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Meyer Consulting 5900 N. Granite Reef Road Suite 100 Scottsdale, AZ 85250 602/321.0753 www.meyerconsultinginc.com. ACOs and Other Partnerships: What it Takes to Make Them Successful Mike Meyer, President October 19, 2011 V6. HOW IMPORTANT ARE ACOS?. - PowerPoint PPT Presentation
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ACOs and Other Partnerships: What it Takes to Make Them SuccessfulMike Meyer, President October 19, 2011 V6
Meyer Consulting5900 N. Granite Reef RoadSuite 100Scottsdale, AZ 85250602/321.0753www.meyerconsultinginc.com
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Results from a nationwide survey of hospitals,
health plans and multi-specialty medical groups
regarding trends in contracting and partnerships
HOW IMPORTANT ARE ACOS?
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What percentage of cost-savings do you believe can be taken out of the healthcare system in the next three years without substantially impacting quality?
0 10 20 30 40 50 60 70 80
Average = 15%
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In preparing your organization for health care reform, which of these partnerships will be the most essential? Why?
Hospital and Physician Partner-shipsHospital, Physician and Health Plan PartnershipsProvider and Major Corporate Part-nershipsProvider, Corporate and Health Plan Partnerships
55%
23%18%4%
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Meyer Consulting Proprietary and Confidential
What types of alternative contracting approaches are you considering?
Accou
ntab
le C
are
Organ
izatio
n
Pay
for P
erfo
rman
ce
Bundl
ed P
aym
ents
Case
Rates
Conta
ct C
apita
tion
0%
20%
40%
60%
80%
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In preparing your organization for health care reform, which of these partnerships will be the most essential? Why?
“Hospital and physician partnerships are obvious…hospitals need the
physicians’ cooperation to drive more effective and efficient outcomes.
The health plan partnership will need to evolve to align financial
incentives equitably and appropriately. It will be a challenge to change
from the current adversarial partnership of necessity to one that is
collaborative.” – Health Plan Respondent
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Culture, Leadership and Organization will Define ACO Partnership Success
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Paradigm Shift
Old Paradigm
Reimbursement
Market Share Quality –
Patient Centric
New Paradigm Quality – Patient and
Population Centric Improving
Patient/Provider satisfaction
Bending the Cost Curve
Market Share Aligned Incentives
(Clinical, Financial)
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The ACO / Partnership Circle
Health Plan• Culture• Mission• Vision
Hospital• Culture• Mission• Vision
Physicians• Culture• Mission• Vision
Leadership
Leadership
Leadership
ACO• Culture• Mission• Vision•
Leadership• Execution
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The ACO / Partnership Circle
Health Plan• Culture• Mission• Vision
Hospital• Culture• Mission• Vision
Physicians• Culture• Mission• Vision
Leadership
Leadership
LeadershipACO• Culture• Mission• Vision•
Leadership• Execution
Major Corporation• Culture• Mission• Vision
Leadership
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Culture Matters11
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Culture Defined
Basically, “organizational culture” is the defining characteristics of an organization.
Culture is comprised of the values, norms, mission and vision of organization members and their behaviors.
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Examples of Types of Health Care Organization Cultures
Physician-Centric Academic Technology-Centric Intrapreneurial Tolerance for Risk
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Continuous Process Improvement
Not-For-Profit For-Profit System
Leadership Matters14
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Characteristics Necessary in ACO Leaders
Ability to align financial and quality incentives Commitment to ACO Mission and Vision Physician-centric Innovator Capable of integrating teams Technology-centric Understanding of quality Entrepreneurial Analytical Someone who gets things done
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Each partner must have a leader who other partners see as competent, fair and committed.
If you don’t have that the ACO partnership WILL FAIL.
Characteristics Necessary in ACO Leaders
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How to Identify ACO Leaders
Finding leaders (Board and Management) with years of ACO experience is difficult.
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How to Identify ACO Leaders
EXTERNAL – In organizations that represent partnerships between physicians, hospitals and health plans Integrated Delivery Systems Sophisticated medical groups Hospitals
INTERNAL - Within each partner organization These leaders bring first-hand
understanding of the desired culture and local market dynamics
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Health plans Consultants Military
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Skills Needed in ACO Leaders
Skill Expert Intermediate
Optional
Medical/Care Management X
Analytics X
Information Technology X
Finance X
Actuarial X
Legal X
Network Development/Management
X
Business Development/Marketing
X
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Organization Matters20
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Models for ACO Organization Structure
Embedded model Separate company by one or more
of the partners Separate ACO/corporation formed
by the partners
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Functions Under the ACO
ACO structure must include authority over certain functions to ensure success
Necessary Functions: Medical/Care Management Analytics/IT Finance and Actuarial Business Development/Marketing Network Development/Management
Optional/Shared Functions: Medical Group Management Legal
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ACO / Partnership Board
How should Board Members be selected; Board Chair?
Is there an agreed upon Mission / Vision Statement?
Does the Board have Fiduciary Responsibility?
Are there Position Descriptions for Board Chair and Members?
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ACO / Partnership Teams
Who are the team members responsible for planning and execution? Is there a CEO or “Leader” designated?
Do team members have time, resources and authority to execute successfully?
How are they selected? What worked and did not work?
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ACO Resources and Compliance
Have sufficient resources been budgeted?
Is venture in compliance with FTC, DOJ and HHS requirements? “Meaningful Clinical Integration”
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Examples26
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Co-Management Organizational and Leadership Model
Health System
SERVICE LINE 1
SERVICE LINE 2
SERVICE LINEAll other functions not specified in the MSA
ACO / Partnership Legal Structure
Operating Agreement
Physician Group(s)
Shareholders
Management Services Agreement
Board Chair
Clinical Management
Financial Management
Operational Management
EVP/COOEVP/CMO
Intra Company Funding
Commitment
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CalPERS ACO Collaboration Structure
SVP Managed Care
HOSPITAL
Chief Operating
Officer, MG
VP, ACO and Network
Management, BSC VP, Managed Care
HOSPITAL
Core Team
ACO Director, BSC
Senior Director,
Managed Care, HOSPITALChief Medical Services
Officer, MG
Executive Pilot Board
Drivers
Data Analytics Resources
Program/Project Resources
Clinical/ProjectResources
Director of Case Management,
HOSPITAL
Director, Case Management/
Medical Review, MG
Director Integrated Health, MG
Director of Clinical Support, MG
Regional Manager Health Resource
Management, MG
Director, Clinical Pharmacy
Programs, BSC
Director Medical Informatics, BSC
Actuarial Analyst,BSC
Senior Business Analyst, BSC
Manager Business Partner Programs,
MG
Senior Program Manager, BSC
Clinical Pharmacy Programs
Coordinator, BSC
Chairman of Hospital Medicine, ,
HOSPITAL
VP, Medical Management and
Palliative Care,HOSPITAL
VP & Chief Nurse Executive, HOSPITAL
Senior Director, Physician &
Ambulatory IT Strategy, HOSPITAL
Chief Information Officers, MG
Director, Regional Services, MG
Manager, Financial
Analysis, MG
Manager Member Health
Improvement, MG
Manager, Clinical Analysis and Reporting,
MG
Case Manager, MG
Network Management
Consultant, MG
Health Educator, RNMG
CCR ManagerMG
CCR Supervisor
MG
Clinical Pharmacy Coordinator,MG
Actuarial Analyst, BSC
Director Clinical Analytics, MG
Project Manager, MG
Project Manager, MG
Program Owners
Director of Case
Management, HOSPITAL
Product Director, BSC
VP, Medical Group Services,
MG
Manager, Managed Care
Operations, HOSPITAL
Chief Operating Officer, BSC
Chief Executive
Officer MG
Network Management, BSC
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CCSF ACO Collaboration Structure
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MG Director, Ambulatory Services Emergency Department, RN Manager
BSC: Medical DirectorDirector Medical InformaticsActuarial Analyst
ER Utilization Mgmt Sub Group
HOSPTIAL: Director, Managed CareDirector of Emergency Nursing Vice President Nursing/CNE
MG: Manager, Prior Authorization – Health Resource Management
Integrated Care Transition Sub Group
Program Management: Program Manager - BSC Program Manager MG Manager, Business Partner Programs
HOSPITAL Project Manager
Avoidable Day Complex Case MgmtDischarge Planning &
Readmissions Reductions
Project Driver:Director of Clinical Services and Quality
Project Manager:
MG: Manager Health Resources Manager, Concurrent Review
HOSPITAL
Project Driver:Director Case Management
Project Manager:
Project Driver:HOSPITAL Assistant Director, Adult Case ManagementHOSPITAL Director, Case ManagementHOSPITAL Director, Utilization & Case Management Project Managers;HOSPITAL Project ManagerMG Project Manager
Subject Matter Experts
MG: Associate Chief Medical OfficerDirector of Patient Transition ManagementDirector, Spine, Orthopedics, Surgery Service LinesProject Manager, Patient Safety/QualityInterim Assistant Director of Social Work
BSC: Medical DirectorDirector Medical InformaticsActuarial Analyst
MG
Chief Medical Services Officer
HOSPITAL
Director, Managed Care;
Vice President, Patient Care Services
HOSPITAL
Manager, Hospital Contracting and Operations
BSC:
Program Director, ACO;
Director, Greenfield
Subject Matter Experts
Project Driver:Director Quality Management
Project Manager: Project Manager
Core Leadership Team
MG
Director, Contracts & Network Development
HOSPITAL ,
Director of Managed Care
HOSPITAL
Executive Director
BSC:
Vice President, Provider Network Management
ACO Governance
Integration Touch Points points: Physician Engagement, Member Engagement, Reporting and IT/System, and Employer (CCSF) Engagement
Finding the Right Partner30
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Test Motivation of the Potential Partner Are they responding promptly? Have they assigned senior people? Do you have a shared vision? Will the partnership work in the long run?
Finding the Right Partners
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Test if Potential Partner has Ability to Execute On core competencies Financial resources If not, can they get there?
Finding the Right Partners
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If Partner is a Provider how are Physicians being paid?
Test Sophistication to be a Partner Is there a solid Board structure? Is there a commitment to Evidence-Based
Medicine?
Finding the Right Partners
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The More Partners, The More Difficult It Gets34
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Good or Bad Partners?
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Put Three in Mix…Even Harder
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Four…Even Harder
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Meyer Consulting
Mike MeyerPresident
5900 North Granite Reef RoadSuite 100
Scottsdale, AZ 85250
Phone: 602/[email protected]
www.meyerconsultinginc.com
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