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

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

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.

The Camden Group Announces Affiliation with Long Time Client GRIPA

Los Angeles, California, May, 26, 2010— The Camden Group, a national healthcare business advisory firm, today announced that it is now affiliated with Greater Rochester Independent Practice Association (GRIPA), a leading physician hospital organization (PHO).

The Camden Group sought the affiliation with GRIPA given the increased demand from healthcare clients to find ways to facilitate improved coordination of care and achieve greater integration in order to deliver greater value to healthcare consumers.  With its 812-physician membership, two community hospitals, and a medical management and IT staff, GRIPA is one of the first in the nation to achieve a favorable advisory opinion from the FTC on their plan for clinical integration.  Camden clients will now have direct access, including site visits, to GRIPA in order to learn and understand ways to deliver accountable care.

“We are thrilled to have this unique opportunity to be affiliated with such a groundbreaking organization – one that we have worked with for several years,” said Steve Valentine, president of The Camden Group.  “Healthcare is changing, and it’s moving in a very clear direction.  GRIPA embodies the future of healthcare and achieves the core objectives defining this new age in accountable healthcare –  greater clinical quality, improved cost effectiveness, and superior patient experience.”

In addition to The Camden Group’s affiliation with GRIPA, the firm announced earlier this year its hiring of GRIPA’S former CEO, James Smith, FACHE, as senior vice president.  Smith is heading up The Camden Group’s advisory services in clinical integration and the development of accountable care organizations.   Eric Nielsen, M.D., the current CMO of GRIPA, also recently joined The Camden Group as Medical Director for the firm.

“This collaboration brings great exposure and expertise for both our organizations,” said Gregg Coughlin, president of GRIPA.  “Healthcare is revolutionizing at an incredible pace, given the anticipated impact of healthcare reform.  Together, we’re dedicated to innovating the industry to make healthcare work better – for everyone.”

This latest news follows the recent announcement by The Camden Group that it has added Robert A. Minkin, former CEO of Exempla Saint Joseph Hospital, to serve as senior advisor to the firm.  Minkin is a leading national expert on bundled payments.  Under Minkin’s leadership as president and CEO, Exempla Saint Joseph won the bid to participate in a three-year CMS Acute Care Episode (“ACE”) demonstration project to “bundle” payments to hospitals and physicians.  Exempla Saint Joseph is one of four hospitals with cardiac programs to participate in the pilot demonstration.

About The Camden Group

The Camden Group provides a vast array of consulting services on areas ranging from hospital operations improvement, strategic, financial and business planning, and physician group advisory services. 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, please visit www.thecamdengroup.com.

Contact:

Sarita Choy, Marketing/Communications Coordinator

The Camden Group

310.320.3990

schoy@thecamdengroup.com

www.thecamdengroup.com

###

by James R. Smith, MBA, FACHE

Now that healthcare legislation has been passed, the industry shift towards accountable care accelerates.   Healthcare costs are expected to continue to rise even as reimbursement rates decline.  As a result of these challenges and in response to the demand for increased quality and enhanced patient experience, accountable care organizations (“ACOs”) and clinically integrated organizations are being formed across the country.  Payers, including government, employers, and health plans, are taking notice of this trend and considering either beginning or expanding their participation with such organizations.  The following are five reasons why hospitals, physicians, and payers should support and develop clinically integrated and “accountable” delivery systems or ACOs:

I.  Increasing healthcare costs. 

Healthcare costs continue to increase and erode the ability to balance state and national budgets, as well as weaken the country’s position in the world market.  The Kaiser Family Foundation estimates that Medicare alone, currently 3.6 percent of the United States Gross Domestic Product (“GDP”), will grow to 4.2 percent of GDP by 2018 and to 6.4 percent of GDP by 2030.  The Commonwealth Fund National Scorecard on U.S. Health System Performance  2008 shows that U.S. healthcare spending per capita and as a percentage of GDP is respectively more than twice and 50 percent higher than the next industrialized nation.  Concurrently, physicians’ and hospitals’ per unit of service revenue increases are not meeting providers’ increased costs, and employers and payers are seeing utilization and technology use sky rocket, driving double digit premium and per member medical cost increases.  Simultaneously international quality studies have shown the U.S. population is a poor performer in many areas of community health.  This expensive healthcare system is not performing to the level expected nor creating the value needed.

International Comparison of Spending on Health 1980-2005

Click picture to enlarge

II.  New incentive systems and models promote quality and cost savings.

New models of shared risk have emerged under different names.  Some pay-for-performance (“P4P”) models compensate physicians for clinical care improvements that require some degree of collaboration with hospitals (e.g., Bridges to Excellence®, Medicare’s Physician Group Practice Demonstration).  Other P4P programs reward hospitals for improvements that may require physicians to collaborate (e.g., The Leap Frog Group, Medicare’s Hospital Quality Incentive Demonstration).  There are also other models led by physician groups or hospitals in which all parties have jointly assumed risk through global capitation or fixed-payment “guarantees” for elective procedures and a ninety-day follow-up period [e.g., HealthCare Partners (“HCP”) or Geisinger Health System respectively].

Some are using clinical integration to evolve a network creating accountability and performance through new community-based models, organized structures, processes, and management [e.g., Greater Rochester Independent Practice Association (“GRIPA”) and Advocate Health].  C. Schoen et al suggest that these options may achieve promising long-term savings as depicted in the next graphic. 

Total National Health Expenditures 2008-2017

Click picture to enlarge

III.  New IT and connectivity solutions allow for creation of structures and processes through integrated delivery systems.

Health and healthcare delivery are re-organizing ‒ enabled by a myriad of new IT and connectivity solutions.  GRIPA Connect™ is an example of a set of solutions used to create an electronically connected provider network.  Installation of these electronically connected provider solutions enabled GRIPA to meet the FTC clinical integration requirements, and created an organization, structures, processes, real-time reporting, and action-oriented culture usually found only in employed physician models.  Technology is now available to allow independent practitioners and hospitals form the connections needed to clinically integrate and collaborate in accountable care.  The following illustrates a CI model and the connections and real-time activity reporting now being used within the network.

Click image to enlarge

A dependable, accessible infrastructure of shared experts and analysts, as well as a set of reports with active management and support by skilled staff can create real physician and network alignment and positive quality, service, and cost saving results.

IV.  New ways to create structure and process result in quality and cost performance improvement.

Due to the advancements in technology, clinically integrated organizations and ACOs are able to monitor, report, and act upon data — in nearly real-time, which facilitates the use of evidence-based guidelines and, for payers, the first opportunity to integrate value-based benefit plans, enabling a new path to metric-driven accountability.  This can be the basis on which to eventually build an aligned partnership of members, providers, and payers focused on the health and wellness of the individual and population, and focused on the best healthcare value (i.e., advanced care quality and cost performance improvement).

The FTC and Medicare have promoted clinical integration and ACOs through a series of regulatory actions and pilots programs during the past decade.  Structures and processes, such as real-time alerts, tracking, and the efficacy of electronic interchange, along with setting guidelines and the ability to exchange immediate feedback, have been demonstrated successfully by GRIPA, Advocate Health, and others.  Lessons on how to build and operate these organizations have been learned and are now being adopted by others.  The tools developed, along with committed physicians and leadership focused on change, support the structures and processes, which enable real-time analysis, action, and adjustment.  The work required is the active focus on care and service coupled with continuous process improvement, which then becomes part of the culture of the network.  The “glue” is the incentives developed to continuously raise the bar while rewarding the efforts of members, employers, and providers.

V.  Healthcare is local ‒ these organizations are constructed at ground level and built, operated, and focused to align payers, members, and providers.

Payers – governmental, commercial and self-funded employers ‒ have an opportunity to adopt and benefit from the development of innovative technology and structural and process change.  As physicians, hospitals, and other providers learn and use these new connections and systems the power of the connected components in a continuum of care becomes apparent.  When there is transparency and communication in near real-time, timeliness, efficiency, and accuracy of care is improved.  These changes will transform the health delivery system and ultimately raise the trust and accountability between participants, physicians, providers, and payers.  The key benefits for payers will initially be quality-based, but as the iterative improvement process continues, and the culture of improvement and transparency is embraced, investments will pay off in reduction of waste, forgone inappropriate tests and procedures, and truly evidence-based care to the benefit of member, payer, and provider.  Systems and networks that have been early adopters of these measures have demonstrated positive results and continue to develop ways to improve.

Members benefit from improved health and quality of life, the motivation to strive for wellness, and personal out-of-pocket savings.  Everyone benefits through a system of care based on scientific evidence, adoption of best practices, high standards of quality of care and service, and enhanced communications between patient and provider. 

Physicians and hospitals gain enhanced linkage and alignment with each other, which facilitates implementation of quality improvement initiatives and provides “branding” consistency to patients and payers.  United branding helps present a collaborative entity working to improve the health of the population it serves.  The expansion of physician leadership in clinical care redesign improves revenue yield (e.g., P4P, global payments), facilitates clinical resource reduction, creates a sustainable form of gain-sharing, and provides a vehicle to increase market share and patient preference.

For more information on developing accountable and clinically integrated organizations, please contact James Smith at jsmith@thecamdengroup.com or 800.360.0603 x6108.

Join us at this upcoming event in Scottsdale, Arizona, February 28 through March 2, 2010.  Our Senior Vice President, Brian Silverstein M.D., and our Senior Medical officer, Eric Nielsen, M.D., will be presenting on Sunday at 2:30 p.m.  They’ll be talking about value-based payment – from clinical integration to accountable care.   

Here’s a link to where you can register:  http://www.healthcarestrategy.com/conferences/2010/PSS2010.asp