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GE Healthcare Camden Group Insights Blog

How to Engage Physicians in Leadership

Posted by Matthew Smith on Nov 7, 2016 4:18:57 PM

First published November 3, 2016 by Physicians Practice

Creating good governance structures and providing leadership training can increase physicians' engagement in medical groups, according to Marc Mertz, vice president of GE Healthcare Camden Group, a healthcare consultancy with offices around the country. 

Mertz teamed up with Peter Valenzuela, chief medical officer of the multispecialty Sutter Medical Group of the Redwoods, a multispecialty group of 125 providers in Santa Rosa, Calif., at this year's Medical Group Management Association (MGMA) annual conference, held at the Moscone Center in San Francisco, Calif. Together the two explained how physicians can take more important roles in running medical groups.

More and more physicians are employees rather than owners of their practices, said Mertz, and this is causing them to feel less invested in the practices' success. Mertz cited a 2006 survey by Jackson Healthcare in which 36 percent of internists and 51 percent of surgical specialists were "actively disengaged" from leadership.

"This is just a recipe of disaster," said Mertz. "We'll never be able to respond to the opportunities and the challenges of the market if you have this level not only of non-engagement but active disengagement."

Addressing the problem requires involving physicians in the vision, strategy, operation, and oversight of the practice so they develop a sense of ownership, even if they don’t have legal or financial control, Mertz said.

Where physicians legally own a practice, they may have a role in the governance through a board of directors. But as employees physicians either have no formal place in medical practice governance or may only serve on advisory boards with no real power.

Instead, physicians should take leadership positions near the top of the organization. "You can call it what you want," Mertz said. "It could be a joint operating committee of a physician leadership council. The key is the physicians are at the table with the administrators dealing with high-level issues."

The physician leadership council or committee can then delegate to subcommittees nitty-gritty decisions, such as finance and technology. These subcommittees can offer an opportunity for young physicians to get involved in some issue they feel passionate about, and this experience will help develop their leadership skills, Mertz said.

Physicians should also help make decisions throughout the medical group, Mertz said. He recommended dyad structures in which a physician is paired with an administrator.

But creating a structure for physicians to participate won't help the organization unless physicians have leadership skills, said Valenzuela.

Sutter Medical Group of the Redwoods drew up a list of leadership skills from the book "FYI: For Your Improvement — Competencies Development Guide" by Heather Barnfield and Michael M. Lombardo. The top leadership asked physicians and their administrator partners to choose the leadership skills they wanted to improve.

The administrators and physician leaders identified 10 skills to work on, and chose coursework from the Harvard ManageMentor online curriculum that focused on those skills. For example, one module coached the leaders on how to run better meetings.

It can be challenging to justify the time physicians take away from clinical care and the money spent on such training, Valenzuela said. But the group has seen a 25 percent increase in work relative value units (WRVUs), a 41 percent increase in total patient encounters, and 28 percent increase in internal referrals from 2013 to 2015, suggesting that this work has paid off.

To learn more about how you can engage physicians in leadership, please click the button below.

Engage Physicians in Leadership

Topics: Physician Engagement, Marc Mertz, Physician Leaders

Making Sense Out of MACRA and Alternative Payment Models

Posted by Matthew Smith on Aug 4, 2016 3:57:47 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

Providers may have developed a false sense of security that time is on their side—MACRA does not start until 2019, right?  While 2019 is the official date for the new payment models, performance beginning January 1, 2017, will determine 2019 payment adjustments.

CMS published the proposed rule defining their intentions under the new Quality Performance Program on May 9, 2016, and accepted comments on the proposed rule until June 27, 2016. CMS is expected to release the final rule by November, but their goal has remained firm: move 80 percent of Medicare payment to alternative payment models (“APM’s”) by the year 2020.

Path of Advanced APMs

While it may make sense for the majority of providers to initially go down the path with Merit-Based Incentive Payment System (“MIPS”), here is the critical information providers should know if they plan to participate in an Advanced APM.

MACRA outlines significant incentives to encourage providers to participate in Advanced APMs, including a 5 percent bonus starting in 2019 and an exemption from MIPS. The Advanced APM program, unlike MIPS, has no potential penalties. However, participation will not come easy. CMS set the standard high and challenges providers to satisfy the Advanced APM criteria.

  • Advanced APMs require providers to accept risk for delivering coordinated, high-quality care. As proposed, Advanced APM models must be a CMS Innovation Center model, a Medicare MSSP ACO, a demonstration under the Health Care Quality Demonstration Program, or a statutorily required demonstration and must meet the following additional requirements:
    • Utilize certified EHR technology
    • Report quality measures comparable to MIPS measures
    • Assume more than nominal financial risk

Initially only the following five Advanced APMs will be recognized under the new rule:

  • Medicare Shared Savings Program (“MSSP”) (Track 2 and Track 3)
  • Next Generation ACO Model
  • Comprehensive Primary Care Plus
  • Comprehensive ESRD Care Model
  • Oncology Care Model

Exclusions Apply

To the dismay of some, three programs have been excluded:  MSSP Track 1, Comprehensive Care for Joint Replacement (“CJR”), and Bundled Payments for Care Improvement (“BPCI”).

CMS will add new payment models and continue to modify models in coming years that satisfy the criteria to qualify as an Advanced AMP. Until 2021, participation requirements for Advanced APMs are only for Medicare payments or patients.

If your organization is trying to determine if moving to an Advanced APM makes sense, you should conduct an organizational self-assessment to identify current capabilities and those still needed to achieve status as an Advanced APM. It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful.

Key Considerations

  • Do you have progressive financial and clinical data analytics and reporting capabilities?
  • Are you prepared to invest in technology and care model redesign to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance?
  • Do you understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where and how providers will be incentivized to achieve these objectives to produce improvements in care coordination and quality?

There is not a one-size fits all strategy, so it is important to know your readiness to participate in an Advanced APM, the different care delivery needs of the community, the scope of risk to be taken, and have the infrastructure in place that will be necessary to achieve success.

MACRA APM


MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at [email protected].  

 

 

Topics: Marc Mertz, MACRA, Alternative Payment Models, APM

Top 10 Actions to Take Now to Prepare for MACRA

Posted by Matthew Smith on Jul 29, 2016 10:11:44 AM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

Most medical groups celebrated the repeal of the sustainable growthrate (“SGR”) and the associated cuts to the physician fee schedule. The SGR was replaced by the Medicare Access and CHIP Reauthorization Act (“MACRA”), a proposed CMS rule that is designed to encourage medical groups to pursue advanced payment models and accountable care.

MACRA replaces several Medicare reporting systems and creates two new programs: the Merit-Based Incentive Payment System (“MIPS”) and Advanced Payment Models (“APMs”). Both programs have pros and cons, but because they are currently scheduled to begin to measure performance on January 1, 2017, medical groups have little time to prepare.

Here are 10 actions your group should be taking now to prepare for MACRA.

  1. Determine your path. The MIPS program replaces the former EHR Incentive (Meaningful Use), Physician Quality Reporting System, and Value-based Payment Modifier programs with four measures of cost, quality, information technology (“IT”) use, and clinical practice improvement activities. How well your group performs on these measures compared to your peers will determine whether your Medicare payments are increased or cut by up to 9 percent by 2022. The APM path is for groups that are willing to take up- and down-side risk under new payment models, including select ACOs, medical homes, and bundled payments. APMs offer a 5 percent bonus payment.

    Many groups would rather avoid the reporting requirements, uncertainty, and potential payment reductions of MIPS. Unfortunately, qualifying for APM will be a challenge unless your group is already in a qualifying program – especially given the January 1, 2017 proposed start date. This aggressive timeline is one of the criticisms of MACRA, and CMS may push back the start date in the final rule. At this point, a vast majority (some projections are as high as 90 percent) of medical groups are expected to pursue MIPS, at least initially. Groups that start under MIPS can apply to move to APM in subsequent years.

  2.  Educate and engage your providers. Under the current performance based incentive programs, groups are rewarded for simply reporting data. If you start under MIPS, you will receive bonuses or pay cuts based on your actual performance against other groups. Active provider participation and engagement are imperative for improving your performance on the MIPS measures for cost, technology use, quality, and clinical practice performance. Start now by educating your providers on MACRA and the crucial role they play in your group’s success. Inform them that their scores will be published on Physician Compare for public consumption. Evaluate your physician compensation plan to ensure that incentives are aligned with your MACRA objectives.
  3. Assess your current technology. Health IT (“HIT”) is foundational to MACRA, which requires participants to use certified electronic health records technology (“CEHRT”). While the number of meaningful use measures has decreased, groups may have HIT challenges relating to interoperability and the exchange of information. Although vendors have made great advances in recent years, gaps still exist, and the development of new capabilities and analytics continues. To meet MACRA requirements specifically relating to the collecting, monitoring, and reporting measures and scores, groups may require additional IT capabilities beyond the CEHRT. Additionally, there is an increase in the use of Qualified Clinical Data Registries (“QCDR”) to collect clinical data to better manage the delivery of care, ultimately improving the quality.
  4. Know your quality measures. APMs typically have a prescribed set of measures based on the program whereas, under MIPs, providers have the option to select measures. However, MACRA does require that quality measures used in APMs be comparable to those used in MIPS. Knowing your quality measures, and if applicable, selecting the right measures, is key as your group’s performance will be determined based on how you compare to peers. It is important that you identify the measures applicable to your group, considering your provider specialty mix and patient population, and then create workflows to support the data capture of such measures. A good place to start is the Quality and Resource Use Report (“QRUR”) since this report compares your scores relative to your peers by calculating the standard deviations from the national mean for both quality and cost. There is also a high-risk bonus adjustment that is based on ICD-10 coding, so accurate diagnosis coding assignment is critical.
  5. Track provider performance. Monitoring your group’s performance at an individual provider level on a consistent basis is vital since every point matters. Groups need to track performance monthly and compare the values to peers as well as targets. Your exceptional performance scores do not guarantee success since your current performance is compared to future benchmarks, which are unknown at this time. Also, CMS has allocated millions of dollars to reward high performing providers who land above performance thresholds, so aiming high may get you additional dollars.
  6. Form a steering committee. Whether you pursue APM or MIPS, it will be important that your group is strategically aligned and that your efforts are coordinated. Much work will be necessary to ensure that your group has capabilities for measure selection, data capture and reporting, workflow analysis and/or development, training, and performance monitoring. A multidisciplinary steering committee consisting of physicians, management, IT, other providers, and staff can be a powerful way to align the group and to address the broad array of tasks. The steering committee will be charged with creating the MACRA strategy and a high level work plan. Members will oversee the plan’s progress, timeline adherence, and provide direction for resolution of any obstacles impacting the plan.
  7. Implement a change management program. Success under MACRA will require strategic and operational changes; change can be difficult to implement and even more difficult to maintain. Consider using a formal change management program that will combine a well-executed plan for change with the leadership needed to sustain that change over time. When executing tactical plans and projects, many groups focus solely on technical change strategies, while change management, like GE’s Change Acceleration Process (“CAP)” program, focuses on both the technical changes and change leadership. Change leadership is an essential, but often overlooked aspect of change strategy; it addresses the human or cultural component that provides the spark needed to activate change. Change leadership will align, mobilize and motivate all stakeholders with a shared vision to support the MACRA program, making success a reality.
  8. Consider partnership opportunities. APM and MIPS both present challenges, especially to smaller groups, that might be easier to overcome with partners. APMs require a group to take downside risk. Groups that do not have experience with risk or have a small patient population can benefit from joining an independent practice association (“IPA”), physician-hospital organization (“PHO”), clinically integrated network (“CIN”), or ACO that can provide care management capabilities, as well as spreading actuarial risk over a larger population. Success under MIPS will require technology resources, care management, and practice operational capabilities that may not be financially sustainable for small groups. Medical groups that have patient-centered medical home (“PCMH”) status receive full credit for achieving the MIPS Clinical Practice Improvement Activities measure, so groups should consider joining a network or hiring an MSO that can provide resources or capabilities to support a PCMH.
  9. Develop care management capabilities. Success under MACRA will require that groups deliver value by improving quality, outcomes, and patient experience while reducing costs. Use data to understand how your group performs today and where there are specific opportunities to improve. Then work with your physicians and staff to develop and implement care management capabilities that support higher performance. You should also look outside the walls of your group to partner with other providers, community resources, and your patients to more effectively manage the health of your population.
  10. Create a roadmap in 2016. MACRA reporting is scheduled to begin in January 2017; hence, the time is now to create a plan and roadmap. Understanding your group’s current challenges will be important as you develop your roadmap. Once you activate your plan, monitor your progress monthly and make any updates based on the final rule. Even if MACRA reporting is delayed, you will have a head start.

If groups take these 10 actions, they will be in a better position to transform the care that is delivered based on the Triple Aim of better care, better experience, and lower cost. And they will be rewarded financially under MACRA.

MACRA


MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at [email protected].  

 

 

Topics: Medical Groups, Lucy Zielinski, Marc Mertz, MACRA, CAP, Change Acceleration Program

Primary Care at a Crossroads

Posted by Matthew Smith on Jul 25, 2016 2:42:30 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

Most primary care practices still operate based on a model developed decades ago: the hours of operation, appointment scheduling rules, staffing, patient flow, and office design were all determined based on physician preference. In an attempt to provide physicians with a more convenient practice model, we created a system that forced patients to accept long waits for appointments, inefficient office flow, and limited ability to communicate with their physicians outside of the exam room.

Yet physicians hardly fared any better in these offices that were actually designed with them at the center. Complex appointment scheduling rules and templates inherently led to mistakes and double booking, phone messages piled up, administrative work increased, patient appointments ran behind, and physicians inevitably spent hours working in the clinic long after patients had left.

While the typcial primary care practice doesn't really work for patients or physicians, in the absence of alternatives, we came to accept this model for what it was. But times are changing. A plethora of new providers are entering the primary care marketplace, and their growing popularity is as much an indictment on traditional physician-centric primary care practices as it is a reflection of new reimbursement models and rising consumerism.

To contunue reading "Primary Care at a Crossroads," please click the button below. You will instantly be directed to the online article published in CAPG Health's Summer 2016 issue.

Primary Care, Practice Management, Practice Transformation


MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at [email protected].  

Topics: Practice Management, Primary Care, Primary Care Providers, Primary Care Access, Marc Mertz, Practice Transformation

Redefine Your Practice's Care Team to Promote Patient-Centered Care

Posted by Matthew Smith on May 20, 2016 11:13:16 AM

Article and video courtesy of MGMA.com

“If we’re not making the patient the boss right now, someone else is going to get our business. It’s as simple as that,” said William Faber, MD, MA, MS, senior vice president, GE Healthcare Camden Group, who spoke about the changing patient relationship during the MGMA/AMA Collaborate in Practice conference, March 20-22, Colorado Springs, Colo.

Faber and Marc Mertz, MHA, FACMPE, MGMA member, vice president, GE Healthcare Camden Group, elaborated on the topic during an exclusive video interview with MGMA [video below].

“We’re reaching a crossroads,” Mertz says. “Historically, practices have been very physician-centric in the way they operate [from scheduling appointments to physical exams]. Yet patients are increasingly demanding greater access and more information to be engaged in their care.”

Responding to that new dynamic requires a fundamental shift in practice operations. “In the past, practices competed against other practices,” Mertz adds. “Now there are retail clinics, urgent care clinics and concierge medicine. Patients will go where they can get the type of care they want.”

Accommodating Patient Demands

Meeting patient needs might require expanded hours, technology that allows patients to schedule appointments, get test results and ask questions online and a care team approach to increase access.

“The main issue is teamwork,” Faber says. “The doctor cannot just look at him- or herself as the full answer to the patient’s needs.” The more realistic answer, which will boost sagging morale, is to create a network. “Work with social workers, retail clinics, urgent care centers and care managers to address these needs,” he suggests. “Taking care of patients now is more of a team sport.”

Encouraging Change

“We are still incentivized to fill the schedule with as many patients as we can,” Mertz says. “Until some of the financial reimbursement models change, I think it will be hard for people to change.”

However, making small adjustments can ease the growing burden on doctors, Faber explains.  For example, he suggests that groups “Participate in new compensation programs that reward doctors for that which only doctors can do,” which means assigning low-acuity patients to other team members.

Collaboration between physicians and administrative leaders (dyads) is key for success. “I think of it as a marriage,” Mertz says. “They’re both jointly responsible and accountable for all aspects of the practice,” which means that neither party should shirk responsibility for clinical aspects or practical pieces of the business. “It’s a true partnership.

“Physicians are ultimately responsible for the clinical care but practice administrators need to be there to push and to challenge, to bring new, innovative technology, new processes and procedures to the table,” Mertz adds.

One new process they recommend: Create a network of facilities that provide convenient access for your patients and consider that network as your care team. “The biggest impediment is the human tendency to stay with what always worked before, just keep doing the same old thing,” Faber explains. “We’re practicing medicine as though it stayed stagnant in the 1970s or ’80s, and everything [has] changed around us.”

Watch more of the interview:

Webinar, Patient Experience, Patient Satisfaction

Topics: William K. Faber MD, Patient Access, Marc Mertz, Care Model, Care Delivery, Patient-Centered Care

Strength In Numbers: Super Clinically Integrated Networks Built to Improve Healthcare Value

Posted by Matthew Smith on Mar 22, 2016 2:27:39 PM

Graham A. Brown, MPH, CRC, Vice President, and Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

As organizations assess their capabilities, resources, and infrastructure to succeed in evolving value-based reimbursement structures, many health systems have begun to partner with other health systems in a manner that allows organizational independence but fosters collaboration in areas where synergies may exist, specifically around population health management.

The creation of super clinically integrated networks ("SCINs") reflects this trend. For some, these SCINs are merely a stepping stone to full integration or merger, but to most, these affiliations are viewed as a vehicle to strengthen each of the independent members by collectively joining forces to improve healthcare value.

These SCINs could have significant strategic potential if they are able to organize appropriately, prioritize initiatives, and advance to the level of jointly assuming risk, developing effective care models, and positioning the members as an attractive option to healthcare purchasers.

Often, SCINs embark on relatively low risk activities at the outset such as optimizing the supply chain, sharing services and overhead, sharing clinical knowledge around best practices, and improving patient access (particularly when organizations are in different markets).

While these may be reasonable starting points that help to garner trust and build momentum, they will not be solid long-term strategies on their own to support sustainability of the SCIN or lead to return on investment for its members.

Establishing goals and objectives of the SCIN at the outset with cohesive strategy formulation and buy-in, as well as ensuring that it is properly resourced, will be integral to their success.

As mentioned, most SCINs that have been formed have a goal of developing joint population health management infrastructure. Defining exactly what this means and responsibilities of the SCIN versus responsibilities of each individual member is a key initial step.

Certainly, there is extensive cost associated with developing the proper infrastructure to support population health. Thus, the economic opportunities to the SCIN should be evident when compared to resourcing population health initiatives as individual organizations.

Ultimately, as the population health infrastructure is built and care model effectuated, there are many opportunities to better manage care and impact overall value. Many SCINs endeavor to offer an attractive, efficient delivery network to self-funded employers via direct to employer contracting; and this activity often begins with their own collective employee health benefits programs. More advanced SCINs progress to joint payer contracting but will need to have achieved clinical and/or financial integration to an acceptable level.

Shifting of financial risk from major payers to the SCIN through a plan-to-plan type arrangement or global capitation are other alternatives as the SCIN evolves and is better equipped to manage risk. Further, the individual exchange marketplaces and Small Business Health Options Program (“SHOP”) allow these advanced delivery networks to access individuals and small groups in an efficient manner and compete more quickly with larger carriers.

Depending on the overall goals, objectives, market characteristics, and current capabilities of each individual member and the SCIN, a provider sponsored health plan may be another opportunity to consider. Between 2012 and 2015, 54 percent of the new Medicare Advantage plan entrants were provider owned.

There is great risk in starting a health plan, but sharing this risk across organizations in the SCIN could be a mechanism to diffuse risk and share collective resources. Additionally, the mere scale in size of the SCIN provides a larger pool of lives than any individual system would have on its own. While the task seem to daunting, particularly at a time when the healthcare system is changing rapidly, embarking on these initiatives collectively may prove to be the best strategy.

There is significant opportunity for super clinical integrated networks to chart their own path and truly transform the delivery system in a positive manner. However, coordinating efforts across multiple large organizations that remain independent is not without its challenges.

Starting with the basics is a reasonable first step so long as there is a well thought out strategy and plan to more fully develop the organization to its potential.

Each individual organization will have its separate priorities. Determining how the SCIN moves forward as “one” while supporting the independence and priorities of the individual organizations will be key to their success.

An effectively designed governance structure of the SCIN that includes the chief executive officer of each member, along with one other key leadership position, is recommended. This will allow nimbleness of the SCIN in decision-making, but will also foster effective communication and alignment of strategies.

Those organizations that can pull it all together could easily set themselves apart and have significant strategic advantage in their respective market(s). Developing a detailed strategic framework for the SCIN that all parties support and holding each other accountable will serve as a foundation of success for these organizations.


BrownG.jpgMr. Brown is a vice president and clinical integration practice leader with GE Healthcare Camden Group and has over 25 years of experience in the areas of payer negotiations, program administration, and change management with healthcare provider, payer, government, and human service clients. He is an experienced leader in business planning and implementation for clinical integration and accountable care organization development across the U.S. He may be reached at [email protected].

 

MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at [email protected].    

 

This article was originally published by Modern Healthcare Executive, November 27, 2015

Topics: CIN, Clinically Integrated Networks, Clinically Integrated Network, Marc Mertz, Graham Brown, Super CIN

Super Clinically Integrated Networks Offer Unique Opportunities

Posted by Matthew Smith on Dec 8, 2015 2:09:45 PM

By Graham Brown, MPH, Vice President and Clinical Integration Practice Leader; Marc Mertz, MHA, FACMPE, Vice President and Physician Services Practice Leader, GE Healthcare Camden Group

As organizations assess their capabilities, resources, and infrastructure to succeed in evolving value-based reimbursement structures, many health systems have begun to partner with other health systems in a manner that allows organizational independence but fosters collaboration in areas where synergies may exist, specifically around population health management.

The creation of super clinically integrated networks ("SCINs") reflects this trend. For some, these SCINs are merely a stepping stone to full integration or merger, but to most, these affiliations are viewed as a vehicle to strengthen each of the independent members by collectively joining forces to improve healthcare value.

These SCINs could have significant strategic potential if they are able to organize appropriately, prioritize initiatives, and advance to the level of jointly assuming risk, developing effective care models, and positioning the members as an attractive option to healthcare purchasers.

Often, SCINs embark on relatively low risk activities at the outset such as optimizing the supply chain, sharing services and overhead, sharing clinical knowledge around best practices, and improving patient access (particularly when organizations are in different markets).

While these may be reasonable starting points that help to garner trust and build momentum, they will not be solid long-term strategies on their own to support sustainability of the SCIN or lead to return on investment for its members.

Establishing goals and objectives of the SCIN at the outset with cohesive strategy formulation and buy-in, as well as ensuring that it is properly resourced, will be integral to their success.

As mentioned, most SCINs that have been formed have a goal of developing joint population health management infrastructure. Defining exactly what this means and responsibilities of the SCIN versus responsibilities of each individual member is a key initial step.

Certainly, there is extensive cost associated with developing the proper infrastructure to support population health. Thus, the economic opportunities to the SCIN should be evident when compared to resourcing population health initiatives as individual organizations.

Ultimately, as the population health infrastructure is built and care model effectuated, there are many opportunities to better manage care and impact overall value. Many SCINs endeavor to offer an attractive, efficient delivery network to self-funded employers via direct to employer contracting; and this activity often begins with their own collective employee health benefits programs. More advanced SCINs progress to joint payer contracting but will need to have achieved clinical and/or financial integration to an acceptable level.

Shifting of financial risk from major payers to the SCIN through a plan-to-plan type arrangement or global capitation are other alternatives as the SCIN evolves and is better equipped to manage risk. Further, the individual exchange marketplaces and Small Business Health Options Program (“SHOP”) allow these advanced delivery networks to access individuals and small groups in an efficient manner and compete more quickly with larger carriers.

Depending on the overall goals, objectives, market characteristics, and current capabilities of each individual member and the SCIN, a provider sponsored health plan may be another opportunity to consider. Between 2012 and 2015, 54 percent of the new Medicare Advantage plan entrants were provider owned.

There is great risk in starting a health plan, but sharing this risk across organizations in the SCIN could be a mechanism to diffuse risk and share collective resources. Additionally, the mere scale in size of the SCIN provides a larger pool of lives than any individual system would have on its own. While the task seem to daunting, particularly at a time when the healthcare system is changing rapidly, embarking on these initiatives collectively may prove to be the best strategy.

There is significant opportunity for super clinical integrated networks to chart their own path and truly transform the delivery system in a positive manner. However, coordinating efforts across multiple large organizations that remain independent is not without its challenges.

Starting with the basics is a reasonable first step so long as there is a well thought out strategy and plan to more fully develop the organization to its potential.

Each individual organization will have its separate priorities. Determining how the SCIN moves forward as “one” while supporting the independence and priorities of the individual organizations will be key to their success.

An effectively designed governance structure of the SCIN that includes the chief executive officer of each member, along with one other key leadership position, is recommended. This will allow nimbleness of the SCIN in decision-making, but will also foster effective communication and alignment of strategies.

Those organizations that can pull it all together could easily set themselves apart and have significant strategic advantage in their respective market(s). Developing a detailed strategic framework for the SCIN that all parties support and holding each other accountable will serve as a foundation of success for these organizations.

This article was originally published by Modern Healthcare Executive, November 27, 2015


Mr. Brown is a vice president and clinical integration practice leader with GE Healthcare Camden Group and has over 25 years of experience in the areas of payer negotiations, program administration, and change management with healthcare provider, payer, government, and human service clients. He is an experienced leader in business planning and implementation for clinical integration and accountable care organization development across the U.S. He may be reached at [email protected] or 585-512-3905.

 

mertz_headshot.pngMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at [email protected] or 310-320-3990.    

 

Topics: CIN, Clinically Integrated Networks, Clinically Integrated Network, Marc Mertz, Graham Brown, Super CIN

Five Ways Medical Groups Can Prepare for Value

Posted by Matthew Smith on Sep 8, 2015 1:52:07 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

Healthcare payment is transitioning from fee-for-service to value-based. Although individual markets and organizations are at different stages of this transition, recent actions of the Centers for Medicare & Medicaid Services and commercial payers clearly indicate that the industry is moving in a single direction.

Here are five things that medical groups should be doing right now to prepare for value.

1. Reduce Costs

To prepare for success under value-based payment models, including risk-based contracts, medical groups need to take a critical look at their costs. The majority of medical group operating costs are in just a few areas: physicians and other providers, staff, facilities, equipment, and supplies. Physician compensation warrants its own discussion (see below), but groups should develop cost-accounting capabilities to evaluate and monitor the other cost categories. Each category of expense should be regularly compared against industry benchmarks. As outliers are identified, groups should quickly develop action plans to bring the expenses in line.

As groups advance into value-based models (including shared savings and risk-based models) they will be held accountable for the cost of care provided. Groups should prepare for this scenario now by collecting total claims data from payers and implementing systems for monitoring and reporting costs by clinical category and by physician.

2. Evaluate Contracting Opportunities

Medical groups are responding to the industry’s shift to value by beginning to develop population health management and care coordination capabilities. While these new approaches are largely about eliminating waste and providing the appropriate care at the right time, they may reduce a group’s payment under a fee-for-service contract. Any reductions in utilization or costs may help the patient, and certainly the payer’s bottom line, but do little to compensate the medical group that has invested in the care model redesign, IT, and staffing necessary to implement population health management.

Medical groups should take a more aggressive and proactive approach to payer contracting. Rather than waiting for health plans to offer new payment models while they invest in care redesign, groups should identify opportunities to negotiate care management payments or shared savings arrangements that allow the group to share in the cost reductions it generates. As the group gains experience, it can consider more advanced models, including risk-based models.

3. Update Physician Compensation and Incentives

As payment models change, medical groups should consider redesigning physician compensation models. Most physician compensation plans are predominantly based on volume—work relative value units, revenue, or charges. As groups progress down the path to value, they will need to implement performance measures such as patient satisfaction, access to care, quality scores, and other indicators that support population health management. Rewarding the behavior changes and the clinical cultural transformation necessary for success in the new value-based models is critical.

Consider the use of a physician compensation committee to ensure compensation plan design and performance measures reflect the objectives and values of the group, and to gain buy-in and support. The committee should include administrators and a representative number of primary care, specialty, and hospital-based physicians.

A new compensation plan should be implemented in a way that allows physicians to modify behaviors based on the new incentives. Consider a phased-in approach or “shadowing” process, in which physicians are paid under the old model but receive reports regarding projected performance under the new model.

4. Create Dashboard Reports to Monitor Performance

Ready access to data allows an organization to quickly respond to opportunities and to correct underperformance before it becomes a major issue. During the transition to value, medical groups should continue to monitor traditional key performance indicators such as physician productivity, revenue cycle performance, and operating costs while beginning to track value-based indicators such as cost of care, quality, patient satisfaction, patient access, and gaps in care. To facilitate this level of monitoring, the organization must develop dashboard reports that quickly indicate group performance relative to targets, and that highlight deficiencies. These reports should be shared often, and action plans developed to address any instances of underperformance.

5. Evaluate Your Fee Schedule

Groups should be aware that price transparency is increasing at a rapid pace. Reporting organizations are collecting charge data from medical groups and sharing it with the public via websites and other forums. Meanwhile, the prevalence of high-deductible health plans is increasing and patients are taking a more active role in deciding what care they receive and where they receive it. Groups with high published rates may very well see patients avoiding their services.

Hospital-based clinics that charge a facility fee in addition to professional fees should evaluate whether the high payment is being offset by decreased volume and higher patient dissatisfaction. All medical groups should evaluate their fees in the wider context of their market and consider how patients would view those fees. Groups then should consider promoting transparency by posting the prices for common services on their websites.


Mr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. Mr. Mertz has managed private practices, hospital-affiliated practices, and academic physician practices. The Medical Group Management Association (“MGMA”) has identified practices under his management as “Best Performing.” He may be reached at [email protected].  

Topics: Value-Based Reimbursement, Physician Compensation, Payment-for-Value, Marc Mertz

Are Your Primary Care Practices at Risk?

Posted by Matthew Smith on Aug 28, 2015 12:56:41 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

If your primary care practices are like most traditional medical offices, they have been designed with the physicians’ preference and convenience in mind. The physician decides which days they will work, the hours they will see patients, the types of appointments they will see, as well as when they will see them. As a result, patients might wait weeks for an appointment. When they do get an appointment, the patient’s experience does not get much better: they wait to be seen, they have to fill out long forms, and they have little face time with the physician. Patients are not the only ones dissatisfied with the status quo. Despite being at the center of the current practice model, primary care physicians are not satisfied with the way their practices are structured; increasing burdens to provide care coordination and quality monitoring while improving patient access makes them feel increasingly overwhelmed and dissatisfied.

An Increasing Pressure to Change

The medical office described above has not changed much in the last 30 years, aside from perhaps the addition of electronic medical records (“EMRs”) or other technologies. Practices have felt little pressure to change their business model, and patients really have not had any other options. That is changing, however, and it is changing very quickly. Retail giants such as Walgreens, CVS, and Walmart are aggressively expanding their clinical services, including primary care. Urgent care centers are popping up seemingly on every corner. The reason for such rapid growth is that these new providers offer patients everything that traditional primary care practices do not: access, convenience, and efficiency.

Is it so farfetched to think that these new providers could ultimately replace primary care as we know it today? Blockbuster probably thought it unlikely that Netflix and its online movie downloads and streaming would drive them out of business. Kodak did not foresee digital photography essentially eliminating the film camera industry. But if these dominant players in long-established industries can be replaced, why not primary care practices?

New Options for House Calls

A primary care practice that continues the status quo ultimately faces a slow death spiral. Every time an established patient gets sick, and they cannot get in to see their physician for several days or even weeks, they are going to go to an alternative provider. And they may never come back. Rather than take the afternoon off from work to see their primary care physician, a patient might stop in and see a nurse practitioner at their drug store after work and be in and out in 20 minutes. Or in some markets, they might use an app on their phone like Amwell to have a virtual visit without leaving their home, or even request an on-demand home visit from an Uber-like service. Patients in major U.S. cities now have multiple options for house calls. Pager is a new service that allows patients in New York to schedule a house call within 2 hours and pay a flat fee per visit. Will your primary care practices be blindsided by Pager just as taxi companies were by Uber?

Retail clinics and other alternative delivery models currently offer a limited scope of services but are expected to expand their services. They will also continue to introduce remote monitoring and telemedicine devices that allow them to engage and monitor patients, as well as manage their chronic conditions, increasingly competing with traditional primary care practices for patients.

Patients are not the only ones looking for alternatives to the current primary care delivery model. Dissatisfied primary care physicians are also looking for more rewarding practice models that do not overwhelm them with long days, an inefficient EMR, and ineffective work flows. Primary care groups risk losing their current physicians and face increasing recruitment challenges.

Where Should You Start?

So where should a primary care practice start? By expanding patient access? Increasing the efficiency of their office and patient flow? Improving patient service? Implementing enhanced technology such as a patient portal and home monitoring devices? Partnering with retail clinics and other innovators? The answer is all of the above. And fast.

Appointment scheduling should be easy, both via telephone and online. Patients should be able to get an appointment when they want it, and that includes the same day. To achieve this, practices must reevaluate the number of types of appointments they offer. They may also have to expand their office hours to include evening or weekends. Physicians need to let go of their perceived control over daily schedules. Rather than cling to a system that does not work for anyone—the patient, physician, or the staff— primary care practices should start over with no more than four appointment types: long and short new patient visits and long and short established patient visits; in many cases this can even be boiled down to two appointment types. Not every appointment will fit perfectly into one of these slots, but the flexibility and simplicity of the scheduling will save time and improve access and satisfaction.

Primary care physicians already use advanced practice clinicians (“APCs”), typically nurse practitioners or physician assistants. In many offices, several physicians will share an APC, who will see the physicians’ sick patients or routine cases. By flipping the ratio of physicians to APCs, a practice can expand access at a lower cost. A single primary care physician can supervise a team of two or three APCs, each of whom manages his or her own panel of patients. The physician handles the complex patients and is available to support the APCs whenever necessary.

Patients do not like to spend two hours in your primary care office, especially when they get just a few minutes with the physician. Every aspect of the patient’s visit and experience should be assessed with a critical eye for any waste or delays. Time studies that track each component of the visit can help identify bottlenecks. Once inefficiencies or waste are identified, engage a multidisciplinary team to redesign the process. Then test and redesign again continuously to improve.

The greatest influence on patient satisfaction is not the physician or the office décor. It is your staff. Recruit employees with this in mind. Train your staff on customer service skills. Physicians must also lead by example. Patients are being seen to receive clinical care, but they must also be treated like customers and human beings.

Optimize the EMR

One of the biggest barriers to office efficiency, as well as a major source of physician dissatisfaction, is the EMR. As new systems have been implemented, practices have modified their procedures and processes to adapt to the EMR design and structure, rather than the other way around by adapting the EMR to serve as a tool to help meet the needs of the practice. This case of the “tail wagging the dog” typically means more work for the physicians and staff— often a lot more work. As a result, efficiency and patient volume have declined, which also reduces patient access. System inefficiency also leads to physician and staff dissatisfaction. Practices need to assess how they use their EMR and identify ways to optimize the system based on efficient work flows and an appropriate delegation of tasks to the lowest cost individuals whenever possible.

Furthermore, consider how your primary care practice will deliver care without requiring patients to come to the office. Relying solely on the traditional face-to-face office visit is quickly becoming archaic. Determine what fits best in your practice: patient portals for secure e-mail messaging, televisits, group visits, home visits, use of other support staff such as educators and pharmacists to respond to patient questions, or partnering with innovators to extend your reach to retail or other settings all must be considered as potential venues for extending the access points for your patients.

Overhauling your primary care practices is no small undertaking. However, failing to do so puts your organization at significant risk, as patients will increasingly seek out providers who offer greater access, convenience, and service. Inefficient and ineffective primary care practices will also make the recruitment and retention of primary care physicians even more difficult than it already is. More than just a defensive effort, redesigning your practices with the patient in the center is good for care delivery and for business.


Mr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. Mr. Mertz has managed private practices, hospital-affiliated practices, and academic physician practices. The Medical Group Management Association (“MGMA”) has identified practices under his management as “Best Performing.” He may be reached at [email protected]

Topics: EMR, Primary Care, Primary Care Access, Primary Care Provider, Marc Mertz, EMR Optimization

Quick Tips for Improved Patient Access

Posted by Matthew Smith on Jun 9, 2015 12:27:34 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

It is hard to have a conversation about healthcare today without mentioning quality. Government and commercial payers are putting increasingly larger portions of providers’ reimbursement at risk for performance on quality measures. Employers are seeking high-quality providers to help maintain a healthy work force. Patients assume that their physicians are high quality. Public reporting sites are introducing a new level of transparency regarding physicians’ quality scores. All of this increased emphasis on quality is justified, and an organization should strive to provide and demonstrate high-quality care. But if patients cannot access your services, it is all for naught.

The Importance of Patient Access

Not only does a lack of patient access impact the ability to provide quality care, but it also impacts your financial performance.

In a fee-for-service environment, poor access means lower volume and lower revenue. In a fee-for-value environment, groups must demonstrate high-quality care and high patient satisfaction--a lack of access will impact both. Regardless of the reimbursement model, a lack of access will drive patients to find other providers. Those other providers are no longer limited to medical groups, as new providers of care are entering the market. Retail providers are rapidly expanding their number of locations and the services that they provide. These locations offer immediate access and low costs, and are often affiliated with health systems or networks. Once patients visit one of these locations they might not return to their original provider.

Getting Started

Evaluate Current Wait Times

Start to address access by evaluating current wait times for appointments in existing care locations. The third next available appointment is a commonly used metric to measure access in a medical group. Best practice is within 24 hours for primary care and three days for specialty services (although some specialties like oncology are increasingly offering same or next-day appointments). Calculate the practice’s patient demand versus practice capacity and implement strategies to increase capacity as needed.

Add Providers and/or Access Points

If access is poor and your physicians are highly productive, then consider expanding the group by adding providers or new access points. If your access is poor and productivity is low, consider evaluating processes: are appointment schedule templates structured correctly, are appointments the correct length, and are staff trained appropriately?

Allow Patient Self-Scheduling

Consider allowing patients to schedule their own visits through a patient portal, providing evening and weekend hours, offering e-visits, and communicating by e-mail and text.

Review Office Operations

Inefficient office operations will also create waste and reduce access. Assess the workflows in the office, and redesign processes so that patient flow is efficient.

The Pyramid of Success

The Pyramid of Success (below) identifies the access points that are the highest priority. Health systems and hospitals are adding hospitals, clinics, health plans, direct contracts with employers, physician practices, and ambulatory sites to their continuum of care delivery system/network. Increasing the number of access points listed at the bottom of the pyramid will help a hospital or health system reach a broader population and support the services listed higher up in the pyramid.

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Mr. Mertz is a vice president with GE Healthcare Camden Group and has 20 years of healthcare management experience. He has 17 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. Mr. Mertz has managed private practices, hospital-affiliated practices, and academic physician practices. The Medical Group Management Association (“MGMA”) has identified practices under his management as “Best Performing.” He may be reached at 310-320-3990.    

Topics: Patient Access, Practice Management, Patient Engagement, Marc Mertz, Medical Practice Workflow

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