The transition from fee-for-service (“FFS”) to fee-for-value (“FFV”) is a challenging journey for many healthcare organizations, but the stakes are high, and the ability of an organization to navigate the road to success in a FFV world is critical. Though most hospitals and health systems face similar strategic, operational, and financial challenges, the priorities, timing, and approach to preparing an organization for FFV will vary from market to market. This five-part series of webinars, co-presented by The Camden Group, a national healthcare business advisory firm, focuses on “stops” along The Camden Group’s “Roadmap to Fee-for-Value.”  Save the dates, and register for these webinars today!

LOS ANGELES, CA, January 19, 2012 – The Camden Group, a leading national healthcare business advisory firm, continues to expand its expertise in key areas affected by healthcare reform. Joining the executive team are Virginia Tyler, FACHE, Peggy Crabtree, RN, and Marge Mercury, RN, who bring proven track records of success in strategic planning, service line management and managed care.

“Providers and health plans alike are undergoing fundamental change brought on by healthcare reform. Virginia, Peggy and Marge are ideally prepared to help healthcare organizations make the necessary transformations. Drawing on first-hand clinical and management experience at providers and health plans, they provide valuable knowledge and insight to our clients as they work on moving from our current fee-for-service system to the emerging fee-for-value model,” says Steven Valentine, president of The Camden Group.

Now part of The Camden Group’s Rochester office, Tyler previously ran her own consulting firm helping healthcare clients with governance, strategic planning, and mergers. Before moving into consulting, Tyler held multiple simultaneous roles with Thompson Health, including serving as vice president of strategic planning and business development, president of Finger Lakes Community Care Network and executive director of the Finger Lakes Community Care Network Independent Physician Association.

Crabtree, who is joining the Los Angeles office, previously was executive director of cardiovascular and imaging service lines for Huntington Memorial Hospital. Before that, she was South Bay Region service area director for clinical departments and service lines at Providence Health System Little Company of Mary Hospital and chief executive officer of Cardiology Consultants of the South Bay. She began her career as an emergency department nurse before moving into nursing administration.

Another addition to the Rochester office, Mercury headed network and business development for Evercare, a United Healthcare Company, before joining The Camden Group. She also was regional director of medical benefits management for Excellus Blue Cross Blue Shield and vice president of managed care services for the Greater Rochester Independent Physician Association. She began her career as a nurse and nurse manager before moving into case management and then provider relations for health plans.

About The Camden Group

With offices  across the country, The Camden Group is one of the nation’s leading healthcare business advisory firms. The firm provides a broad array of healthcare consulting services in areas ranging from strategic and business planning and financial advisory and compliance, to hospital operations improvement, hospital/physician alignment, clinical integration, bundled payments, and developing accountable care organizations. Since its founding in 1970, The Camden Group has advised more than 1,000 hospitals, medical groups, outpatient facilities, and other healthcare organizations nationwide. For more information, visit us online at www.TheCamdenGroup.com.

Contact:

Sarita Choy, Marketing/Communications Director

The Camden Group

310.320.3990

schoy@thecamdengroup.com

www.thecamdengroup.com

The Camden Group Foresees New Care Models Taking Hold As Healthcare Reform Advances Amid Sluggish Economy

Los Angeles, California, January 5, 2012—The fragile recovery, presidential election year, and expected pivotal Supreme Court decision regarding mandating health insurance coverage will serve as a challenging backdrop this year for healthcare providers as they make more tough decisions about their future and that of the communities they serve. Struggling with rising costs, limited access to capital, and soft patient volumes, hospitals and physicians will increasingly turn to new relationships, mergers, and alliances as they transition to fee-for-value, according to The Camden Group’s annual Top Trends in Healthcare in 2012.

“While these are unsettling times for healthcare, uncertainty cannot be an excuse for paralysis,” says Steven T. Valentine, president of The Camden Group. “The reality is that healthcare reform is locking into place on schedule, and we expect it to continue as presently configured. Preparing to accept and manage financial risk for a defined population is a core competency that providers must develop in the next three years.”

The Camden Group predicts the following top trends:

• Top 3 priorities for hospital CEOs will be cutting costs, driving volume, and hospital-physician alignment.
  • To survive, operating costs must drop by 10 to 20 percent in the next three to five years.
  • The key is capturing greater market share while per capita use-rates continue to slide.
  • With health plans making medical group acquisitions, other medical groups and hospitals will become nervous about potential change in ownership and disruption of referral patterns.
  • Employment is a top choice for physicians intent on mitigating the unknown future of reimbursement, soft volume and development of new care models.
  • Co-management arrangements also will increase.

• The lackluster economy and high unemployment rate will hold down growth but not costs.
  • More people will opt for low premium, high deductible health plans, and both employed and unemployed will defer treatment whenever possible.
  • While most Medicaid payments are flat (or less), Medicare is up less than 2 percent, and many health plans are limiting increases to less than 5 percent. Medical groups and hospitals are coping with wage rates rising 3 percent or more, benefit costs going up 8 to 10 percent, and utility, supplies, and drug costs increasing at least 10 percent.

• Care model changes will accelerate while IT to support the new models consumes attention and capital. 
  • Development of medical homes and bundled payments will increase, and clinical integration will be pursued with or without accountable care organizations.
  • Hospitals will begin to consolidate case management, hospitalists, and intensivists into a centralized, coordinated function.
  • Case management services will be embedded in medical groups and extended to post-acute care. 
  • IT focus will be on meaningful use standards and ICD-10 conversion, with development of HIEs, ambulatory EMR, CPOE, enterprise data warehouses, and results reporting.

• Capital remains king.
  • Access to capital will continue to get tougher for nonprofits while for-profits will see their access increase.
  • Non-profits will boost fundraising efforts while lack of access forces independents to weigh their ability to go it alone.
  • Private equity and public companies will leverage their access to capital to expand their reach into healthcare. 
  • Health plans, with their huge cash reserves, also will invest in managed care capabilities and acquire physician provider groups. 

• The stronger get stronger while the weak merge…or else.
  • Struggling facilities and medical groups will continue to see markets consolidate as volume concentrates to the leaders.
  • With healthcare reform, as many as 1 in every 20 acute-care hospitals could close by 2020.
  • Also by 2020, most states will have a handful of large systems, with very few true independent hospitals without some type of alliance.

• C-suites will see higher turnover.
  • With all of the change due to healthcare reform, delivery models, inadequate payment, labor strife, and declining inpatient volume, new leaders will emerge.
  • C-suites will restructure and reduce management ranks.

About The Camden Group

With offices in Los Angeles, Chicago, New York, and Boston, The Camden Group is one of the nation’s leading healthcare business advisory firms. The firm provides a broad array of healthcare consulting services in areas ranging from strategic and business planning and financial advisory and compliance, to hospital operations improvement, hospital/physician alignment, clinical integration, bundled payments, and developing accountable care organizations.  Since its founding in 1970, The Camden Group has advised more than 1,000 hospitals, medical groups, outpatient facilities, and other healthcare organizations nationwide. For more information, visit us online at www.TheCamdenGroup.com.

Contact:

Sarita Choy, Marketing/Communications Director

The Camden Group

310.320.3990

schoy@thecamdengroup.com

www.thecamdengroup.com

 M&A Expert Joins Firm to Lead New England Region

Los Angeles, California, December 14, 2011 – Stephen D. Gelineau will join The Camden Group, a national leading healthcare business advisory firm, on January 3, 2012 as senior vice president. As part of The Camden Group’s continuing national expansion, he will open and head the firm’s Boston office.

Gelineau is a seasoned healthcare strategic advisor who specializes in healthcare mergers and acquisitions, including hospital affiliation feasibility studies and healthcare system formation. He also brings strong expertise in strategy development and implementation, leadership structure alignment, hospital-physician integration and medical staff planning issues. Additionally he has facilitated more than 200 strategic planning retreats for clients.

“Steve is a proven leader in helping organizations develop and execute successful growth strategies while navigating the constant and complex changes and requirements facing U.S. healthcare,” says Steven Valentine, president of The Camden Group. “For more than 30 years, he has worked with national, regional, academic, and community healthcare organizations of all types and sizes, both as a management executive and a management consultant. Steve offers exactly the combination of experience and fresh thinking that our clients need as they move from a fee-for-service to fee-for-value model.”

Most recently, Gelineau was a partner and senior vice president at the Cambridge Research Institute, where he served as a strategic advisor to chief executive officers, management teams, governing boards and physician leaders. Prior to becoming a consultant, he held executive positions with an academic medical center, a health system and several community hospitals.

Gelineau is a founding member of the Healthcare Executive Forum and serves as faculty for the American College of Healthcare Executives. He is a member of the New England Society for Healthcare Strategy, the Forum for Healthcare Strategists, the Society for Healthcare Planning & Market Development of the American Hospital Association, and the Healthcare Financial Management Association.

He holds a bachelor of science degree in organizational behavior and a master of science degree in management from the Lesley University School of Management in Cambridge, Massachusetts.

About The Camden Group

The Camden Group is one of the nation’s leading healthcare business advisory firms. The firm provides a broad array of healthcare consulting services in areas ranging from strategic and business planning and financial advisory and compliance, to hospital operations improvement, hospital/physician alignment, care management, clinical integration, bundled payments, and developing accountable care organizations.  Since its founding in 1970, The Camden Group has advised more than 1,000 hospitals, medical groups, outpatient facilities, and other healthcare organizations nationwide. The Camden Group operates from offices in California, Illinois, New York and Massachusetts. For The Camden Group’s “Charting the Course: From Fee-for-Service to Fee-for-Value,” visit us online at www.TheCamdenGroup.com.

Contact:

Sarita Choy, Marketing/Communications Director

The Camden Group

310.320.3990

schoy@thecamdengroup.com

www.thecamdengroup.com

Check out this article on successful medical group acquisitions by one of our senior managers, Marc Mertz! It was published in today’s Hospitals & Health Networks Daily.  http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=6770006071

Jim Smith, MBA, FACHE, who leads our New York office, is the opening keynote speaker at New England Healthcare Assembly’s 32nd Annual Trustee Conference.  This conference will address critical issues that hospital trustees should focus on.  Join us there!

http://www.mhalink.org/AM/Template.cfm?Section=Upcoming_Programs_and_Events&template=/CM/ContentDisplay.cfm&ContentID=17322

One of our senior vice presidents, Jay Warden, MBA, will be co-presenting the webinar, “Midwestern Healthcare Environment:  A Preview for 2012.” 

Don’t miss this discussion on Midwest 2012 issues, trends, challenges, and opportunities.  Register at:  http://www.healthwebsummit.com/ppmidwest120911.htm.

Today’s Health Care Innovation Challenge webinar provided additional details on requirements, eligibility, and other application specifics.

Highlights from today’s CMMI webinar:

1. Application scoring criteria are heavily weighted for program design, capacity for successful implementation, and long-term financial sustainability (75% of total)

2. CMMI is not reserving funds for an Innovation Challenge Round 2 (this is it)

3. A successful applicant will need to demonstrate that the initiative is partnered (or has relationships) with payers, ACOs, health systems, primary care, or brings together public-private care delivery entities.  Meaning: Awardees will need to be connected to a care delivery system with solid referral and reimbursement channels

4. Two additional webinars that provide guidance on application development

Slides from today’s webinar are not yet publicly available – they will be posted to the CMMI web page in a few days.

Some initial thoughts on the CMMI Health Care Innovation Challenge, from Eric Nielsen, M.D., and James Smith, MBA, FACHE, two of the senior thought leaders at our firm:

The CMMI Health Care Innovation Challenge gives a funding opportunity for providers, payers, and local governments who care for Medicaid and Medicare recipients – particularly the old, vulnerable, and complex patients who often also have behavioral health issues.  Many are these patients are the heaviest utilizers of healthcare services and often fall through the gaps of the current healthcare delivery system.  These grants will allow for new initiatives or expansions of current projects to improve quality, efficiency, and access for these populations.  These are initiatives that you might not otherwise take on given the present financial environment, the cutbacks and layoffs occurring at hospitals throughout the country, and the threatened decrease in fee-for-service reimbursement, which remains the lifeblood of hospitals and physicians. Primary care physicians don’t have the time or resources to coordinate care for these patients under the present reimbursement system.  There are new care models available that can help, such as the patient-centered medical home, co-management arrangements, bundled payments, and clinical integration, but these programs take time and resources to come to fruition.  This new program has the potential to help hospital and provider groups improve care, provide better access and care coordination for patients, and lower cost for CMS and other payers.  Based on the initial response from some of our clients, we think that there will be significant interest in these in the Health Care Innovation Challenge.

Read more about this new CMMI funding initiative at http://innovations.cms.gov/initiatives/innovation-challenge/index.html.

CMMI released yet another initiative yesterday – the Health Care Innovation Challenge. The three-year funding opportunity continues CMMI’s promotion of the Three-part Aim – Better Quality, Lower Costs, and Better Health – for CMS beneficiaries.  It is aimed at attracting large-scale initiatives (funding ranges from $1M to $30M) with an emphasis on vulnerable/high risk/high need populations, and presents a more open-ended, flexible, and less structured opportunity for all healthcare entities (open to providers, payers, governments, public-private partnerships, multi-payer collaboratives) compared to other initiatives that CMMI has announced in the last year.  In fact, in the brief Q&A session today, CMMI allowed that an organization can have multiple applications for funding. 

Organizations must be focused and targeted in their approach, since there is not much time to plan: letters of intent are due on December 19, 2011 and applications are due January 27, 2012. Both the LOI and the Application will be accepted only via online submission through the Grants.gov website.  Awardees will be notified in March 2012 (estimated) of receipt of funding.  

You will notice the timing of this overlaps with the Models 2-4 Bundled Payments for Care Improvement (due March 15, 2012) and the Medicare Shared Savings Program (due January 20, 2012) applications. 

More will follow after our team participates in the informational webinar on Thursday, November 16, 2011 from 2-3:30 pm ET.

For more information, here is the link to CMMI’s website (http://innovations.cms.gov/initiatives/innovation-challenge/index.html)