ECG Management Consultants

Beginning in 2014, Affordable Care Act (ACA) reforms will result in an influx of patients with new insurance benefits via health exchanges and potential Medicaid expansion. Concurrently, Medicaid rolls will continue to burgeon due to the economic downturn, driving states to explore more cost-effective managed Medicaid solutions. Organizations will need to leverage external care resources to optimize care for beneficiaries newly insured through exchanges and prepare for expanded risk-based reimbursement for all populations. This Executive Briefing explores how building strategic partnerships between hospitals, health systems, and Federally Qualified Health Centers (FQHCs) is a key pathway to successfully prepare for the future and maximize the community benefit of investments.

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Hospitals across the nation are increasingly turning to call coverage compensation arrangements as a means of providing vital medical services and remaining in compliance with federal law. While the number and complexity of these agreements have grown, many healthcare organizations are entering into such contracts despite uncertainty that the terms are both legally defensible and financially prudent. This Diagnostic addresses some of the most pressing and frequently asked questions about call coverage arrangements and suggests a robust, thoroughly vetted methodology for arriving at payments that are individually tailored to a given arrangement and remain within the appropriate market range.

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In the next few years, we expect compensation and production trends to be most impacted by the continued shortage of primary care physicians, increased demand for specialty care, and implementation of key provisions of healthcare reform. This presentation discusses physician market trends, nonproductivity compensation frameworks, benchmark data, compensation plan examples, and how to align compensation with performance.

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In an environment where value is rewarded, high-functioning multispecialty practices are positioned to have a strategic advantage. This presentation provides detailed case studies of how two organizations with differing organizational characteristics, capabilities, and market conditions are utilizing their respective employed physician organizations to lead organizational transformation efforts toward integrated care delivery.

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With medical groups facing reimbursement pressures and declining volumes, organizations are reviewing every aspect of their operations to make fundamental changes to the ways they function. In an environment where savings are rewarded, it may be more difficult for efficient organizations, such as those in the Northwest, to reap ongoing benefits. This presentation explores the keys to success in this new environment, including developing a Medicare strategy, collaborating with payors, aligning physician incentives, building operational effectiveness and stability, and exploring new partnerships.

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Physician compensation and performance incentives are undergoing a fundamental shift as healthcare providers embrace value-based delivery models. Physician organizations generally recognize that production-driven plans will need to evolve to reflect changing economics, but there is a reluctance to move too far ahead of reimbursement changes. In this presentation, we review the impact of healthcare reform on provider compensation and plan methodologies, including emerging physician compensation plan trends; compensation trends relative to production for primary care, surgical, medical, and hospital-based specialties; market trends in APC compensation; and value-based compensation considerations.

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Physician organizations and health systems are under renewed pressure to come together to build economies of scale, align incentives, and share risk. To attract and manage physicians, health systems need to offer a variety of compelling structural options, develop high-performing physician management capabilities, integrate clinical services across the continuum of care, and effectively manage risk within shared contracts. This presentation explores a range of options for success in these endeavors, including physician employment, medical foundations, hospital-affiliated group practices, clinically integrated physician networks, physician hospital organizations, medical group joint ventures, comanagement agreements, and management services organizations.

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While current provider contracts may still use traditional per diem, DRG, or fee schedule methodologies, evolving methodologies are increasingly encouraging clinical integration and enhanced coordination between hospitals, physicians, and other providers. The evolution to value-based reimbursement and quality metric payment components has gained considerable momentum as the industry’s stakeholders contemplate how to achieve more transparent price, quality, and service value. This presentation provides a comprehensive review of current hospital and physician reimbursement structures and evolving models that drive improved efficiencies, outcomes, and transparency.

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Physician practices, whether independent or hospital-affiliated, are experiencing financial instability driven by rising costs, shrinking reimbursement, ongoing shortages, and mounting regulatory compliance requirements. This presentation discusses key steps that can be taken to attain financial, operational, and organizational success in your physician practice and specifically identifies and provides examples of trends that are driving a greater need for practice improvement and benchmarking.

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In response to healthcare reform, the role of managed care departments is growing to encompass a wide variety of areas, including new payor contracting trends, adjustments to reimbursement and rate structures, payor strategies, incentive plans, narrow networks, and health exchanges. This presentation discusses how organizations will need to anticipate changes in the healthcare delivery system and adjust their managed care services accordingly to optimize financial performance.

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