MERCURY ADVISORY GROUP
Organizational Development for ACOs & PHOs www.mercuryadvisorygroup.com
Execution
Without Excuses
Helping You Build Your Provider Network Infrastructure We build your foundation with education and concensus building to create momentum for clinical, operational, financial integration and physician alignment...
Initial Project Deliverable (First Meeting) • • • • • •
Ideation / Agreement on goals Operatonal Objectives Data collaboration plan Align the entire continuum of care Agreement on practice standards Commitment to active care coordination
Many of the clients with whom we work rushed to file their application and articles of incorporation before completing this critical step in the development of their network. Without this elaboration and commitment, it will be difficult for the organization’s leaders to lead, and will impede integration and provider alignment to organizational goals and performance objectives.
PROJECT ONE Educational session an follow-on discussion to acheve consensus on ACO / PHO goals, business model, and adoption of key performance metrics for cost, quality, economic integration/shared risk, and compliance. If the organization will seek PCMH Accreditation, a gap analysis and time line development may be undertaken then or set for a return visit at a later date.
PROJECT TWO (Working Weekend Retreat) A working weekend retreat with a task force assigned to complete the working draft of bylaws, credentialing and privileging criteria, policies and procedures; quality standards and corrective action plan policies and procedures, and other working documents critical to organizational development and operations. We bring model documents so that the task force can complete these assignments in the weekend retreat and have draft documents ready for implementation.
PROJECT THREE (Working Weekend Retreat) A working general session of the membership to discuss and achieve consensus on the continuum of care. Representatives should be present from all stakeholder domains, including: acute care, ambulatory care, telehealth, post acute home care, and post-acute SNF. Care navigators should be present and engaged in the discussions to voice any concerns about practicability, execution of and accountability for meeting organizational goals and objectives.
Why consider PCMH Accreditation for your ACO? PCMH Accreditation is critical to your ACO’s success for the following reasons: • • • •
Demonstrates primary care provider commitment to triple aim goals Ensures focused attention on activities that improve quality and reduce cost Enhances a team-based approach to care and patient engagement Guides the culture change needed for success in value-based care delivery
EHR Interoperability and Networking EMR data from ICD-10 is critical to ACO / PHO performance and provider alignment. If your ACO elects the MSSP busines model, you will be required to meet Meaningful Use (MU) criteria to achieve certain incentives. Interoperability will enable your ACO / PHO to: • Report ambulatory clinical quality measures to CMS and other payors • Generate lists of patients by specific conditions to campaign engagement • Provid a summary care record for each transition of care or referral to eliminate clinical, diagnostic and medication redundancies and set referral and consultation expectations for deliverable
Issues Associated with Integration and Alignment 1. 2. 3. 4. 5.
Physician Autonomy Specialization Functionalism Management Information Systems
Making it Easier to Be in the Business of Healthcare
Development and Agreement on Practice Standards No Cookbooks Allowed! Nip whining and complaints in the bud by engaging primary care and specialists to come up with their own, unique practice standards.
Care coordination within ACOs should include:
We facilitate this session to engage primary care and specialists in task-oriented exercises designed to build practice standards proprietary to the group, adopted by consensus, and built around the capacity and technology available for use by the group.
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ACO participants must agree to practice standards, including, but not limited to: • •
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Patient navigators, who serve as care coordinators in hospital and practices Integrated in multi-disciplinary workflows Sharing care coordination plans, care coordination tasks and secure messages in a standardized format, available online Proactive preventive, acute, chronic and end of life care A common language for care coordination lifecycle status
Clinical work groups to set coordination pathways Initial focus on conditions used for quality metrics • Diabetes • COPD/Asthma • Congestive heart failure • CAD/Hypertension/Ischemic Vascular Disease Depression Preventive health NQF Metrics, primarily outcomes A common coordination plan across the ACO
Superior execution is built on three core tenets
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Operational excellence
Operational excellence comes from informed leadership and committed team members. Leadership requires communication of vision and mission, access to useful data that enables and facilitates decision support, and organization-wide commitment to the integration and alignment of the network’s participating and affiliated physicians and other clinicians, coupled with patient activation and engagement.
Organizational focus
Focus is set by leadership and driven a solutions orientation supported by timely access to good data, clearly articulated measurable objectives, and a culture that embraces the intentional limitation of its range of activities, in terms of services, markets and technologies, of physical, cognitive or cultural assets, of individual or organizational capabilities, or a combination of all of those to produce the triple aim goals.
Single point accountability
The organization embraces the responsibility for development of a “living brand” that is known for integration and alignment of care delivery resources, and for its reputation for sharing financial and medical responsibility for providing coordinated care to patients. The ACO’s brand is distinguished by its ability to limit unnecessary healthcare spending and maintaining better health and patient delight through its collaborative efforts.
The key to cultural change is to eliminate ACO silos
The first order of business is to eliminate any dysfunctional silos within the organization. This begins with seamless sharing of information The elimination of silos in the management and delivery of healthcare requires a cultural change from habits deeply embedded in the DNA of every ACO. To do so will take strong commitment and brutal discipline and leadership that must win the hearts and minds of the people involved in the ACO. In order to be successful at this radical change from silo preservation to integration and alignment, the people involved must have a clear understanding of why the change in strategy or in culture is needed. They must also be motivated to make the change. The leadership must inspire the necessary institutional politics to make the change happen. The leadership must be courageous and start this important work even if only a few influential participants are ready to change. In time, the others will follow or leave to find a group that is more aligned with their goals and objectives.
The ACO’s brand is distinguished by its ability to limit unnecessary health care spending and maintaining better health and patient delivery through its collaborative efforts.
Our experts bring decades of experiences to your project and help you to do a better job of being in the Business of Healthcare
Making Integration Work 12 “Must Do” Action Items for ACO Success •
Articulate the “Vision Thing” So Others Can Feel It
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Train Managers and Physicians in the Principles of Systems Thinking
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Help the Organization see Whole Processes
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Bring Customers into the Design Process: Payers, Patients, Referral Sources and Internal Customers
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Connect with the Baby Boomers and Senior Populations
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Build Value-added Information Systems
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Get Everybody on Board. Sweat Equity Builds the Team.
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Balance Perspective. Broad enough to be comprehensive, yet anchored enough to the realities of implementation
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Build an Image of Consistency. Outcomes, Quality Improvement, Measurement, and Competency
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Increase the “Value” of Care -- Pay for “Care” not Data.
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Reconnect with Communities, Not only as Citizens, but as Economic Engines of Importance.
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Develop a New Breed of Physician Leaders
ACO Governance Issues Resist the temptation to slot too many positions or to guarantee the representation of specific interests. Focus on individuals elected by the group who will represent the entire group structure and culture. Give the Board substantial power so that it can act aggressively on everyone’s behalf, yet keep power balanced so that there is the option to replace an individual, if necessary. It does not help the group for providers and shareholders to make every business decision; it interferes with the efficiency and does nothing to gain the advantages desired in the market. When hiring an Administrator, seek a candidate with strong operations management and people skills. If necessary find someone to help them with contracting and marketing. The candidate must have both administrative and clinical experience and training, so that they can have empathy and see the administrative and clinical issues simultaneously.
The ACO / PHO Development Timetable Education. The successful implementation of a ACO / PHO requires education. That education process begins and ends with the medical staff. Communications efforts concerning the changing healthcare scene in the community needs assessment, and the details about the new organization, structure and governance must be addressed and planned carefully to ensure acceptance by and alignment of the membership at large. Committee selection. The organization’s membership should be involved in the establishment of committees and the committees should reflect the appropriate mix of primary care, specialist and hospital-based physicians and administrative staff. Designation of authority. It is important to establish a process by which those physicians who are involved in the ACO leadership have the ability to represent the interests of the membership. Physicians on the leadership committee must be comfortable with making decisions on behalf of other physicians. If physicians are not comfortable with making decisions and then gathering support for those decision by being advocates of the process with their colleagues, the process by which decision-making at the ACO development committee level will grind to a halt. Choose physicians leaders for this role who have earned the respect and can speak on behalf of physicians of the ACO for this role. Creation of the integrated physician organization. As part of the ACO overall development process, physicians should initially organize themselves in a physician organization, which will allow physicians to speak with a collective voice. This is extremely critical in any PHO development. This step will shorten the time frame during which a successful PHO can be created and will reduce the potential for acrimony with the hospital(s). Creation of the ACO structure and governance. Once the physician organization issues have been decided, the ACO / PHO governance structure and issues associated with the creation of the ACO should be finalized. Partnership and shared control with a hospital would be determined and recorded at this level if not previously settled. Contracting committee. Once governance and structural issues have been settled, attention should be focused on building a contracting strategy and business rules for working with third-party payers. Operational plan and budget. An operational plan and budget must be developed in order to manage day-to-day operations. This process will also assist in providing guidance concerning how much capital should be raised to launch and sustain operations for the first 90-180 days post-launch. Raising capital and execution of documents. After the preceding steps, the ACO is ready to raise its capital and actually organize itself. In many ACOs formed to meet deadlines set by CMS, the preceding steps were not undertaken and completed. If this is the case with your ACO, these steps must be gap filled and completed. Skip this foundation-building and risk your organization’s peril. Documents must be prepared and distributed and the appropriate funds returned by the participants with the executed documents for acceptance by the ACO. Case law is already on the books for IPAs, PHOs and MSOs that did this improperly and were sanctioned by the Securities Exchange Commission. Our Practice Leader was called to testify as an expert for that case. We cannot turn a blind eye to this if you choose to set aside regulatory compliance in this step. Preoperational planning. Prior to commencement of operations, the actual administrative team that will manage the ACO must be in place, and it must begin planning for future operations so a smooth startup of operations can occur. Recruiting personnel that will operate the ACO may be a part of this process. Commencement of operations. After the governance issues have been settled, after the operational plan has been implemented with the appropriate personnel and after the capital has been raised, and the ACO formed, operations should be commenced. Despite the work associated with ACO formation, the real work to creating a successful ACO will be the operational aspect rather than the formation phase.
Most providers have never faced real credentialing and privileging tasks associated with managed care, other than completing their CAQH forms and updates. There’s far more to this process than just approving the applications.
Credentialing and Privileging Matters Now that you have a new legal entity, it will carry its own liability for credentials vetting, and privileging competencies. If you engage a generalist attorney who is unfamiliar with these matters, you could overlook their importance and skip mitigating these risks entirely. Often, we are hired to serve as a general counsel’s expert to gap fill the knowledge to the standard of practice they may lack. Your new entity will incur liability for: • • • • • •
Ostensible agency Respondeat Superior Compensation and incentive arrangements Errors and omissions Corporate responsibility, and Vicarious liability -- just to name a few
Vetting Process There are industry-accepted standards of practice in place that dictate how provider credentials vetting is to be done. These include “primary source verification”. In the “old days” of IPAs, PHOs, and MSOs, the Board would read an application of a provider and the three letters of recommendation and say “We all know him/her... do we have a motion to accept?” and that was that. That is unacceptable by today’s standards.
Criteria-based Core Privileging Standards
Before an insurer will insure you for these risks, or quote premium prices, they will want to review your standards, policies and procedures. You can approach this three ways:
This process incorporates predefined criteria in conjunction with clinical realistic, well-defined core privileges. The term core privileges refers to those clinical activities within a specialty or subspecialty that any appropriately trained, actively practicing practitioner with good references would be competent to perform. In the criteriabased core privileging approach, practitioners who meet predefined criteria are eligible to apply for core privileges, and those who can document additional training and experience may request special (or noncore) privileges.
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“Go bare” and take the liability risk on the shoulders of the shareholders.
Special noncore privileges nearly always correspond to one or more of the following:
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Buy insurance without showing the insurer that your ACO has mitigated the risk with proper procedures, policies and standards in place, and pay exorbitant premiums - in case you get sued, or
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We’ll help you to establish the proper vetting practices, policies, procedures, and privileging standards so that your ACO is in a better position to purchase adequate cover and mitigate risk.
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New advances in technology (e.g.,robotics, etc.) Hi-risk / problem-prone, volume sensitive diagnoses or procedures that would not be automatically incorporated within the core Issues that occasionally cross specialty lines
Criteria-based core privileging reflects a thought process that ACO governance and quality chairs will use to decide whether to recommend privileges and staff appointments for a practitioner. The approach has several other advantages that help make it the chosen method: 1. 2. 3. 4.
Consistency Flexibility Objective pre-screening Mitigation of antitrust accusations for denied applicants
While this sounds overwhelming, and time consuming, our clients enjoy a leapfrog advantage to this because we supply all the model draft forms, policies and procedures to be used by the ACO so that the decision-makers can simply make the necessary modifications and adopt them by resolution and get busy on implementation.
You’ll save time and money when we help you establish your ACO network framework
Antitrust Concerns for ACOs and PHOs These concerns are raised when a group of individuals join together, preserving their individual corporate separateness while functioning as a collective bargaining unit. • • • • • •
Exclusion / Restraint of Trade Naked Price Fixing Refusal to Deal Monopoly Monopsony Essential Market Force
The Problem Your ACO could be found guilty of any concerted effort to manipulate the market inappropriately. There are right ways and wrong ways to go about building a competitive strategy. The ones you want to consider are those that benefit the market and offer the market choices of a better product with solid competitive advantages.
The Solutions While your attorney will tell you “what” the law says you can and cannot do, we can show you “how”to do the right thing. We guide you through the process of “economic integration” that takes advantage of the inherent characteristics of a “shared savings” model ACO or PHO. You’ll save time, money and aggravation by setting up your business and contracting strategy so that you can bring value and efficiencies to the market (the payers and buyers) and wrap ACO /PHO business strategies around good medicine, quality and safety considerations, and an organizational culture that is centered on provider collaboration, efficiencies, and savings.
Understanding Economic Integration Economic integration is a term that describes the best case scenario for sponsoring providers of an ACO or PHO to establish fee schedules and enjoy some negotiating clout with payers and healthcare buyers (self-funded employers and unions, for example). The method may vary as to the structural needs of the organization and the tax implications. The formation of the ACO or PHO may be viewed as offering a new product in the marketplace.
Under a Supreme Court decision in Broadcast Music, Inc. v CBS (441 U.S. 1 (1979)), the per se rule (i.e., the venture is in and of itself inherently violative of antitrust statutes) against price fixing does not apply if the “price fixing” involved is ancillary to the creation of a new product, and if there are obvious efficiencies and pro-competitive results flowing from the joint venture activity that could not otherwise be achieved. Additionally, the FTC has established through various letters and dicta in case law that price fixing liability can essentially be avoided altogether if, in addition to offering a new product and efficiencies, the provider share economic risk.
We show you how to set up your ACO in a way that meets the tests of clinical, administrative and financial integration
After having built more than 200 IPAs, PHOs, ACOs, MSOs and other integrated health systems since 1993, we can show you several ways to demonstrate economic integration that will enable you to meet your objectives for contracting and compliance. These include, but are not limited to: • • • • • • • • •
Your quality standards and corrective action plans Your billing protocols Your contracting business rules Your operating expenses and employment practices Stark Law implications on referrals in the network Privity of contract matters Provider payment from capitation proceeds Bonus distributions Purchase of professional liability insurance for the ACO
Marketing, Branding and Public Relations for ACOs & PHOs Your ACO or PHO is a new business entity. How will the market come to know about its existence, its value and its competitive and comparative adgantage?
Competitive advantage
What does your ACO do best? How do you leverage on that to be profitable? How do you improve and innovate to get ahead and stay ahead of the competition? There’s absolutely nothing wrong with this approach, as it’s proven to be successful and an indispensable part of a vibrant market system. Do you know how to do this? Do you need help to get started?
Comparative advantage
Comparative advantage on the other hand takes into account two things – different productivity levels, and scarce resources of labor or capital. In this sense, your providers could be considered precious resources if they are only available through one ACO or PHO. If they participate with more than one integrated system, that strategy is no longer as strong an option upon which you can compete.
Branding
Defining your ACO’s unique promise to the marketplace is critical to building a strong brand as well as maintaining and expanding relationships with patients. Translating the brand promise into a consistent patient experiences across points of care – both digital and traditional – helps the promise resonate with patients and drive up engagement.
Your ACO must create the logical connections for patients and payors so that they can really understand what your brand represents
Contracting with Payers and Healthcare Buyers Are you ready to negotiate contracts? Our Practice Leader, Maria Todd, wrote the definitive handbook on managed care contracting, The Managed Care Contracting Handbook, now in second edition and two other leading books on physician integration and network development. She has personally guided thousands of healthcare providers and integrated health systems in contracting with payers, employers, exchanges, and unions in capitated, pay-for-performance, discounted fee for service, and bundled case rate contracts since 1989. She’s available to help you negotiate or teach your team how to prepare and negotiate to better contracts with a sound strategy and system.
You’ll need these items on hand to negotiate network contracts Don’t set up the meeting and embarass yourself or try to fake it if you aren’t ready, trained and rehearsed. If there is a rival ACO or PHO competitor nearby, you won’t get a second opportunity to negotiate with leverage or save face.
Network Negotiation Requires Data, Skill and Preparation Your Business Information • ACO or PHO Description and Statistics • Your current book of business (number of patients, contracts by age and insurer) • Statistics on current network patients by occupation and ICD-10 key diagnostic groups • Number of ACO /PHO patients currently seen in office and in hospital per day / per week • New patients per month • Referrals processed per month • Monthly patient attrition statistics and reasons for departure • Monthly inbound referrals by insurer or other source • Average office charges and collections by procedure • Comparison of a fee range against what the contract offers • Range of average paid-to-allowed ratios by payer and plan • Range of average paid-to-billed ratios by payer and plan • Results of recently conducted patient satisfaction surveys • Cost analyses expense per visit and per active patient • Clinical outcomes data (HEDIS or SF36) (where applicable) The Contract Draft • •
Your Utilization Management Program Their Utilization Management Program
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Your Quality Program Their Quality Program
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Your Denials and Appeals Procedure Their Denials and Appeals Processes
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Your marketing and brand standards Their Marketing Collateral and Ways to Feature the ACO/PHO
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Formulary List of Drugs Your ACO Providers Prefer Their Approved Forumlary List and Prescription Plan Details
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Your ByLaws and Participation Agreements Their Due Process and Disciplinary Policies
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Your operations manual and SOPs Their Provider Manual (where all the cost monsters lurk)
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Your provider roster with all active and affiliate providers Their participating provider list (who’s already listed, competitor analysis, market share analysis)
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Their incorporation and other legal information The CV of their Medical Director List of all Department Heads and Last Word Decision-makers
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Additional Clarifications • Clean Claim Definition • How long is a month for prorated payment issues
Education and Training for ACOs and Integrated Health Systems We offer ACOs and PHOs several options for skills building and fast track development to meet your budget and time constraints. PRIVATE COACHING SESSIONS
Through the Healthcare Business Institute, our nonprofit education foundation, we can send qualifed consultants to train at your location or ours, or to head up a strategic planning and training retreat for your Board and Members.
SEMINARS & WEBINARS
You can also elect to attend public seminars and webinars we sponsor where you can train in small classes with other providers who are looking for similar skills and solutions. We send students home with a toolkit of checklists, presentation slides and other materials so they can share what they learned with your group.
WEB-BASED COACHING
We offer clients the option to work with us face-to-face and then follow at regularly scheduled intervals each month through private tele-conference calls with managers, team leaders and the ACO’s Board of Directors. This is an excellent way to access the experts you need while only paying for time and not travel. Use the time to bounce ideas, get advice, learn best practices or innovate.
ACCREDITATION COACHNG
Whether you plan to achieve accreditation as a PCMH or an
10 Ways Your ACO or PHO will Benefit from our Workshops ACO class participants benefit from class discussions and exercises designed to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Advance organizational renewal Engage organization culture change Enhance proďŹ tability and competitiveness Ensure health and well-being of organizations and employees Facilitate learning and development Improve problem solving Increase effectiveness Initiate and/or manage change Strengthen system and process improvement Support adaptation to change
Mercury Advisory Group’s thought leaders and experts help innovators to use knowledge, power and influence to invent the future in healthcare
Hands-on Workshops Mercury Advisory Group offers a comprehensive group of public healthcare business educational programs that can be easily tailored to your specific needs and challenges. There is a training program to match your budget requirements and bring tremendous value to your company. Any workshop or section of a workshop can be customized just for your group and offered at your location or at our training facilities in Denver, Colorado.
In-house Training & Workshops Role-based training assessments and exams can be developed for your group that are specifically tailored to the key requirements of employee job functions as well as areas requiring further skills and competency assessment. This is great for revenue cycle, managed care, and ACO care navigator roles, as well as for insurance billers, collectors, and front-office staff. We’ve been conducting and developing course curricula for more than 30 years. Let us leverage our training experience and resources for your employees.
Skills training and coaching is available for: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Physician leadership / governance Credentialing and Privileging Care Navigators Telehealth coordinators Polypharmacy managers Predictive modeling & populaton health analysts Social media & brand engagement specialists Team leaders and department managers Managed care contract analysts & negotiators Marketing & branding specialists Disease management and care management nurses Chief medical officers and clinical directors Healthcare informaties and decision support analysts
We teach you the skills you need to know to succeed in the Business of Healthcare
Who should attend: ACO Administrators and Key Physician Leaders Care Navigators Care Coordinators
Directors of Nursing Social Workers Data Analysts Medical Directors
Health System Directors and Managers Contract Negotiators Hospital Executives Multispecialty Group Executives
Physicians Health Insurers Provider Relations Coordinators Physician Leaders
Workshop: Organizational Development for ACOs & PHOs 2014 Upcoming Dates & Locations: Denver - July 11 Los Angeles - July 14th Phoenix - July 16 Fort Lauderdale - August 11
Orlando - August Tampa - August 15 Raleigh - August 25
Learn How to BE a Successful ACO In this workshop, Maria Todd will cover: • •
More than 500 organizations in the USA accountable for more than 48 million lives are now involved in startup ACOs that are less than 3 out from their original incorporation date. Once the ACO or integrated health system has established its corporate form, bylaws, and landed a contract or two, the organization has to take a serious look at business process, operations, controls, and capacity training and development for those that run the day-to-day affairs of the business. The overall objective is to achieve a Triple Aim outcome characterized by: 1.
Improving the experience of care
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Improving the health of populations and
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Reducing per capita costs of healthcare.
Before ACOs can take on responsibility for groups of patients they first have to take responsibilities for their own cultural and organizational development. Medicare and participating insurers will generally offer financial rewards for ACOs that save money and hit quality goals for these patients. At the same time, ACOs may risk losing money if their costs run higher than expected. The idea is build a functional culture of “aligned accountability” that successfully eliminates duplication of services and facilitates patient engagement to drive preventive efforts that ultimately reduce the need for high-cost services such as hospital inpatient stays. Registration $459 Discounts for multiple registrants from the same organization Call 800.209.7263 to Register by Phone
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How ACO leadership can create a common culture and to bring personnel, processes, and policies together How to develop a system for qualitative feedback to ACO participating physicians and employees on their performance How to help manage conflict between employees, between physicians, and between the ACO and payers How to use organization development principles and processes to improve the organization’s culture through interventions that are (1) planned, (2) organization-wide, and (3) managed from the top, to (4) increase organization effectiveness and health through (5) planned interventions in the organizations “processes,” using behavioral-science knowledge. Ways to develop the key components of organization culture: beliefs, attitudes, values, and structures that transcend clinical affairs, adoption of technology, reimbursement contracting and negotiations, and managing to lead people.
Organizational development in an ACO must be centered on assuring healthy inter- and intra-unit relationships and helping clinicians initiate and manage the change associated with unprecedented healthcare reform initiatives, many of which were implemented without much guidance as to “how to get the job done”. The ACO’s primary emphasis is on aligning relationships and processes between and among individuals and groups, between staff and clinicians, and between clinicians and engaged patients. This is quite different than the integrated health delivery systems of the 1990s in the Clinton era for four primary reasons: 1. 2. 3. 4.
Access to and manipulation of predictive modeling tools that weren’t available in the 1990s Access to and exploitation of the power and capabilities of electronic medical records A demand for value-based healthcare driven by physicians that use evidence-based medicine tools and reference databases Accountability for cost, quality, safety, efficacy, patient engagement and consumer delight
Find complete details on this course at: www.mercuryadvisorygroup.com/training-education/
2014 Upcoming Dates & Locations: Denver - July 21
Workshop: Integrated Network Formation So, you want to build an ACO... Let us Help You Start Off on the Right Foot The ACOs in America have already captured 14% of the market, serving more than 30 million Americans. Across the nation, an estimated 45% of the population live in regions served by one or more ACOs. It’s only natural that a large percentage of our nation’s 650,000 physicians are considering their options to build or participate in an existing ACO or other integrated health system.
How large is the market? Is there room for another ACO?
Explore what is involved in forming and operating an ACO or Integrated Health Delivery System
To determine how large the market is, you must first define what it is you mean by “ACO”. If you choose to define “ACO” as a catch-all term for providers participating in population-oriented, value-based care delivery and reimbursement models, then the market is 150 million patients, give or take a few thousand.
In this workshop, Maria Todd will cover: • • • • • • • • • • •
Clinical and Economic Integration Physician Alignment: Taking integration to a much higher functional level The dizzying array of payment methods and how to make sense of them The costly payer loopholes most ACOs overlook and how to avoid them How to analyze the payers’ terms, conditions and payment terms offered How to analyze the market before you add another competitor to the field Market share is important: All about ACO branding. marketing and advertising Contracting leverage: how to build it and use it effectively Sorting through the dizzying array of health information systems options Preserving physician autonomy while working as a group The Holy Grail of Healthcare Reform: Effective Patient Engagement
11 Benefits of Attending this Class
It depends. This question is the first step you must define in order to determine if another ACO would be viable where you want to build it.
An estimated 2.5 million Medicare patients (and “booming”) are contracted with Medicare, another 15 million non-Medicare patients that receive care through Medicare ACOs, and estimated 14 million patients cared for through non-Medicare ACOs that are contracted with private payers. That leaves about 80% of the addressable market. To make the best decisions for your professional success and ongoing satisfaction, you must first know and understand your options. This comprehensive introduction to the issues will prepare you now. You will learn: 1.
In this workshop, participants will benefit from class discussions, a library of model forms, policies, procedures and documents you’ll need, and instructorled exercises designed to: Help you build a balanced organizational strategy: broad enough to be comprehensive, yet anchored enough to the realities of implementation 2. Help you analyze your market using proven business analyst tools and methods 3. Articulate the “Vision Thing” to make it real for stakeholders 4. Develop “systems thinking” instead of building more “silos” 5. Help ACO leadership see “Whole Processes” 6. Help you connect with the population you are targeting 7. Save hundreds of hours developing documents, policies, procedures and forms you didn’t know you’d need 8. Network with other providers who are looking for similar solutions 9. Increase effectiveness negotiating with payers 10. Strengthen system and process improvement 11. Understand the corporate liabilities associated with credentialing and privileging
2. 3.
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Basic models of ACOs compared and contrasted with other managed care organizational models showing the pros and cons of each How to form an ACO Specific steps for organizing and financing a physician-owned managed care corporation with an explanation of the complexities, expenses, and risks involved How to use leverage in payer contracting in the integrated network setting How to avoid antitrust violations in integrated network negotiations
Registration $459 Discounts for multiple registrants from the same organization Call 800.209.7263 to Register by Phone
Find complete details on this course at: www.mercuryadvisorygroup.com/training-education/
Who should attend: ACO Administrators and Key Physician Leaders Care Navigators Care Coordinators Directors of Nursing Social Workers Data Analysts
Medical Directors Health System Directors and Managers Contract Negotiators Hospital Executives Multispecialty Group Executives Physicians
Health Insurers Provider Relations Coordinators Physician Leaders Marketing and Social Media Coordinators Patient Engagement Strategists Physicians considering PCMH development
Public Health and Health Promotion Specialists Consultants Investors
MERCURY ADVISORY GROUP
Making it Easier to Be in the Business of Healthcare
600 17th Street, Suite 2800-S Denver, Colorado USA Phone: 1-800-727-4160 E-mail: info@mercuryadvisorygroup.com Website: www.mercuryadvisorygroup.com Š2014 Mercury Advisory Group – All international rights reserved. No part of this publication may be reproduced by any mechanical, photographic or electronic process, nor may it be stored in a retrieval system, transmitted or otherwise copied for public or private use without prior written permission from the publisher. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional advice. If legal advice, or other expert assistance is required, the services or a competent professional should be sought. Portions of this publication have been adapted from IPA, PHO, MSO Development Strategies, by Maria K Todd, and Physician Integration and Alignment: IPA, PHO, MSO, ACOs and Beyond, by Maria K Todd. Adapted and reprinted by permission of the author.