How Healthcare Reform Impacts Your Business Today
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How Healthcare Reform Impacts Your Business Today

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As most of us await the Supreme Court decision on health reform, and one thing is certain: a repeal of Healthcare Reform will not reinvigorate sales nor reverse spending cuts. The time to understand ...

As most of us await the Supreme Court decision on health reform, and one thing is certain: a repeal of Healthcare Reform will not reinvigorate sales nor reverse spending cuts. The time to understand and integrate the many regulatory changes of October 1, 2012, into your company’s mission is NOW.


With these slides, you can expect to learn:

The key elements of provider-focused healthcare reforms, including:
ACOs
Value Based Purchasing
Bundled Payments
IT incentives
How to recognize and evaluate the process of project justification
The connection between performance metrics, organizational initiatives, reform implications and your solutions
Actionable Recommendations

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How Healthcare Reform Impacts Your Business Today How Healthcare Reform Impacts Your Business Today Presentation Transcript

  • How Healthcare Reform Impacts Your Business Today June 27, 2012 Gunter Wessels, Ph.D., MBA Sam O’Rear, M.A. BA Partner, Practice Principal, TIGI Senior Partner, Founder, TIGI gunter@mytigi.net sam@mytigi.net @gunterwessels @TIGI_Inc www.tigi.net © TIGI 2012 All rights reserved
  • ObjectivesEvaluate the key elements of provider-focused healthcarereforms, including: • ACOs • Value Based Purchasing • Bundled Payments • IT incentivesRecognize and evaluate the process of project justification.The connection between performance metrics, organizationalinitiatives, reform implications and your solutions.Recognize that you need to build the business case for yoursolutions, in the current healthcare environment. © TIGI 2012 All rights reserved
  • Implications of Reform 1 Project Delays/Deferrals 2 Financing Hurdles 3 Customer Cost Reductions © TIGI 2012 All rights reserved
  • The Budgeting Process Project initiation Problem Alternatives and resources available Cost information Benefit information Prior performance benchmarking Risk projection Evaluation of Projects Financial viability, resources and reserves Cost Funding Decision Financial viability, resources and reserves Management Medical staff Public Image, competitive positioning Project Implementation and Reporting Project funds sourcing Forecast generation Measure development Budget adjustment © TIGI 2012 All rights reserved
  • Evolution of Healthcare Delivery Management Utilization Population Quality Management Management Management Payer Focus: Payer Focus: Payer Focus: • Referral Management • Clinical Quality Indicator • Wellness Programs • Prior authorization/pre-certification Monitoring • Demand Management • Concurrent Review • Credentialing and Re- • Disease Management credentialing • Discharge Planning • Case management • Delegation Oversight • Retrospective Review/Appeals • Pharmacy Management © TIGI 2012 All rights reserved
  • Patient Protection & Affordable Care Act 2010 Reform is Creating Turmoil and Opportunity Reform Elements: Insurance Reform • Controversy: Individual and State Mandates • Constitutional Challenge Delivery-System Reform • Limited Controversy: Quality-based payment Core Provisions • Value Based Purchasing • Accountable Care • Bundled Payments • Continuation of Health IT © TIGI 2012 All rights reserved
  • Volume Changes Elective Procedure Volumes Down 1-5% Nationally Non-Elective Procedure Volumes Steady “ A survey of more than 375 acute care hospitals found inpatient volumes down 2.2% and outpatient volumes down 1.1% for April. Inpatient surgeries “ were up 3%, outpatient surgeries were up 3.5%, and births were up 1.1%. ER visits fell 1.8% © TIGI 2012 All rights reserved
  • More Granular Data About Disease & Procedures ICD-10 Coding system and EMR/EHR • Implementation Accelerated, And Then Delayed • Part of Meaningful-Use Stage 2 • Automated Core-Measures Reporting • Automated PQRI Reporting Capture • Enhanced Analytics Useful for Comparative Effectiveness CMS Innovation Institute, and Comparative Effectiveness NIH research (ARRA 2009) Useful for Cost Effectiveness Independent Payment Advisory Board- (IPAB) Repealed by the House...in Limbo © TIGI 2012 All rights reserved
  • Cascading Consequences for Suppliers 1 Provider Consolidation 2 Supplier Consolidation 3 Pricing Pressure Intensifying 4 ROSI (Return on Sales Investment) Becomes More Challenging 5 Less Executive Decision-Maker Access 6 More Complex Interactions (committees, approvals, delays, etc) © TIGI 2012 All rights reserved
  • What Providers Are Doing Integrating Clinical Mission, Operational Effectiveness, and Financial Performance• Building a strong infrastructure for their medical policy• Focusing on enhancing their application of EBM (evidence-based medicine)• Engaging the physicians in a collaboration model supported by the EMR design• Committing to marketing initiatives that will build their brands• Learning how to price services for alternative revenue models involving risk• Evolving to missions of prevention as well as intervention• Reviewing use and application of technologies to balance asset utilization w/attaining the clinical mission © TIGI 2012 All rights reserved
  • Framing Reform in Context Key Words in Healthcare Management Core Measures Improvement Disease Management Benchmarking Patient Flow Improvement Leveraging IT Shared Governance and Alignment Reducing Process Variance Patient Satisfaction Improvement Patient and Employee Experience Coding and Charge Capture Margin Erosion and Reimbursement Trends Accounting for Severity and Complexity © TIGI 2012 All rights reserved
  • Success as a Supplier in This Terrain Your Solution Must Link To One Of The 5 Hurts Of Healthcare Executives 1 Revenue 2 Operational Efficiency 3 Quality & Safety 4 Regulation & Compliance 5 Competition © TIGI 2012 All rights reserved
  • Recommendations for Suppliers Focus Your Sales & Marketing Teams onto The Five Hurts Frame Solutions with the Three Dimensions of Value: Clinical Operational Financial Search & Discover Service Line Management, and Their Unique Set of Hurts Demonstrate to Your Customers How Your Solutions Will Increase Their Flexibility Recognize That Some Customers Understand Their Market Better Than Others and Want to Collaborate Trust That Your Marketplace is Growing and That Your Services Are Increasing in Value © TIGI 2012 All rights reserved
  • Questions? www.tigi.net © TIGI 2012 All rights reserved
  • Upcoming EventsWebinars:July: 5 More Medical Device Strategies Doomed to Fail in 2012 To Register: http://www.tigi.net/webinar-calendarOpen Enrollment, 1 Day Workshop:TIGI and MassDevice Present, TIGI Bootcamp 2012The Changing Healthcare Buying Environment: Adapting to the New Normal,August 22 in Boston To Register: http://www.tigi.net/the-changing-healthcare-buying-environment/ © TIGI 2012 All rights reserved
  • Thank You Gunter Wessels, Ph.D., MBA Sam O’Rear, MA, BAPartner, Practice Principal, TIGI Senior Partner, Founder, TIGI gunter@mytigi.net sam@mytigi.net @gunterwessels @TIGI_Inc www.tigi.net © TIGI 2012 All rights reserved