Beginning in 2012 Medicare will provide financial incentives to organizations that agree to manage the care for defined populations and be at risk for clinical quality and cost control. It is only reasonable that commercial payers will follow this lead as a means of stabilizing insurance premiums for covered groups. Healthcare delivery systems will need to assemble the resources needed to respond to this challenge. These include:
The Horizon Group is uniquely positioned to assist organizations in determining their readiness for the ACO model. Our experience in hospital/physician alignment strategies, data system analysis and implementation, revenue cycle management, and physician compensation plan design provides clients with a single source answer to a readiness assessment.
Once you know where you are we can help develop a comprehensive plan to get where you need to be to succeed in the changing economic environment. Organizations that want to thrive in the future need to start now to build a platform for ACO development, Horizon can help. Our multidisciplinary team of seasoned professionals includes hospital and physician practice management executives, reimbursement specialists, data system analysts, and clinician thought leaders.
Task 1- Visioning Session
Consultants will meet with organization leadership (hospital/physicians) to elicit their thoughts about where the organization is on the “integration” continuum. This information will serve as a backdrop for the session so that the facilitator can be sure that all opinions are expressed. An alternative would be to hold separate sessions for hospital and physician leadership and then a joint session where summary data from the prior sessions would be shared.
This session sets the philosophical framework for the efforts needed to enhance the collaborative environment needed to move toward integration. This process will also create a formal Steering Committee that will receive progress reports and provide the internal structure needed to assure that the project receives the needed organizational priority. The group must have the power and prestige needed to eliminate turf barriers.
Task 2- Assessment
Consulting team will create a picture of the current status of the organization to include data capabilities, medical staff complexion to include employed vs. community, available legal vehicles for the ACO, current financial performance, and payer profiles.
The findings from this assessment and the output from the Visioning session will provide the data for the development of the status report at Task 3.
Task 3- Status Report
The team will collaborate on the development of a “Readiness Report” that will provide management/leadership with a picture of the current position of the organization along the integration continuum and the steps that would be needed to position the organization for ACO development. This would be delivered in both written and presentation formats with the goal being the validation of the findings my leadership.
Task 4- Action Plan
Using the document (as modified if needed) created at Task 3 the consulting team will develop a detailed plan for addressing any gaps that require attention to move the organization toward ACO-readiness. While each of the projects could be viewed as a stand-alone the intent is to present the client with a comprehensive plan to address organizational and resource shortcomings and to initiate the work needed to create a hospital/collaborative environment.
This Task will also identify the resource gaps (technology? financial?) that need to be addressed preliminary to program development.
Task 5- Infrastructure Development
The consulting team will guide the creation of the structure and resources needed to move beyond the planning stage. Some elements may still be in transition when the work in Task 6 begins.
Task 6- Demonstration Project
The group will identify a clinical area, service, or procedure that would benefit from a quality improvement/cost reduction effort. Physicians would be paid on a fee-for-service basis for the time that they invest in the project since approval of a gain-share project would be costly and time consuming. This exercise will be educational for both system management and clinical leadership and provide a sense of the resources needed to expand the effort.
Task 7- Program Expansion
Using the results of the demonstration effort the team will expand the focus to other clinical areas that are identified as either quality or cost outliers when compared to available clinical best-practices data.
Task 8- Market Assessment
Working with client staff reimbursement consultants will approach market payers to identify demonstration opportunities.
Summary
At the end of this process the client will understand what is needed to create and operate as an ACO. Organizations with large gaps between their current position and the structure needed to succeed in a risk-shared environment may require extended timeframes to move through the process, especially if physician resources are not adequate.
More Information
If you would like to learn more about our program or would like to receive a detailed proposal please contact Greg Mertz, Managing Director, at gjm@thehorizongroup.com.
