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LEADERSHIP 
“WayPoint’s leadership reflects that rare breed of well-rounded individuals who 
can execute. They aren’t afraid to put their fingers on the keyboard. They don’t 
just describe the work, they break it down into logical steps and do it. Together 
we produce outcomes.” 
David Bradshaw, MHMD Chief Information, Planning & Marketing Officer 
“It has been a very rewarding opportunity to work with WayPoint; one that has 
been marked with good physician communication, trust, and integrity.” 
Tom Wall, MD, Medical Director, Triad HealthCare Network 
Waypoint professionals work with your team to deliver custom solutions that 
reflect experience, best practices and an independent point of view. 
3
Jim McCoy, Managing Director Jim brings a wealth of healthcare experience to WayPoint, particularly in improving 
quality, safety and patient experience through clinical integration. He’s worked with 
clients ranging from integrated health care systems and large medical groups to 
hospitals and various specialty providers. 
Prior to starting WayPoint, Jim gained direct industry experience through multiple roles 
at Texas Health Resources, including Director of Market Management and Assistant 
Administrator responsible for strategic planning and core operational functions. During 
this time, Jim developed and managed a large multi-specialty physician independent 
practice association. Jim has also served in leadership roles at Ernst & Young’s Health 
Sciences Advisory Practice. Jim has led a long list of initiatives, including: 
·· Patient centered medical home (PCMH) and related incentive programs 
·· Innovative population management payer contracting relationships 
·· Inpatient quality and safety incentive programs 
·· Accountable Care Organization start-up 
·· Medicare Shared Savings Program participation 
·· Strengthening health information technology and population management infrastructure 
·· Hospital and medical group operational efficiency and profitability studies 
·· Hospital and medical group revenue cycle and pricing strategies 
·· Managed care negotiations and payment dispute resolution 
·· Transaction support including fair market value assessments 
·· Due diligence including financial and market projections 
·· New business formation, mergers and acquisition support services 
·· Strategic planning, including market studies and financial projections 
·· New facility and service line planning 
·· Real estate and major capital expenditure planning 
·· Physician compensation plan development 
·· Claims dispute resolution and litigation support 
·· Clinical integration 
·· Operational restructuring to support an accountable care organization (ACO) 
·· Physician alignment 
Jim graduated from the University of Texas at Austin and earned his MBA in Finance at 
the University of Texas at Arlington. He lives in Fort Worth with his wife and two sons 
and is active in a variety of DFW-area community groups, including: 
·· American College of Health Care Executives 
·· Dallas Fort Worth Health Industry Council 
·· Alumni – Cook Children’s Health Care System “Experience the Mission” Program 
·· First Tee of Fort Worth – current board member and instructor 
·· West Side Little League 
·· Fort Worth Texas Exes Chapter – past president 
4
Brett Kirstein, Managing Director Brett has served the healthcare industry in a consulting capacity for the past 24 years. 
During that time, he’s led all types of engagements in leadership roles including: 
·· Partner, Arthur Andersen Healthcare Consulting, where he led the Revenue Cycle Practice for the 
Southwest region 
·· Vice President, Hitachi Consulting, where he shared in the leadership of the Finance Business 
Solutions Practice 
·· President, Revenue Cycle Solutions, where he founded a professional services firm to serve his 
healthcare clients at a more strategic level 
·· Managing Director of WayPoint 
Brett’s consulting approach has always been to impact results through measurable 
process improvement, strategy articulation and technology implementations. In 
addition to supporting large integrated health systems, academic medical centers and 
not-for-profit acute care systems of all sizes, he has worked extensively in long term 
care for several regional and national chains. Most recently, Brett has led initiatives 
including: 
·· Drafted and submitted the Medicare Shared Savings Program application for three of the largest 
ACO’s nationally 
·· Supported the start-up and operations of a hospital system led ACO with 60,000 covered lives 
·· Implemented population health management technology tools including claims based risk 
stratification and physician intelligence tools as well as an HIE 
·· Supported hospital and physician efforts to create a clinically integrated network 
·· Led strategic initiatives to redesign the clinical improvement process as well as physician 
incentives in the areas of quality and safety and specialty service lines 
·· Managed-care contract analysis and negotiations 
·· Implemented enterprise wide labor management technology including time and attendance and 
scheduling 
·· Supported various revenue cycle redesign initiatives including CBO planning and outsourcing 
evaluations 
·· Led pre- and post-merger integration planning and implementation for $2B long term care 
company 
·· Led various process improvement engagements including payables, payroll, accounting, clinical 
risk management and business development 
Brett is a 20-year CPA in the State of Texas and graduated from the University of Texas 
at Austin with a BBA and MPA in taxation. He lives in Dallas with his wife and two 
children and volunteers in various community efforts and professional organizations. 
Most recently, he was the past Chair of the Board for Head Start of Greater Dallas and 
is a current board member of Educational First Steps. 
5
CLIENTS 
“WayPoint has become a part of our team. They understand the people on our 
team and the functions they provide. No matter what the issue is, they help us 
articulate a better vision and execute it into action.” 
Chris Lloyd, MHMD CEO 
“Waypoint is highly responsive and very much hands-on in their approach. 
Because they had similar experience with other ACOs, their guidance through 
the application process was a comfort to us. You’re not getting buzz words, 
you’re getting expertise that drives results.” 
Chief Operating Officer, Regional Market Leading Health System / ACO 
Waypoint professionals work with your team to deliver custom solutions that 
reflect experience, best practices and an independent point of view. 
6
RECENT CLIENT EXPERIENCE 
CLIENT OBJECTIVES 
WayPoint has vast experience in Population Management, Clinical Integration and ACO 
initiatives. Readiness assessment, design and implementation experience includes: 
• ACO / CIN / PCMH start-up activities 
• Innovative value based payer contracting relationships 
• Population health management technology implementation 
- Analytics to identify at risk patient populations 
- Analytics to improve provider performance and measure quality 
• Care management people, process and technology resource deployment 
• CMS Medicare Shared Savings Program participation 
SOLUTIONS 
For a variety of clients WayPoint has assessed existing clinical integration resources and 
incentive structures while supporting leadership to develop market-specific capabilities in 
following implementation areas: 
• Enterprise scope, structure, governance and leadership 
• Provider network composition and development 
• Reporting tools and processes 
• Care team incentives 
• Health information technology resource plans 
• Staffing plans and operating budget estimates 
Specialized resources were identified in order to: 
• Promote clinical process improvement 
• Identify population-specific health needs and high-risk patients 
• Deliver disease management programs / coordinate care 
• Enhance patient access, communication, and engagement 
RESULTS 
• PCMH implementation in 12 months (100 physicians+ certified to date) 
• CMS Medicare Shared Savings Program ACO approved 
• Multiple commercial payer ACO contracts 
• Named one of Becker’s “100 ACOs to Know” 
• Included in 29 MSSP ACOs achieving shared savings 
13
SERVICES 
“WayPoint accelerates our programs. Our PCMH was up and running in a 
year. An ACO application could take 3 years, yet MHMD and WayPoint did it in 
three months. Readiness assessment is vital. We couldn’t have done it without 
WayPoint.” 
Keith Fernandez, MD, MHMD President & Physician in Chief 
“We value WayPoint’s frank assessments and one-on-one approach. They 
haven’t been a single engagement for us but a valued on-going partnership.” 
Chief Financial Officer, Regional Market Leading Health System 
Waypoint professionals work with your team to deliver custom solutions that 
reflect experience, best practices and an independent point of view. 
11
STRENGTHEN STRATEGY 
WayPoint strengthens each client’s 
strategy with a collaborative approach, 
combining qualitative and quantitative 
analysis to align incentives and improve 
performance. Successfully meeting 
today’s challenges requires integration 
strategies such as medical homes, 
population health, and clinical integration 
assessment and implementation. 
We quickly identify key issues, focus on priorities and develop 
custom solutions within a shorter period of time. Our strategy 
services include: 
• Integration strategies 
- ACO readiness assessment, design and implementation 
- Medicare Shared Savings Program participation 
- Population Health / Clinical Integration / Medical Home 
• Market studies and financial projections 
• New facility and service line planning 
IMPROVE CLINICAL PROCESS 
WayPoint has deep experience across 
the hospital, physician and payer industry 
sectors. Clinical process improvement 
models that align incentives between the 
hospital system and physicians must be 
developed in order to reduce costs and 
maintain or improve quality. 
We have successfully executed a wide range of population health, 
clinical integration and ACO initiatives that support the following: 
• Improve quality, efficiency and patient experience 
• Integrate the diverse skills and resources of physicians, 
administrators and other clinicians 
• Effectively engage physician leadership 
• Respond to market-based transparency needs 
STREAMLINE OPERATIONS 
WayPoint has worked in nearly every 
operational area of hospital and physician 
organizations. We apply this experience 
provides to identify areas of opportunity, 
and then design, launch and support 
operations improvement programs that 
make more efficient use of resources and 
improve financial performance. 
Operational review areas include: 
• Governance 
• Clinical service lines 
• Management services 
• Common and interoperative technology platforms 
• Alternate reimbursement and incentive model formats 
• Payer contracting relationships and opportunities 
MAXIMIZE REVENUE AND PROFIT 
Reimbursement model changes are 
fundamental drivers of healthcare 
transformation. End-to end rethinking of 
the healthcare organization is required in 
order to efficiency and quality. 
We have worked with a wide range of organizations to maximize 
revenue and growth in areas such as: 
• Managed care contracting 
• Service line development 
• Incentive model design 
• Pre/Post Transactional integration 
• Revenue cycle management 
12
EXECUTIVE 
BRIEFINGS 
Waypoint professionals work with your team to deliver custom solutions that 
reflect experience, best practices and an independent point of view. 
14
Success Factors of 
Clinical Integration 
1. Historic Model 
Care is fragmented by 
service line and specialty. 
Siloed protocols and 
pathways with little 
coordination. 
4. Breakthrough 
Population management 
including evidence-based 
medicine protocols, risk 
stratification and disease 
management across 
the continuum 
of care. 
Provider integration is achieved with collaborative 
physician-led clinical process improvement. 
Payer/provider alignment and integration maximizes 
care quality and clinical process improvement. 
Data shared demonstrates value, quality and 
clinical process improvement. 
CIN/ACO members engage with onboarding and 
navigation resources that clearly define services 
and how to access them. 
Patients are engaged and supported with 
education, care coordination, expanded access 
and network navigation support. 
Messaging is consistent from health benefit 
plan enrollment to the physician’s office. 
Value-based economic incentives are developed 
to allow providers to share financial success. 
Operating Principles 
Evolving Integration Efforts 
Clinical Process Improvement 
Governance 
A local representative organization, 
inclusive of quality physicians and 
the hospital, responds to and 
manages the changing industry. 
Leadership is multi-specialty 
physician-driven with a strong 
primary care foundation. 
Support resources in place to 
ease administrative burdens and 
address barriers to small practice 
adoption and compliance. 
Evidence-based medicine 
protocols and quality 
measurement goals are 
consistent in clinical 
practices. 
Care is coordinated with 
physicians, hospitals and 
other care continuum 
providers outside of 
primary care. 
Clinical data reporting 
demonstrates quality and 
clinical process 
improvement achievements. 
Beneficiaries are engaged to 
improve compliance with 
preventive care and chronic 
disease management. 
Healthcare resource 
efficiencies through 
standards consistent 
with clinical quality 
improvement objectives 
2. Transitional 
Care is coordinated across 
specialties and care sites. 
Protocols and pathways 
continue to be based within 
a given setting of care such 
as hospital or inpatient 
rehabilitation facility. 
3. Advanced 
Seamless transition in 
care between relevant 
settings and specialties. 
Protocols and pathways are 
based on service lines 
across providers instead 
of a single setting 
of care. 
Providers integrated across 
the continuum of care work 
collaboratively in active 
clinical process improvement 
to improve quality of care. 
WayPointHC.com 
15
ACO Growth and 
Early Positive Results 
Reduced spending by 2.5% 
61% 61% 
57% 
A C A D E M I C 
I N D U S T RY 
Inpatient admissions reduced by 2.5% 
57% 
A C A D E M I C 
I N D U S T RY 
31% 
Improvements in population health 
A C A D E M I C 
I N D U S T RY 
31% 
29% 
Improved access 
A C A D E M I C 
I N D U S T RY 
31% 
14% 
Fewer emergency department visits 
57% 
A C A D E M I C 
I N D U S T RY 
Readmissions reduced by 9.7% 
A C A D E M I C 
I N D U S T RY 
29% 
13% 
Increased preventive services 
A C A D E M I C 
I N D U S T RY 
31% 
29% 
Improved satisfaction 
A C A D E M I C 
23% 
I N D U S T RY 
14% 
Outpatient services increased by 
7.4% 
13.2% 
reduction in potentially preventable 
initial admissions 
21% 23% 
of hospital and health systems 
do not plan to create or join an 
ACO in the forseeable future 
of hospital and health systems not 
yet part of an ACO plan to create 
or join one by the end of this year 
5 things to know about ACOs 
that joined the program 
before fall 2012: 
Large, nonprofit teaching hospitals were 
the typical hospital participants 
Little difference in performance on quality metrics 
between participating and nonparticipating hospitals 
Hospital referral regions tended to have larger populations 
and more Medicare spending per beneficiary 
Patients were more likely to be white, older than 80 years old 
with higher incomes than other Medicare beneficiaries 
Patients had 5.8% lower total costs of care ($7,694) than 
patients not in an ACO ($8,164) at the baseline 
Rizzo, Ellie; “7 Latest Findings about ACOs,” Becker’s Hospital Review, January 15, 2014 
Punke, Heather; “Early ACOs, Medical Homes Show Outcomes, Cost Improvements: Study, “ Becker’s Hospital Review, January 10, 2014 
Punke, Heather; “5 things to know about the early Medicare ACOs,” Becker’s Hospital Review, January 8, 2014 WayPointHC.com 
16
Clinical Integration and Process Improvement 
Network physicians, hospitals, and other care continuum providers work collaboratively in 
active clinical process improvement programs across service lines and specialities to define, 
establish, implement, monitor, evaluate and periodically update the processes of: 
A. Evidence-based medicine 
• Promote clinical practices consistent with evidence-based 
medicine protocols and quality measurement goals. 
• Deploy locally adopted, nationally accepted, validated clinical 
measures for performance, efficiency and patient experience. 
• Establish priorities consistent with evidence-based medicine 
principles and potential clinical quality impact. 
• Apply principles across the ambulatory and inpatient 
care continuum to include wellness, prevention, disease 
management and interventional clinical activities. 
• Take into consideration unique local health needs, 
process limitations and resource limitations. 
B. Beneficiary engagement 
• Identify unique health needs of the assigned population 
through clinically integrated health information technology 
that identifies individual health risk factors and facilitates 
the application and management of appropriate disease 
management resources. 
• Monitor gaps in care aimed to prevent adverse unintended 
consequences (including barriers to access, underutilization, 
overutilization for medically complex/difficult to treat 
patients) and to improve patient compliance with 
preventitive care and chronic diesase magangement. 
• Train, educate and register members on patient access and 
informational tools as applicable such as a patient portal, 
online scheduling, educational resources, wellness resources, 
e-prescribing, etc. 
• Promote shared decision making around unique needs and 
values through defined, proactive visit planning and care 
planning resources while communicating clinical information 
and knowledge to patients and families. 
• Maintain written patient clinical information access, 
communication and consumer safety policies. 
C. Care coordination 
• Establish, maintain and monitor structured relationships with 
physicians, hospitals and other care continuum providers 
outside of the primary care setting. 
• Employ clinically integrated health information technology 
resources to assist with clinical decision-making and 
performance monitoring at the point-of-care for care 
coordination and at the population and individual level for 
coordinated and managed care transitions. 
• As an extension of physician-led care teams, promote care 
coordination through care coordination staff working under 
defined care coordination standards (example: admission 
guidelines, discharge summary guidelines, medication 
reconciliation, rehabilitation protocols and post-acute 
placement guidelines). 
D. Conservation of healthcare resources 
• Collectively assume accountability for quality, cost and 
patient experience. 
• Monitor and control utilization of healthcare services that are 
designed to benefit the consumer through controlling costs 
and assuring quality of care, resulting in 
improved outcomes. 
• In concert with protocols establish, maintain and monitor 
compliance with clinical resources standards (ex: drug 
formulary standards and medical device 
vendor standards). 
E. Clinical data reporting 
• Establish and maintain transparent internal and external 
reporting standards on quality, outcomes and cost metrics. 
• Monitor gaps in care and barriers to care. 
• Internally monitor progress against inpatient and outpatient 
quality standards. 
• Through clinical data sharing and reporting, externally 
demonstrate quality and clinical process 
improvement achievements. 
• Maintain balanced incentives that align incentives and 
reward demonstrated clinical process improvement around 
quality, efficiency and patient experience. 
17
Patient Engagement and the ACO 
Getting patients to actively participate in their health 
is key to the ACO’s success. Yet patient engagement 
is difficult as the conventional American thinking of 
“doctor knows best” has created an environment where 
the patient is a passive participant. Health benefit plan 
purchasers in particular are skeptical, and sometimes 
confused, about the ACO’s ability to engage, educate 
and motivate members to achieve compliance with 
disease management and wellness programs. 
This points to a need to redefine what it means to be an 
“engaged” patient. It’s not just about making annual well 
check appointments; it’s a continuous focus on health 
promotion matched to individual needs over time across 
a variety of caregiver touch points. Communication and 
education efforts need to help the ACO patient navigate 
the provider network, access wellness resources and 
participate in disease management programs. These 
efforts should focus on making it easier for patients to 
utilize the system appropriately through proactive on-boarding 
and outreach. 
Commercial ACOs are complex organizations that 
aggregate provider and payer resources to deliver a wide 
range of disease management, wellness programs and 
administrative support services to patients and employer 
groups. Overlap is common. To mitigate confusion, 
health plans and providers must intentionally develop 
unified procedures and educational materials that create 
a seamless experience for the patient from benefit plan 
enrollment to the physician’s office. To realize full health 
benefit potential, the physician-led care team must be 
knowledgeable about available disease management and 
wellness programs. Further, the physician must affirm 
and support the patient’s decision to participate. 
Those ACOs who successfully streamline access to 
health and wellness programs, in concert with proactive 
physician-led teams, will achieve the best outcomes 
and derive significant competitive advantage. Given the 
size and complexity of many ACOs, “streamlining” can 
only be achieved by a sustained focus on the following 
fundamental process and service areas: 
• Easy access and use by members 
• Clarity on services included 
• Clarity on who provides the service 
• Consistent messaging from enrollment to the 
physician’s office 
• Reporting against expectations 
The successful ACO will see its environment through 
the eyes of its patients and empower them to actively 
engage and maintain their health. 
18
Driving a Higher Level of Service and Results 
Through ACO Member Onboarding 
The successful ACO will see its environment through the eyes of its 
patients and empower them to actively engage and maintain their health. 
Given the size and complexity of many ACOs, this first requires educating 
and motivating ACO members through proactive onboarding, outreach and 
navigation resources to manage relationship and value expectations. 
Many consumers are skeptical of ACOs because they 
are largely unproven. This challenge can be countered by 
demonstrating a higher level of service and results through 
physician-driven outreach and proactive services. As a 
starting point, sustained focus should be given to the 
following process and service areas: 
·· Easy access and use by ACO members 
·· Clarity on care management services, including how 
and where to access services 
·· Emphasize the importance of activating a medical 
home relationship 
·· Consistent messaging across the ACO 
·· Reporting to demonstrate services and value 
Consistent messaging from enrollment to the physician’s 
office is critical to managing beneficiary expectations and 
avoiding information overload. First, engage employers 
before open enrollment with marketing materials that 
demonstrate results, payer/provider integration, physician-led 
care teams and proactive member support. Begin setting 
patient expectations at open enrollment with educational 
materials. Then deliver on expectations by proactively 
onboarding ACO members with orientation materials and 
navigational resources that clearly define what services 
are available, how to access those services and activate 
the medical home relationship. Train, educate and register 
members on patient access and informational tools such as 
a patient portal, online scheduling, wellness programming 
and e-prescribing. A centralized Member Communication 
Center is recommended to ensure consistent messaging and 
easy access. 
To reinforce consistent patient care and avoid conflicting 
care management information that may erode compliance, 
physician leadership should be coordinated around care 
programs: 
·· Clarify roles and hand-offs where duplication or multiple 
options exist with defined processes for transitions in 
care. 
·· Consolidate customer service and referral functions 
(such as call centers) where management resources are 
strongest. 
·· Remove barriers that make it difficult for the market 
to associate a service offering as being seamlessly 
delivered by the ACO. 
And finally, report against expectations and demonstrate 
the ACOs services and value with a standardized reporting 
package that includes member experience surveys, clinical 
quality data, care management program enrollment and 
financial utilization data. Help consumers and employers 
connect the dots between care management programs and 
results. 
WayPoint Healthcare Advisors has unique experience in 
providing solutions that align payers, physicians, hospitals 
and clinical services. We believe that ACO member 
onboarding is only the start of an ongoing process to achieve 
patient engagement. How the ACO successfully deploys 
patient engagement will be addressed in the June issue of 
WayPoint Coordinates. 
19
Build a Technology Roadmap 
for Your ACO 
The pressure for data has never been higher. Despite always being at the 
center of many healthcare improvement initiatives, data has mostly told us 
about past activities: utilization patterns, cost per case, volume information, 
profit and loss, etc. 
If you are operating an accountable care organization or 
considering alternative payment models, that type of data 
still provides useful information but the desired dataset has 
grown exponentially. Now we want to know things before 
they happen. I am reminded of a Tom Cruise movie from 
2002, Minority Report. The story was based on a group 
of people referred to as “Pre-Cogs.” They would predict 
crimes before they happened so the police could arrest 
the person before the crime occurred. Today, technology is 
racing towards a similar model where chronic conditions 
and episodic care are predicted using complex algorithms 
based on historical and concurrent clinical and demographic 
information. Conceptually, this sounds great but before your 
organization dives in with both feet, spend the time 
to craft a thoughtful technology plan or selection process 
that prioritizes necessary tools, required datasets and 
support services. 
Planning and 
Organization Requirements Build Vendor Selection Implementation 
Planning 
Activities 
·· Validate timing and 
objectives 
·· Identify Selection 
Steering Committee 
·· Identify business and 
IT SMEs and schedule 
interviews 
·· Develop charter, as 
necessary 
·· Begin vendor research 
·· Identify other 
organizations with 
experience 
·· Identify internal 
evaluation team 
·· Identify project risks/ 
barriers 
Activities 
·· Create current state 
technology architecture 
·· Create desired data flow 
·· Document interface 
needs and concerns 
·· Define “must haves”/ 
basics 
·· Build preliminary 
requirements (technical 
and functional) 
·· Identify “lost 
functionality” from 
current custom 
applications 
·· Document prelim 
security issues 
Activities: 
·· Finalize vendor research 
·· Send requirements for 
initial response 
·· Develop demo scripts 
·· Develop evaluation 
methodology 
·· Review initial vendor 
responses 
·· Avoid “sales pitch” 
·· Create vendor short list 
·· Hold vendor demos/ 
visit reference sites 
·· Consider vendor 
development roadmap 
Activities 
·· Finalize vendor selection 
·· Develop cost model 
·· Develop implementation 
plan 
·· Develop communication 
plan 
20
Current efforts among technology vendors to develop risk-based 
predictive models are fast and furious. Because of 
this, it is more important than ever to fully understand the 
vendor development roadmap and the dataset requirements 
to ensure everything works as the demonstration suggests. 
Integrating data has always been a challenge; however, the 
increasing desire to integrate concurrent clinical information 
from a physician’s electronic record has complicated the 
process even more. It may sound easy to pull in medications 
from the patient record but depending on how frequency 
and dosage is entered into an electronic system, this 
can be very difficult. Additionally, knowing whether the 
prescription is filled and the patient is taking the medication 
as prescribed is another factor that is optimal to know. This 
is just a single example of the many clinical data points 
that today’s applications require to make accurate risk 
assessments. Even if you figure out how to do this for one 
electronic medical record, another may raise completely 
different interface concerns. Many of the new EMRs are 
storing data in the cloud and possibly limiting your access 
to data. If you are in the middle of negotiating a new 
agreement, pay close attention to data access and ensure 
you will have access for a reasonable fee or no fee at all. 
Most vendors have great demonstrations. Most don’t 
highlight weaknesses or real-world challenges to extracting 
and using data. This is a good time to be a skeptic and 
challenge the process. There are great tools to assist your 
organization in taking on risk or just dipping your toe into 
the value-based payment world. Just make sure you think 
about the following high level steps: 
1. Form a selection team and follow a process. 
2. Seek out those that may have blazed the trail 
before you. 
3. Build realistic requirements and a vision for what 
you want to accomplish. 
4. Challenge the demo and really explore data issues 
and interfaces. 
5. Develop a realistic timeframe and plan for interim 
successes. 
6. Understand the difference between current and 
planned functionality. 
7. Dedicate the right amount of resources to be 
successful. 
21

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WayPoint Firm Credentials

  • 1. LEADERSHIP “WayPoint’s leadership reflects that rare breed of well-rounded individuals who can execute. They aren’t afraid to put their fingers on the keyboard. They don’t just describe the work, they break it down into logical steps and do it. Together we produce outcomes.” David Bradshaw, MHMD Chief Information, Planning & Marketing Officer “It has been a very rewarding opportunity to work with WayPoint; one that has been marked with good physician communication, trust, and integrity.” Tom Wall, MD, Medical Director, Triad HealthCare Network Waypoint professionals work with your team to deliver custom solutions that reflect experience, best practices and an independent point of view. 3
  • 2. Jim McCoy, Managing Director Jim brings a wealth of healthcare experience to WayPoint, particularly in improving quality, safety and patient experience through clinical integration. He’s worked with clients ranging from integrated health care systems and large medical groups to hospitals and various specialty providers. Prior to starting WayPoint, Jim gained direct industry experience through multiple roles at Texas Health Resources, including Director of Market Management and Assistant Administrator responsible for strategic planning and core operational functions. During this time, Jim developed and managed a large multi-specialty physician independent practice association. Jim has also served in leadership roles at Ernst & Young’s Health Sciences Advisory Practice. Jim has led a long list of initiatives, including: ·· Patient centered medical home (PCMH) and related incentive programs ·· Innovative population management payer contracting relationships ·· Inpatient quality and safety incentive programs ·· Accountable Care Organization start-up ·· Medicare Shared Savings Program participation ·· Strengthening health information technology and population management infrastructure ·· Hospital and medical group operational efficiency and profitability studies ·· Hospital and medical group revenue cycle and pricing strategies ·· Managed care negotiations and payment dispute resolution ·· Transaction support including fair market value assessments ·· Due diligence including financial and market projections ·· New business formation, mergers and acquisition support services ·· Strategic planning, including market studies and financial projections ·· New facility and service line planning ·· Real estate and major capital expenditure planning ·· Physician compensation plan development ·· Claims dispute resolution and litigation support ·· Clinical integration ·· Operational restructuring to support an accountable care organization (ACO) ·· Physician alignment Jim graduated from the University of Texas at Austin and earned his MBA in Finance at the University of Texas at Arlington. He lives in Fort Worth with his wife and two sons and is active in a variety of DFW-area community groups, including: ·· American College of Health Care Executives ·· Dallas Fort Worth Health Industry Council ·· Alumni – Cook Children’s Health Care System “Experience the Mission” Program ·· First Tee of Fort Worth – current board member and instructor ·· West Side Little League ·· Fort Worth Texas Exes Chapter – past president 4
  • 3. Brett Kirstein, Managing Director Brett has served the healthcare industry in a consulting capacity for the past 24 years. During that time, he’s led all types of engagements in leadership roles including: ·· Partner, Arthur Andersen Healthcare Consulting, where he led the Revenue Cycle Practice for the Southwest region ·· Vice President, Hitachi Consulting, where he shared in the leadership of the Finance Business Solutions Practice ·· President, Revenue Cycle Solutions, where he founded a professional services firm to serve his healthcare clients at a more strategic level ·· Managing Director of WayPoint Brett’s consulting approach has always been to impact results through measurable process improvement, strategy articulation and technology implementations. In addition to supporting large integrated health systems, academic medical centers and not-for-profit acute care systems of all sizes, he has worked extensively in long term care for several regional and national chains. Most recently, Brett has led initiatives including: ·· Drafted and submitted the Medicare Shared Savings Program application for three of the largest ACO’s nationally ·· Supported the start-up and operations of a hospital system led ACO with 60,000 covered lives ·· Implemented population health management technology tools including claims based risk stratification and physician intelligence tools as well as an HIE ·· Supported hospital and physician efforts to create a clinically integrated network ·· Led strategic initiatives to redesign the clinical improvement process as well as physician incentives in the areas of quality and safety and specialty service lines ·· Managed-care contract analysis and negotiations ·· Implemented enterprise wide labor management technology including time and attendance and scheduling ·· Supported various revenue cycle redesign initiatives including CBO planning and outsourcing evaluations ·· Led pre- and post-merger integration planning and implementation for $2B long term care company ·· Led various process improvement engagements including payables, payroll, accounting, clinical risk management and business development Brett is a 20-year CPA in the State of Texas and graduated from the University of Texas at Austin with a BBA and MPA in taxation. He lives in Dallas with his wife and two children and volunteers in various community efforts and professional organizations. Most recently, he was the past Chair of the Board for Head Start of Greater Dallas and is a current board member of Educational First Steps. 5
  • 4. CLIENTS “WayPoint has become a part of our team. They understand the people on our team and the functions they provide. No matter what the issue is, they help us articulate a better vision and execute it into action.” Chris Lloyd, MHMD CEO “Waypoint is highly responsive and very much hands-on in their approach. Because they had similar experience with other ACOs, their guidance through the application process was a comfort to us. You’re not getting buzz words, you’re getting expertise that drives results.” Chief Operating Officer, Regional Market Leading Health System / ACO Waypoint professionals work with your team to deliver custom solutions that reflect experience, best practices and an independent point of view. 6
  • 5. RECENT CLIENT EXPERIENCE CLIENT OBJECTIVES WayPoint has vast experience in Population Management, Clinical Integration and ACO initiatives. Readiness assessment, design and implementation experience includes: • ACO / CIN / PCMH start-up activities • Innovative value based payer contracting relationships • Population health management technology implementation - Analytics to identify at risk patient populations - Analytics to improve provider performance and measure quality • Care management people, process and technology resource deployment • CMS Medicare Shared Savings Program participation SOLUTIONS For a variety of clients WayPoint has assessed existing clinical integration resources and incentive structures while supporting leadership to develop market-specific capabilities in following implementation areas: • Enterprise scope, structure, governance and leadership • Provider network composition and development • Reporting tools and processes • Care team incentives • Health information technology resource plans • Staffing plans and operating budget estimates Specialized resources were identified in order to: • Promote clinical process improvement • Identify population-specific health needs and high-risk patients • Deliver disease management programs / coordinate care • Enhance patient access, communication, and engagement RESULTS • PCMH implementation in 12 months (100 physicians+ certified to date) • CMS Medicare Shared Savings Program ACO approved • Multiple commercial payer ACO contracts • Named one of Becker’s “100 ACOs to Know” • Included in 29 MSSP ACOs achieving shared savings 13
  • 6. SERVICES “WayPoint accelerates our programs. Our PCMH was up and running in a year. An ACO application could take 3 years, yet MHMD and WayPoint did it in three months. Readiness assessment is vital. We couldn’t have done it without WayPoint.” Keith Fernandez, MD, MHMD President & Physician in Chief “We value WayPoint’s frank assessments and one-on-one approach. They haven’t been a single engagement for us but a valued on-going partnership.” Chief Financial Officer, Regional Market Leading Health System Waypoint professionals work with your team to deliver custom solutions that reflect experience, best practices and an independent point of view. 11
  • 7. STRENGTHEN STRATEGY WayPoint strengthens each client’s strategy with a collaborative approach, combining qualitative and quantitative analysis to align incentives and improve performance. Successfully meeting today’s challenges requires integration strategies such as medical homes, population health, and clinical integration assessment and implementation. We quickly identify key issues, focus on priorities and develop custom solutions within a shorter period of time. Our strategy services include: • Integration strategies - ACO readiness assessment, design and implementation - Medicare Shared Savings Program participation - Population Health / Clinical Integration / Medical Home • Market studies and financial projections • New facility and service line planning IMPROVE CLINICAL PROCESS WayPoint has deep experience across the hospital, physician and payer industry sectors. Clinical process improvement models that align incentives between the hospital system and physicians must be developed in order to reduce costs and maintain or improve quality. We have successfully executed a wide range of population health, clinical integration and ACO initiatives that support the following: • Improve quality, efficiency and patient experience • Integrate the diverse skills and resources of physicians, administrators and other clinicians • Effectively engage physician leadership • Respond to market-based transparency needs STREAMLINE OPERATIONS WayPoint has worked in nearly every operational area of hospital and physician organizations. We apply this experience provides to identify areas of opportunity, and then design, launch and support operations improvement programs that make more efficient use of resources and improve financial performance. Operational review areas include: • Governance • Clinical service lines • Management services • Common and interoperative technology platforms • Alternate reimbursement and incentive model formats • Payer contracting relationships and opportunities MAXIMIZE REVENUE AND PROFIT Reimbursement model changes are fundamental drivers of healthcare transformation. End-to end rethinking of the healthcare organization is required in order to efficiency and quality. We have worked with a wide range of organizations to maximize revenue and growth in areas such as: • Managed care contracting • Service line development • Incentive model design • Pre/Post Transactional integration • Revenue cycle management 12
  • 8. EXECUTIVE BRIEFINGS Waypoint professionals work with your team to deliver custom solutions that reflect experience, best practices and an independent point of view. 14
  • 9. Success Factors of Clinical Integration 1. Historic Model Care is fragmented by service line and specialty. Siloed protocols and pathways with little coordination. 4. Breakthrough Population management including evidence-based medicine protocols, risk stratification and disease management across the continuum of care. Provider integration is achieved with collaborative physician-led clinical process improvement. Payer/provider alignment and integration maximizes care quality and clinical process improvement. Data shared demonstrates value, quality and clinical process improvement. CIN/ACO members engage with onboarding and navigation resources that clearly define services and how to access them. Patients are engaged and supported with education, care coordination, expanded access and network navigation support. Messaging is consistent from health benefit plan enrollment to the physician’s office. Value-based economic incentives are developed to allow providers to share financial success. Operating Principles Evolving Integration Efforts Clinical Process Improvement Governance A local representative organization, inclusive of quality physicians and the hospital, responds to and manages the changing industry. Leadership is multi-specialty physician-driven with a strong primary care foundation. Support resources in place to ease administrative burdens and address barriers to small practice adoption and compliance. Evidence-based medicine protocols and quality measurement goals are consistent in clinical practices. Care is coordinated with physicians, hospitals and other care continuum providers outside of primary care. Clinical data reporting demonstrates quality and clinical process improvement achievements. Beneficiaries are engaged to improve compliance with preventive care and chronic disease management. Healthcare resource efficiencies through standards consistent with clinical quality improvement objectives 2. Transitional Care is coordinated across specialties and care sites. Protocols and pathways continue to be based within a given setting of care such as hospital or inpatient rehabilitation facility. 3. Advanced Seamless transition in care between relevant settings and specialties. Protocols and pathways are based on service lines across providers instead of a single setting of care. Providers integrated across the continuum of care work collaboratively in active clinical process improvement to improve quality of care. WayPointHC.com 15
  • 10. ACO Growth and Early Positive Results Reduced spending by 2.5% 61% 61% 57% A C A D E M I C I N D U S T RY Inpatient admissions reduced by 2.5% 57% A C A D E M I C I N D U S T RY 31% Improvements in population health A C A D E M I C I N D U S T RY 31% 29% Improved access A C A D E M I C I N D U S T RY 31% 14% Fewer emergency department visits 57% A C A D E M I C I N D U S T RY Readmissions reduced by 9.7% A C A D E M I C I N D U S T RY 29% 13% Increased preventive services A C A D E M I C I N D U S T RY 31% 29% Improved satisfaction A C A D E M I C 23% I N D U S T RY 14% Outpatient services increased by 7.4% 13.2% reduction in potentially preventable initial admissions 21% 23% of hospital and health systems do not plan to create or join an ACO in the forseeable future of hospital and health systems not yet part of an ACO plan to create or join one by the end of this year 5 things to know about ACOs that joined the program before fall 2012: Large, nonprofit teaching hospitals were the typical hospital participants Little difference in performance on quality metrics between participating and nonparticipating hospitals Hospital referral regions tended to have larger populations and more Medicare spending per beneficiary Patients were more likely to be white, older than 80 years old with higher incomes than other Medicare beneficiaries Patients had 5.8% lower total costs of care ($7,694) than patients not in an ACO ($8,164) at the baseline Rizzo, Ellie; “7 Latest Findings about ACOs,” Becker’s Hospital Review, January 15, 2014 Punke, Heather; “Early ACOs, Medical Homes Show Outcomes, Cost Improvements: Study, “ Becker’s Hospital Review, January 10, 2014 Punke, Heather; “5 things to know about the early Medicare ACOs,” Becker’s Hospital Review, January 8, 2014 WayPointHC.com 16
  • 11. Clinical Integration and Process Improvement Network physicians, hospitals, and other care continuum providers work collaboratively in active clinical process improvement programs across service lines and specialities to define, establish, implement, monitor, evaluate and periodically update the processes of: A. Evidence-based medicine • Promote clinical practices consistent with evidence-based medicine protocols and quality measurement goals. • Deploy locally adopted, nationally accepted, validated clinical measures for performance, efficiency and patient experience. • Establish priorities consistent with evidence-based medicine principles and potential clinical quality impact. • Apply principles across the ambulatory and inpatient care continuum to include wellness, prevention, disease management and interventional clinical activities. • Take into consideration unique local health needs, process limitations and resource limitations. B. Beneficiary engagement • Identify unique health needs of the assigned population through clinically integrated health information technology that identifies individual health risk factors and facilitates the application and management of appropriate disease management resources. • Monitor gaps in care aimed to prevent adverse unintended consequences (including barriers to access, underutilization, overutilization for medically complex/difficult to treat patients) and to improve patient compliance with preventitive care and chronic diesase magangement. • Train, educate and register members on patient access and informational tools as applicable such as a patient portal, online scheduling, educational resources, wellness resources, e-prescribing, etc. • Promote shared decision making around unique needs and values through defined, proactive visit planning and care planning resources while communicating clinical information and knowledge to patients and families. • Maintain written patient clinical information access, communication and consumer safety policies. C. Care coordination • Establish, maintain and monitor structured relationships with physicians, hospitals and other care continuum providers outside of the primary care setting. • Employ clinically integrated health information technology resources to assist with clinical decision-making and performance monitoring at the point-of-care for care coordination and at the population and individual level for coordinated and managed care transitions. • As an extension of physician-led care teams, promote care coordination through care coordination staff working under defined care coordination standards (example: admission guidelines, discharge summary guidelines, medication reconciliation, rehabilitation protocols and post-acute placement guidelines). D. Conservation of healthcare resources • Collectively assume accountability for quality, cost and patient experience. • Monitor and control utilization of healthcare services that are designed to benefit the consumer through controlling costs and assuring quality of care, resulting in improved outcomes. • In concert with protocols establish, maintain and monitor compliance with clinical resources standards (ex: drug formulary standards and medical device vendor standards). E. Clinical data reporting • Establish and maintain transparent internal and external reporting standards on quality, outcomes and cost metrics. • Monitor gaps in care and barriers to care. • Internally monitor progress against inpatient and outpatient quality standards. • Through clinical data sharing and reporting, externally demonstrate quality and clinical process improvement achievements. • Maintain balanced incentives that align incentives and reward demonstrated clinical process improvement around quality, efficiency and patient experience. 17
  • 12. Patient Engagement and the ACO Getting patients to actively participate in their health is key to the ACO’s success. Yet patient engagement is difficult as the conventional American thinking of “doctor knows best” has created an environment where the patient is a passive participant. Health benefit plan purchasers in particular are skeptical, and sometimes confused, about the ACO’s ability to engage, educate and motivate members to achieve compliance with disease management and wellness programs. This points to a need to redefine what it means to be an “engaged” patient. It’s not just about making annual well check appointments; it’s a continuous focus on health promotion matched to individual needs over time across a variety of caregiver touch points. Communication and education efforts need to help the ACO patient navigate the provider network, access wellness resources and participate in disease management programs. These efforts should focus on making it easier for patients to utilize the system appropriately through proactive on-boarding and outreach. Commercial ACOs are complex organizations that aggregate provider and payer resources to deliver a wide range of disease management, wellness programs and administrative support services to patients and employer groups. Overlap is common. To mitigate confusion, health plans and providers must intentionally develop unified procedures and educational materials that create a seamless experience for the patient from benefit plan enrollment to the physician’s office. To realize full health benefit potential, the physician-led care team must be knowledgeable about available disease management and wellness programs. Further, the physician must affirm and support the patient’s decision to participate. Those ACOs who successfully streamline access to health and wellness programs, in concert with proactive physician-led teams, will achieve the best outcomes and derive significant competitive advantage. Given the size and complexity of many ACOs, “streamlining” can only be achieved by a sustained focus on the following fundamental process and service areas: • Easy access and use by members • Clarity on services included • Clarity on who provides the service • Consistent messaging from enrollment to the physician’s office • Reporting against expectations The successful ACO will see its environment through the eyes of its patients and empower them to actively engage and maintain their health. 18
  • 13. Driving a Higher Level of Service and Results Through ACO Member Onboarding The successful ACO will see its environment through the eyes of its patients and empower them to actively engage and maintain their health. Given the size and complexity of many ACOs, this first requires educating and motivating ACO members through proactive onboarding, outreach and navigation resources to manage relationship and value expectations. Many consumers are skeptical of ACOs because they are largely unproven. This challenge can be countered by demonstrating a higher level of service and results through physician-driven outreach and proactive services. As a starting point, sustained focus should be given to the following process and service areas: ·· Easy access and use by ACO members ·· Clarity on care management services, including how and where to access services ·· Emphasize the importance of activating a medical home relationship ·· Consistent messaging across the ACO ·· Reporting to demonstrate services and value Consistent messaging from enrollment to the physician’s office is critical to managing beneficiary expectations and avoiding information overload. First, engage employers before open enrollment with marketing materials that demonstrate results, payer/provider integration, physician-led care teams and proactive member support. Begin setting patient expectations at open enrollment with educational materials. Then deliver on expectations by proactively onboarding ACO members with orientation materials and navigational resources that clearly define what services are available, how to access those services and activate the medical home relationship. Train, educate and register members on patient access and informational tools such as a patient portal, online scheduling, wellness programming and e-prescribing. A centralized Member Communication Center is recommended to ensure consistent messaging and easy access. To reinforce consistent patient care and avoid conflicting care management information that may erode compliance, physician leadership should be coordinated around care programs: ·· Clarify roles and hand-offs where duplication or multiple options exist with defined processes for transitions in care. ·· Consolidate customer service and referral functions (such as call centers) where management resources are strongest. ·· Remove barriers that make it difficult for the market to associate a service offering as being seamlessly delivered by the ACO. And finally, report against expectations and demonstrate the ACOs services and value with a standardized reporting package that includes member experience surveys, clinical quality data, care management program enrollment and financial utilization data. Help consumers and employers connect the dots between care management programs and results. WayPoint Healthcare Advisors has unique experience in providing solutions that align payers, physicians, hospitals and clinical services. We believe that ACO member onboarding is only the start of an ongoing process to achieve patient engagement. How the ACO successfully deploys patient engagement will be addressed in the June issue of WayPoint Coordinates. 19
  • 14. Build a Technology Roadmap for Your ACO The pressure for data has never been higher. Despite always being at the center of many healthcare improvement initiatives, data has mostly told us about past activities: utilization patterns, cost per case, volume information, profit and loss, etc. If you are operating an accountable care organization or considering alternative payment models, that type of data still provides useful information but the desired dataset has grown exponentially. Now we want to know things before they happen. I am reminded of a Tom Cruise movie from 2002, Minority Report. The story was based on a group of people referred to as “Pre-Cogs.” They would predict crimes before they happened so the police could arrest the person before the crime occurred. Today, technology is racing towards a similar model where chronic conditions and episodic care are predicted using complex algorithms based on historical and concurrent clinical and demographic information. Conceptually, this sounds great but before your organization dives in with both feet, spend the time to craft a thoughtful technology plan or selection process that prioritizes necessary tools, required datasets and support services. Planning and Organization Requirements Build Vendor Selection Implementation Planning Activities ·· Validate timing and objectives ·· Identify Selection Steering Committee ·· Identify business and IT SMEs and schedule interviews ·· Develop charter, as necessary ·· Begin vendor research ·· Identify other organizations with experience ·· Identify internal evaluation team ·· Identify project risks/ barriers Activities ·· Create current state technology architecture ·· Create desired data flow ·· Document interface needs and concerns ·· Define “must haves”/ basics ·· Build preliminary requirements (technical and functional) ·· Identify “lost functionality” from current custom applications ·· Document prelim security issues Activities: ·· Finalize vendor research ·· Send requirements for initial response ·· Develop demo scripts ·· Develop evaluation methodology ·· Review initial vendor responses ·· Avoid “sales pitch” ·· Create vendor short list ·· Hold vendor demos/ visit reference sites ·· Consider vendor development roadmap Activities ·· Finalize vendor selection ·· Develop cost model ·· Develop implementation plan ·· Develop communication plan 20
  • 15. Current efforts among technology vendors to develop risk-based predictive models are fast and furious. Because of this, it is more important than ever to fully understand the vendor development roadmap and the dataset requirements to ensure everything works as the demonstration suggests. Integrating data has always been a challenge; however, the increasing desire to integrate concurrent clinical information from a physician’s electronic record has complicated the process even more. It may sound easy to pull in medications from the patient record but depending on how frequency and dosage is entered into an electronic system, this can be very difficult. Additionally, knowing whether the prescription is filled and the patient is taking the medication as prescribed is another factor that is optimal to know. This is just a single example of the many clinical data points that today’s applications require to make accurate risk assessments. Even if you figure out how to do this for one electronic medical record, another may raise completely different interface concerns. Many of the new EMRs are storing data in the cloud and possibly limiting your access to data. If you are in the middle of negotiating a new agreement, pay close attention to data access and ensure you will have access for a reasonable fee or no fee at all. Most vendors have great demonstrations. Most don’t highlight weaknesses or real-world challenges to extracting and using data. This is a good time to be a skeptic and challenge the process. There are great tools to assist your organization in taking on risk or just dipping your toe into the value-based payment world. Just make sure you think about the following high level steps: 1. Form a selection team and follow a process. 2. Seek out those that may have blazed the trail before you. 3. Build realistic requirements and a vision for what you want to accomplish. 4. Challenge the demo and really explore data issues and interfaces. 5. Develop a realistic timeframe and plan for interim successes. 6. Understand the difference between current and planned functionality. 7. Dedicate the right amount of resources to be successful. 21