845 fifer presentation

HFMA Update: Strategies for

Success in Today’s Marketplace

Joseph J. Fifer, FHFMA, CPAPresident and CEO, HFMA

Dixie Institute 2015

February 18, 2015

Joe Fifer

Joseph J. Fifer, FHFMA, CPA is president and chief

executive officer of the Healthcare Financial

Management Association. HFMA provides the

resources healthcare organizations need to achieve

sound fiscal health in order to provide excellent

patient care. With more than 40,000 members,

HFMA is the nation's leading membership

organization of healthcare finance executives and

leaders. In 2014, Fifer was named to Modern

Healthcare’s list of the 100 Most Influential People in

Healthcare.

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Agenda

• Leading the Financial Management of Health Care

• Delivering Value Across Traditional Boundaries

• Promoting Price Transparency

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Realignment Is Erasing Traditional Healthcare Boundaries

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Driven by demands for care transformation, the healthcare industry is

realigning at an an unprecedented pace.

The Triple Aim framework was developed by

the Institute for Healthcare Improvement in

Cambridge, Mass. (www.ihi.org).

SHARED GOAL

HFMA Changes Health Care

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OUR MISSION

Leading the

financial

management

of health care

OUR VISION

HFMA will

bring value

to the industry

as the leading

organization

for healthcare

finance

HFMA Services Carry Benefits Across Healthcare Boundaries

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Our core membership of financial professionals comes together with other healthcare leaders

through the wide array of services HFMA offers.

CAREER DEVELOPMENT

AND CERTIFICATIONFINANCIAL

PROFESSIONALS

OTHER

HEALTHCARE

LEADERS

HFMA SERVICES

MEMBERSHIP

CONTINUING EDUCATION

SMALL GROUP-FOCUSED

INTERACTIONS

INFORMATION ANALYSIS

AND PERSPECTIVE

STANDARD SETTING/

GUIDANCE DEVELOPMENT

ORGANIZATIONAL

PERFORMANCE

IMPROVEMENT

VIRTUAL AND FACE-TO-FACE

NETWORKING

Agenda




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Value Is Driving Realignment Today

Beyond Traditional Mergers & Acquisitions

• An emphasis on value-focused

acquisition and affiliation

strategies

• An understanding that different

needs require different

approaches

• The emergence of new

organizational combinations

• A blurring of lines between

competitors and collaborators

• The need to change governance

and organizational structures as

systems change

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Value Advisory Group and Sponsors

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High Level of Interest in Acquisitions

and Affiliations

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Source: HFMA Value Project Report, 2014

Multiple Models Are Being Pursued

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Mergers and acquisitions are occurring more frequently between organizations that are both financially strong

• Driven by strategy more than financial need

• Financially weaker organizations are more attractive if

they possess other strategic assets: market position,

affiliated physician networks, outpatient clinics, good

payer mix

• Significance of not-for-profit/for-profit status of potential

partners is diminishing

• Appetite for hospital-heavy acquisitions is diminishing

Mergers Occur Between Financial Equals

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Multiple Drivers Include Population Health Management

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Value-Focused Physician Strategies

New HFMA Value Report Focus: Critical Role of Physicians

• Alignment and employment options

• Compensation and incentives

• Financial support and sustainability of the physician enterprise

• Physician leadership and governance structures

• Population management capabilities

Alignment and Employment Options

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Financial Support and Sustainability

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• Measure and benchmark performance

• Hold physicians accountable for costs

• Recognize importance of smooth onboarding and

credentialing process

• Balance employed specialists with adequate

primary care network.

Strategies to Manage Financial Support of Employed Physicians

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Population Management Capabilities: Realigning Incentives

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• Having timely information

• Reducing fragmentation of services

• Improving coordination of care

• Increasing access to care

• Engaging the patient

Additional Conditions for Effective Population Management

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CMS Seeks to Propel Industry Forward

“Today, for the first time, we are setting

clear goals –and establishing a clear

timeline --for moving from volume to

value in Medicare payments.

Our first goal is for 30% of all

Medicare provider payments to be

in alternative payment models…

by 2016. Our goal would then be to

get to 50% by 2018.

Our second goal is for virtually all

Medicare fee-for-service payments

to be tied to quality and value; at

least 85% in 2016 and 90% in 2018.”

--HHS Secretary Sylvia Burwell

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Sylvia Burwell. Progress Towards Achieving Better Care, Smarter Spending, Healthier People. HHS blog, Jan. 26, 2015.

http://www.hhs.gov/blog/2015/01/26/progress-towards-better-care-smarter-spending-healthier-people.html

Agenda




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Realignment Can Raise Red Flags

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People and Media Are Speaking Out

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“Reference pricing?

That won’t solve

anything. Hospitals

will just shift the cost

elsewhere.”

“Do the deal and

prices go up

30%. Quality,

too. Yeah...right”

“Health systems

are carving up the

geography!”

Help Patients Make the Value Connection

• Patients and other care

purchasers expect more

transparency.

• Patients also expect to be better

off after receiving care than they

were before—they expect value.

• When you deliver value, make

sure that patients and other care

purchasers know it.

• Be transparent about how

realignment improves health

care for patients.

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Source: HFMA Value Project

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Our Payment System Was Not Designed for Price Transparency

• Historically, prices have served a wholesale

function

• Only recently have prices been viewed as retail

• Without transparency, neither consumers nor

hospitals could compare hospital prices

• With thousands of items, the chargemaster is not

“transparency-friendly”—and not reflective of

“price”

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Would this be a

reasonable pricing

system for buying a

truck? Yet, that is the

system hospitals and

doctors are REQUIRED

to use.

The Time Is Right for Transparency

In a system where. . .

– Charges are primarily used as a factor in a payment

calculation

– Actual prices are essentially invisible to the consumer,

and…

– Charges have little relationship to the service being

acquired

change is inevitable!

We all contributed to this situation—hospitals, physicians,

payers, the business community, and even patients.

We all need to work together to fix it!

HFMA Resources

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hfma.org/dollars

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HFMA Price Transparency Task Force

Task Force Report

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• Clarifies basic definitions that are often misused

• Sets forth guiding principles

• Establishes roles for payers, providers, others

• Reflects consensus of key stakeholders

hfma.org/dollars

Price Information Resource for Consumers

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• Describes how to request price

estimates, step by step

• Clarifies what estimates may or

may not include

• Explains in-network and

out-of-network care

• Defines key terms

• Available for posting on your

website at no charge

• Hardcopies available for purchase

in bulk at a nominal price through

AHA’s online storehfma.org/transparency

ahaonlinestore.org

Best Practices for Patient Financial

Communications & Medical Acct. Resolution

35hfma.org/dollars

Patient Financial Communications Training

• Agenda for live training

on site for your patient

access staff

• Slide deck that can be

customized

• Sample financial

policies

• Coaching guidelines

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hfma.org/dollars

Recognition Signifies Commitment to

Community

• Recognition demonstrates commitment

to best practices in patient financial

communications

• Based on HFMA review of an application

and supporting documentation

• All provider organizations may apply

• Recognition valid for two years

• Adopters may use the phrase

“Supporter of the Patient Financial

Communications Best Practices” in their

marketing materials

• Makes a strong statement to your community

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hfma.org/dollars

• Logic will get you

from A to B.

Imagination will

take you

everywhere.

• - Albert Einstein

Documents

845 fifer presentation