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Top 10 Trends for 2017: Twists and Turns Ahead!

Posted by Matthew Smith on Jan 19, 2017 1:31:54 PM

By Laura P. Jacobs, MPH, President, GE Healthcare Camden Group

No one can say that the healthcare landscape is boring – and 2017 may be an especially interesting ride. Repeal/Replace? New transactions? Impact of digital? How will consumers behave? Who will the new disrupters be? How will population health models evolve? Who will merge with whom? The year will bring incremental changes in a variety of arenas, and it could deliver monumental shifts in other ways. Here’s how we size up the top trends and the related management imperatives to succeed:

1. Repeal, Replace, or Revise

The fate of the Affordable Care Act (ACA) is still uncertain, but regardless there will be changes to which healthcare organizations must respond. Major changes to Medicare, Medicaid, and individual coverage may not take effect in 2017, but financial planning will take heightened importance to identify potential scenarios for ensuing years. High deductible health plans and HSAs, price transparency, and continued focus on affordability will put pressure on providers to deliver value in order to win.

2. The March to Value Continues

Regardless of the specific changes that may come with changes to the ACA, payers (Medicare, Medicaid, employers, and commercial insurance carriers) will continue to seek ways to lower costs and improve the experience for patients. The Centers for Medicare & Medicaid Services (CMS) will continue to link payments to performance on a variety of outcomes (e.g. hospital-acquired conditions, readmits, value-based measures). The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) will have significant impact on physician reimbursement, and as a result will galvanize integrated delivery systems, physician networks, and medical groups to implement efficient ways to demonstrate quality, patient experience, effective use of electronic medical records, and overall efficient resource utilization. Medicaid is moving to managed care in many markets, and commercial carriers and employers will continue to emulate many of the CMS payment models: ACOs, bundled payment, pay-for-performance.

The lines between payer and provider will continue to blur, as payers acquire or provide services to providers (note Optum’s [United Health Group] recent announcement of its purchase of Surgical Care Affiliates [SCA], a leading ambulatory surgery center and surgical hospital provider). With the expected growth of the Medicare Advantage market, providers will evaluate their role as partners or competitors with payers in this space. We expect to see more joint venture or partnership arrangements between payers and providers to launch new health plan products or delivery models. We will also likely see more large, self-insured employers reaching out to providers seeking performance-based payment models to drive lower overall health costs and better outcomes.

Harmonizing your population health strategies with your market’s pace of movement to value-based payment may be one of the most important strategies for your organization: moving too fast or too slowly could challenge both market position and financial performance.

3. The Cost Imperative

While value-based payment models require healthcare organizations to demonstrate quality and patient experience outcomes, the predominant focus is still on cost. With governmental budget pressure, employer pressure on commercial premiums, and in some markets highly consolidated payer dynamics, providers will continue to be challenged to reduce costs and find new efficiencies in the delivery of care. The focus for providers will be to redesign patient throughput, reduce variation through defined work flows and clinical protocols, and optimize use of existing facilities. Capital preservation will be as important as operating expense management to sustain or improve financial performance. Some leading hospitals are developing capacity command centers that combine systems engineering principles, commonly seen in industries such as aviation and power, with predictive analytics to manage and optimize patient flow, safety, and experience – and avoid costly outlays for new bed towers or surgery centers. Bottom line for healthcare leaders is that traditional ways of reducing costs (across the board spending cuts or layoffs) will not create the sustainable cost or quality advantages that will be necessary to succeed either in the short- or long-term. This means re-engineering the process of care across the continuum, engaging clinicians in every aspect of redesign, and imbedding a culture that supports effective change management become increasingly critical.

4. Let’s Make a Deal

Consolidation will continue across the industry. Payers will continue to consolidate as a result of continued premium pressures and the need to defray infrastructure costs. Provider transactions in every form will continue to be active in the year ahead: hospitals, surgery centers, physician groups, post-acute providers, population health “enablement” companies, technology companies , and others will come together in a variety of combinations. Organizations will seek partnerships to serve larger populations, acquire business expertise in a new area, and find efficiencies. With some organizations at a peak in their expansion or acquisition activity, 2017 will also be a critical time to focus on integrating the components that have been acquired or merged. Unless a concerted effort is put in place to identify, structure, and activate an integration plan that is designed to realize the intended goals, many organizations may find they have over-reached or cannot achieve the expected benefits of the expansion.

5. Consumerism Continues to Strengthen

Healthcare has traditionally not been very consumer-friendly (arcane billing practices and charges, hard to make appointments, fragmented care, access on the provider’s terms and so forth). But with deductibles that will increase again in 2017, as well as new disrupters in both the digital and care delivery space, providers must pay closer attention to the consumer experience – whether or not they have actually been a “patient” yet. This means price transparency, access where, when, and how the patient desires, quality reporting, a social media strategy, and digital outreach to create consumer awareness and loyalty will be increasingly important. Determining the definition and attributes (not just the logo) of the health system’s “brand” must carry through all venues of care, whether the consumer uses an app, a website, a phone, or an in-person visit to interact with the organization.

6. Care Everywhere

Care models will continue to evolve in 2017 thanks to the explosion of mobile technology, applications for home and self-monitoring, and the expansion of urgent care facilities and retail care centers. Private equity-backed as well as employer-backed new models for primary care, complex care, and digital tools will continue to proliferate. Telemedicine and “video-visits” will become more widely used – to improve access to complex care for remote areas as well as to provide greater convenience for consumers who would prefer not to leave their home or office for care. As an example, more than half of Kaiser Permanente’s patient visits are done virtually. Competitors will not be limited to those physically located near or in your service area; the new competitive dynamic will include those that can reach your population by cell phone or the internet. It will be imperative that management establish its access strategy and consider all of the tools available as care is being redesigned.

7. Capitalizing on Digital

After making significant investments in electronic medical records and a plethora of other information technology tools – financial systems, data warehousing, care management, predictive analytics, disease management, scheduling, and reporting among them – there’s a rallying cry to convert this mass of data points into actionable information. The call to action now is not necessarily what the next IT purchase will be, but how will the systems that have been purchased co-exist and even work with one another to optimize decision-making and forward-looking actions. The hospital, filled with “smart” equipment and systems, can be characterized now as a complex data “organism.” True transformation will come when organizations utilize artificial intelligence (AI) and the “internet of things” (digital systems “talking” to each other) to optimize patient flow, productivity, clinical decision-making, and the role of clinicians and other care team members.

8. “Outside the Box” Healthcare Cost Drivers

While inpatient and physician care still account for the majority of healthcare costs, pharmacy costs have been increasing at a faster pace, and will likely to continue to do so into 2017 and beyond. There is a rising focus on behavioral health, as individuals with mental health disorders often generate higher medical costs and greater use of emergency departments. With reimbursement for behavioral health still lagging, providers in this space will see increased demand, but will likely struggle financially unless avenues for reducing costs through care redesign or changes in reimbursement are effected. Population health programs will increase their focus on impacting the social determinants of health, as the impact that areas outside of healthcare (housing, nutrition, transportation) have on health status gains greater awareness. This will require health systems to determine how to optimize relationships with community service organizations to drive better outcomes and better health for at-risk individuals.

9. Clinical Advances Continue

Health systems such as Geisinger Health System are making headlines with their use of DNA sequencing on patients to help refine care protocols and interventions. We will see other examples of the expansion of precision medicine, using an individual’s genetic profile, although it will remain fairly limited in the near term. The Cancer Moonshot and other initiatives funded by the 21st Century Cures Act will provide an impetus for speeding up clinical advances and the introduction of new drugs in the years ahead. Watch for the use of robotics in situations both inside the operating room and at the bedside: lifting, moving, and even interacting with patients. Watch for 3D printing to augment the availability of organs for organ replacement. Academic medical centers and research institutes will have opportunities to partner with technology companies as well as community providers to explore and evaluate medical advances. Venture funding for monetizing intellectual property will continue to flow to those initiatives that make healthcare more cost effective and produce reliable outcomes.

10. Managing the Most Precious Resource

Human capital needs are changing. Workforce management is and will remain of paramount importance as the healthcare world evolves. With labor costs comprising the lion’s share of expenses, it makes sense from a purely financial perspective. But with today’s lower unemployment rate, and demand for many key roles in healthcare outstripping supply, healthcare organizations must prioritize workforce management as a cornerstone to change management and operational excellence. Generational differences demand different approaches and even policies in human resource management. Healthcare workers, including clinicians, non-clinicians, as well as the management team are increasingly facing burn-out due to constant change and ever-rising expectations. New approaches for recruitment, talent development and training, leadership coaching, and workforce management must be embraced as roles, responsibilities, and expectations evolve.

Managing an organization through these changes will not be any easier in 2017 than it was in the past years. Keeping an eye on the horizon, while staying attentive to the buffeting winds on all sides will allow healthcare leaders to maintain perspective and stay focused on making the tough decisions necessary to remain aloft. 

Strategic Planning in Uncertain Times


Jacobs.jpgMs. Jacobs is president at GE Healthcare Camden Group and has been with the firm since 1990. She has more than 30 years of experience in the areas of integrated delivery system development, payer strategy, population health management, healthcare strategic and financial planning, transactions, and governance/ management systems. She is a noted speaker and industry resource on the impact of healthcare trends, most notably the requirements for success in value-based payment models, clinical integration, and creating successful integrated delivery systems. She may be reached at laura.jacobs@ge.com.

 

Topics: Affordable Care Act, Obamacare, Trends, Mergers & Acquisitions, Laura Jacobs, Healthcare Data Analytics, Healthcare Consumerism

Stay Focused While Developing Your System Integration Plans

Posted by Matthew Smith on Oct 20, 2016 4:00:21 PM

By Brandon Klar, MHSA, Senior Manager, GE Healthcare Camden Group

As the healthcare industry continues to experience consolidation and health systems evolve to meet industry challenges, operational integration initiatives present great opportunities to enhance system-wide performance.

Many health systems speak to the integration goals as they design their strategic partnerships, but only a portion develop realistic, achievable, and sustainable integration plans and even fewer accomplish the goals set forth in those plans.

System integration plans fall short and occasionally fail to achieve their desired outcomes most frequently because they lack effective solutions, fail to consider the impact of system operations on the community, and don’t have the necessary support from the workforce. As much as a well-orchestrated integration planning process and an invested leadership team can work to position a system for integration success, a system integration strategy must be grounded in value creation, risk management, and employee engagement to ensure any integration plan to reach its goals.

Value Creation

To achieve success in a value-based world, health systems must actively seek to enhance the value of their clinical services. Defining value as healthcare outcomes per cost, a health system’s pursuit of value creation will involve enhancing the quality of its services while reducing the per unit delivery cost.

Value creation through health system optimization can be achieved through both horizontal and vertical integration strategies. Horizontal integration strategies are focused on reducing unnecessary duplicative resources, enhancing system operational performance, and aligning/optimizing clinical programs and resources. While duplication of select resources and clinical services may be warranted to maintain access in select geographic areas, plans must carefully balance community needs with efficient resource distribution to deliver high-quality cost-effective clinical programs.

Conversely, vertical integration strategies are focused on enhancing the value throughout the continuum of care by effectively positioning access points, redesigning the care model, and promoting information technology and data sharing. As systems form and evolve, seamless handoffs between system providers and multidisciplinary care plans will reduce unnecessary resource utilization and provide for the efficient navigation of patients through the system with high quality and high satisfaction outcomes.

Risk Management

Risk is inherent within every system integration initiative. The term “system integration” can often trigger employment uncertainties and high employee and physician anxiety which heightens the internal challenge to achieve a successful integration. Community resistance or concerns for the planned integration efforts are also possible based upon the drivers that prompted the system to take action. While identified risks may become realities and unanticipated challenges can arise with little warning, effective risk management planning is essential.

Identification and analysis of the integration risks by the system integration leaders and their teams are foundational to the planning process. Balancing the benefits of integration initiatives against the probability of the risk may prompt either the development of preventative and contingency plans, or the abandonment of the integration initiative all together. Regardless, every risk should be thoughtfully analyzed in the context of the benefits of the system integration plan and weighed carefully.

Employee and Physician Engagement

The third pillar to effective health system integration is employee and physician engagement. While system integration planning is overseen and led by senior system leaders, it is imperative that employees and physicians have a voice within the planning process to foster effective integration results.

Solicitation of ideas, involvement in plan development, transparency in the planning process, and frequent communication will provide systems with the best chance for developing an effective integration solution, and fostering acceptance, accountability, and alignment among the stakeholders. This planning approach will also provide the system with the platform to accelerate the change process, and achieve and sustain its integration goals and objectives. While some confidentiality is warranted in the integration planning and implementation process, employee and physician engagement is necessary for success.

As health systems take on their integration planning and implementation process, a focus on the three pillars will provide the foundation to strategically position themselves to be nimble and efficient in a value-driven world.

This is Part 2 in our System Integration blog Series. Part 1 may be found here. Part 3 will examine the 5 steps in a successful system integration planning process.

For more details surrounding health system integration planning, please download our PDF via the button, below:

Health System Integration 


B_Klar.jpgMr. Klar is a senior manager with GE Healthcare Camden Group with over 12 years of experience in healthcare management. Mr. Klar specializes in strategic and business planning advisory services, including service line planning, master facility planning, and transaction work (e.g., mergers, acquisitions, affiliations, joint ventures). He has extensive experience in the creation of strategic partnerships, the facilitation of inaugural health system strategic plan development, as well as the creation and implementation of business plans of operational efficiency, system-wide integration plans, and clinical programmatic alignment plans. He may be reached at brandon.klar@ge.com.

Topics: Business Plan of Operational Efficiency, BPOE, Mergers & Acquisitions, Health System Efficiencies, Brandon Klar, Health System Integration

Health System Integration: You Need a Plan!

Posted by Matthew Smith on Oct 3, 2016 1:25:10 PM

By Brandon Klar, MHSA, Senior Manager, GE Healthcare Camden Group

Success within population health is grounded in a health system’s collective ability to improve the health and wellness of those in its communities, and other patient groups it may serve. With a goal of achieving the Triple Aim, systems are restructuring their operations to strengthen the value proposition of their clinical services. With a desire to enhance access, improve quality, and control costs, many systems are looking towards formal strategic partnerships as a means to attain the necessary scope and scale to be successful.

As systems expand, they have the opportunity to achieve system-oriented efficiencies. Through both horizontal and vertical integration strategies, systems desire to position themselves within the market as high-quality and cost-effective providers to attract patients and payers. While many systems pursue these objectives, some fail to achieve full integration due to a lack of effective planning, poor management collaboration, or subpar implementation. Regardless of the reason, a sound integration plan focused on the goals of the system and dedicated true integration will increase the odds of success.  

System Integration plans can be developed both pre-transaction and post-transaction, as well as by systems that have been operating for some time, but in more of a “loose federation” model than as a truly integrated system. Below, you will find an overview of system integration plans, the critical factors in developing them, and associated benefits and limitations.

Pre-Transaction Integration Plans

The development of pre-transaction integration plans provides the aligning entities a road map to achieve their partnership goals and objectives once the transaction is final. Developed prior to the signing of a definitive agreement, these plans serve to lay the foundation for administrative, support, clinical, and service line integration across the continuum as it relates to the location of services, management and staffing, and the optimization of non-salary resources and contracts.

Pre-transaction integration plans allow the entities to build upon their shared strategic vision and construct a newly integrated operating model by which the two entities can optimize their individual strengths and maximize their collective resources. Recognizing that each entity brings with it their unique resources and capabilities, pre-transaction planning is focused on:

  • Cataloging the collective resources and capabilities of the newly proposed system
  • Understanding the existing operating models and functional area interdependencies
  • Framing a new operating model for the integrated system functions
  • Selecting horizontal and vertical integration strategies to align operations
  • Developing action plans with clearly defined goals, resource requirements, barriers, accountable parties, and quality and cost impact analyses
  • Designing an implementation governance structure to oversee the capture of short-term wins post-transaction while coordinating for long-term integration

In addition to preparing the system for operational integration, pre-transaction integration plans can also serve a role in supporting regulatory approval of the proposed transactions by Departments of Health, Attorneys General, and the Federal Trade Commission. While the burdens of proof and detail required may vary by state and regulatory agency, these plans illustrate that the transacting parties are committed to the transaction, have a roadmap to integrate operations at a systems level, and possess a plan to reduce overall system costs. These plans have been proven helpful in demonstrating the value that can be derived by a transaction for a community, but are limited in their detail as the parties are unable to exchange competitively sensitive information prior to the transaction.

In the preparation of these pre-transaction integration plans, parties have utilized both anti-trust counsel and a system integration consulting firm to prevent undue disclosure of sensitive information and support in the development of a more meaningful integration plan.

Post-Transaction Integration Plans

Post-transaction integration plans seek to enhance the integration of entities with a system both horizontally and vertically outside of the confines and limitations of the transaction process. These plans are developed to support system operational integration at two points in a system’s journey: (1) Immediately following a transaction, and/or (2) Years post transaction to optimize a system’s operational performance.

As systems pursue integration post-transaction, they should build upon their pre-transaction plans or previously completed integration initiatives. As the parties are now able to share competitively sensitive information, the integration plans can be further refined, enhanced, and validated. To efficiently drive system integration planning and implementation, the newly formed system should:

  • Activate a system integration governance structure to oversee operational integration
  • Establish an Integration Management Office (“IMO”) in line with an integration governance structure to manage processes, team collaboration, and track progress
  • Convene functional area integration teams to drive integration plan refinement and implementation
  • Engage employee and physician stakeholders to keep them informed and solicit ideas
  • Construct a community communication plan to highlight benefits and any changes to care design and delivery

Integration plan refinement and implementation immediately following a transaction can both position the system for success, or doom it for failure. While integration planning and implementation will drive efficiency, attention must be paid to cultural alignment. Individual functional plans and strategies should have their benefits objectively weighed against the cultural or political turbulence that could result. This process requires collaboration between the integrated management teams, and will require input from both internal and external system stakeholders if the plans are to successfully drive acceptance, accountability, and alignment within the system.

Many systems fall short of achieving full integration immediately following a transaction, and thus have opportunity to further optimize system performance years later. These systems may have either decided not to pursue specific integration opportunities in fear of cultural turbulence, stakeholder resistance, or a lack of guidance, will-power or resources to do so. Regardless of the reason, systems should reassess their degree of integration at least annually to identify new opportunities that may have arisen or determine if previous barriers to implementation or resistance to change have been mitigated. It is not uncommon for systems to achieve between 5 to 10% in sustainable, operational annual cost savings years after a transaction as a direct result of future integration plans.

As consolidation trends and cost pressures accelerate, the keys to a successful integration initiative are to focus on value creation, risk management, and employee and physician engagement in order to develop a realistic, achievable, and sustainable plan that positons the system for success.  

For more details surrounding health system integration planning, please download our PDF via the button, below:

 Health System Integration


B_Klar.jpgMr. Klar is a senior manager with GE Healthcare Camden Group with over 12 years of experience in healthcare management. Mr. Klar specializes in strategic and business planning advisory services, including service line planning, master facility planning, and transaction work (e.g., mergers, acquisitions, affiliations, joint ventures). He has extensive experience in the creation of strategic partnerships, the facilitation of inaugural health system strategic plan development, as well as the creation and implementation of business plans of operational efficiency, system-wide integration plans, and clinical programmatic alignment plans. He may be reached at brandon.klar@ge.com.

Topics: Business Plan of Operational Efficiency, BPOE, Mergers & Acquisitions, Health System Efficiencies, Brandon Klar, Health System Integration

Charting a Path to Health System Efficiencies Following a Merger

Posted by Matthew Smith on Mar 7, 2016 4:16:28 PM

By Brandon Klar, MHSA, Vice President, GE Healthcare Camden Group

Healthcare reform is driving an increase in health system mergers and acquisitions. Almost without exception, these moves are billed as an opportunity to reduce costs and leverage scale to improve care delivery. Unfortunately, many merged organizations fail to fully realize the operational health system efficiencies envisioned before the transaction.

Once select management positions are integrated and group-purchasing contracts have been consolidated, integration efforts often slow considerably or grind to a halt entirely. This pattern is seen both with true mergers, where two organizations are combined to create a new entity, and with transactions in which an organization acquires and absorbs another organization.

This failure to achieve the full potential of a merger or an acquisition carries two risks. First, incomplete integration can actually increase system costs, particularly when the combined organization creates a new layer of corporate oversight on top of the two merged entities. Second, poor integration can create trouble with regulators. The Federal Trade Commission, state attorneys general, and other agencies often approve health system mergers based in part on promised operational efficiencies. When these efficiencies fail to materialize, regulatory bodies can take action.

Please click the button below to continue reading this article in its entirety:

BPOE, Business Plan of Operational Efficiencies

Topics: BPOE, Mergers & Acquisitions, Brandon Klar, Value Management

Top 10 Pivotal Factors for Successful Mergers and Acquisitions

Posted by Matthew Smith on Oct 28, 2015 3:32:11 PM

Healthcare executives are surveying industry change, their market position, and their ability to meet organization goals and mission as they evaluate opportunities while simultaneously protect the well-being of their own organization. However, for a variety of factors, from operational to financial to cultural, not every consolidation is the right one. Before savvy leaders dive headfirst into the current merger and acquisition frenzy, they need to take a measured step back and assess the following ten factors that will prove pivotal to a successful merger or affiliation.

1. Define your mission, vision, and objectives. In a constantly evolving and unclear environment, it is critical to thoroughly articulate the ambitions of any significant change your organization is contemplating. Why is your organization considering this alliance, and will this arrangement help achieve desired goals? The reasons for mergers are plenty. Acquiring economies of scale, achieving geographic expansion, increasing access points, and enhancing access to capital are among the primary motivations in the current transformative climate. Gaining consensus among your board and executive leadership early will contribute to a unified search process, enhance communication, and align your key stakeholders.

2. Timing is everything – determine the right time. In a period of high consolidation activity, it is easy to get wrapped up in the excitement. Do your organization’s current position and situation necessitate a move right now? Many organizations rush to the negotiating table without fully assessing whether the timing is optimal, or if they are ready for the transition. Conversely, the market today does not look like the market did six months ago, nor will it look like the market six months from now. As the market evolves, so do options both available and unavailable to your organization. Potential targets or acquirers may align with competitors, or market activity could force your organization’s hand to the point where consolidation is the only option. A keen awareness of your organizational strength and market position is paramount when evaluating potential maneuvers.

3. Know the market – what is your outlook for the future, and what is its effect on your organization? The shift towards value-based payments and accountable care means that now more than ever healthcare providers are forming “tightly aligned” networks to reduce costs and improve the quality of patient care. Are other major players expanding their population base through additional access points, developing accountable care organizations (“ACOs”) and exclusive contracting arrangements, and creating a full continuum of care into the post-acute arena? The organizations with critical mass are going to come out on top. Failing to adequately assess your competitors and their situations could portend a situation where your affiliation options become limited and your market share eroded.

4. In a value-based environment, size matters. How can you increase your defined population? As mentioned above, for thriving and financially sustainable providers, it will be crucial that they grow, fortify, and protect the defined population that they serve. It is becoming increasingly crucial that organizations provide sufficient access points to coordinated provider networks through both traditional mediums (emergency departments and physician offices) as well as innovative entry point alternatives found in the new competitive provider environment that exists today (health plans, urgent care centers, m-health, and retail clinics). Consider alternative points of care to acquire or affiliate with in order to expand access and improve the coordination of care for your population – your competition likely is.

5. Choose the right affiliation structure – there are more options than just mergers and acquisitions. Today’s healthcare environment provides an increased number of innovative alignment options for organizations contemplating integration. Gone are the days where organizations needed to complete outright sales or mergers with full change-of-control. Instead, many organizations are pursuing affiliations to meet organizational goals and strengthen financially, including joint ventures, clinically integrated networks, sales to real estate investment trusts, or joint operating agreements. Affiliating can be an attractive option to maintaining a degree of organizational independence while propelling the organization’s mission and fulfilling its defined objectives. Just be clear that the affiliation structure will be the best option to meet your goals.

6. Evaluate cultural alignment to protect against breakdowns once the transaction is complete. Easily the most overlooked aspect of any potential merger is the eventual fusion, and potential friction, of combining two organizational cultures. Post-transaction success requires more than diligent financial analysis and combined market share. More and more transactions are stumbling out of the gates because leadership underestimated the difficulty of one or both organizations adopting new protocols and systems, blending the governing boards, or understanding management styles and philosophies. Assessing the history, mission, and cultural aspects of each organization is imperative to develop the understanding required to construct the mutually beneficial and shared vision necessary to achieve the future entity’s operational efficiencies and full potential.

7. Ensure that both boards and communities are behind the transaction and mission. Good communication is required to ensure as smooth a process as possible with any transaction. It is vital that all key parties, from the boards and medical staffs to employees and patients, have a firm grasp of why the organization is pursuing this action, and how they will benefit from it. Achieving alignment and understanding among the community will confirm the necessary parties are in sync while addressing and relieving any anxieties the deal may foster.

8. Conduct effective due diligence to ensure that the efficiencies and business justifications support the transaction. During the due diligence process, it will become clear how your potential partner is performing: their vision, goals, actions, and composition of the C-suite and board. The due diligence process is the appropriate time to ask as many questions as possible; it is imperative that you get the answers you need. A high frequency of meetings and discussions, particularly face-to-face interactions, and transparency with financial and quality data are strongly encouraged to generate the necessary levels of understanding to ensure the transaction remains compliant with antitrust legislation and that the market benefits desired and proposed are feasible.

9. Consider the partners’ “whole being” as an organization that can meet your needs. As an organization, identify how future industry changes will impact your needs across the care continuum. This may include bundled payments, ACOs, clinical integration, patient-centered medical homes, ambulatory delivery sites, payment changes, access to capital, new care models, and health plans, etc. Physician alignment models, recruitment, and research are also opportunities that should be addressed. Projecting future industry developments and the impact to your strategy and needs could put your organization ahead of the game in the years to come.

10. Once the merger is complete, execute the business plan of operational efficiencies (“BPOE”) to position your organization to achieve the gains that were the reason for the merger. The BPOE serves as a great tool to define the financial, operational, and clinical opportunities that will be gained through the merger before it happens. After the transaction is complete, use the BPOE to measure and manage progress on the implementation actions necessary to achieve the intended goals and efficiencies. These may include program and service consolidation, elimination of service duplication, and infrastructure integration. Theoretical synergies mean little without implementing and actualizing them. The BPOE should serve as the blueprint to follow in order to propel your organization to enact the clinical, operational, and financial benefits that compelled the transaction in the first place. 

Topics: Mergers, Acquisitions, Mergers & Acquisitions, Mergers and Acquisitions

Charting a Path to Health System Efficiencies Following a Merger

Posted by Matthew Smith on Jun 11, 2015 9:43:24 AM

A business plan of operational efficiencies can help a health system achieve large-scale gains in cost performance and organizational alignment following a merger or an acquisition.

By Brandon Klar, MHSA, Senior Manager, The Camden Group (via the June, 2015 issue of HFM Magazine)

Brand-Strategy-Mergers-Acquisitions.jpgHealthcare reform is driving an increase in health system mergers and acquisitions. Almost without exception, these moves are billed as an opportunity to reduce costs and leverage scale to improve care delivery. Unfortunately, many merged organizations fail to fully realize the operational health system efficiencies envisioned before the transaction. Once select management positions are integrated and group-purchasing contracts have been consolidated, integration efforts often slow considerably or grind to a halt entirely. This pattern is seen both with true mergers, where two organizations are combined to create a new entity, and with transactions in which an organization acquires and absorbs another organization.

This failure to achieve the full potential of a merger or an acquisition carries two risks. First, incomplete integration can actually increase system costs, particularly when the combined organization creates a new layer of corporate oversight on top of the two merged entities. Second, poor integration can create trouble with regulators. The Federal Trade Commission, state attorneys general, and other agencies often approve health system mergers based in part on promised operational efficiencies. When these efficiencies fail to materialize, regulatory bodies can take action.

Please click the button below to continue reading this article on the Healthcare Financial Management Association's ("HFMA") website:

BPOE, Business Plan of Operational Efficiencies, The Camden Group

Topics: HFMA, Mergers, BPOE, Mergers & Acquisitions, Health System Efficiencies, Hospital mergers and acquisitions, Brandon Klar

Mergers & Acquisitions: An Opportunity to Align Charges Across a System

Posted by Matthew Smith on May 20, 2015 2:30:00 PM

By Matt Briskin, MPH, Senior Consultant, and Tawnya Bosko, MHA, MS, MSHL, Senior  Manager The Camden Group

health-dollar-335x251.jpgWith merger and acquisition (“M&A”) activity remaining steady, hospital systems have the opportunity to strategically align charge description master (“CDM” or “chargemaster”) prices to fit with their system-level corporate strategy, specifically targeting defensible pricing, revenue growth, or the managed care strategy.

Hospital M&A Activity on the Rise

Recent projections suggest that M&A in the healthcare industry will continue to rise in the next year. Given this trend, hospitals should seize the opportunity to align their chargemasters during the phase of integration, but also need to be aware of the risks associated with alignment.

M&A: A Great Opportunity to Align CDMs

Given a system with multiple hospitals in the same market with homogenous patient-payer mixes and service offerings, prices likely need to be aligned such that services provided at hospitals located close to one another are charging patients the same price for the identical good or service. Having prices that are aligned across hospitals in the same market where the hospitals are within reasonable cost-to-charge ratios refers to the practice of ‘defensible pricing’ and is very important as an increasing amount of states regulate that hospital chargemasters be available to the public. Furthermore, from a revenue perspective, as hospital systems grow larger, they may desire to renegotiate their payer contracts to support the changes in the organization. As a result, systems may be in a position to negotiate different reimbursement methodologies. Having all hospital systems on similar pricing schedules will support the overall managed care strategy for the newly developed system and may save the system from answering payer questions such as “Why does Hospital A charge so much more than Hospital B for the same service?” Furthermore, aligning the CDM across the system could lead to operational efficiencies from integration of functionality to support the CDM.

When Not to Merge CDMs

On the opposite end of the spectrum, healthcare systems with hospitals serving diverse patient populations or different markets may want to price goods and services differently across the system. Similarly, a hospital system with a specialty facility may benefit from having a separate CDM due to the nature of highly-skilled or unique services provided at that hospital. 

Systems with recently acquired hospitals need to closely evaluate whether aligning prices across a ‘system CDM’ is the best strategy.  Successful system-wide CDM strategies should be approached with clearly defined goals and revenue projections from day one. Without clearly defined goals and up-front due-diligence, hospital systems run the risk of lost revenue from reimbursement or patient leakage (ultimately, lost revenue) if prices are too high and patients seek services at a lower-priced competitor. As hospitals plan their post M&A integration strategies, the CDM should make the list of items under consideration.


Briskin_headshot.pngMr. Briskin is a senior consultant with The Camden Group specializing in finance. He has extensive experience working with both payers and providers. Mr. Briskin specializes in revenue enhancement initiatives related to chargemaster pricing optimization and managed care strategy. He may be reached at mbriskin@thecamdengroup.com or 714-263-8206.

 

 

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Ms. Bosko is a senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization  and MSO development, managed care strategy, and physician alignment. She may be reached at tbosko@thecamdengroup.com or 310-320-3990.

 

 

 

Topics: Tawnya Bosko, Mergers, Acquisitions, Mergers & Acquisitions, Chargemaster, CDM, Matt Briskin

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