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What ever the mind or a man can conceive and believe, it can achieve.” • •Napoleon Hill
MISSION QUICK COMPREHENSIVE AND COST-EFFECTIVE CARE .
VISION
Patients-Trust us. Patients-Trust us.
Teammate are empowered to do their best work. Teammate are empowered to do their best work.
Payors -recognize Shield Medical Group for its quality and provides more growth opportunities. Payors -recognize Shield Medical Group for its quality and provides more growth opportunities.
24/7 AVAILABLE ALWAYS CONNECTED PATIENT-CENTERED. TEAM-BASED COORDINATED CONCIERGE CARE Values Values
I have come to clear understanding that any business including medical practices should arrange their affairs as below 1. Create value [create service lines required by the patient’s] 2. Market [differentiate from other practices and healthcare systems to get attention] 3. Sale [provide patients with quick, comprehensive and cost-effective care] 4. Value delivery [understand patient’s expectation and exceeded all the time] 5. Value Capture [must provide the services at a price which patients can aford and the practice make enough profit to continue its operation]
Business Model Philosophy
My personal philosophy OF Business Development Availability, Availability, Availability Accountably – Added by Dr. Shinto Affability Affability- Capability
My Principles •Capabilities - resources process and priorities •Value= expectation +performance •Quality= expectation – performance •SUCESS= planning - effort –consistency • Customers DO NOT BUY UNTILL IT IS URGENT • Quality- clinical outcome physical experience and emotional experience •Cost- improve efficiency and decreasing disease burden. • care paths, group visits ( smoking , obesity And exercise) chronic disease registries
Source of My Principles
•KT - begin with end in mind.
•Gandhi- Be the change you desire.
•It is not dress rehearsal, it is my Life
•You cannot pour out of empty cup
•Steve Job- Sell what they want and give what they need
Mental Map FOR EVERYTHING WE DO ?
Why?
VALUE CREATION VALUE.
Right people.
Right thinking
Sticking to hedgehog -Right action-culture of discipline, freedom/responsibil ity
What Creates Value?
Services Qualilty
How
Marketing Sales Value Delivery (Services and Products) Value capture(Finances) Proper Payor credentialing Look for Change and embrace it.
we Achieve it?
Change in the business model
CHANGE IN BUSINESS FOCUS CHANGE IN SETTING OF CARE LIKE OUTPATIENT SURGICAL CENTERS
CHANGE IN AFFILIATIONS
CHANGE IN EXPECTATION OF CARE BY INSURANCE.
CHANGE IN EXPECTATION OF CARE BY CONSUMER.
CHANGE IN MARKETING AFFILIATIONS.
Key Players in Healthcare Delivery System
Employees
Patients
4. Payors [health insurances, self-insured]
1. Office-representing the physical structure of medical practice, systems and processes. 2.
-they represent the humanistic side of medical practice. 3.
-they are the lifeline of medical practice.
MEDICAL COMPONENTS OF A HUMAN
EVERY PATIENT COUNTS AND EVERY PATIENT MATTERS Build system around patient experience and expectation Process Patient experience Outcome Efficiency. Quality= expectation –performance Measure and Follow Leading Metrics
Final Product CLINICAL OUTCOME GREAT PLACE TO WORK PATIENT EXPERIENCE CLINICIAN EXPERIENCE
Managed care Goals Reduce IP days/1000 Decrease ER utiliztion 5 Star Hedis Scores Reduce Pharmacy cost Accurate HCCs Reduce MBR ratio
High risk report, Members not seen within last 6 months, Tract people with very high and low scores .
Process
CFO -proving above data in actionable form
Resources - coders for prospective and retrospective reviews. Health coach for - CO ORDINATING • Case management, • Disease management, • Quality(HEDIS and Star) • Referrals Patient • Portal and coordinating with specialists.
CEO - CHECK OVER ALL
4 METHODS OF INCREASING REVENUE Increase number of customers 01 Increase average transaction size 02 3. Increase the frequency of visits by client 03 4. Increase the price 04
Health Coach in nutshell
• Schedule all the post hospital pt to my office
• Check next day and previous day schedule to ensure that pts are on my schedule
• 25 th – all terminations are confirmed to be with plan
• New pt on 1 st of every month are scheduled for follow up
• Flow sheets are completed
• Focus report f/u –
• Disease management and case management
• Pts with hcc less than1.5
• Pts not seen in last 6 months Final
• # of HMO pts seen /week/month/in 3 months
• All codes documented
Primary Care Lines of service
1. Office visits. 2. Hospital visits. 3. Nursing home visits. 4. Assisted living visits. 5. MANAGED-CARE PRACTICE. 6. Tele Visit. 7. Other
ancillary services visit including home health, hospice care and others etc.
What are the 6 Activities of Health care givers Labs Radiology Medication Education Coordination of Care (Referrals ,DME, Scheduling of Tests and procedures) CCM/TCM/PCM
Office Services Components
1. Telephone. 2. Front desk. 3. Medical assistant. 4. Exam room. 5. Discharge. 6. Medications. 7. Lab tests. 8. Radiology Tests. 9. Referral services. 10. DME. 11. Coordination of care-hospice, home health, refer to nursing homes, refer to assisted living.
Medical System Startup Check List CULTURE = PRIORITIES + PROCESSES. BOUNDARIE S POLITICS
OF SUCCESS ACCESS MOVING THROUGH VISIT.
Impression made by doctor. After care
PILLARS
How is the staff behavior
Way to Organize the Processes ● PREVISIT ● VISIT ● POST VISIT
UTILIZATION REPORTS • Total number of consuls •Total number of ER visits. •Total number of radiology referrals •Total number of hospitalizations •HEIDS Data report •5 Star report •HOS reports •Gap reports •Total pharmacy cost and cost weight drug and cost were patient •All reports cost per 1000 • All reports with variance from target per 1000
GAP REPORTS Daily Reports Weekly Reports. Monthly Reports. Weekly document upload to Humana and WellCare.
Membership Projections We are currently at about 700 MA Members Expect to be 1000 Next 2-3 Months
Membership Growth
Service Fund Through October 2022
CURRENT IBTDA AS IT IS. LET US FOLLOW RANDALL’S DOCUMENTS FOR ACCURACY
As per Quick book as Nov 17th
Projected IBDTA by Dec 2022 • Current IBDTA by Nov 2022(We have not received Surplus number for Nov).=$1540330 • Historical Monthly IBDTA contribution per month=$154033 • Projected IBDTA as of December 2022=$1848396
Upon Acquisition • UNITED BOOK OF BUSINESS START GENERATING $350 PMPM. WE ESTIMATE THAT WE ARE NOT CAPTURING $832K PER YEAR AT THIS TIME DUE TO WELLMED. • STOP LOSS DROPS TO ABOUT $ 10 PMPM FROM 132PMPM. • CURRENLY, WE LOSE $700K (net premium paid - recoveries) • RANDALL’S SALARY GET SHARED. • IBDTA INCREASES FROM $1.7 MILLION TO MORE THAN $ 2.5 MILLIONS AT LEAST
PMPM DATA ● AVERAGE PREMIUM- $1038 ● AVERAGE EXPENSE - $625 ● AVERAGE INCOME $344 ● OPERATING EXPENSE $145
MY PERSONAL GOAL • I WAS WORKIGN ON TO REACH 1000 MEMBERS. • REACH PROFITABILIY OF $ 344 PMPM • IBDTA OF 4.1 MILLIONS • SELL 100% OF STAKE AND WORK WITH COMPANY TO DEVELOP AS LONG AS I AM NEEDED. I WOULD LIKE TO WORK ANOTHER 10 YEARS • IF SALE HAPPENS AT ANY STAGE, WOULD NEED PERMISSON TO DEVELOP NURSING HOME, TELEHEALH AND VIRTUAL CONSULTING BUSINESS