The Wright Center - 18 Months in Review

Dear Friends, Coworkers, Colleagues and Community Partners:

Change is fraught with uncertainty. When it comes to our dynamic healthcare landscape, fluent and deliberate transformation is vital. A reactive approach to new challenges may be sufficient for an organization to survive, but effective delivery of our mission demands more. As you will see in this report, we have been hard at work, diligently reinventing our culture to drive proactive thinking and patient-centered innovation at every level of our organization. Only in this way can we fully activate The Wright Center’s potential as an enormously valuable community asset.

The Wright Center is a unique Graduate Medical Education Safety-Net Consortium (GME-SNC) that leverages the inextricable link between patient care and inter-professional medical education to optimize care delivery while fueling a pipeline for sustainable workforce development.

Our teaching clinics are committed to engaging people, our most valued resource, in an inclusive culture of learning to discover and deliver our collective genius. We do this while always focusing on cultivating joy in our daily work for higher purpose.

During our 38 year history, we have become recognized locally and nationally for inspiring physician renewal to address the communities we serve. We have built innovative learning and care delivery environments and expanded our influence through collective enlightenment, grassroots initiatives and organic transformation.

We have worked diligently to solidify our reputation as an industry leader, celebrating The Wright Center’s organizational brand as a unique community-based GME-SNC. Growing from our humble beginnings of six learners in a single Internal Medicine residency program, today we offer training opportunities for 189 physicians through flourishing ACGME and AOA-accredited Internal Medicine and Family Medicine Residency programs, along with a Cardiovascular Disease Fellowship.

The last 18 months in particular have been very exciting as we positioned our organization to swiftly and decisively adapt more proactively than ever to the changing healthcare marketplace and its welcomed progression to a value-based care delivery system. As a grant-funded operation, especially in times of tenuous industry finances, we have kept our focus and commitment to mission-based management, strategic innovations and outcomes delivery. I have been so inspired by the professional contributions and growth of our staff, residents and providers as we all strive to be better every day.

Our team is iteratively improving all of our care delivery systems and learning environments; optimizing and sharing our results; and transforming our organizational culture along the way. This is more than mere change; it is rooted in a true cultural shift where innovation, accountability and team-based dynamics become deeply ingrained within our organization. Our Wright Center Balanced Scorecard – a justified, outcomes oriented and performance-based recognition framework – was developed to highlight the connection between employees’ daily tasks, departmental and organizational performance and the collaborative advancement of our mission and vision. Our “Plan. Do. Study. Act.” (PDSA) Quality Management System has enabled the leveraging of our learners and employees as system improvers while promoting trackable accountability, consistent and transparent data collection and thorough analysis for cost-efficient use of resources.

We continue to encourage and enable the spread of learner-driven improvements to collectively improve education and care delivery across our own and numerous partnering organizations. We measure and report these activities in our Balanced Scorecard to define our performance and the value we deliver in our partnerships.

America’s healthcare debacle demands rising above everyday challenges by optimizing our unique contributions for sincere advocacy and empowerment of every patient, every learner and every employee.

Our organizational transformation allows us to grow thoughtfully, attract top-level talent and cultivate a spirit of high expectations for patients, learners and staff.

We will continuously measure, improve and celebrate our successes and adjust our course of action as necessary. By developing responsive physician and care team skill sets, we will strive to set the new norm for high-quality 21st century patient-centered care.

Thank you for joining us on this inspiring journey and allowing us to share our story.

By partnering with like-minded organizations, we have created a comprehensive network of learning environments throughout Northeast Pennsylvania and the United States. We have become a well-respected pipeline for recruiting and retaining compassionate, competent physicians desiring relevant, 21st century skill sets.

Expanding Residency and Fellowship Programs

Our ACGME/AOA-accredited Internal Medicine and Family Medicine residencies and Cardiology fellowship were designed to empower residents as innovators and nimble leaders within an ever-changing healthcare system. As a non-profit Graduate Medical Education Safety-Net Consortium (GME-SNC), The Wright Center engages community partners to create diverse training opportunities and learning environments for residents and fellows. Throughout the past 18 months, we have strengthened partnerships with our clinical learning environments and we continue to receive federal funding with the intent to further address the physician shortage and misdistribution of the healthcare workforce. Our GME-SNC model immerses trainees in community venues where they are most needed, increasing their long-term likelihood of working in such settings.

Our Internal Medicine and Family Medicine residents train within Luzerne, Lackawanna, Wayne and Pike County. The 2015-16 regional trainee numbers are currently the largest to date, at 131 residents/fellows: • Regional Family Medicine residents | 37 • Regional Internal Medicine residents | 87 • Regional Cardiology fellows | 7

We continue to partner with A.T. Still University School of Osteopathic Medicine in Arizona to grow the National Family Medicine Residency Network established in the fiscal year (FY)2013-14. Our 58 National Network residents train in family medicine at one of six FQHC partner sites located in Portland, OR; Auburn, WA; Tucson, AZ; Brooklyn, NY; New Richmond, OH; and Washington, D.C. Plans are in place to expand the National Network training model into nine more states as funding becomes available. In June 2015, we oriented our third class of 17 National Network interns for a full complement of first, second and third year residents, also hiring our first group of chief residents, selected for their exceptional clinical and leadership skills.

Infusing Federal Resources for Expansion and Growth

The Health Resources and Services Administration (HRSA) recognized the great need for primary care doctors and right-venue healthcare as it rolled out the Teaching Health Center (THC) initiative in 2010.

The Wright Center was recognized as a pioneering THC and federal resources were provided to allow program expansion and encourage residents to actively serve the nation’s underserved patient population.

We will continue to play a leading advocacy role for federal support to promote resident training in local, community-based settings throughout America to address our provider shortage, misdistribution and related health disparities. In FY2014-15, The Wright Center received $13.8 million in continued THC funding.

Unifying Communities through the GME-SNC Model Our hospital affiliations allow us to provide diverse, innovative learning environments for trainees within Northeast Pennsylvania.

Some of our first, second and third year residents, along with faculty and mentors, take time for a photo.

Through our innovative GME-SNC model, community stakeholders, resources and assets align to collectively address foundational healthcare issues by advancing local solutions with national implications.

Our Wright Center for Primary Care and regional public health-based learning environments keep our trainees immersed in community-based settings.

• Maternal and Family Health Services • Rural Health Corporation • Scranton Counseling Center • Scranton Primary Health Care Center • Wayne Memorial Community Health Center Our National Network residents train at the following FQHC partner sites:

Internal Medicine resident, Dr. Kevin Musto, was the first TCMC graduate to enter residency at The Wright Center. He plans to practice primary care in Northeast Pennsylvania once he completes his training.

Our Wright Center for Primary Care clinical learning environments create an opportunity to leverage learners as clinical and educational system quality improvers, finding new ways to advance health metrics in our community and addressing our patients’ physical and behavioral health needs.

Enabling Access to Right Venue Care

The Wright Center recently opened a clinic in the lower level of Scranton Counseling Center to serve the seriously mentally ill population of Lackawanna County. Within the first 90 days of opening the clinic, staff completed 264 new patient visits, a testament to the real disparity of care and lack of access that exists within this population. The Wright Center Mid Valley clinic, in Jermyn, expanded service hours to include Sundays and is now serving patients seven days a week. The clinic is open 83 hours a week, 362 days a year. We also provide School-Based Health services to students within the Scranton School District, intending to meet patients where they are.

Collaborating for Quality Improvement and Shared Savings

In January 2015, The Wright Center joined the Keystone Accountable Care Organization (ACO) and in December 2015 formally became part of its governance structure. An ACO is a set of healthcare providers working together and accepting collective responsibility for the cost of care delivered to a population of patients.

Members of an ACO seek to provide more effective patient care through improved efficiencies, better outcomes and open exchange of information, resulting in shared savings. The Wright Center also joined the Keystone Health Information Exchange in January 2015, gaining access to patient information from other participating providers to assist with care coordination and medical management.

A local supporter of The Wright Center, Ann Moskovitz, delivered a gift in March 2015 in memory of her late husband, I. Leo Moskovitz. The donation was used to purchase and customize a cloud-based inventory management system to integrate inventory, medications and vaccinations with patients’ Electronic Health Records. The system improved our ability to track medications, streamlined ordering and improved patient safety.

The system has been integrated into the Mid Valley, Clarks Summit and Scranton locations.

Recognized for Excellence in Health Information Technology (HIT)

The Wright Center created a three-part case study series focused on innovative use of HIT to engage staff and improve health metrics and was recognized with a Healthcare Information and Management Systems Society (HIMSS) Ambulatory Davies Award as one of only two winners nationwide in the category in November 2015. This prestigious recognition showcases our unique integration of HIT to empanel patients for continuity of care and leverage learners to identify and implement improvements within daily practice. Suggestions are tracked and successes are shared within a homegrown “Plan. Do. Study. Act.” (PDSA) system and the effectiveness of individuals and teams is measured using a “Performance Assessment and Competency Evaluation” (PACE) Card platform. Our case studies will be showcased at the HIMSS Conference in March 2016 to an audience of more than 40,000 attendees. By sharing our progress, we hope to inspire healthcare organizations to better serve their patients, track patient-related successes and move health metrics.

View our case studies online: www.thewrightcenter.org/HIMSS

Closing the Referral Loop: Promoting Care Coordination

We recognize the importance of linking the care provided between primary care physicians and specialists. Closing the Referral Loop, a project led by The Wright Center in partnership with the American Medical Association and the Pennsylvania Department of Health, was intended to improve physician-to-physician referrals. Establishing accountability and negotiating responsibility for referrals between specialists and primary care physicians was found to improve information transfer between care environments, as well as physician and patient satisfaction.

After the first year, the number of referrals with documented answers from the specialist received by the primary care physician increased from 50% to 75%. The number of referrals “closed” in a timely manner increased from 40% to 70%.

Participants from some of the 12 primary care physician/specialist teams (dyads) gathered for discussion at the final learning session in June 2015.

Our Wright Center Dental Service expansion was initially funded by a PA Department of Health Primary Care Access Expansion Challenge Grant.

Since the Oral Health Clinic’s inception, we have served 1,278 new patients.

Integrating Oral Health

Our service area includes low-income, federally designated Dental Health Professional Shortage Areas in three counties and the need for quality, right-venue dental services is dire.

In response, we implemented a basic dental service line at the Mid Valley practice in 2014 to integrate oral health services into our primary care setting.

Ultimately, we aim to offer a full range of preventive and emergency services by expanding into a fully renovated and functional dental clinic. To further meet patients where they are, we also provide basic dental services within the Scranton School District, utilizing portable chairs and equipment to reach students in our School-Based Health Center program.

We proactively address community health through collaborative partnerships and deliberate stewardship of grants and resources.

The Wright Center’s growth aligns with the intention of The Affordable Care Act, converging local and federal funding into Northeast Pennsylvania and other partnering communities across the United States.

Asian Medical Home

The Asian population in Scranton has increased approximately 175% during the last decade to more than 2,500 residents today.

Barriers to obtaining healthcare include language, lack of transportation and insurance, over-reliance on home remedies and reluctance to seek care unless severely ill. The Wright Center embarked on a journey to provide culturally competent care through its newlyestablished Asian Medical Home. To further support this effort, the Pennsylvania Medical Society awarded a $5,000 grant to establish pop-up clinics to meet this population where they are in the community. In addition, the NEPA Healthcare Foundation and the Willary Foundation awarded $50,000 and $10,000 grants (respectively) to expand an access point of care at Skyview Park Apartments, a low-income housing complex with 188 units, to enhance our culturally sensitive and community immersed services.

Community Health Events

In May, we hosted a Wonderful Women Event, funded by a grant from the Susan G. Komen® Northeastern Pennsylvania Affiliate.

Guests networked with women in their community, painted and planted pink flowers in the newly-established “Garden of Hope.” In October, our Wright Center Fall Into Health Fair centered on various health-related activities and over 50 local partners attended to showcase available services. Attendees took part in a 5K run/walk and enjoyed a morning focused on community and wellness.

Giving Back Our Community Health Hub (CHH) is a non-profit aiming to transition The Wright Center for Primary Care into a federally-designated safety-net provider to enhance primary care access to the underserved.

CHH members reside in the service area, effectively representing the patients and community, and promoting non-discriminatory, comprehensive, high-quality primary care. Its governance will lay the foundation for The Wright Center’s application to achieve Federally Qualified Health Center (FQHC) look-alike status as the organization continues to expand its reach and serve the underserved.

Infectious Disease Clinic

Through a HRSA Ryan White Part C grant, approximately $315,000 is provided to The Wright Center Infectious Disease Clinic annually. We provide comprehensive healthcare services, prevention education and support to more than 400 people living with HIV and AIDS in a seven-county area within Northeast Pennsylvania. The Northeast Regional HIV Planning Coalition and United Way of Wyoming Valley also invest almost $385,000 annually to support the clinic and its services.

Tobacco Free Northeast PA Partnership

Our Tobacco Cessation program serves those in Lackawanna, Luzerne, Pike, Susquehanna and Wayne counties through a grant from Tobacco Free Northeast PA. Fifteen Wright Center employees provided cessation services to over 200 clients in 2015 who, as a result, have been linked to quit resources, free nicotine replacement treatment options, individualized quit plans and one-on-one counseling. Of the 213 patients enrolled in the Tobacco Cessation program, 113 completed it — an impressive 53%. Of those who completed the program, 82% report quitting completely or significantly reducing their tobacco use.

Digital Imaging and Radiology Services

Through a grant from The Scranton Area Community Foundation, we were able to provide digital imaging and radiology services to 187 uninsured adults and children in Lackawanna County.

In the FY2014-15, we stewarded resources, sponsorships and donations to more than 50 partner organizations.

In collaboration with Maternal and Family Health Services, we were awarded an Access Matters grant in late 2015 to deliver age-appropriate sexual and reproductive health education to Scranton School District students, As a give-back, aiming to decrease unintended all employees pregnancy and sexually participate in at least transmitted diseases. one community event each year.

Front (L-R): Third year residents of our National Family Medicine Network, Dr. Manny Vogt, Dr. Perel Schneid, Dr. Patricia Saravia and Dr. Regina Ragasa. Back: Dr. I'kyori Swaby, Lutheran Medical Center.

Four residents from the National Network’s Brooklyn site traveled to Jamaica on a medical mission trip, bringing supplies and medications to a local clinic. Third year Wright Center resident, Dr. Manny Vogt, organized the trip through the Blue Mountain Project and Dr. I'kyori Swaby of NYU Lutheran Medical Center joined as the team’s precepting physician. The group stayed with host families and conducted home visits for the elderly who could not travel to the clinic. “Our residency training is based at the Caribbean Family Health Center in Brooklyn and we see a large Jamaican population. The trip gave us a chance to get to know our patients and understand their culture on a much more personal level,” said Dr. Vogt.

Focusing on Employee Development

We strive to develop leaders dedicated to building a culture of continuous improvement. This year, we experienced unparalleled expansion, welcoming new members to our finance, communications, grants and human resources teams, as well as clinical operations. We implemented an in-house leadership development program and performance based bonuses to drive professional growth, empowerment and retention of our organization's most talented workforce.

Retaining Physicians and Faculty

After completing their training, 63% of our graduates continue their careers within Pennsylvania. Notably, 17 of our graduates have advanced to leadership positions within The Wright Center and on our governing boards. Our training model, replicated at Federally Qualified Health Centers (FQHCs) in our National Network, is showing a similar retention trend at 68% as our first class prepares to graduate this summer and solidifies post-graduation employment.

Recruitment and retention of best-in-class faculty has always been a focus and in 2015 two strategic changes within Graduate Medical Education were announced. Dr. Timothy Burke, a 2013 Wright Center graduate, was appointed Program Director, Osteopathic Internal Medicine and Dr. Wasique Mirza was appointed Acting Program Director, Allopathic Internal Medicine.

The Wright Center is an especially active contributor to the economic health of Northeast Pennsylvania. Aside from contributions we make in the form of jobs, salaries and benefits, we influence the economy in indirect ways, such as resident and visitor spending. Additional regional output is generated by the graduates who remain in our community once they enter the workforce. As we expand our training model regionally and nationally, we will bolster partnerships with like-minded organizations and positively contribute to the economies of communities we serve across America.

Dr. Mirza also retained his position as Medical Director at Scranton Primary Health Care Center. Our partnership with Scranton Primary Health Care Center promotes strengthening of safety-net services in Northeast Pennsylvania while developing physicians committed to delivering high-quality care to all.

Expanding for Economic Impact

The Wright Center and Lackawanna College are partners in the initiative to develop Cornerstone Commons, a six-story building at 401 Adams Avenue, Scranton, that will transform an underutilized property into an integrated educational and care facility to spur growth downtown. This project will increase the number of students, staff, educators, professionals and members of the public utilizing the space and generate significant activity for local businesses. The Wright Center plans to occupy nearly 30,000 square feet, housing a comprehensive primary care safety-net clinic that includes services for students of Lackawanna College and The Commonwealth Medical College. The building will house non-discriminatory dental, mental/behavioral health, women’s health and HIV/infectious disease services. Maternal and Family Health Services and United Neighborhood Centers plan to provide on-site services in partnership with The Wright Center to encourage one-stop access. The clinic will be easily accessible to those with transportation challenges and the facility will support a learning environment for various academic degrees and continuing education programs.

331 people were employed

by The Wright Center as of December 2015.

63 new staff positions were created in 2014-15.

On the Horizon...

Providing an exceptional care and educational experience for our patients and residents is our daily privilege and mission.

Dr. Christopher Minello, 2015 Wright Center Internal Medicine Graduate, accepted a faculty-physician position with The Wright Center and now practices primary care in his hometown of Clarks Summit.

Financial Strength

As a backbone organization, The Wright Center has proven itself to be a successful vehicle for responsibly stewarding federal funds into the Northeast Pennsylvania economy. At the close of FY2014-15, operations reflected net assets of over $11 million. The Wright Center for Graduate Medical Education received revenues from federal grants, hospital affiliations (residency and fellowship agreements) and reimbursements, IRB and research fees, interest and dividends. The Wright Center Medical Group received supplies and revenues from patient services, grant support, 340B drug pricing and various contributions.

By the Numbers:

FY2014-15 compared to FY2013-14

Increase in Residents and Fellows: 24.6% Increase in Total Operating Revenue: 18% Grant Funds as a % of Total Operating Revenue: 44.5% Salaries and Benefits as a % of Total Operating Revenue: 54%

In June 2016, we will graduate 59 physicians, continuing to fuel a workforce renewal pipeline prepared to serve the evolving healthcare needs of today’s patients and communities. Building on the proven success of our GME-SNC model, we plan to develop new residencies and fellowships responsive to public health needs and to expand our training programs into additional communities.

To answer the call of the Institute of Medicine’s Sub-Committee on The Future of GME Finance and Governance, we will continue to lead advocacy efforts for federally supported GME innovations that converge resources and integrate 21st century educational curricula with the highest quality, affordable patient-centered care.

The Wright Center is in the midst of a significant, transformation-driven governance evolution with the recent incorporation of The Wright Center Alliance.

The parent organization will encompass education and patient care as we enhance our shared governance and operational framework to promote organic growth, strategic planning, inclusive stakeholder engagement and community activation.

Responsive to identified patient and community needs, we will expand much needed Hepatitis C services in 2016.

We also plan to integrate pediatric and adolescent primary care providers into Scranton Counseling Center, along with expanding access for our recently established adult patient base within this venue.

The Wright Center for Primary Care will be applying for FQHC Look-Alike status as we continue intense focus on serving the medically underserved in Northeast Pennsylvania. We also see potential to be recognized as an FQHC New Access Point at our envisioned facility in Scranton, Cornerstone Commons.

As committed to in our Vision, we will integrate patient care delivery, workforce development and innovation to be the leading model of healthcare in America by 2017.

We humbly acknowledge our board members who unselfishly dedicate their time to The Wright Center; our residents and fellows who entrust us with their education; our patients who place their confidence in our team; and our employees and staff who actively deliver our Mission and Vision every day.

The Wright Center for Graduate Medical Education: Linda Thomas-Hemak, MD, President/CEO | Randall Brundage, DO,Chair | Mark Perry, Esq., Vice Chair | Marlene Karam, Secretary Cornelio Catena | Ed Chabalowski | Edward Dzielak, DO | Linda Famiglio, MD | Joseph Ferrario | James Gavin | Michael Hanley | John Kearney Michael Kondash, DO, ex officio | Douglas Lawrence, PhD | Carlon Preate | Brooks Turkel | Michael Washo | Robert Weil, MD | Robert Wright, MD The Wright Center Medical Group: Linda Thomas-Hemak, MD, President/CEO | Mladen Jecmenica, MD, Vice President | Susan Baroody, DO, Secretary Timothy Burke, DO, Treasurer | William Dempsey, MD | Jignesh Sheth, MD Community Health Hub: Linda Thomas-Hemak, MD, Chair | Gerard Geoffroy, Vice Chair | Kellen Kraky, Secretary | Mary Marrara, Treasurer Bryan Adkins | Carol Chaykosky | LeeAnn Eschbach, PhD | Charles Hemak | Michael Kushner | Julio Ramos, MD Bette Saxton | Elaine Shepard | Cara Sherman | Larissa Valonis | Kathy Wallace | Daniel West, PhD