trials to determine if Girl Talk improves sexual health knowledge, increases contraception usage, and decreases sexually-transmitted infections and unplanned pregnancy.

Research led by Betty R. Vohr, MD, director of Women & Infants’ Neonatal Follow-Up Program, found that there are certain social and emotional factors that increase the risk of postpartum depression in mothers of preterm infants. The research—entitled “Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of Preterm Infants”—was published in The Journal of Pediatrics. Dr. Vohr said research revealed that mothers with previous a mental health disorder who were experiencing negative perceptions of themselves and their infants at the time of discharge from the NICU were at increased risk for depression one month after discharge. The conclusion was that a comprehensive mental health assessment before discharge is needed to identify women at risk and provide appropriate referrals.

CNE NEW

NURTURING LEADERS AND STUDENTS

we are fortunate to employ some of the brightest, most At Care New England,

innovative and inquisitive minds in health care. evolution and

Our staff understands that

education is not

to past experiences

limited

captured on a resume

or informative paperwork distributed at employee

independently and through organized programs, they have embraced orientation. Rather,

the concept of learning as a lifelong

journey.

he approach of lifelong learning is fostered across Care New England by offering creative and progressive programs designed to challenge our staff to expand their knowledge and skills.

This often leads to advancement in their field or discovery of a new passion to pursue.

Consider these programs offered in 2016: Kent Hospital established a one-year pharmacy residency program affiliated with the University of Rhode Island College of Pharmacy. This is one of four post-graduate, year-one pharmacy residency programs in the state, expanding clinical services at the hospital by having pharmacy residents provide patient care rounds, and target drug and patient monitoring. Areas of rotation/learning for the residents include: cardiology, critical care, infectious disease, internal medicine, neonatology, psychiatry, outpatient oncology, practice management, and drug information. Third-year internal medicine residents from Memorial Hospital, in affiliation with Warren Alpert Medical School of Brown University, started participating in a one-month consultation rotation at Butler Hospital. Working with Drs. Ana Tuya Fulton and John Vitelli, the residents help the internal medicine team at Butler obtain medical history and conduct physical evaluations upon admission. In addition, they provide medical consultations on an as-needed basis, tending to medical concerns ranging from minor rashes to managing brittle diabetes or unstable hypertension. Approximately 30 percent of Butler patients require a medical consult while being treated for brain and behavioral health concerns. Residents also take part in the innovative concurrent care program to help manage the treatment of some of Butlerâ&#x20AC;&#x2122;s most medically complex patients with daily medical follow-up. Helping our employees develop new skills, we are able to enhance our ability as a health care system to provide high-quality and cutting-edge health care to the people of our communities.

NURTURING NEW LEADERS AND STUDENTS

LEARNING TO LEAD

t The Providence Center (TPC), being committed to an integrated care model has included the expansion of the role of its nurses. From 2011 to 2016, TPC programs experienced a 57 percent increase in nurse

staffing, from 33 to 52 individuals. Nurses have become more and more important as the focus at TPC continues to shift to the patients’ overall health. In 2016, TPC introduced its Clinical Advancement Program to give its nurses an opportunity to build their careers. One of the first to enroll was Jillian Pastina (pictured upper right) from emergency services who enjoys working directly with patients, but also wanted to advance her career.

The Clinical Advancement Program is based on a four-stage scaled curriculum that recognizes and rewards nurses for professional growth. The first class of four nurses was offered 17 options for demonstrating their skills and leadership acumen. They needed to complete at least four leadership activities to advance a stage. “I chose to run a medical competency training class, document examples of how I feel I’ve impacted a patient’s care, and advance my education,” Pastina says of the work that enabled her to earn a clinical nurse III level. Two others earned the same distinction, while a fourth is working on the highest level. Along the way, Pastina says she was happy to see examples of what she’s done as a nursing leader. “Part of my motivation to do this was to show my desire to advance my career, and to show that nurses can be in these roles too,” she says. “This is a good way to give nurses advanced training and let us stay here, working with patients at the same time.”

EDUCATING THE NEXT GENERATION OF HOME CARE NURSES

raditionally, new nurses are not recruited to work in home care agencies where they work independently in patients’ homes. Instead, they’re required to work on a medical-surgical floor in a

hospital first and then transition to home care.

An innovative new program at the VNA of Care New England is breaking tradition by training new graduates to work in home care at the beginning of their nursing careers. The Graduate Nurse Residency Program welcomed six nurses in the fall, pairing them with Lisa DiMaria, PhD, an experienced community care nurse who makes joint patient visits with the new nurses to mentor them through each challenge. The goal is to facilitate the successful transition of newly licensed nurses to independent clinicians in the home health environment in one year. The program, which will be offered annually,

NURTURING NEW LEADERS AND STUDENTS

includes three phases that incorporate clinical skills, weekly didactic sessions and, finally, professional role development. The residency provides training on multiple topics encountered in home care, such as wound care and management, palliative and end-of-life care, and managing patients with multiple chronic illnesses. Dawn Landry (pictured above right with patient Mary Barrow) is part of the inaugural class of graduate nurse residents. She left a career as a social worker in long-term care to earn her bachelor’s in nursing, with the goal of eventually working as a visiting nurse. “This program is great. We get to know the support team in the office because we’re here a little more than other nurses at this point. So when we go out in the field full-time, we’ll know where to go for help,” she explains. “Plus, if there’s something we haven’t done before—like I had never used a wound vac—the residency preceptor will go out with us. The goal is to teach us good home care skills from the get-go.” Dr. DiMaria agrees, noting that, “Residency programs are a great way to transition new nurses. They provide them with much-needed support during what can be a challenging first year in practice, all while enhancing our nursing workforce.”

“

Resident programs are a great way to transition new nurses. They provide them with muchneeded support during what can be a challenging first year in practice, all while enhancing our nursing workforce.

”

After working with the residency preceptor, then in pairs for the first few months, the graduate nurse residents begin seeing three patients a day independently. They will gradually work up to five to six patients a day, managing their care and working collaboratively with other disciplines at the VNA such as physical and occupational therapy, social work, nutrition, and speech therapy. “This is a good fit for me because it’s a mix of nursing and social work. You need to be able to see the whole picture of what’s going on in a person’s home,” she explains. “It’s just been a great opportunity. I see it as a privilege to work in patient homes. They welcome us into their lives. The challenge is to help them make changes that will keep them out of the hospital.”

THIS IS

CARE

NEW ENGLAND

Care New England Health System continues to seek ways to expand access to health care. Through its members, Butler , Kent , Memorial , and Women & Infants hospitals, The Providence Center , VNA of Care New England, and Care New England Wellness Center, we are committed to creating

healthier communities.

QUICK FACTS AND FIGURES Care New England

President and CEO: Dennis Keefe Licensed beds: 963 Admissions: 46,270 Patient days: 221,992 ER visits: 136,401 Deliveries: 10,019 Surgeries (inpatient and outpatient): 20,339 Laboratory tests: 2,612,023

Diagnostic imaging procedures: 253,558 Employees: 7,563 Physicians: 1,905 Volunteers: 1,215 Residents: 201 Research dollars (total revenue): $23,382,036 Operating income: ($49,593,616)* Uncompensated care: ($17,310,594)

President and COO: Lawrence Price, MD Licensed beds: 143 Admissions: 8,549 Patient days: 61,494 Partial days: 22,438 Patient evaluations and patient assessment days: 10,178 Outpatient visits: 23,039

Employees: 903 Physicians: 178 Volunteers: 146 Residents: 62 Research dollars (total revenue): $11,316,280 Operating income: ($4,258,390) Uncompensated care: ($7,173,181)

Kent Hospital

President and COO: Michael Dacey, MD Licensed beds: 359 Admissions: 13,460 Patient days: 64,002 ER visits: 70,902 Deliveries: 818 Surgeries (inpatient and outpatient): 9,452 Laboratory tests: 1,244,246 Diagnostic imaging procedures: 134,749

Observation cases: 6,108 Employees: 1,778 Physicians: 819 Volunteers: 182 Residents: 53 Research dollars (total revenue): $122,609 Operating income: $6,666,856 Uncompensated care: ($3,555,290)

Memorial Hospital

President and COO: Michael Dacey, MD Licensed beds: 294 Admissions: 4,246 Patient days: 18,323 ER visits: 36,876 Deliveries: 316 Surgeries (inpatient and outpatient): 3,622 Laboratory tests: 411,595 Diagnostic imaging procedures: 53,490

Observation cases: 2,473 Employees: 730 Residents: 78 Research dollars (total revenue): $1,625,299 Operating income: ($32,781,096) Uncompensated care: ($1,809,982)

45 Willard Avenue Providence, RI 02905 (401) 453-7900 or 1-888-4CARENE carenewengland.org

Butler Hospital

345 Blackstone Boulevard Providence, RI 02906 (401) 455-6200 butler.org

455 Toll Gate Road Warwick, RI 02886 (401) 737-7000 kenthospital.org

111 Brewster Street Pawtucket, RI 02861 (401) 729-2000 mhri.org

*This includes restructuring and refinancing costs.

Uncompensated care is charity care and does not include any provision for bad debt.

THIS IS CARE NEW ENGLAND

Women & Infants Hospital 101 Dudley Street Providence, RI 02905 (401) 274-1100 womenandinfants.org

The Providence Center

528 North Main Street Providence, RI 02904 (401) 528-0123 Admin | (401) 276-4020 Intake providencecenter.org

Care New England Wellness Center 2191 Post Road Warwick, RI 02886 (401) 732-3066 wellnessctr.org

VNA of Care New England

51 Health Lane Warwick, RI 02886 (401) 737-6050 vnacarenewengland.org

President and COO: Mark Marcantano Licensed beds: 167 adult beds, 60 newborn bassinets, 80 neonatal intensive care beds Admissions: 20,015 Patient days: 78,173 ER visits: 28,623 Deliveries: 8,885 Surgeries (inpatient and outpatient): 7,265 Laboratory tests: 956,182

Diagnostic imaging procedures: 65,319 Employees: 2,362 Physicians: 735 Volunteers: 579 Residents: 60 Research dollars (total revenue): $10,458,586 Operating income: $16,745,405 Uncompensated care: ($4,740,312)

President: Dale K. Klatzker, PhD Vice President and COO: Deborah Oâ&#x20AC;&#x2122;Brien, BS, RN, MPA Clients served: 18,000 Kept appointments: 168,000 Intake calls: 36,000 Employees: 775 Psychiatrists: 11

Service locations: 18 Client residences: 14 Operating income: ($507,065) Uncompensated Care: $0

Wellness Manager: Janella MacKinnon Employees: 9 Average visits per day: 125 Average visits per year: 6,532

Vice President of Operations: Kathleen Peirce, RN, MS Patients: 7,935 Home care visits: 93,428 Hospice patient days: 29,227 Independent living services: 52,108 hours Flu and pneumonia shots: 12,778 Employees (VNA-HT-BSH): 366

Operating income: ($1,212,020) Uncompensated care: ($31,828) Advanced illness management visits: 624 Volunteers: 8 Blackstone Health Meals served to elderly and handicapped: 139,661 Adult Day patient care days: 10,207

BOARD OF DIRECTORS

Denise Arcand, MD is a board-certified family medicine physician in practice since 2001, and began her term as president of Kent Hospital’s medical staff in January 2015. She participates in medical student education at the University of New England College of Osteopathic Medicine. Dr. Arcand is a member of the Kent County Medical Society, the American Academy of Family Practice and the Rhode Island Academy of Family Practice. She earned her medical degree from Laval Medical School and completed her residency at Central Maine Medical Center.

James Botvin has chaired The Providence Center Board of Trustees since 2006. He was elected in 1999 and has served as treasurer and chair of the Finance/Administrative Committee. He serves ex-officio on all Board committees, and chairs the Executive Committee and the Pension Plan Board of Directors. Mr. Botvin has devoted more than 40 years to Colonial Toyota, where he currently serves as Vice President. In 2007, he was appointed to the RI Dealers Commission. He serves as chairman of the Dealer Hearing Board, and he is also a member of the RI Commodores. Botvin earned a degree in accounting from the University of Rhode Island. Mario Bueno is executive director and adult education director of Progreso Latino, a multiservice community-based organization in Central Falls that strives to empower the Latino and immigrant communities to achieve greater self-sufficiency and socioeconomic progress by providing programs that support personal growth and social change. Mr. Bueno is also the founder and past director of the United Workers Committee (now Fuerza Laboral), the only immigrant workers’ rights center in the state. He earned a bachelor of arts degree in economics and political science from the University of Rhode Island and master of education degree in educational leadership from Rhode Island College.

THIS IS CARE NEW ENGLAND

Allen H. Cicchitelli was elected to the Butler Hospital Board of Trustees in 1999 and was the first chair of the Butler Foundation, on which he remains a member. As retired president of Nature’s Best Dairy, he helped grow the company’s market across five states, increasing sales 52 times. He is currently president of Northeast Ventures Inc. He has served on the boards of Rhode Island Hospitality and Tourism Association, Rhode Island Food Dealers Association, University of Rhode Island (URI) Alumni Association, Metacomet Country Club, and Dunkin’ Donuts Independent Franchise Owners Group. He earned a bachelor’s degree in business administration from URI. Sharon Conard-Wells is executive director of West Elmwood Housing Development Corporation, a private, nonprofit corporation striving to improve quality of life for families by creating opportunities for home ownership, community engagement, and economic development. During her tenure, the agency has grown to operate five lines of business, including real estate development, lending, community building, asset management, and home ownership promotion and preservation. Conard-Wells received her master of education degree from Cambridge College and a fellowship from Harvard University Kennedy School of Government. She is a former member of the Women & Infants Board of Directors. Esther Emard, MSN, RN, MSLIR, ADT has more than 30 years of experience in nursing, health care administration, and quality improvement leadership. She is on the faculty for The George Washington University School of Nursing. She was Chief Operating Officer for the National Committee for Quality Assurance from 1999 to 2012 and then a consultant for the organization. Prior to that, she was senior vice president for network and medical management for Harvard Pilgrim Health Care. She is a member of the Blueprint for Health for the State of Vermont Planning and Evaluation Committee and the Visiting Nurse Association of America Board of Directors. She earned a bachelor’s degree in nursing from the University of Massachusetts and master’s degrees in nursing and labor and industrial relations from the University of Rhode Island.

Robert G. Flanders Jr., Esq. (Supreme Court Justice Ret.) was elected to the Women & Infants Board of Trustees in 1997. A former state Supreme Court justice, he is a partner with the law firm of Whelan, Corrente, Flanders, Kinder & Siket. He was the president and CEO of the Dunes Club and the state-appointed receiver for the financially troubled City of Central Fall, Rhode Island. Mr. Flanders has served as chair of the Rhode Island Board of Regents for Elementary and Secondary Education, chair of the Greater Providence YMCA Board of Trustees, chair of the Voter Initiative Alliance, and a member of the Brown University Leadership Council. He is a trustee of the Providence Public Library and the Rhode Island Bar Foundation, as well as a director of Professional Facilities Management, Inc., and Research Engineering & Manufacturing, Inc. He graduated magna cum laude from Brown University and earned his law degree from Harvard University.

Gary E. Furtado is president and chief executive officer of Navigant Credit Union, where he has been employed for 38 years, 28 as its leader. He earned a bachelor’s degree and master’s degree in business administration from Bryant University. He has served as a member of the Memorial Hospital Board of Trustees Executive Committee as well as past board chair. He also serves the following organizations: Credit Union National Association, board of directors; Blackstone River Valley National Heritage Corridor, board of directors; Pawtucket Boys & Girls Club, executive committee; Little Sisters of the Poor, board chair; and Narragansett Council, Boy Scouts of America, advisory council.

John R. Galvin was elected to the Women & Infants Board of Trustees in 2009 and served as chair of its finance committee. He is executive vice president of AAA Northeast and former chief financial officer of Collette Vacations, where he served on the board and executive committee. He is a longtime member of the Rhode Island Society of Certified Public Accountants. He sits on the boards of Meeting Street Center and Gilbane Inc., and is a past member of the board and executive committee of the U.S. Tour Operators Association and the Providence Boys & Girls Club. He earned

a degree in business administration from the University of MassachusettsAmherst and a master’s of business administration from Bryant University. He completed the OPM Executive Education Program at the Harvard Business School.

Michele R. Gange, MD is a board-certified obstetrician/gynecologist and serves as Women & Infants medical staff president. She is also a clinical assistant professor at The Warren Alpert Medical School of Brown University. A physician with Southern New England HealthCare for Women, Broadway Ob/Gyn Division, she graduated with an undergraduate degree in psychology from Brown University, where she also earned her medical degree. She completed a residency at Women & Infants. A member of the American College of Obstetrics and Gynecology, she serves on several hospital committees, including chairing the Quality and Medical Executive committees. She is one of five team chiefs charged with teaching residents at the hospital and earned a Dean’s Excellence in Teaching Award in 2014 from the Warren Alpert Medical School. In 2016 Dr. Gange received the National Faculty Excellence Award from the Council in Resident Education in Obstetrics and Gynecology. Kent W. Gladding was elected to the VNA of Care New England Board of Trustees in 2009 and served as its chair and on the Executive, Strategic Planning and Nominating committees. He is director of investments and chief strategist for Washington Trust Investors, where he chairs the Equity Income Strategy Committee. Prior to that, he served as senior vice president and chief investment officer at RBS Citizens Bank. He is former board chair for the Child Lead Action Project in Providence. He earned a degree in journalism from Syracuse University and a master’s in accounting from the University of Rhode Island. He is a CPA and a member of the CFA Institute and the American Institute of Certified Public Accountants.

BOARD OF DIRECTORS

Emily C. Harrison, MD, MPH was elected president of the medical staff at Memorial Hospital in 2016. She is a family medicine physician, founder and medical director of family medicine with Affinity Family Medicine Pawtucket. She earned a bachelor’s degree in Latin American Studies from Harvard University, a medical degree from the University of Vermont College of Medicine, and a master’s of public health from Brown University. She completed a fellowship in maternal child health through the Brown University Department of Family Practice at Memorial Hospital, working at Thundermist Community Health Center. She is a volunteer and has served as director of women’s health and executive director for Shoulder to Shoulder, working at a Brown-affiliated health clinic in Honduras. She earned the American Academy of Family Practitioners National Humanitarian in Medicine Award in 2012.

Douglas L. Jacobs was elected to the Women & Infants Board of Trustees in 2004 and served as its chair. Treasurer of the Care New England Board, he is a retired executive vice president and treasurer of FleetBoston Financial Group. He serves as a director and chair of the audit committees of Fortress Investment Group, OneMain Financial Corp., New Residential Investment Corp., and Clear Channel Outdoor Holdings. He earned a bachelor’s degree from Amherst College and a master’s of business administration from the Wharton School of Business at the University of Pennsylvania.

William M. Kapos is president and chief executive officer of Excellent Coffee Company, a family-owned importer, roaster and distributor. He has held this position for more than 45 years since graduating from Northeastern University with a bachelor’s degree in business administration. He served on the Memorial Hospital Board of Trustees for more than 15 years and as treasurer for five years. He is a former board member of the Assumption Greek Orthodox Church, serving as president for five years. He is also a former board member of the Northern Rhode Island Chamber of Commerce, the Rhode Island Hospitality and Tourism Association, New England Coffee Association, and the Boston-based Alpha Omega Council. He is a former member of the Agawam Hunt Club and a current member of the University Club and the Dunes Club, where he is treasurer.

THIS IS CARE NEW ENGLAND

Dennis D. Keefe was named president and chief executive officer of Care New England in 2011, coming from Cambridge Health Alliance, where he was chief executive officer from 2002 to 2011. He served as the City of Cambridge commissioner of public health at the same time. He earned a bachelor of science degree in health sciences summa cum laude from Northeastern University, where he also earned a master’s of business administration in business/health care administration. He is an adjunct lecturer at Brown University, Department of Health Services, Policy and Practice. He was most recently co-chair of the Governor’s Healthcare Leaders’ Workgroup and served as co-chair of the Reinvent Medicaid Working Group. He is also co-chair of the Providence Mayor’s Non-Profit Working Group. He currently sits on the Boards of the Rhode Island Quality Institute, the Hospital Association of Rhode Island, the Integra Community Care Network, the Narragansett Council of the Boy Scouts of America, and the Greater Providence Chamber of Commerce. He has served as Chair of the Hospital Association of Rhode Island, Essential Hospitals Institute and Integra Community Care Network. He has also served on the State of Rhode Island’s Health Care Planning and Accountability Advisory Council. He received the Distinguished Citizen Award from the Narragansett Council, Boy Scouts of America in 2014 and the Citizen of the Year Award from the March of Dimes in 2016. He was Chair of the 2015 Southern New England Heart Walk and was campaign chair of the 2013 March of Dimes March for Babies Walk.

Diane Lipscombe, PhD is a professor in the Department of Neuroscience at Brown University, and is director of the Brown Institute for Brain Science. She runs a research laboratory at Brown and has been funded by the National Institutes of Health (NIH) for 25 years. She is an expert on studying proteins that control the flow of calcium into neurons. These calcium channels are important drug targets in the treatment of neuropathic pain and hypertension and are risk factors in schizophrenia and other psychiatric disorders. She has authored many publications and given named lectures, including the Joan Mott Prize Lecture for the Physiological Society in the United Kingdom. She has been recognized by her peers with teaching and mentorship awards particularly for her contributions to graduate training. She is an elected fellow of the American Association for the Advancement of Science and a Council member for the Society for Neuroscience.

Louis Marino, MD is president of the medical staff at Butler Hospital, where he has been on the medical staff since 1996 and serves as associate medical director for geriatric services. Boardcertified in both psychiatry and geriatric psychiatry, he earned a bachelor’s degree in biology from Wesleyan University and his medical degree from the State University of New York Downstate Medical Center. He completed a residency in general psychiatry and a fellowship in geriatric psychiatry at the University Center of Pittsburgh. He is a clinical associate professor at The Warren Alpert Medical School of Brown University, and he is also on staff at Kent Hospital. He is past president of the Rhode Island Psychiatric Society and is a distinguished fellow of the American Psychiatric Association, in addition to being a member of the American Association of Geriatric Psychiatrists. Devoted to issues related to medical education, he serves in a number of roles within the psychiatry residency program and is chair of Butler’s Education and Continuing Medical Education committees. He is a contributor to many trade journals and has served as a reviewer for Neurology and The Journals of Gerontology: Biological Sciences.

Joseph J. McGair, Esq. was elected to the Kent Board of Trustees in 2002. He is a practicing attorney and president of the law firm Petrarca and McGair in Warwick. He served in the Rhode Island Senate from 1991 to 1995 and on the Warwick City Council from 1977 to 1984. He also served as the Warwick city prosecutor and associate city solicitor. He has served as president of the Warwick Columbus Corporation and the Warwick Rotary Club, chair of the Warwick Chamber of Commerce, vice chair of the board at Channel One, chair of the board at Justice Assistance, and a board member with Prevent Blindness, Foster Grandparents, Kent County Visiting Nurses, and Warwick Central Geriatric Association. He graduated from Providence College and earned a law degree from Suffolk University Law School.

Patrick J. Murray Jr. is president and chief executive officer of Bristol County Savings Bank and president of the Bristol County Savings Charitable Foundation. He earned a bachelor’s degree in accounting from Bentley College and attended the National School of Banking at Fairfield University. He was a member of the Memorial Hospital Board of Trustees and its assistant treasurer. He is on the board of directors of the Depositors Insurance Fund and at the Savings Banks Employees Retirement Association. In addition, he serves: Annawon Council Boy Scouts of America, board of directors and past president; United Way of Greater Attleboro/Taunton, board of directors and past chair; Taunton Business Improvement District Inc., director and treasurer; and Bristol Community College Foundation, board of trustees and past chair. Robert G. Padula was named to the Butler Hospital Board of Trustees in 2008. He is the former CEO of Gencorp Insurance Group, Inc., and is currently the chairman of Hilb Group New England, Gencorp’s parent company. Mr. Padula holds the Chartered Property Casualty Underwriter (CPCU) and Associate in Risk Management insurance designations. He is past president of Independent Insurance Agents of Rhode Island, the Rhode Island CPCU Society, and the Rhode Island CPCU Scholarship Fund. He has served on the advisory boards of several national and regional insurance carriers, and in 2000 he received the Independent Insurance Agents of Rhode Island’s Carleton I. Fisher Outstanding Agent award. He is a graduate of the University of Bridgeport and did graduate work in business administration at Providence College. Cynthia B. Patterson was elected to the Women & Infants Board of Trustees in 1983 and served as its chair from 1991 to 1996. She has served as secretary and vice chair of the Care New England Board. She retired as director of development for the Lincoln School and Audubon Society of Rhode Island. She is executive director of the Lalor Foundation, and has served on the boards at the Lincoln, Gordon and Providence Country Day schools, Planned Parenthood of Rhode Island, Warren Alpert Medical School, the Providence Athenaeum and the Audubon Society. She earned a bachelor’s degree from Brown University and worked toward a master’s in business administration at the University of Rhode Island. 55

BOARD OF DIRECTORS

Charles R. Reppucci was elected to the Butler Hospital Board of Trustees in 1984 and served as vice chair and chair-elect of the Care New England Board before assuming the chair in January 2016. He is executive director and chief operating officer and the senior non-lawyer executive of Hinckley, Allen & Snyder LLC. He is vice chair of the board of the Rhode Island Blood Center, past chair of the board at Vector Health Systems, and treasurer of the Legal Aid Society of Rhode Island. A former CPA, he earned a degree in accounting from University of Rhode Island and a master’s of business administration from Providence College.

George W. Shuster served as chair of the Care New England Board of Trustees, which he joined in 1996, from 2011 to 2015. He was elected to the Kent Hospital Board of Trustees in 1993. He is chairman emeritus of the board at Cranston Print Works. He served as officer and chair of UNITEHERE Textile Workers’ Pension Fund, co-chair of the Center for Design and Business, chair of the Girl Scouts of Southeastern New England, chair of the National Textile Association, vice chair and secretary of the Providence Public Library, secretary of the Rhode Island Audubon Society, president of the Narragansett Council of the Boy Scouts of America, and co-chair of the American Manufacturing Trade Action Coalition. He is a Phi Beta Kappa graduate of Yale University and earned graduate degrees from the Massachusetts Institute of Technology and Yale Law School.

THIS IS CARE NEW ENGLAND

Maribeth Q. Williamson was elected to the Kent Hospital Board of Trustees in 2003. She worked at Amica Insurance for more than 30 years, retiring as vice president and controller. She earned a degree in accounting from University of Rhode Island and a master’s in taxation from Bryant University. She is a trustee/ director at the Rhode Island Zoological Society, Trinity Repertory Company, and remains a member of the Kent Foundation Board.

MANAGEMENT TEAM AS OF FISCAL YEAR 2016

Dennis D. Keefe

President and Chief Executive Officer

Sandra L. Coletta

Michael J. Dacey, MD

James Fanale

Joseph Iannoni

Dale Klatzker, PhD

Mark R. Marcantano

Executive VP and COO, CNE

Executive VP and CFO, CNE

Lawrence H. Price, MD President and COO, Butler Hospital

THIS IS CARE NEW ENGLAND

President and COO, Kent Hospital and Memorial Hospital

President, The Providence Center

Executive VP, Physician Enterprise, Chief Clinical Officer, CNE

President and COO, Women & Infants Hospital

Rebecca Burke, RN, MS, NEA-BC

Gail E. Costa

Senior VP, Patient Care Services, Chief Nursing Officer, Kent Hospital

Senior VP, Strategy and System Development/ Chief Strategy Officer, CNE

Eileen Dobbing, RN, BSN, MBA

Frances Falsey

Suma Gaddam

Robert I. Insoft, MD

May Kernan

Senior VP, Marketing Communications, CNE

Mary Leveillee, PhD, RN, PMHCNS-BC

Angelleen Peters-Lewis, RN, PhD

Susan B. Mouradian

Deborah M. Oâ&#x20AC;&#x2122;Brien, RN, BS, MPA

Kathleen Peirce, RN, BSN, MS

Maureen G. Phipps, MD, MPH

Raymond O. Powrie, MD, FRCP(c), FACP

Alyssa V. Boss, Esq. Senior VP, General Counsel, CNE

Senior VP, Patient Care Services, Chief Nursing Officer, Memorial Hospital

Senior VP, Quality and Clinical Effectiveness, Chief Medical Officer, Women & Infants Hospital

Senior VP, Patient Care Services, System Chief Nursing Officer, CNE

VP of Operations, Executive Director, Chief Nursing Officer, VNA of Care New England

Patricia R. Recupero, JD, MD Senior VP, Education and Training, CNE

Senior VP, Clinical Shared Services, CNE

Chief Philanthropy Officer, CNE

Chief of Ob/Gyn,Women & Infants Hospital and CNE

Joseph Spinale, DO

Senior VP, Chief Medical Officer

Senior VP and Chief Information Officer, Information Services, CNE

Senior VP, Patient Care Services, Chief Nursing Officer, Butler Hospital

VP/COO, The Providence Center

Senior VP, Chief Medical Quality Officer, CNE Chief of Medicine, Women & Infants Hospital

James Sullivan, PhD, MD

Senior VP and Chief Medical Officer, Butler Hospital

Marilyn J. Walsh Senior VP, Chief Human Resources Officer, CNE

BOARD COMMITTEE STRUCTURE CNE Board of Directors and Officers

Compensation Committee

Governance and Nominating Committee

Charles Reppucci, Chairperson

George Shuster, Chairperson

Robert Flanders, Jr., Esq., Chairperson

Gary Furtado, Vice Chairperson

Allen Cicchitelli, Vice Chairperson

Joseph McGair, Esq., Vice Chairperson

Cynthia Patterson, Vice Chairperson and Secretary

Lisa Bisaccia

Mario Bueno

Dennis Keefe, President

Gary Furtado

Thomas Celona

Douglas Jacobs, Treasurer

James Hopkins

Adriana Dawson

Joseph Iannoni, Assistant Treasurer

Dennis Keefe (guest)

Margaret Farrell, Esq.

Alyssa Boss, Assistant Secretary

Joseph McGair, Esq.

Kent Gladding

Denise Arcand, MD

Charles Reppucci (guest)

Douglas Jacobs

James Botvin

Maribeth Williamson

William Kapos

Mario Bueno

Dennis Keefe (guest)

Allen Cicchitelli

Credentials Committee

Charles Reppucci

Sharon Conard-Wells

Esther Emard, MSN, RN, MSLIR, ADT, Chairperson

George Shuster

Esther Emard, MSN, RN, MSLIR, ADT

Margaret Farrell, Esq., Vice Chairperson

Anne Szostak

Robert Flanders, Jr., Esq.

Denise Arcand, MD

John Galvin

David Carcieri, MD

Investment Committee

Michele Gange, MD

Robert Flanders, Jr., Esq.

Kent Gladding, Chairperson

Kent Gladding

Martin Furman, MD

Gary Furtado, Vice Chairperson

Emily Harrison, MD

Allen Cicchitelli

William Kapos

James Hopkins

Michelle CortĂŠs-Harkins

Diane Lipscombe, PhD

Dennis Keefe (guest)

Joseph Dewhirst

Louis Marino, MD

Jonathan Farnum

Joseph McGair, Esq.

Cynthia Patterson

John Galvin

Patrick Murray, Jr.

Raymond Powrie, MD

C. Michael Hazard

Robert Padula

John Hynes

George Shuster

Finance Committee

Dennis Keefe

Maribeth Williamson

Douglas Jacobs, Chairperson

Janet Marcantonio

John Galvin, Vice Chairperson

Michael Matone

Audit and Compliance Committee

David Carcieri, MD (guest)

F. Paul Mooney, Jr.

Maribeth Williamson, Chairperson

Allen Cicchitelli

Peter Phillips

Patrick Murray, Jr., Vice Chairperson

Andrew Erickson

George Shuster

Paul Alexander

Jonathan Farnum

James Botvin

Margaret Farrell, Esq.

John Galvin (guest)

Gary Furtado

William Kapos

Joseph Iannoni

Dennis Keefe (guest)

Dennis Keefe

Hollie Lussier

Patrick Murray, Jr.

Howard Ostrowsky

Maureen Phipps, MD, MPH (guest)

Michael Tikoian

Charles Reppucci George Shuster (guest) Patricia Thompson

THIS IS CARE NEW ENGLAND

Quality Committee Joseph McGair, Esq., Chairperson Esther Emard, MSN, RN, MSLIR, ADT, Vice Chairperson William Allen Margaret Farrell, Esq. Suzanne Gilstein George Shuster Raymond Brigidi (Patient/Family Representative) Vacant (Patient/Family Representative) CNE Staff (ex officio) Sandra Coletta Patricia Ellis, MPH Sumalatha Gaddam Joseph Iannoni Dennis Keefe Angelleen Peters-Lewis, RN, PhD Raymond Powrie, MD Patricia Recupero, JD, MD Operating Unit Presidents (ex officio) Butler Hospital: Lawrence Price, MD Kent and Memorial hospitals: Michael Dacey, MD Women & Infants Hospital: Mark Marcantano

Public and Community Health Committee Operating Unit Medical Directors of Quality and/or Chief Medical Officers (ex officio)

Cynthia Patterson, Chairperson

Butler Hospital: Lisa Shea, MD and James Sullivan, MD, PhD

Kyle Bennett

Kent Hospital: Joseph Spinale, DO Memorial Hospital: vacant Women & Infants Hospital: Robert Insoft, MD VNA of Care New England: Kate Lally, MD Operating Unit Chief Nursing Officers or similar Patient Care Services Position (ex officio) Butler Hospital: Mary Leveillee, PhD, RN, PMHCNS-BC Kent Hospital: Rebecca Burke, RN, MS, NEA-BC Memorial Hospital: Eileen Dobbing, RN, BSN, MBA Women & Infants Hospital: Matthew Quin, RN, MSN VNA of Care New England: Kathleen Peirce, RN, BSN, MS The Providence Center Representatives (ex officio) Dale Klatzker, PhD, President Deborah Oâ&#x20AC;&#x2122;Brien, RN, MPA, Vice President and Chief Operating Officer Lisa Peterson, LMHC, LCDP, LCDCS, QMHP, Associate Director of Compliance and Quality Improvement

Mario Bueno, Vice Chairperson Channavy Chhay Sharon Conard-Wells Gail Costa Michele Cyr, MD Karen Davie Adriana Dawson Joseph Diaz, MD James Fanale, MD Dennis Keefe May Kernan Dale Klatzker, PhD Ana Novais Angelleen Peters-Lewis, RN, PhD Raymond Powrie, MD Michael Souza James Sullivan, MD

Strategic Planning Committee Charles Reppucci, Chairperson Maribeth Williamson, Vice Chairperson William Allen

Operating Unit Quality Committee Chairs (ex officio)

Denise Arcand, MD

Butler Hospital: James Hopkins, Chairperson

James Botvin

Kent Hospital: Kenneth MacNaught and Andrew Erickson, Co-chairpersons

Margaret Farrell, Esq.

Memorial Hospital: Gregory Scown, Chairperson

Kent Gladding

Women & Infants Hospital: Michele Gange, MD, and Lisa Bisaccia, Co-chairpersons

Emily Harrison, MD

VNA of Care New England: Jonathan Gates, MD, and Esther Emard, MSN, RN, MSLIR, ADT, Co-chairpersons

William Hunt

Michele Gange, MD

James Hopkins Douglas Jacobs Dennis Keefe Hollie Lussier Louis Marino, MD James Padbury, MD, MPH Cynthia Patterson Maureen Phipps, MD, MPH Lisa Shea, MD Joseph Spinale, DO

ACCOUNTABILITY

AND

FINANCES

The financial

pressures for health care providers are real . Organizations

are mid-stream in shifting from volumebased to outcomes-based payment

investment in infrastructure required. In the models

and the

short-term, this is a challenging process, but one that will deliver

a stronger health care system and healthier communities in the long-term.

OPERATING MARGIN

Actual FY 2014

Actual FY 2015

Actual FY 2016

Operating Margin

$8,505,804

($1,785,748)

($68,279,804)

Total Margin

$11,140,275

($27,835,311)

($52,842,762)

$1,068,010,694

$1,137,939,493

$1,154,723,846

0.80%

(0.16%)

1.0%

(2.45%)

Total Revenues Operating Margin % Total Margin %

ACCOUNTABILITY AND FINANCES

(5.91%) (4.58%)

STRATEGIC FRAMEWORK The purpose of the Balanced Scorecard is simple: If it can be measured, it can be managed. In use since 2011, it is CNEâ&#x20AC;&#x2122;s tool to manage our strategic performance. The framework translates the strategy into precise objectives that are communicated and measured in an effort to make incremental improvements.

THREE-YEAR GOALS A: Quality

B: Population health management

C: Physician partnership

D: Strategic partnerships

E: Academic and research excellence

F: Operational strength

BALANCED SCORECARD OBJECTIVES A.1: Baldrige

A.2: Culture of excellence

A.3: Best-in-class quality

A.4: Best-in-class safety

A.5: Patient experience

A.6: Enabling infrastructure

B.7: Collaboration and integration

B.8: Appropriate care/settings

B.9: Community needs

B.10: Care retention

B.11: ACO implementation

B.12: Specialists

B.13: ACO expansion

B.14: Population health

C.15: Aligned incentives

C.16: Clinical integration

D.17: System Development Planâ&#x20AC;&#x201C;Phase 2

D.18: Brown relationship

E.19: Unified approach across CNE

E.20: Growth and alignment of research

F.21: Cost-effective care

F.22: Bond rating

F.23: Staff productivity

F.24: Information technology

F.25: Operational integration

BALANCED SCORECARD

QUALITY, POPULATION HEALTH MANAGEMENT

GOAL

OBJECTIVE

MEASURE

RESULTS

FY 2016 TARGET

SCORE

Process band score.

++++(4)

Results band score.

++++(4)

One-year retention across CNE.

81.4%

77%

++++(4)

Three-year retention across CNE.

75.7%

60%

++++(4)

68%

70%

++(2)

62.7%

65%

+++(3)

Composite Catheter-Associated Urinary Tract Infection (CAUTI) Standard Infection Ratio (SIR).

0.28

0.37

++++(4)

Composite Clostridium Difficile (CDIFF) SIR.

1.14

0.45

Composite Central Line-Associated Bloodstream Infection (CLABSI) SIR.

0.71

0.17

Composite Methicillin-Resistant Staphylococcus Aureus (MRSA) SIR.

0.40

++++(4)

Composite Surgical Site Infection (SSI) SIR.

2.46

0.40

CNE hand hygiene compliance – inpatient.

93%

90%

++++(4)

CNE hand hygiene compliance – outpatient.

94%

90%

++++(4)

D. Keefe/G. Costa A. QUALITY (R. Powrie)

1. Baldrige

M. Walsh 2. Culture of excellence

Positive work environment (From Press Ganey Employee Voice Survey). R. Powrie 3. Best-in-class quality

Composite score of quality measures from each operating unit. R. Powrie

4. Best-in-class safety

ACCOUNTABILITY AND FINANCES

GOAL

OBJECTIVE

MEASURE

RESULTS

FY 2016 TARGET

SCORE

Kent Hospital average patient experience percentile ranking.

43 percentile

75 percentile

Butler Hospital average patient experience percentile ranking.

65 percentile

75 percentile

++(2)

Memorial Hospital average patient experience percentile ranking.

39 percentile

75 percentile

Women & Infants Hospital average patient experience percentile ranking.

59 percentile

75 percentile

++(2)

VNA average patient experience percentile ranking.

61 percentile

75 percentile

++(2)

R. Powrie A. QUALITY (R. Powrie)

5. Patient experience

S. Gaddam 6. Enabling infrastructure

Develop and deploy enterprise technology framework to support measurement and monitoring of quality initiatives.

Hospital quality reporting and patient on-trac have been deployed. Sepsis module has been evaluated and recommended for approval.

Install Cerner Content/ modules for the following quality initiatives: Hospital quality reporting, patient on-trac for LOS monitoring reduction, and sepsis.

++++(4)

Option 2B implemented for Memorial.

Establish formal clinical leadership structure for clinical integration.

++++(4)

J. Fanale/S. Coletta B. POPULATION HEALTH MANAGEMENT (J. Fanale & S. Coletta)

7. Collaboration and integration

Implement clinical programs across CNE. R. Powrie/J. Fanale

8. Appropriate care/settings

Butler Hospital reduction in readmissions.

17.9%

17.7%

++(2)

Kent Hospital reduction in readmissions.

11.2%

11.8%

++++(4)

Memorial Hospital reduction in readmissions.

10.7%

9.4%

Kent Hospital reduction in ALOS.

4.73

4.82

++++(4)

Memorial Hospital reduction in ALOS.

4.14

4.04

+(1)

Women & Infants Hospital reduction in ALOS.

2.69

3.02

++++(4)

BALANCED SCORECARD

POPULATION HEALTH MANAGEMENT, PHYSICIAN PARTNERSHIP, STRATEGIC PARTNERSHIPS, ACADEMIC AND RESEARCH EXCELLENCE

GOAL

OBJECTIVE

MEASURE

RESULTS

FY 2016 TARGET

SCORE

D. Keefe B. POPULATION HEALTH MANAGEMENT (J. Fanale & S. Coletta)

9. Community needs

Develop and implement Public & Community Health Committee of the Board.

The CNE Board approved and adopted the CHNAs for all four hospitals. The CHNAs include broad community health improvement plans for three health priorities.

Establish formal clinical leadership structure for clinical integration.

++++(4)

J. Fanale 10. Care retention

34.8%

35.1%

++(2)

Reduce ED visits for Blue Cross Medicare Advantage/1,000 lives.

418

353.59

Reduce ED visits for Medicare Shared Savings Program (MSSP) population/1,000 lives.

537

583.30

++++(4)

Inpatient hospital retention within CNE. J. Fanale

11. ACO implementation

J. Fanale 12. Specialists

Develop and implement comprehensive specialist network for Integra.

Integra specialist network developed and participant agreements signed.

++++(4)

Complete

Participation in Medicaid Accountable Entity through pilot participation and apply for certification as Accountable Entity.

++++(4)

133,000

125,000

++++(4)

Cardiology, orthopedics, gastroenterology and ENT complete.

J. Fanale 13. ACO expansion

Develop and implement plan.

J. Fanale 14. Population health

Lives under contract.

ACCOUNTABILITY AND FINANCES

GOAL

OBJECTIVE

MEASURE

RESULTS

FY 2016 TARGET

SCORE

J. Fanale C. PHYSICIAN PARTNERSHIP (J. Fanale & S. Coletta)

15. Aligned incentives

Develop/implement compensation system for CNE medical group.

Compensation plan developed and being implemented.

Compensation plan instituted.

++++(4)

Baseline assessment of panel size for Primary Care Providers.

Panel size defined.

++++(4)

Percent of providers meeting productivity target.

51.2%

30%

++++(4)

659

++++(4)

S. Gaddam 16. Clinical integration

Employed and affiliated physicians using Epic.

Wave 3 completed.

D. Keefe D. STRATEGIC PARTNERSHIPS (D. Keefe)

17. System Development Plan â&#x20AC;&#x201C; Phase 2

Achieve the objectives of the System Development Plan.

In our mutual best interest, CNE and Southcoast Health System have voted to terminate the agreement to affiliate.

Continue implementation.

++++(4)

Brown/CNE joint research planning in progress.

Implement initiatives.

++++(4)

1) Internal Medicine and Emergency Medicine received initial accreditation 2) Family Medicine recived pre-accreditation.

Preliminary approval of 2 out of 3 programs and full approval of at least 1 out of 3 programs.

++++(4)

Total funded research grant expenditures.

$24.1M

$24M

++++(4)

Strategic plan for CNE research developed.

1) One-page documents on research domains across CNE completed 2) Research resource compendium completed 3) Strategic Plan presented to Huron to help formualte resource projections.

D. Keefe 18. Brown relationship

Accomplish Brown/CNE strategic initiatives to further our relationship. M. Phipps

E. ACADEMIC AND RESEARCH EXCELLENCE (M. Phipps)

19. Unified approach across CNE

Kentâ&#x20AC;&#x2122;s application for ACGME accreditation.

M. Phipps 20. Growth & alignment of research

++++(4)

BALANCED SCORECARD OPERATIONAL STRENGTH

GOAL

OBJECTIVE

MEASURE

RESULTS

FY 2016 TARGET

SCORE

Labor expense/adjusted discharge.

$11,049

—

++++(4)

Labor expense/adjusted patient day.

$2,303

—

++++(4)

Labor expense–paid$/FTE.

$79,461

—

++++(4)

10.3%

10.9%

CNE achievement of annual operating margin.

-3.69%

-3.2%

+++(3)

Women & Infants Hospital achievement of annual operating margin.

3.27%

-0.10%

—

Butler Hospital achievement of annual operating margin.

-3.98%

-7.0%

—

Memorial Hospital achievement of annual operating margin.

-25.35%

-8.6%

—

1.75%

3.9%

—

49.7 days

50 days

++++(4)

System credit rating: Fitch.

BBB-

BBB

System credit rating: S&P.

++++(4)

System outlook by Fitch.

Negative

Stable

System outlook by S&P.

Stable

++++(4)

J. Iannoni/S. Coletta F. OPERATIONAL STRENGTH (S. Coletta)

21. Cost-effective care

Supply and drug expense as a percentage of net patient revenue. J. Iannoni 22. Bond rating

Kent Hospital achievement of annual operating margin. Days cash on hand.

ACCOUNTABILITY AND FINANCES

GOAL

OBJECTIVE

MEASURE

RESULTS

FY 2016 TARGET

SCORE

54%

100%

S. Coletta F. OPERATIONAL STRENGTH (S. Coletta)

23. Staff productivity

Percentage of Group 1 departments meeting or exceeding their performance on target. S. Gaddam

24. Information technology

Develop analytics for valuedriven decision making.

Aeos has been deployed and Decision Support System for CNE-Strata is on track to go live.

Complete installation of Aeos for Revenue Cycle and complete installation of Decision Support System for CNE-Strata.

++++(4)

J. Iannoni 25. Operational integration

t3 scorecard

$76,408,619

$77,869,146

++++(4) TOTAL: 80 out of 100

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