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

Join us at the Second National ACO Congress in Los Angeles, California, November 1-3.  Laura Jacobs, EVP, The Camden Group, will be speaking at the Preconference on “CMS ACO Regulations Part 2 – A Deep Dive into the Revised Regulations.    http://www.acocongress.com/index.html.

Steve Valentine, President, The Camden Group will be presenting during Healthcare Intelligence Network’s eighth annual healthcare trends forecast. Don’t miss this webinar on key trends and opportunities for healthcare organizations in 2012!

http://hin.3dcartstores.com/Healthcare-Trends-in-2012-A-Strategic-Industry-Forecast-a-45-minute-webinar-on-November-2nd-2011_p_4274.html#.TqrbtZONZME.twitter

Laura P. Jacobs, MPH, our Executive Vice President,  contributed to a special edition of Accountable Care News, the monthly newsletter for industry professionals interested in accountable care organizations and related issues.  This special edition focuses on analysis and commentary from a panel of national experts on the just-issued proposed ACO regulations and guidance.  Download the article from our ACO Resource Center or from www.accountablecarenews.com!

Our Senior Vice President Dr. Brian Silverstein was recently interviewed by Becker’s Hospital Review regarding his thoughts on accountable care organizations. 

1. This won’t be the 1990s all over again. ACOs won’t face the same problems capitated arrangements faced in the 1990s. Capitation failed in most parts of the country because incentives were not aligned, the technology was not in place and payors slashed rates for  physicians, expecting they would make it up on volume. “The country was not ready,” Dr. Silverstein says. But today the technology is better, more doctors accept the use of best practices, and rather than simply reducing rates, ACOs aim to reduce utilization and focus on quality, he says.

For the full article, please click on the link below: 
http://www.beckershospitalreview.com/hospital-physician-relationships/7-observations-about-acos-from-dr-brian-silverstein-at-the-camden-group.html

Accountable care organizations are the future of health care.  A five-step plan will prepare your organization for upcoming changes.

Click here for the full article written by Brian J. Silverstein, M.D. and Michael J. Randall.  It first appeared on July 12, 2010 in HHN Magazine online site.

Federal and state government incentives for physicians and hospitals to install and meet “meaningful use” requirements for information technology (“IT”) have created an unrelenting push to implement electronic medical records.  While meeting government guidelines is important, senior management leaders need to remember that to make healthcare systems more effective and efficient, these strategies must deliver better tools for caregivers.  Any of the strategies being employed to improve the quality of healthcare and reduce costs require the ability to manage, interpret, and coordinate information in real-time.  The tenets of pay-for-performance programs, medical home models, clinical integration (“CI”), and accountable care organizations (“ACOs”) are based on improving care delivery through coordination of the entire  continuum of care.  Here are the top ten questions senior leadership should discuss in preparation for this “new world.”

1.    Why should we consider CI or becoming an ACO?  CI has demonstrated results in improving quality and reducing costs – key goals to achieve in the path toward accountable care.  Organizations that meet the Federal Trade Commission’s (“FTC”) definition of CI achieve efficiencies by monitoring and controlling quality, service, and costs, selectively choosing physician participants, and making a significant investment of monetary or human capital in infrastructure.  An additional benefit for organized groups of independent physicians that become clinically integrated is that if these groups meet FTC guidelines, they will be allowed to jointly contract with payers.  In many markets, a majority of physicians are not in an employed group model; the CI structure allows them to provide better patient care as well as be rewarded by increasing the quality, service, and cost effectiveness of the care.  Ultimately, CI is an early stepping stone to becoming an ACO. 

2.    What are the keys to a successful information strategy for CI and ACOs?  Regardless of the organizational model (e.g., large multi-specialty group, IPA, PHO, or integrated delivery system), the information system should lead to higher quality, effective, and efficient patient care.  The system must provide the right information, at the right time, in the right form and be supported by an infrastructure to assure its security, maintenance, and use.  Providers must be able to make timely, personalized decisions for the individual patient at the point of care.  These decisions must be based on current, comprehensive information and patient history. 

3.    How will this information strategy improve the quality of healthcare, reduce costs, and provide the ability to manage, interpret, and coordinate information in real-time?  Real advantages and productivity gains are realized only if the caregivers have access to real-time information at the bedside, exam table, or through secure email exchanges between providers, staff, and patients.  Physicians and caregivers should easily be able to collect, visualize, and interpret information and compare it to network protocols, guidelines, and databases when it counts – that is, at the time of decisions.  The information strategy must avoid locking information into inaccessible “islands.” 

4.    Does the proposed strategy facilitate working toward the goals of quality, service, and cost reductions implicit in the new payment incentives?  Payment incentives rely on the ability of an organization to demonstrate and document care processes and the achievement of performance targets, including clinical and patient satisfaction metrics.  Some of these requirements can be met with relatively simple IT solutions, but more sophisticated and comprehensive systems are needed to drive improvements throughout the continuum of care.  The IT strategy must focus resources on assisting the caregiver in knowing not only what to do, but when to do it (i.e., real time alerts).  It must also indicate if their performance is getting better or worse. 

5.     How can we incorporate independent physicians and small medical groups in CI?  Using CI tools, even small to mid-sized physician groups, in partnership with an IPA, PHO, hospital, or integrated delivery system, can use information technology to begin to impact the health status of their patients, meet the requirements of payers, and identify process improvement opportunities. 

6.    Does the technical infrastructure of this information strategy meet the requirements set by the FTC?  The technical infrastructure for CI must address two key components to meet the FTC definitions: “the use of common information technology to ensure exchange of all relevant patient data” and “the development and adoption of clinical protocols.”  The exchange of all relevant patient data requires a platform that can integrate data from multiple community sources (e.g., hospitals, physician offices, labs,) and store this data in a central data repository.  This immediate availability of trusted data is the key to patient care collaboration, the identification of diseases and corresponding care protocols, and performance monitoring at the provider, practice, and network levels.  The assembly of patient data from multiple sources requires careful consideration to ensure accuracy and completeness.   

7.    Does this strategy facilitate the integration of existing systems across the provider and service continuum?  Integration of existing systems across the provider and service continuum must be considered when designing a CI infrastructure.  Regional health information exchanges, hospital enterprise systems, electronic medical records, ancillary provider portals, and patient portals can all potentially be leveraged as part of the overall solution.  These solutions must be evaluated carefully as they alone will not guarantee that CI has, or will be, achieved.  Regardless of the solution chosen, at least one should be available to virtually every physician.  As the tools become more comprehensive, the ability to drive results increases dramatically.

 8.    Do the information tools meet the criteria and requirements in order to be successful in CI and accountable care?  To meet the functional needs related to the exchange of patient data, the technical support for CI must meet the following:

■     Provides immediately available clinical results to be viewed across service providers

■     Provides access to the established clinical guidelines

■     Provides a secure mechanism for provider communication

■     Allows providers to assign patient access to referring or consulting providers

■     Provides access to protocol adherence and measure quality outcomes at the provider, practice, and   network level

■     Allows electronic prescribing

■     Enables clinical decision support based on network determined guidelines including point of care alerts

■     Tracks physician performance against benchmarks and their peers

9.    What are the resources required and timelines for implementing an information strategy for CI and ACOs?

There are various methods to approaching the development of a successful long-term information strategy for CI and ACOs.  An evaluation of a build vs. buy scenario will determine the best approach with the greatest potential for success and, in many cases, a combination of the two will be the final solution.  Factors that may play into the decision include current internal resources, expertise, and internal systems, current vendor applications already in contract, vendor experience and satisfaction, desired timing of implementation, and cost.  There are pros and cons to each approach which can be generalized, but individual organizations should pay careful attention to the internal IT culture and history of IT implementations before choosing an approach.

10.  How will we know when the changes in information strategy have led to the desired outcomes for quality and efficiency, and how should we continue to support these ideas and capabilities?  The only way to be aware of successes or failures is to measure them!  When information is organized into a structured system, the focus must be on meeting the needs of physicians, providers, and patients’ care while decreasing errors, gaps, delays, and variation in practice.  What are the users’ satisfaction levels with the content, its ease of use, and its relevance to meeting their needs?  The strategy should create a highly flexible integrated system with tools that help each patient/member become healthier, leading to a healthier population while focusing on impacting cost, efficiency, and quality.  As with all work, it is never complete and will lead to the next iteration as the bar is raised.

For more information on clinical integration and accountable care organizations, please contact Jim Smith at 800.360.0603 x6108 or jsmith@thecamdengroup.com or Claire Heideman at 312-775-1703 or cheideman@thecamdengroup.com.

Bundled payment is one of several CMS pilot projects for payment reform designed to achieve clinical and financial integration between physicians and hospitals, leading to enhanced quality and reduced costs.  The process of care redesign associated with managing effectively within a global payment (Part A and Part B) can be an early stepping stone to developing more comprehensive models of care integration, such as an accountable care organization (“ACO”)…

Click here for the complete article written by Senior Vice President Mark Dubow, MBA and Senior Advisor Robert Minkin, MBA which was published by CA Healthcare News in their June 2010 issue.