Operations and Finance

Back in (the) Black! Our Structured, Disciplined Approach to Creating Margin to Achieve Our Mission
Christine A. Schon, M.P.A., M.H.C.D.S., FACMPE, Chief Operating Officer, Cheshire Medical Center; Jason C. Vallee, M.A., MAOM, Ph.D., Vice President, Patient Experience, and Kathryn Willbarger, Senior Vice President Finance, Cheshire Medical Center, Dartmouth-Hitchcock

For healthcare organizations facing financial difficulty, ever-declining margins can lead to a strategic paralysis that threatens long-term financial sustainability. This case study will reveal how Dartmouth-Hitchcock Clinic got “back in the black”—turning a projected deficit into a 3% net gain—using a structured, disciplined approach to financial performance improvement. You’ll depart this session with a step-by-step guide to improving your organization’s margin, including diagnosing your current culture, replacing “tribal thinking” with strategic thinking, and creating a plan to ensure long-term financial stability. Learn how this structured approach can be extended beyond finance to improve all operational areas needing strategic leadership.

Upon completion of this activity, participants should be able to:

Describe the processes and methods for assessing the current state with regard to your organization’s perspective on finance, sustainability, and achieving margin
Develop a step-by-step approach to improving your organization’s margin
Create a plan for long-term financial sustainability
Apply the approach to all operational leadership activities

Building a Quality-Driven, Narrow SNF Network
Richard P. Morel, M.D., M.M.M., FACP, Deputy Chief Medical Officer, CareMount Health Solutions

About 40% of hospitalized patients are discharged to post-acute care settings, where costs are rapidly increasing and the quality of services is highly variable. In this session, learn how CareMount ACO, a physician-owned multispecialty medical group and Medicare Next Generation ACO in New York’s Hudson Valley, formed a narrow network of 23 skilled nursing facilities (SNFs) to reduce costs and ensure quality. Discover how to assess the cost and quality of post-acute providers, how to use an RFI-based approach to narrow your network, and why the NextGen ACO payment model offers an opportunity to integrate post-acute care with independent physician groups.

Upon completion of this activity, participants should be able to:

Employ data to assess the variability in quality and cost for the care provided by your post-acute network
Analyze how and why the NextGen ACO payment model offers the financing strategy and opportunity to integrate post-acute care delivery with independent physician groups
Plan an RFI-based approach to narrowing your network that is attractive to SNFs
Explain why care quality is the most important factor in selecting partner SNFs to contract under the total cost of care
Describe the importance of a care coordination program across acute and post-acute settings

Group Practice Standard Staffing Models: How to Create Them Since They Don't Exist
James Demopoulos, M.H.A., Senior Vice President and Chief Operating Officer, Lehigh Valley Physician Group

Changes in healthcare delivery models and a focus on population health are leading some organizations to develop brand-new staffing models that go well beyond traditional staff-to-provider ratios. At the forefront of such efforts is Lehigh Valley Physician Group, which is using Lean tools to correlate practice performance metrics to individual staff roles within a practice. This unique methodology takes into account quality, patient and colleague experience, growth and productivity, and financial and operational goals in determining appropriate staffing levels. Participants will be shown a step-by-step process for moving beyond ratios to assessing the contributions of roles and skill sets to performance. Learn how to improve your key performance metrics by more directly aligning the number, types, and skill sets of staff with specific improvement initiatives.

Upon completion of this activity, participants should be able to:

Identify key practice metrics to understand and target as part of the methodology, including weighting those measures
Describe how to use Lean tools to correlate practice performance metrics to individual staff roles within a practice, including quality, access and patient experience, operations, growth and productivity, financial, and colleague experience
Describe how to target and then pressure test the correlations of staffing roles and ratios to performance through analyzing your highest performing practices and those with the greatest opportunity
Describe how to map the staff to outcomes correlations
Define the standard staffing skill sets, role mix and ratios by provider, and competencies that define the standard staffing model by discipline (Family Medicine will be used as the illustrative example for building the standard model whose methodology can be applied to any service line/specialty)
Leverage the standard model to load level among like discipline practices, as a glide path for future growth and as a position control tool for recruitment and filling vacancies
Leverage the standard model as a development tool to identify skill set and competency gaps and then deliver education to close those gaps
Improve key performance metrics by aligning staff with goals through a much more direct correlation between number, types, and skill sets of staff and our countless improvement initiatives

Effective Referral Management: Lowering Costs for Specialty Care
Keith Fernandez, M.D., Chief Clinical Officer, and Mark Foulke, Executive Vice President, Transformational Value-Based Care, Privia Medical Group

One of the imperatives for success in the healthcare industry’s shift to value-based care and risk management is proper management of referrals. Recognizing that primary care physicians lack data about the performance or cost of specialists in their community, Virginia-based Privia Health created a customized database that ranks specialists based on input from both physicians and payers, resulting in a 95% increase in referral volume for some higher-ranked providers. Our speakers will outline steps in forming a cost-efficient, high-quality network across all payers. You will depart with a deeper understanding of how technology tools can improve the referral process and drive lower cost, high-quality care.

Upon completion of this activity, participants should be able to:

Increase utilization of preferred specialists
Drive lower cost, high-quality care
Embrace technology tools to make referrals
Manage and improve continuity of care through an integrated set of select specialists

A Case for Integrated Case Management: A Budget Neutral Model for Wraparound Patient Care
Mark Gwynne, D.O., President and Executive Medical Director, Robert Malone, Pharm.D., CPP, Chief Operating Officer, and Stephanie Turner, R.N., FNP-BC, CHCQM, Director, Population Health Clinical Services, UNC Health Alliance

Case management services, long recognized as a key component to patient-centered care, are also evolving as the healthcare industry shifts to value-based care. In this case study, presenters from North Carolina’s UNC Health Alliance will explain how a team of more the 100 RNs, LCSWs, RD/CDEs, and CMAs have nimbly adapted from siloed work to a successfully integrated, interdisciplinary, budget-neutral model. Participants will learn about the critical elements when implementing an integrated case management model—including staffing ratios, funding, and management structure—and how to establish meaningful ROI key performance indicators.

Upon completion of this activity, participants should be able to:

Identify the vital component interdisciplinary care teams play in population health management
Describe how to implement an integrated case management model, including staffing ratios, funding and management structure
Establish meaningful ROI key performance indicators to measure outcomes

A Medicare Advantage Cautionary Tale: Pay Attention to Newly Attributed Patients
Frank Colangelo M.D., M.S.-HQS, FACP, Vice President, Chief Quality Officer, Board Member, and Robert Crossey, D.O., President, Premier Medical Associates

Organizations accepting risk from Medicare Advantage (MA) need complete data from their payer partners or risk facing unexpected consequences. Case in point: Pennsylvania-based Premier Medical Associates suffered losses in its first downside risk contract due to newly attributed MA patients, less than 10% of their population. In this cautionary tale shared by Premier’s leaders, learn how to avoid MA losses by obtaining data on all MA patients, including newly attributed patients, and how to develop trusted relationships with payer partners under risk-based contracts.

Upon completion of this activity, participants should be able to:

Evaluate the need for obtaining data on all patients under MA, including newly attributed patients
Discuss the importance of developing a relationship of trust with payer partners under risk-based contracts
Contrast infrastructure requirements for value-based care with data requirements

Defining and Selling the Value Proposition of the Physician Enterprise
Mark Behl, M.B.A., M.H.A., Senior Vice President, CommonSpirit Health Physician Enterprise, CommonSpirit Health

In a world where success is measured by profit and loss, how do ambulatory leaders define and prove the value of medical group models? In this session, the head of ambulatory strategy for CommonSpirit Health’s West Division will outline how leaders can sell the value of an employed physician model in a hospital-centric world: how to define it, what should be measured, and the top 10 metrics that will define a successful physician enterprise going forward. Topics include how a digital strategy can help foster a consumer-based approach in which physicians develop trusted, long-term relationships with patients. Our speaker will share a useful toolkit and proven techniques to help participants define the value proposition of the physician enterprise to their shareholders.

Upon completion of this activity, participants should be able to:

Utilize a toolkit that helps them define the value proposition of the physician enterprise to their stakeholders
Delineate the top 10 metrics that will define the physician enterprise of the future

Aligning Incentives: How to Transform Your Physician Compensation Plan in the Era of Value-Based Payment
Kenneth B. Robbins, M.D., Chief Medical Officer and Executive Vice President, Hawai'i Pacific Health, Straub Clinic Hospital

Medical groups moving from volume-based to value-based payment are facing new challenges incorporating non-productivity-based incentives in their compensation plans. This presentation will showcase how Hawaii Pacific Health has successfully incorporated non-productivity metrics in its physician compensation plan, including incentives for service excellence, panel size, pay for quality, alternative visits, and unique patients. Positive outcomes include increased provider engagement, higher patient satisfaction, and lower physician turnover. Drawing on his deep experience as a chief medical officer, Dr. Robbins will provide a thorough review of the process used and challenges encountered in aligning physician compensation with value-based payment.

Upon completion of this activity, participants should be able to:

Describe the challenges in designing a physician compensation plan that addresses both the intrinsic and extrinsic motivations of physicians
Name five categories of nonproductivity metrics that can transform a physician compensation plan to align with value-based payment
Identify the process required for making a successful large-scale change to a physician compensation plan

Cutting Cost of Care within a Learning Collaborative
Panelists: Beth Averbeck, M.D., Senior Medical Director, Primary Care, HealthPartners; Jeff James, M.B.A., CPA, Chief Executive Officer, Wilmington Health; Nina Taggart, M.D., M.A., M.B.A., Senior Medical Director for Accountable Care - Lehigh Valley PHO, Medical Director - Lehigh Valley ACO; John Cuddeback, M.D., Ph.D., Chief Medical Informatics Officer, AMGA Moderated by: Jill Powelson, Dr.P.H., M.P.H., M.B.A., R.N., Senior Director, Collaborative for Performance Excellence, AMGA

Managing the cost of care is becoming a priority for healthcare organizations as they progress on the path toward increased risk. This panel presentation will provide actionable insights about high-cost areas within the total cost of care, with a focus on “winners and losers” in the battle to optimize costs. Attendees will learn about analytics-informed best practices from healthcare organizations focusing on the cost of care domain of AMGA’s Collaborative for Performance Excellence.

Upon completion of this activity, participants should be able to:

Identify key components in the total cost of care
Recognize areas of opportunity in segmenting the cost of care
Describe actionable best practices to “right size” the cost of care