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GE Healthcare Camden Group Insights Blog

Building a Value Model for Population Health Management

Posted by Matthew Smith on Jun 16, 2017 10:40:18 AM

By Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

Most healthcare leaders understand the importance of managing the health of their patient populations. Building the tools for effective patient population management is key to improving outcomes while “bending the cost curve” in U.S. healthcare.

At the same time, executives are concerned about the cost of population health initiatives. What level of investment is needed to effect change? What is the right pace for transitioning from fee-for-service (FFS) to value-based payment? Finance leaders, in particular, are concerned about preserving margins during the transition.

How can a healthcare organization maintain profitability as spending increases on population health initiatives while FFS revenue decreases?The only way to answer these questions is to use a data-driven “value model” to predict and manage the total financial impact of the population health initiatives.

An ideal value model will accomplish three goals:

  1. Quantify the output of population health interventions, including shifts in utilization and changes in cost of care.
  2. Help identify population health investments that will move the organization forward while retaining margin.
  3. Allow finance leaders to support value-based contracting with predictions of costs and the quality of outcomes.

 To continue reading this article, please click on the button below to download a PDF.

Value Model, Population Health

Topics: Value-Based Care, Population Health, Value-Based Contracting, Daniel J. Marino, Value Model

The Seven Strategic Levers of Value-Based Care

Posted by Matthew Smith on May 10, 2017 1:52:29 PM

Hospital leaders are carefully watching the healthcare industry’s transformation from volume-driven care to value-based care. But while most leaders understand the basics, many are uncertain about how to guide their organizations through this transformation.

The good news is that focus will pay off. Healthcare leaders can guide the development of a value-based organization by concentrating on a handful of key priorities. We have described a list of seven strategies that we call the “levers” of value-based care, ranging from advanced cost management to comprehensive data aggregation.

To immediately read this article in its entirety, please click the button below.

Value-Based Care

Topics: Value-Based Care, Daniel J. Marino, Healthcare Data

Webinar Reminder: Building an Analytics-Based Value Model to Validate Transformation Investments

Posted by Matthew Smith on Nov 29, 2016 2:10:38 PM

Please join GE Healthcare Camden Group for a complimentary, 60-minute webinarBuilding an Analytics-Based Value Model to Validate Transformation Investments, on Thursday, December 8, 2016, at 12:00 P.M., ET.

Date:

Thursday, December 8th, 12:00 P.M., Eastern

Background:

Healthcare organizations are struggling to understand the impact of their investments in population health initiatives. To help measure performance risk and evaluate return on investment ("ROI"), organizations are building and implementing analytics-based value models as decision-making tools. Creating these value models allows healthcare organizations to quantify risks and evaluate viability. It also allows organizations to measure and track ROI in digital health technology and resources associated with various programs aimed at managing the health of the populations they serve.

GE Healthcare Camden Group's team of analysts, data scientists, and actuaries builds comprehensive analytics-based value models for organization leaders (CFO, CMO, CIO, Population Health Leaders) wanting to evaluate their ROI from investments in care management programs, look to better manage utilization, and predict outcomes.

Overview:

In this complimentary webinar, members of the GE Healthcare Camden Group team will deliver an overview of the analytics-based value model and how high-performing healthcare organizations are leveraging these to guide strategic decision making and prioritize investments in value-based care initiatives.  

Topics to be Addressed:

Held in a round-table format with GE Healthcare Camden Group senior leaders representing the roles of an organization's CFO, CMO, and CIO, the webinar will address the following questions facing today's leaders:
  • Where should organizations invest resources in order to drive the most value from their care management programs?
  • What is the impact on their programs to both acute and ambulatory utilization?
  • Which programs are driving the greatest value and how are these measured?
  • What “value levers” are important in order to drive the best outcomes?
  • What is the expected outcomes from managing certain medical conditions and/or population risk cohorts?
  • What is the typical ROI of their care management programs and population health initiatives?
  • How can this information be used to support risk-based contracting with payers and other providers?

GE Healthcare Camden Group Presenters:

Marino_Dan.jpgDaniel Marino, MBA, MHA, Executive Vice President Mr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. With a comprehensive background in all aspects of practice management and hospital/physician alignment, Mr. Marino is a nationally acknowledged innovator in the development of Accountable Care Organizations and clinical integration programs.

chopra2-110511-edited-239718-edited.jpgShaillee J. Chopra, PMP, Senior Manager Ms. Chopra is a senior manager with GE Healthcare Camden Group and specializes in developing and managing innovative technology portfolios for value-based and clinically integrated healthcare networks. She is highly experienced in leading information technology and consumer experience strategy development, as well as transformations to enable clinical integration, accountable care, and population health management strategies for organizations invested in innovation and transformation of care delivery models.

 

DiLoreto.pngDavid DiLoreto, M.D., MBA Dr. DiLoreto, senior vice president at GE Healthcare Camden Group, is a physician-executive who is highly experienced in executive management, strategy and operations of healthcare delivery systems, and managed care companies. He has deep management expertise in community-based and academic health systems, large group medical practices, hospitals, and managed care organizations. His areas of specialty include clinical transformation, population health, business process improvement, leadership development, medical informatics, and data management and analytics.

GreenB1.pngRobert Green, MBA, FACHE, CHFP Mr. Green is a senior vice president and the practice lead for the Financial Operations and Transactions practice. He has more than 26 years of healthcare experience with 13 years of healthcare consulting experience and 13 years of provider-based financial, operational, and strategic experience among health systems, hospitals, medical groups, management services organizations, and physician hospital organizations.

 

To Register:

To register, simply click the button below, complete a short registration form, and press the "Cick to Register!" button. You will receive a confirming email. A second email will be sent the week of December 5th with webinar login/call-in instructions.

Please note: This webinar is intended for providers, provider organizations, and industry partners. Because of the proprietarty nature of the information shared during this webinar, independent consultants and consulting agencies will not be provided access to programming. GE Healthcare Camden Group reserves to the right to limit attendance at this event. 

Value Model, Webinar, Digital Health Analytics

Questions?

Please contact Matthew Smith at [email protected]

Topics: Webinar, Daniel J. Marino, Shaillee Chopra, Digital Health Services and Data Analytics, Value Model, David DiLoreto, Robert Green

New Webinar: Building an Analytics-Based Value Model to Validate Transformation Investments

Posted by Matthew Smith on Nov 16, 2016 1:16:09 PM

Please join GE Healthcare Camden Group for a complimentary, 60-minute webinarBuilding an Analytics-Based Value Model to Validate Transformation Investments, on Thursday, December 8, 2016, at 12:00 P.M., ET.

Date:

Thursday, December 8th, 12:00 P.M., Eastern

Background:

Healthcare organizations are struggling to understand the impact of their investments in population health initiatives. To help measure performance risk and evaluate return on investment ("ROI"), organizations are building and implementing analytics-based value models as decision-making tools. Creating these value models allows healthcare organizations to quantify risks and evaluate viability. It also allows organizations to measure and track ROI in digital health technology and resources associated with various programs aimed at managing the health of the populations they serve.

GE Healthcare Camden Group's team of analysts, data scientists, and actuaries builds comprehensive analytics-based value models for organization leaders (CFO, CMO, CIO, Population Health Leaders) wanting to evaluate their ROI from investments in care management programs, look to better manage utilization, and predict outcomes.

Overview:

In this complimentary webinar, members of the GE Healthcare Camden Group team will deliver an overview of the analytics-based value model and how high-performing healthcare organizations are leveraging these to guide strategic decision making and prioritize investments in value-based care initiatives.  

Topics to be Addressed:

Held in a round-table format with GE Healthcare Camden Group senior leaders representing the roles of an organization's CFO, CMO, and CIO, the webinar will address the following questions facing today's leaders:
  • Where should organizations invest resources in order to drive the most value from their care management programs?
  • What is the impact on their programs to both acute and ambulatory utilization?
  • Which programs are driving the greatest value and how are these measured?
  • What “value levers” are important in order to drive the best outcomes?
  • What is the expected outcomes from managing certain medical conditions and/or population risk cohorts?
  • What is the typical ROI of their care management programs and population health initiatives?
  • How can this information be used to support risk-based contracting with payers and other providers?

GE Healthcare Camden Group Presenters:

Marino_Dan.jpgDaniel Marino, MBA, MHA, Executive Vice President Mr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. With a comprehensive background in all aspects of practice management and hospital/physician alignment, Mr. Marino is a nationally acknowledged innovator in the development of Accountable Care Organizations and clinical integration programs.

chopra2-110511-edited-239718-edited.jpgShaillee J. Chopra, PMP, Senior Manager Ms. Chopra is a senior manager with GE Healthcare Camden Group and specializes in developing and managing innovative technology portfolios for value-based and clinically integrated healthcare networks. She is highly experienced in leading information technology and consumer experience strategy development, as well as transformations to enable clinical integration, accountable care, and population health management strategies for organizations invested in innovation and transformation of care delivery models.

 

DiLoreto.pngDavid DiLoreto, M.D., MBA Dr. DiLoreto, senior vice president at GE Healthcare Camden Group, is a physician-executive who is highly experienced in executive management, strategy and operations of healthcare delivery systems, and managed care companies. He has deep management expertise in community-based and academic health systems, large group medical practices, hospitals, and managed care organizations. His areas of specialty include clinical transformation, population health, business process improvement, leadership development, medical informatics, and data management and analytics.

GreenB1.pngRobert Green, MBA, FACHE, CHFP Mr. Green is a senior vice president and the practice lead for the Financial Operations and Transactions practice. He has more than 26 years of healthcare experience with 13 years of healthcare consulting experience and 13 years of provider-based financial, operational, and strategic experience among health systems, hospitals, medical groups, management services organizations, and physician hospital organizations.

 

To Register:

To register, simply click the button below, complete a short registration form, and press the "Cick to Register!" button. You will receive a confirming email. A second email will be sent the week of December 5th with webinar login/call-in instructions.

Please note: This webinar is intended for providers, provider organizations, and industry partners. Because of the proprietarty nature of the information shared during this webinar, independent consultants and consulting agencies will not be provided access to programming. GE Healthcare Camden Group reserves to the right to limit attendance at this event. 

Value Model, Webinar, Digital Health Analytics

Questions?

Please contact Matthew Smith at [email protected]

Topics: Webinar, Daniel J. Marino, Shaillee Chopra, Digital Health Services and Data Analytics, Value Model, David DiLoreto, Robert Green

Utilizing Analytics to Measure Risk and Evaluate ROI in Your Organization's Value-Based Care Initiatives

Posted by Matthew Smith on Oct 4, 2016 2:06:19 PM

By Shaillee Chopra, PMP, Senior Manager, and Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

Data AnalyticsHealthcare organizations transitioning from fee-for-service to value-based models are making substantial investments in building technology and operational infrastructure to drive new services and workflows. Developing an effective and an efficient care delivery system from which to identify and drive profitability under risk arrangements remains of utmost importance. However, developing an analytics framework to support population health management, evaluate potential and expected returns from investment continues to be a struggle for many healthcare organizations.

Creating an analytics-based evaluation model enables healthcare organizations to quantify risks and evaluate viability and value-add of outcomes associated with various decisions. It also allows them to measure and track return on their investments in technology and resources associated with various programs aimed at managing health of populations they serve.

An Analytics-Based Value Model for Population Health

The framework for this model is grounded in measurement of utilization by place of service. It provides near real-time insight into “what works and what does not” in an operational environment. It also serves as a mechanism to ensure an organization’s positive position during re-contracting discussions with payers since it is supported with demonstrable value of delivering the right care to the right patient at optimal cost in the most appropriate setting. It serves as an information-based decision making model that enables the organization to make the transition to pay-for-value while preserving margins and without upsetting the apple cart of existing payer -provider relationships.

The Need for a Value Model Within an Organization’s Population Health Framework

A value model allows your organization to develop a deeper understanding around which variables drive outcomes that impact decisions about investments and resource allocation. For example, high-performing and value-based organizations are committed to improving quality and reducing avoidable utilization and costs. Cost reductions are a byproduct of the reduction in avoidable ER and acute inpatient utilization for individuals with chronic conditions. These costs are offset by an increase in “good utilization” such as increased PCP visits, wellness screenings, and pharmacy costs associated with medication adherence.  An analytics-based value model allows your organization to meaningfully sift through large amounts of data to identify and isolate important variables for future strategic success.

It allows for assessment of returns on investments made in various disease management intervention programs for at-risk, rising-risk and chronically ill population cohorts. It identifies assets and value levers that can be leveraged to prioritize and tweak the operational models for optimal returns.

Finally, it allows your organization to use analytics as a cornerstone for an innovative and data-driven approach to population health management.

Key Questions to Ask Within Your Healthcare Organization

Top performing healthcare organizations that are invested in developing their analytic capabilities begin with the end in mind and work from an analytics roadmap. Below are some of the key questions to consider to ensure you are achieving outcomes you desire without “boiling the ocean” and wasting valuable resources on programs that have minimally aligned outcomes:

  • What are the key questions you want to answer? Do you have 3-5 clearly defined use cases?
  • Accuracy, validity and credibility of your data: Do you know what data is needed? Do you have the right data? Is the data useable, i.e., accurate and credible? What data do you not have? Do you have a data acquisition strategy?
  • Analytics roadmap: Have you established a needs based analytics framework within your organization? Do you have right skillset and adequate tools to conduct analytics? After you perform analytics do you know how to interpret the results and make them actionable?
  • Driving actions: Do you have an actionable strategy for executing on the results? What are the actionable opportunities to execute against? How are you evaluating competing analytic priorities for resources and investment?
  • Monitoring impact and evaluate results: Have you implemented processes to track performance as part of your activation plan? Are you tracking both outcomes and the steps required to achieve the outcomes? Are you leveraging predictive modelling to consider varied “What if” scenarios to continually optimize the focus areas of your operational work plan?

Utilizing an analytics-based value model allows your healthcare organization to optimally invest resources and dollars towards operational programs that generate outcomes and value most alignment with strategic goals.

Value Model, Health Analytics


chopra2-110511-edited-239718-edited.jpgMs. Chopra is a senior manager with GE Healthcare Camden Group and specializes in developing and managing innovative technology portfolios for value-based and clinically integrated healthcare networks. She is highly experienced in leading information technology and consumer experience strategy development, as well as transformations to enable clinical integration, accountable care, and population health management strategies for organizations invested in innovation and transformation of care delivery models. She may be reached at [email protected].

 

Marino_Dan.jpgMr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. With a comprehensive background in all aspects of practice management and hospital/physician alignment, Mr. Marino is a nationally acknowledged innovator in the development of Accountable Care Organizations and clinical integration programs. He may be reached at [email protected].

Topics: Value-Based Care, Healthcare Analytics, Daniel J. Marino, Data Analytics, Shaillee Chopra, Digital Health Services and Data Analytics, Value Model

Meet the Practice: Digital Health Services and Advanced Analytics

Posted by Matthew Smith on Jun 14, 2016 1:45:24 PM

This Meet the Practice overview, examining the new Digital Health Services and Advanced Analytics practice, is part of an ongoing series in which GE Healthcare Camden Group's senior leaders share insights into our six practice areas.

Practice Lead: Daniel J. Marino, Executive Vice President

Explain the needs and problems you solve for clients through this practice.

The U.S. healthcare system is experiencing significant shifts in the way healthcare is accessed and delivered, fueling a strong desire for operational efficiencies, value-driven outcomes, and action-oriented information. In order to ensure that intelligible, actionable information is created, organizations are creating digital health strategies that focus on producing value-driven analytics while supporting their operational capabilities and needs.

As a result, there is a need to assist healthcare provider organizations in:

  • Building an operationally-focused information services and analytic strategy
  • Provide direction in creating comprehensive and powerful advanced analytics
  • Incorporating enterprise-wide data governance integrating clinical, financial and technical master data management
  • Focusing on analytic deliverables and capabilities and less on application functionality
  • Improving integration of applications and technology with provider workflows and care model delivery
  • Maximizing the optimal use of existing applications
  • Providing objective, vendor agnostic professional advisory services to provider organizations

Ultimately, we enable clinically integrated organizations to maximize value through an operationally driven digital health strategy.


Building_Action_Oriented_Information-1.png


What is the value or ROI that is provided by solving these challenges?

Organizations with a comprehensive digital health and analytics roadmap will be able to realize benefits in strategic development, operational optimization, and performance effectiveness.

From a strategic development point-of-view, organizations will be able to expand their provider networks through enhanced connectivity, integrated care management, analytics, and value-based programs. Operationally, they will benefit from real-time performance data which supports operational output for clinical, financial, and contracting objectives. They will also see improved performance effectiveness via cost-of-care modeling to support value-based contracting, and improved outcome tracking and clinical program effectiveness measures.

What types of organizations need your services?

We engage provider organizations at various stages of digital preparedness. Many organizations are simply looking for a starting point in working with their population health analytics vendor and want to ensure that they have a results-oriented digital health development blueprint and are aggregating the right data that leads to meaningful information. Other organizations are looking to create a complex data strategy and roadmap amidst a sea of ever-changing priorities and information requirements.

What synergies differentiate this practice area (and GE Healthcare Camden Group)?

Within GE Healthcare Camden Group, our Digital Health Services and Advanced Analytics practice provides a 360 degree operational perspective to the information services and analytic challenges existing within healthcare organizations.

Because we are vendor agnostic, our objective experts understand the clinical and operational impact of the ever-changing technology landscape and are equipped to advise on IT/IS strategies, system selection, activation support, and advanced analytics.

As a firm, GE Healthcare Camden Group provides professional advisory services across the care continuum incorporating our expertise in information services and analytics. We have built a reputation as a trusted partner to clinical, operational, and financial healthcare leaders by helping them close the gap between their challenges and the optimal solutions for success.

To learn more about GE Healthcare Camden Group's Digital Health Services and Advanced Analytics practice, please click the button below for a PDF download.

Digital Health, Advanced Analytics


Marino_Dan.jpgMr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. With a comprehensive background in all aspects of practice management and hospital/physician alignment, Mr. Marino is a nationally acknowledged innovator in the development of Accountable Care Organizations and clinical integration programs. He may be reached at [email protected].

Digital Health Services and Advanced Analytics

Topics: Value-Based Care, Daniel J. Marino, Data Analytics, Digial Health, Digital Health Strategy, Digital Health Services and Data Analytics

The Move from Volume to Value: Now is the Time for Change

Posted by Matthew Smith on Jun 2, 2016 12:19:54 PM

By Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

Healthcare delivery (and physician reimbursement specifically) is undergoing unprecedented transformation. While most physician practices still operate largely in a fee-for-service ("FFS") world, government and commercial payers alike have signified their intent to reimburse physicians and other providers based on value.

Thriving in an Uncertain World

Many physicians recognize that the FFS system is imperfect at best, but the evolving value-based reimbursement system is ill-defined, leaving physicians facing a great deal of uncertainty. During this time of uncertainty, medical practices have opportunities to improve performance and position themselves for success in the rapidly changing healthcare market. It is natural to begin focusing on clinical measures and outcomes as a means for proving value, but it is just as important to remain financially viable during the transition. By understanding the structures of evolving reimbursement methodologies, changing health plan dynamics, and developing market trends, we can thrive in this uncertain world.

The Department of Health and Human Services’ (HHS) is actively involved in the fundamental shift in reimbursement, moving from volume to value in Medicare payments, reinforcing the shift to value-based care. Organizations that begin to incorporate strategies around the “value proposition” will be in the best position to meet industry demands for value-based reimbursement. This will require a dedicated strategic “call to action” across organizations and their provider community.

Controlling the Momentum of Change

There remains a fundamental question regarding how quick an organization should move to value-based care and controlling the momentum of change. Although some of the drivers are market dependent, others are based on embracing key concepts around the “triple-aim principles” and preparing the organization for the future. High-performing organizations are building their clinically integrated networks, forming ACOs, and incorporating reimbursement programs around bundled payments and minimal risk-based contracts, while still reaping some opportunities from the current fee-for-service contracts. 

The transition into value-based care is a paradigm shift of culture, care model redesign, reimbursement, and quality outcomes that takes time. Organizations that begin to plot the “value-based care” path now, while fee-for-service is still their predominant reimbursement, will be in the best position to refine their care delivery models and protect their revenue streams. It will come down to embracing the concepts of patient-centered care while focusing on improving access and reducing the cost curve. Health systems must begin to squeeze operating costs out of the system and incorporate patient-centered care models focusing on an “ambulatory-focused” model of care that carefully manages transitions across the continuum.

Balancing Risk

Many commercial payers in some markets have already begun the transition, with many more to follow.  A strong value proposition along with creating the patient-centered strategy is key to finding the right “change momentum” for your organization. Focusing on providing the value proposition, engaging physicians to lead the care redesign, and incorporating programs such as bundled payments and shared savings help to make sure organizations appropriately embrace the pace of change within their market. It also ensures the organization can maintain a steady forward pace by balancing appropriate risk with solid potential for clinical and financial gains.

Volume to Value


Marino_Dan.jpgMr. Marino is an executive vice president with GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. With a comprehensive background in all aspects of practice management and hospital/physician alignment, Mr. Marino is a nationally acknowledged innovator in the development of Accountable Care Organizations and clinical integration programs. He may be reached at [email protected].
 

Topics: HHS, Bundled Payments, Department of Health and Human Services, Value-Based Reimbursement, Value-Based Care, Daniel J. Marino

Patient Access Innovations: Integrating Patients Within the System of Care

Posted by Matthew Smith on Dec 1, 2015 3:21:44 PM

Provider coordination is of paramount importance for healthcare organizations preparing for the industry’s shift in focus from volume to value. The most ambitious coordination model that has been developed to date is the clinically integrated network ("CIN")—a contractual collaboration among hospitals, physicians, and other providers to manage patients across the entire continuum of care. A CIN uses population health management tools, including care management techniques, to build value through improving patient outcomes and controlling costs. This innovative model offers providers access to value-based payment contracts and an opportunity to improve quality and reduce costs.

Despite the compelling benefits of clinical integration, this approach also poses risks. Value-based payment contracts hold CIN participants accountable for both clinical and financial outcomes, although the ability to influence these outcomes depends largely on patient choice and patient compliance. Whenever a patient leaves the CIN, even if the patient returns to the network for certain services, network providers lose the opportunity to fully manage the patient’s care and utilization, ultimately undercutting their ability to coordinate the patient’s care and accrue the benefits of improved clinical outcomes and reduced costs.

This risk makes it critically important for CINs to keep patients within their organized systems of care. CINs need to make sure patients can access the network easily and are motivated to stay connected, requiring a strategic focus on patient access and engagement.

Based on the experiences of leading CINs, strategies aimed at improving patient access tend to be most effective when they are focused on three primary objectives: expanding entry points to the network, making access more convenient and inexpensive, and keeping patients engaged in the care they receive from network providers. The following five strategies, in particular, have been proven effective for ensuring in-network access and strengthening patient engagement.

To read the rest of this article in its entirety, please click the button below to immediately access the article on the hfm magazine site:

 Patient Access, Clinically Integrated Networks

Topics: Clinical Integration, Clinically Integrated Networks, Patient Access, Patient Engagement, Daniel J. Marino, Value-Based Payments

Clinically Integrated Networks: Control Your Own Momentum

Posted by Matthew Smith on Nov 4, 2015 3:18:18 PM

By Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

Many hospital leaders fear the consequences of moving too fast. Last year, we talked to healthcare leaders nationwide about preparing for value-based payment. For many, the biggest fear is reducing their hospital revenues. What will happen if you transition care to lower-reimbursement ambulatory settings faster than you can grow value-based revenue? How do you increase volume to cover the shift in revenue from acute to ambulatory or post acute? Others are concerned about investment costs. Value-based care is new territory. That means many big upfront investments could end up being unnecessary.

Yet moving too slowly carries significant risks. Hospitals that fail to act now could soon lose market share to value-driven competitors. Lagging organizations will be forced to accept lower reimbursement on their remaining volume. They will not be in a position to accept value-based contracts from payers and will also be unable to offset utilization reductions with new revenue streams.

The ultimate penalty of inaction is that you will allow others to dictate your future. How do you find the right pace in transitioning your hospital to value-based care? The key to establishing the right momentum is to clinically integrate with other providers. A well calibrated clinical integration strategy will allow you to maximize value for your organization while minimizing risk.

The Basic Framework

Clinically Integrated Network, CINA clinically integrated network (“CIN”) is a group of provider organizations that come together to form an organized system of care. The network can include one or more hospitals, their employed physicians, independent community physicians, post acute providers, and other provider organizations. Member organizations remain independent but are aligned contractually. The entire network is physician-led and incorporates a multi-stakeholder governance body that oversees quality initiatives, financial goals, and other strategic issues.

Leading clinically integrated networks share a handful of key attributes and capabilities:

  • Physician-led organization with a focus on quality of care within a patient-centric model.
  • Care management capabilities to help improve quality and outcomes while reducing costs.
  • Clinical programs that optimize services for specific diseases and patient groups.
  • Advanced technology that is leveraged to improve electronic interoperability, standardize optimal care, and improve services at the point of care.
  • Population health capabilities that allow the CIN to aggregate data and manage the high-level factors that influence health outcomes.

The ultimate goal of a CIN is to secure value-based payment contracts. Providers receive financial rewards for superior quality and outcomes along with successfully managing cost trends. Value-based contracts align provider incentives with the needs of payers, employers, and patients.

Plan to Evolve

While clinical integration is complex and challenging, it is also a versatile strategy. CINs can develop infrastructure and capabilities step-by-step. Member organizations are able to assume risk at a steady pace while achieving powerful forward momentum.
Here is a simplified pathway for transitioning your organization from traditional volume-based payment to robust value-based care:

Phase 1: Lay the CIN foundation. Start by assembling the building blocks of a clinically integrated network. The risk is low, and potential gains are moderate. Key activities include establishing the appropriate governance structure and building the provider network. Establish the desired care model and the focus of quality programs with the ability to track outcomes. Network leaders should begin negotiating limited risk-based contracts that include provider quality and cost management incentives. Emphasize referral management strategies to keep patients within the CIN and the organized system of care. CINs that properly execute on the foundational elements and establish an organized system of care can create opportunities to increase revenue five to ten percent.

Phase 2: Develop a clinically integrated collaborative. As a CIN begins to experience success in creating an organized system of care, the next step is to assume additional risk, but target bigger rewards, by expanding the network regionally. Move strategically into other markets by partnering with providers that can benefit from your CIN’s provider network, technology, and care management infrastructure. At the same time, refine the network’s ability to manage costs, expand clinical guidelines, and support risk-based contracts. Hone capabilities for managing the entire enterprise through monitoring, analytics, and reporting. Explore opportunities to partner with payers in narrow-network health plans.

Phase 3: Transition to full-risk contracts. The most advanced CINs are creating provider-sponsored health plans that offer compelling revenue opportunities. This phase carries the most risk, but it can be mitigated substantially through strong care delivery, cost management, and utilization management capabilities. Networks at this stage can function as full-service ACOs, including organizations acting as provider sponsored health plans assuming full-risk contracts, similar to Geisinger Health System, Intermountain Healthcare, or Northshore Long Island Jewish Health System. Another strategic option is to offer insurance products directly to the market, either alone or in partnership with a payer. Direct employer contracting allows the CIN to “commoditize” its services, potentially increasing revenue 10 to 15 percent over traditional contracts. In order for this to be achieved, provider-sponsored health plans would need to be in place accompanied by a large provider network and organized systems of care. If “payer dependencies” are removed or limited, the healthcare spend decrease translates into revenue opportunities for the CIN.

Target Financial Opportunities to Mitigate Risk

One key to reducing the risk of value-based care is to take full advantage of its unique financial opportunities. Pay attention to four categories:

  • Infrastructure cost savings. Creating a strong shared administrative and care management infrastructure can allow a CIN to reduce per-member per-month (“PMPM”) costs 20 to 30 percent within 5 to 10 years.
  • Increased volume. Entering into narrow-network contracts with payers and employers can drive strong membership growth and patient volumes.
  • Increased domestic utilization. Minimizing patient leakage allows the CIN to maximize influence over care transitions and quality, a key to controlling costs.
  • Advanced care programs. Hospitals have the opportunity to develop advanced clinical programs and centers of excellence. Offering these programs to other network providers will increase revenue while further leveraging network effects.

The Starting Point

As you plan and launch a CIN, keep in mind one absolute necessity. Your organization must offer a strong value proposition to participating providers, payers, and patients.

For physicians, participation in your network must be an opportunity to improve patient care through access to care management, as well as clinical program and technology resources. Your CIN should also provide a management infrastructure that eases the challenges of practicing medicine today. It must facilitate care redesign to enhance care efficiency and patient focus, and optimize clinical resources.

For payers, your network must provide higher quality care, better patient outcomes, and better patient access, all while reducing the cost of care.

For patients, your network must provide access, affordability, and tools to facilitate care coordination and engagement.

A strong value proposition is key to finding the right “change momentum” for your organization. Focusing on providing value helps make sure you do not embrace change too quickly for your market. It also ensures your organization can maintain a steady forward pace by balancing appropriate risk with solid potential for clinical and financial gains.

Clinical Integration Networks, CIN, Daniel J. Marino


Mr. Marino is an Executive Vice President at GE Healthcare Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at [email protected].
 
 
 

Topics: Clinical Integration, CIN, Clinically Integrated Networks, Daniel J. Marino

New Download: The New Paradigm of Patient Access

Posted by Matthew Smith on Sep 29, 2015 1:04:53 PM

In order for new clinically integrated networks (CINs) to achieve success, they must increase ways for patients to access care. To accomplish this, CINs and hospital leaders must embrace non-traditional access points that patients use to enter their systems.

Patients may choose to access the system through retail clinics because it is easy and convenient, and they are able to get what they need quickly. Those components, successfully integrated into a CIN, can serve as significant access points into a network.

In instances when CINs identify outside providers where their patients are going to get care, CINs should establish a contractual relationship with the provider. Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. 

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics. More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the patient outmigration rate (patients going outside the network—sometimes referred to as "leakage") is more than 5 to 10 percent, the providers must find ways to keep more patients in the network.

Increasing access can also turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

This new download provides insight surrounding:

  • How people rate access
  • What consumers want (old vs. new models)
  • Expectations surrounding access redesign
  • Consumer trust statistics
  • The new paradigm of patient access
  • Objectives of "best in class" patient access
  • Creating loyal patients for life
  • The continuum of organized care

Please click the button below to access the download page:

Patient Access, The Camden Group, Clinical Integration

Topics: Clinical Integration, Clinically Integrated Networks, Patient Access, Daniel J. Marino

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