VP OF VARIATION REDUCTION, SUTTER HEALTH
2015 - 2017
Leader of clinician engagement and affordability initiatives in Office of Patient Experience at Sutter Health, a not for profit health care system of 24 hospitals in 100 Northern California cities, serving 3 million patients.
Led a team that uses unblinded peer-comparison feedback to engage physicians in analyzing practice patterns to reduce variation, increase quality and lower costs. Integrated this effort with other care improvement domains including quality, safety, and pharmacy. Cumulative impact was 1,239 projects including 4,042 clinicians.
Expanded Variation Reduction to 13 large hospitals, achieving cumulative savings of $60M
Led effort to create cost accounting system for standardized costs across 24 hospitals, enabling identification of clinical savings opportunities by DRG.
Developed analytics expertise in inpatient costs and clinician attribution which has become systemwide resource, and is now sought after outside the organization. Developed 100+ new metrics of monitoring primary and specialty clinical care processes.
Lead author for research publication demonstrating the effectiveness of Variation Reduction as a new methodology of achieving affordability of healthcare
Won grant from Robert Wood Johnson and American Board of Internal Medicine for implementing Choosing Wisely guidelines.
VP OF CLINICAL TRANSFORMATION, SUTTER MEDICAL NETWORK
2012 - 2015
Senior Executive at the Sutter Medical Network (SMN), a network of nearly 5,000 foundation and independent practice association primary care and specialty physicians affiliated with Sutter Health, a Northern California not-for-profit health system.
Expanded Variation Reduction into a system-wide affordability initiative in all medical groups and standardized performance metrics, and made this a required participation standard for Sutter Medical Network.
Standardized display of drug costs in Electronic Health Record (Epic) resulting in new revenue from gain sharing with health plans for increasing use of generic pharmaceuticals.
Increased Press-Ganey patient satisfaction scores by leading multiple classes in the “Art of Communication for Physicians.” As a result, Medical Groups were recognized in national edition of Consumer Reports for improvements in patient satisfaction.
CHIEF MEDICAL OFFICER, SUTTER PHYSICIAN SERVICES
2008 - 2012
Senior Executive at Sutter Physician Services, a Sutter Health subsidiary that provides a variety of patient access, revenue cycle, and accountable care solutions to health care provider and payer organizations. Today the team of over 1,500 people, based in Sacramento, with a service center in Salt Lake City, and five regional offices provides services to over 550,000 members from more than 30 health care organizations; managing more than $2.25 billion in receivables and managed care services each year.
Created outreach program that accomplished 90th percentile quality scores for colon cancer and breast cancer screening.
Standardized ambulatory visit types from over 600 to 11, thereby enabling online self-scheduling by patients.
Led medical director forum for clinical leaders in 8 medial groups and 5 IPAs.
Brought together all the claims data from 5 foundations into one database which enabled episode grouping, identification of savings opportunities, and identification of best practices.
Created software tool for visualizing differences between clinicians’ efficiency, subsequently commercially sold by Optum as “Care Pattern Analyzer” in Impact Intelligence Suite.
Developed new line of business, named ‘Variation Reduction’ and contracted with 5 foundations for $3M in revenue for this service.
Promoted to systemwide VP role in Sutter Medical Network.
VP OF CLINICAL SERVICES, HILL PHYSICIANS MEDICAL GROUP
2004 - 2008
Senior Executive at large multi-specialty IPA with 3,000 physicians and 330,000 members in eight California counties
Managed 120 employees in authorizations, concurrent review, disease management, care coordination, and medical bill review.
Guided IT adoption through EMR Advisory Group, EMR Clinical team, and Provider IT Committee.
Led the Quality Improvement committee and oversee Pay for Performance initiatives in the domains of efficiency, satisfaction, and IT systemness.
Led process to select and implement new medical management software that increased automation, staffing efficiency, and provided web based applications in all physician offices.
Developed and managed roll out of office based software tools, such as diabetes disease registry and satisfaction survey kiosk.
Launched new method of proactive, outbound case management through predictive modeling that increased count of new cases managed by 2000.
Enhanced automation of authorization processing, such that rate of automatically processed authorizations more than tripled.
Created method of analyzing specialist performance that provides graphical drill downs and clinical insight into variation in behaviors that has produced gains in utilization efficiency.
CHIEF MEDICAL OFFICER & DIRECTOR OF PROVIDER RELATIONS, SAN FRANCISCO HEALTH PLAN
2003 – 2004
Senior Executive at Local Initiative Health Plan with four lines of business
Spearheaded quality improvement team that firmly established health plan as state leader in HEDIS preventive care rates through provider and member incentive programs.
Managed provider relations department with full responsibility for contracting pharmacy care and ancillary network.
Contracted for and implemented web based decision support application for practices to manage preventive health care reminders.
REGIONAL MEDICAL DIRECTOR, NORTHERN CALIFORNIA, PACIFICARE OF CALIFORNIA
2000 – 2003
Lead Physician Executive for regional team of consultants managing medical risk for 220,000 members in 24 medical groups and IPAs
Led team of nurses, case managers and pharmacists to design and implement action plans for medical groups that accomplished significant improvements in utilization and medical management performance.
Solved the problem of inadequate access to skilled nursing facility beds by creating a database with clinical information for 650 facilities and instituted program of bed leasing in target submarkets. Database is now used statewide.
Spearheaded initiative to reduce admissions by implementing alternatives to admission program, with over $400,000 in annualized savings due to ER diversions.
MEDICAL DIRECTOR, CONTRA COSTA HEALTH PLAN
1997 – 2000
Senior Executive for a $90 million HMO, managed the strategic planning, staffing, and day-to-day operations of 70 clinical health plan employees and oversight of clinical practice and regulatory compliance for 300 physicians
Orchestrated membership expansion from 20,000 to 50,000, leading organization through aggressive restructuring. Expanded provider network by contracting with 120 community physicians, which resulted in significant improvement in patient satisfaction on CAHPS survey.
Recruited pharmacists, created formulary and prior authorization process; led P&T committee that implemented policies and measures to save $1.5 million in drug cost expenditures.
ASSISTANT CLINICAL PROFESSOR, UC DAVIS, DEPT. OF FAMILY MEDICINE, FACULTY IN OB/GYN DEPARTMENT RESIDENCY PROGRAM
1989 – 1999
Recognized as an effective communicator, selected as Educator of the Year. (1991)
Led team that installed database network for outcomes analysis and document management system for over 10,000 newborn deliveries.
Supervised over 4,000 deliveries, including high risk obstetrics and Cesarean sections.
MICHAEL VAN DUREN, MD, MBA
Physician Executive with 20 Years Experience