At Mercury Advisory Group our experts have distilled the ACO and Integrated Physician Network Development process into six distinct steps that every ACO, IPA, PHO or MSO must take regardless of the business model they ultimately select: 1.
ACO/PHO Ideation elaboration
o o 2.
Anchored enough to the realities of implementation
Feasibility Analysis and Market Research
o o o o o 3.
Broad enough to be comprehensive
Local Market Analysis Competitor Analysis Provider Profiling Addressable Market Assessment Local and National Payer Analysis
Corporate Formation, Organizational Development, Provider Network Development
o o
Business Strategy Organizational Documents (Bylaws, Applications, Credentialing & Privileging Criteria, Vetting Procedures, Provider Participation Agreements, etc.)
o o o 4.
Management Systems Payer Due Diligence Offer Analysis Contract negotiation Website & social media strategy
Environment of care and customer delight
o o o o 6.
Business Process Development
Business Development
o o o o 5.
Minimum Viable Product MVP/USP Determination
Day-to-day patient engagement Predictive Modeling and Navigator Daily Action Items Provider feedback and education Systems documentation and CQI
Outcomes reporting and measurement & evaluation
We Make it Easier to Be in the Business of Accountable Healthcare
Practice Leader In 1991, Maria Todd left a large national HMO Provider Relations role to work as an IPA Executive Director in Aurora, Colorado. For nearly 20 years, she has been a internationally recognized authority on managed care program development and administration. Her experience is extensive in the design and organization of IPAs, PHOs, and MSOs through the USA. Ms. Todd brings the diversity of a clinical, administrative, paralegal and former HMO Provider relations background to the organizational and negotiation table. As President and CEO of Mercury Advisory Group, a Denver-based international healthcare consulting firm, she provides consulting services to doctors, hospitals, governments, investors and other healthcare providers. She manages a team of healthcare business and clinical experts which develops clinical and administrative guidelines for physicians, emerging integrated delivery groups and hospitals. She serves as developmental consultant to several new and established integrated health delivery systems throughout the USA, and has consulted to the United States Military, the Veteran’s Administration, and Cleveland Clinic, among many others. In 2010, the US Patent and Trademark Office (USPTO) granted Maria Todd the registration of a new term of art, the Globally Integrated Health Delivery System® for her application of the integrated health system concept and operations to the medical tourism and health travel arena. She built the first and only globally integrated health delivery system which combined all the elements of ACO accountability, predictive modeling, case management, provider credentialing and privileging, quality, safety, clinical outcomes and patient satisfaction metrics, telehealth and telemedicine technology applications, electronic medical records, international cloud-based data and privacy security, and TPA operations for provider claims settlement and bill audit. To this, she added a fully-documented system to manage complex and specialized health travel logistics coordination to the mix. Ms. Todd lectures nationally and has personally conducted over 2700 seminars, webinars and educational programs on managed care and integrated delivery system development since 1993, with well over 60,000 attendees. She is available to address physicians and hospitals as well as state and national associations on these and other issues. She is the author of a number of best-selling healthcare management handbooks, including,
• • • • • • • •
The Managed Care Contracting Handbook, 2nd ed The Physician Employment Contract Handbook, 2nd ed IPA, PHO, MSO Development Strategies Physician Integration and Alignment: IPA, PHO, MSO, ACOs and Beyond The Handbook of Concierge Medical Practice Design The Handbook of Medical Tourism Program Development The Medical Tourism Facilitator’s Handbook The Employers’ Guide to Medical Tourism Benefit Design
The Step-by-Step ACO Development Program Maria Todd’s ACO / PHO Development Program is highlighted in her books, titled IPA, PHO, MSO Development Strategies (1997, McGraw Hill and HFMA,
Chicago)
and
Physician
Integration
&
Alignment: IPA, PHO, MSO, ACOs and Beyond (2012, CRC | Productivity Press, New York). Her
ACO/PHO
development
program
is
a
comprehensive package of advice and guidance, research and payer analysis services, contracting support, and a library of documents and templates designed to support you and your staff in each of the areas you need to focus your attentions to get off to a solid start. The program includes: 1.
A detailed outline for everything you’ll need to know to plan, launch and thrive in an Accountable Care Organization (ACO) or Physician Hospital Organization (PHO) whether you are paid on a discounted fee-forservice, bundled case rates, or shared risk and capitation (or some other arrangement).
2.
A complete collection of easily-edited forms, policies, office and Care Navigator procedures and correspondence templates to save you time and money.
3.
Working draft documents that your attorney can review for final approval
4.
A complete organizational branding outline
5.
A step-by-step marketing outline and action plan that includes social media marketing, print, video, and local advertising and public relations activities designed to set your organization’s local market identity on the fast track to success.
6.
A unique, proprietary Healthy Lifestyle CalculatorTM and other mobile health applications that can be branded to your organization and used to help activate and engage patients as they reduce health risks and meet healthy living objectives throughout the course of the year. This proprietary mobile health app for use on a computer, mobile phone or tablet device will be licensed and white-labeled for your organization along with a suite of other free to use tools we’ve bundled to differentiate our clients from their competition. The first year’s license fee for the app to use for your ACO/PHO patients is included with our program.
7.
A unique, proprietary Managed Care Contract AnalyzerTM software application that loads onto MS Word® and enables contract analysts to quickly identify vague, problematic costly or dangerous terms in contracts. It color codes more than 150 words and phrases that are “Known offenders” that cost money, time, and aggravation. Thousands of our clients have use this tool since its first release in 1995. The license fee for the application is perpetual and included with our service package. It is not for sale without the training we provide to use the app.
Our experts guide you step-by-step to success • • • • • •
ACO Feasibility Analysis and Market Research (Never assume a Field of Dreams “IYBITWC” attitude!) Business Decisions, Organization-wide Communications Network Development ACO /PHO Brand Analysis and Niche Identification Revenue Cycle & Care Navigator competency training Business Process Documentation Post-Launch Continuous Operational and Quality Improvement
We also offer a turnkey program that includes all of the above. Our complete program is perfect for busy providers who need to focus on patient care and have us do all the research, fact-finding and recommend a complete strategy and then implement it. Our team will become an extension of (or substitute for your regular staff. We will manage all the organizational development, surveys, stakeholder input, and support you every step of the way. You’ll meet with Maria and her team once a week by phone or in person (in Denver) to stay in the loop and make decisions on next steps. Maria’s team handles all the heavy lifting, the paperwork, the market analysis, competitor analysis of your competition, staff hiring, training and development, marketing, public relations, and payer contracting and negotiation training for your internal ACO /PHO contract negotiators. We can also negotiate on your behalf, depending on your economic integration and risk-sharing level. We work closely with your physicians, practice managers, hospital executives, your ACO/PHO attorney, and your accountant or CFO to help you meet and exceed your stated goals.
ACO /PHO Development Coaching Program Our Coaching Program is designed for physicians and ACO /PHO Organizers who want to pursue their own network development, strategic planning and contracted reimbursement independently and want an experienced adviser or sounding board to help or be on call. We help clients who have already began or plan to execution their action plan on their own and need a little additional guidance. Maria’s coaching option makes it easy for you to purchase blocks of time for phone coaching from a ACO/PHO team of experts to use as you need it. Blocks start at 90 minutes per month, billed quarterly. Unused time rolls over to the following period.
Related Services Available • • • •
Outsourced Contract Review and Recommendations Outsourced Payer Negotiations Leadership Retreats and Strategic Planning Facilitation Team Member and Staff Coaching (On-site at your location, or at our training facility or at a Colorado Mountain Resort)
• • • • •
Outsourced Data Compilation Outsourced Reporting to CMS and Payers Outsourced Provider Fee Settlement and Revenue Distribution Outsourced Predictive Modeling , Patient Engagement and Care Navigation Outsourced Case Management
Call us to learn more. 800.727.4160