ECG Management Consultants

Healthcare organizations are mobilizing their physician and administrative leaders to expand their focus beyond volume to include service experience, cost, quality, and outcomes. If these organizations are to succeed, substantial work is required to create the care delivery model of tomorrow while they continue to provide care today. Probably the most critical elements in this transition are physicians who have the most direct line of sight on both cost and quality. Not surprisingly, there has been a surge in interest in transitioning to physician compensation systems that are more closely aligned with the value-based future. However, in the flurry of activity surrounding paying doctors based on “value,” we repeatedly see healthcare organizations with a strong sense of urgency despite a poorly defined direction. This Insight provides the information necessary to help you decide how to best manage the pace and implications of payment reform on physician compensation within your organization.

For the renewal of its 1115 Medicaid waiver, the state of California engaged multiple key constituents in work groups to develop a demonstration program based on four care delivery models for children with chronic medical conditions. Thereafter, the state issued a Request for Proposal (RFP) for innovative programs based on these models that would allow combining various state program funds to cover the costs associated with delivering care. CHOC Children’s developed an accountable care organization (ACO) medical home model for eight of the chronic medical conditions. This presentation discusses the four models approved by the state, the process that CHOC Children’s followed to develop a financial framework and care delivery model, and the CHOC Children’s proposal approved by the state.

Due to the passage of the Patient Protection and Affordable Care Act in 2010, healthcare providers have been placed in the position of trying to anticipate and respond to the next legislative ruling and potential market changes. Unfortunately, there are no purely political solutions to improving value in healthcare. As such, providers and payors are left to innovate through transformation and optimization strategies. Providers are working to determine whether a proactive or reactive approach to healthcare reform is best and are seeking to implement strategies that will mitigate short-term challenges while also positioning themselves for long-term success. This session explores the types of value-based arrangements currently being pursued by providers. It also discusses the key tenets of developing a successful value-based strategy, including a framework for conducting the appropriate analytics, and specific recommendations for its successful implementation.

Accountable care organizations are under way, and healthcare organizations are weighing their options. This panel discussion offers a discussion among health system executives about their accountable care strategies.

The introduction of health exchanges will have far-reaching implications from a financial, operational, and strategic perspective. Health plans are positioning themselves to improve their market share and profitability with lower reimbursement proposals to providers for the exchange population. These proposals will impact commercially insured businesses. This Executive Briefing explores the key issues an organization should consider when integrating health exchange-based patients into managed care contracts.

In response to the challenge of reducing health care costs while improving quality, SSM Health Care St. Louis (SSMSL) has embarked on the transformation of its organization driven by trends that, unabated, threaten the future stability of its mission as well as the quality and strength of the US health care system. Rather than enrolling in the MSSP as an ACO, SSMSL has chosen instead to think in terms of a functional definition of accountable care: creating an organization capable of assuming and managing global clinical and financial responsibility for the care of a defined population. This article explores the reasoning behind SSMSL’s decision as well as their strategy and timeline for implementation.

Clinical integration entails the evaluation and modification of practice patterns, as well as the creation of interdependence and cooperation among physicians to control costs and ensure quality. This presentation presents highly effective strategies to engage physicians to examine, address, and reduce patient care variations and optimize utilization management. The discussion includes an examination of ongoing efforts to improve quality, access, and affordability and a review of case studies of initiatives at community hospitals that have successfully developed structures to promote clinical integration with independent physicians. The session focuses on a clinical integration program’s approach, the infrastructure and information systems required to support it, and the hospital/physician financial arrangements that facilitate physician participation and support an organization’s journey toward clinical integration.

Despite all the political rhetoric surrounding the Patient Protection and Affordable Care Act (PPACA), the initial unpopularity of the Medicare Shared Savings Program (MSSP) in the provider community, and the complexity of the requirements for participation in the MSSP, a sizable number of organizations are considering participation. CMS currently counts 65 organizations as participants in shared savings arrangements, including the Pioneer Accountable Care Organization (ACO) members, Cohort I of the MSSP, and the Physician Group Practice Transition Demonstration participants. This Diagnostic explores the mechanics behind this reimbursement model and the reasons why organizations are considering participation, regardless of what happens on the national regulatory front.

One of the major challenges of healthcare reform is the effective movement from volume- to value-based reimbursement methodologies. Providers are assessing their ability to drive segments of their markets into active population management programs in four primary areas: employer groups, commercial payors, Medicare, and Medicaid. This presentation examines strategic pacing for migration into population management and focuses on the building blocks required for clinical integration and accountable care.

How can healthcare organizations structure leadership and processes to achieve accountability? Through this presentation, from an established model and an organization earlier in the journey, you will learn how to build the foundation of an effective clinical integration program, with a focus on quality reporting via EMR, embedded care coordination in the clinical office, and a patient-centered approach.