This document analyzes the strategic position of Presence Mercy Medical Center. It conducts a situation analysis including a remote analysis of the healthcare industry, Porter's 5 forces analysis, and a SWOT analysis. It profiles Presence Mercy and its main competitor, Rush-Copley Medical Center. The document recommends a two-phase strategy. Phase one focuses on controlling costs through technology upgrades and developing physician relationships. Phase two suggests expanding services through new clinics in underserved areas to capture more market share from competitors like Rush-Copley.
This document summarizes key points from a presentation on sustaining physician-led healthcare organizations. It discusses the current state of the US healthcare system including challenges around demographics, consumerism, technology, and economics. It then covers implications of the Affordable Care Act, such as Medicaid expansion decisions by states and the growth of high-deductible health plans. Finally, it discusses factors needed to build sustainable organizations, including value-based payments, delivery redesign, and blurred lines between providers and payers.
The Emergency Triage, Treat, and Transport (ET3) Model Medical Triage Line Notice of Funding Opportunity (NOFO) webinar provided an overview of the application process and NOFO requirements for implementing 911 medical triage lines. This webinar was intended for those interested in learning more about the ET3 Model’s Notice of Funding Opportunity, which was released March 12.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The ET3 Model and Medicaid: Opportunities for Alignment webinar provided background on the ET3 Model, discussed the benefits for states of aligning coverage and payment policies with ET3, and explored considerations for states seeking to implement new Medicaid services that align with the ET3 Model. This webinar was intended for state Medicaid agencies, ET3 Model Participants, and other stakeholders interested in learning more about optional Medicaid alignment with the ET3 Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 11, 2019 from 1:30pm-3:00 p.m. EST entitled, Direct Contracting Overview/Direct Contracting Entity (DCE) Types/Alignment. During this webinar, presenters provided an overview of the Direct Contracting Model Professional and Global Options, including information about the participation and eligibility requirements, Direct Contracting Entity (DCE) types, payment mechanisms, and beneficiary alignment methodology.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
How Healthcare Reform Is Affecting Radiology, Pam KassingTriMed Media Group
How Healthcare Reform Is Affecting Radiology - Presented by: http://www.healthimaging.com - speaker: Pam Kassing, MS, Senior Director of Health Policy, American College of Radiology. Presented at the GE Virtual Conference, September 14, 2011.
The Primary Care First (PCF) Model Options team hosted a series of four informational webinars about the PCF Model Options. Topics discussed included the model options' aims, requirements, benefits of participation, and application next steps. Attendees had the opportunity to submit questions to the model options team during each of the webinars. Each of the webinars covered the same information.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The CMS Innovation Center held the third in a series of webinar events for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Thursday, June 16, 2016 from 12:00p.m. – 1:00p.m. EDT. This webinar provided a technical presentation and demonstration of the application process and online application in detail.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes key points from a presentation on sustaining physician-led healthcare organizations. It discusses the current state of the US healthcare system including challenges around demographics, consumerism, technology, and economics. It then covers implications of the Affordable Care Act, such as Medicaid expansion decisions by states and the growth of high-deductible health plans. Finally, it discusses factors needed to build sustainable organizations, including value-based payments, delivery redesign, and blurred lines between providers and payers.
The Emergency Triage, Treat, and Transport (ET3) Model Medical Triage Line Notice of Funding Opportunity (NOFO) webinar provided an overview of the application process and NOFO requirements for implementing 911 medical triage lines. This webinar was intended for those interested in learning more about the ET3 Model’s Notice of Funding Opportunity, which was released March 12.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The ET3 Model and Medicaid: Opportunities for Alignment webinar provided background on the ET3 Model, discussed the benefits for states of aligning coverage and payment policies with ET3, and explored considerations for states seeking to implement new Medicaid services that align with the ET3 Model. This webinar was intended for state Medicaid agencies, ET3 Model Participants, and other stakeholders interested in learning more about optional Medicaid alignment with the ET3 Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 11, 2019 from 1:30pm-3:00 p.m. EST entitled, Direct Contracting Overview/Direct Contracting Entity (DCE) Types/Alignment. During this webinar, presenters provided an overview of the Direct Contracting Model Professional and Global Options, including information about the participation and eligibility requirements, Direct Contracting Entity (DCE) types, payment mechanisms, and beneficiary alignment methodology.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
How Healthcare Reform Is Affecting Radiology, Pam KassingTriMed Media Group
How Healthcare Reform Is Affecting Radiology - Presented by: http://www.healthimaging.com - speaker: Pam Kassing, MS, Senior Director of Health Policy, American College of Radiology. Presented at the GE Virtual Conference, September 14, 2011.
The Primary Care First (PCF) Model Options team hosted a series of four informational webinars about the PCF Model Options. Topics discussed included the model options' aims, requirements, benefits of participation, and application next steps. Attendees had the opportunity to submit questions to the model options team during each of the webinars. Each of the webinars covered the same information.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The CMS Innovation Center held the third in a series of webinar events for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Thursday, June 16, 2016 from 12:00p.m. – 1:00p.m. EDT. This webinar provided a technical presentation and demonstration of the application process and online application in detail.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This presentation covers the basics of Healthcare domain and the testing challenges faced there off.Good content for people having interest or working in Health Care domain.
This webinar will highlight key areas from the document discussing what a strong application to the BPCI initiative should include. We encourage you to review the Models 2-4 application questions and the new Application Guidance document posted on the Bundled Payments for Care Improvement webpage, prior to this webinar.
More at: http://www.innovations.cms.gov/resources/Bundled-Payments-Application-Guidance.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document provides instructions for completing the application for the Direct Decision Support (DDS) Model. It reviews the application process and sections, including organizational structure, financial plan, beneficiary engagement plan, and data requirements. It highlights the importance of the financial plan worksheets in ensuring consistency and transparency in reporting costs. The worksheets include tabs for cost summary, program expenses, beneficiary engagement and savings projections, and automatically calculate totals.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
Presented by PYA’s Jim Lloyd (Consulting Principal) and Robert Mundy (Consulting Senior Manager), "Valuation of Dental Practices,” provide valuable insights regarding dental practice operations, merger and acquisition activity, and valuation approaches. The presentation also covers:
Key operating statistics that drive the value of dental practices.
Compensation trends for dentists.
Regulatory constraints and related issues.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing letter of intent overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, March 22 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses the state of healthcare in the United States, National Imaging Associates (NIA) and their RadMD enterprise portal. It describes how the US healthcare system is large, costly and fragmented. NIA created RadMD to connect physicians, improve information sharing and manage diagnostic imaging costs/quality. RadMD integrates clinical data and transaction processing to facilitate the healthcare process for providers, payers and patients.
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
This document discusses network alliances as an alternative to traditional mergers and acquisitions for hospitals. It describes network alliances as formal relationships between two or more entities to share resources and capabilities. The document outlines the key considerations for developing a network alliance strategy, including defining the scope of the relationship and ensuring the form follows the intended functions. It provides an example case study of the Health Network of Missouri, describing its purpose, corporate structure, governance structure, voting rights, and committee organization as a network alliance between five hospital systems.
The document discusses CMS's Chronic Care Management program, which pays providers to coordinate care for Medicare patients with multiple chronic conditions. Key points:
- The CCM program pays providers $42 per patient per month to perform 20 minutes of care management and coordination activities outside of office visits.
- To qualify for CCM, patients must have Medicare fee-for-service and two or more chronic conditions expected to last over a year.
- Eligible providers must obtain patient consent and provide 24/7 access, care management, care coordination, and electronic care plans shared with other providers.
- The program aims to improve outcomes and lower costs for patients with multiple chronic conditions by encouraging coordinated chronic care management between visits
How Specialty Pharmacies Can Use Data to Drive RevenueSara Wilson
Therigy has built a proprietary suite of technology products for specialty pharmacies to deliver best-in-class patient support.
Therigy’s data analytics solutions support the complex data capture and unique reporting requirement in the specialty space.
The Beneficiary Engagement and Incentives: Shared Decision Making (SDM) Model team hosted a webinar on Tuesday, February 7, 2017. During this webinar Model team members provided an overview of the application, provided technical guidance followed by a question-and-answer (Q&A) segment.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes a presentation given by Albert Lowey-Ball on implementation of the Affordable Care Act (ACA) in California. Key points include:
- Medi-Cal enrollment expanded by 3.9 million people while Covered California enrollment reached 1.4 million.
- Provider networks are narrowing and differentiating as the healthcare marketplace consolidates among health plans, hospital systems, and medical groups.
- Implementation has been successful in expanding coverage but challenges remain around reaching certain hard-to-enroll populations and stabilizing premium increases.
- The expansion presents implications for specialty medical groups like radiology to carefully partner with dominant health plans and hospital systems.
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
Healthcare Savings Via Pharmacy Benefit Management ProgramsThe Partners Group
Optimize your employees’ drug benefit costs, while decreasing costs and simultaneously improving overall drug benefit coverage.
Pharmacy benefit costs are the fastest growing segment of national health expenditures… rising at a rate faster than hospital care and physician services combined. Learn how employers are achieving significant savings via the TPG Proprietary Pharmacy Benefit Program.
In This Seminar We Cover:
• Options for controlling health care pharmacy costs without impacting your membership.
• Overview of the latest trends in the pharmacy benefits arena and new programs that will improve members’ RX utilization and lower your self-funded prescription drug spend.
• Methods to establish true transparency into the cost of your plan’s prescription drug program and how to continuously monitor your drug costs vs. the pharmacy contract.
• Real life case studies of actual plan savings from the 2014 plan year.
• How to become eligible for a pharmacy audit completed by The Partners Group.
This Medicare-Medicaid ACO Model webinar included information on the structure of the Model, Model details including beneficiary attribution, financial methodology and quality measurement options within the Model, and an explanation of data, learning and evaluation. The state-specific development and application process, including instructions for submitting letters of intent were also discussed. This webinar was open to the general public and targeted towards interested states.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses trends in medical device regulation and innovation. It finds that while FDA approval times for novel PMA devices have improved recently, 510(k) clearance times remain much longer than historic averages. Additionally, a gap remains where medical devices are approved 3-5 years faster in Europe compared to the US. The FDA has made improvements but more work is still needed to further streamline processes and reduce review times for medical devices.
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
Making the shift to value-based care is not easy. However, a growing number of healthcare organizations are finding success leveraging Lean process improvement and health IT to reduce waste, lower costs, and improve quality.
In fact, leading health systems like Bon Secours, Prevea Health, and North Mississippi Medical Center are using these principles to improve care management processes and achieve better patient outcomes.
We have assembled these strategies into a new whitepaper. You will learn:
- How key concepts of Lean thinking can be applied to healthcare
- Why high-performing practices are using Lean to enable care team members to provide better care
- The financial advantages of a team-based, population health management approach in a value-based reimbursement system
MMS State of the State Conference: Susan Dentzer - Rationalizing Health Spend...Frank Fortin
The document discusses challenges facing Massachusetts and the US in controlling rising healthcare costs. It notes that current spending growth rates threaten Massachusetts' reforms and the nation's fiscal health. Several key drivers of higher spending are identified, including new medical technologies, chronic diseases like obesity, and low productivity growth in the healthcare sector. Solutions proposed include reducing unnecessary variations in supply-sensitive care, payment reforms like bundled payments that incentivize quality over quantity, and policies to improve prevention and management of chronic conditions.
Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
Turning Price Transparency Into a Competitive Advantage in the Age of Consume...Megan Williams
The document discusses turning price transparency into a competitive advantage under new CMS rules requiring hospitals to publicly post their standard charges. It notes that audits show significant non-compliance and price disparities for the same procedures across hospitals. The role of cost accounting data in evaluating service line and contract profitability is discussed, as are opportunities to use cost data for strategic budgeting, performance improvement, and population health management. Questions are posed about how hospitals currently set prices and whether decreases could make them more competitive.
Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker Series
Karyn DiGiorgio (University of California)
More info at: vsee.com/conference
This presentation covers the basics of Healthcare domain and the testing challenges faced there off.Good content for people having interest or working in Health Care domain.
This webinar will highlight key areas from the document discussing what a strong application to the BPCI initiative should include. We encourage you to review the Models 2-4 application questions and the new Application Guidance document posted on the Bundled Payments for Care Improvement webpage, prior to this webinar.
More at: http://www.innovations.cms.gov/resources/Bundled-Payments-Application-Guidance.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document provides instructions for completing the application for the Direct Decision Support (DDS) Model. It reviews the application process and sections, including organizational structure, financial plan, beneficiary engagement plan, and data requirements. It highlights the importance of the financial plan worksheets in ensuring consistency and transparency in reporting costs. The worksheets include tabs for cost summary, program expenses, beneficiary engagement and savings projections, and automatically calculate totals.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
Presented by PYA’s Jim Lloyd (Consulting Principal) and Robert Mundy (Consulting Senior Manager), "Valuation of Dental Practices,” provide valuable insights regarding dental practice operations, merger and acquisition activity, and valuation approaches. The presentation also covers:
Key operating statistics that drive the value of dental practices.
Compensation trends for dentists.
Regulatory constraints and related issues.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum providing letter of intent overview for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, March 22 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses the state of healthcare in the United States, National Imaging Associates (NIA) and their RadMD enterprise portal. It describes how the US healthcare system is large, costly and fragmented. NIA created RadMD to connect physicians, improve information sharing and manage diagnostic imaging costs/quality. RadMD integrates clinical data and transaction processing to facilitate the healthcare process for providers, payers and patients.
An Alternative to Traditional M&A: Hospital Network AlliancesPYA, P.C.
This document discusses network alliances as an alternative to traditional mergers and acquisitions for hospitals. It describes network alliances as formal relationships between two or more entities to share resources and capabilities. The document outlines the key considerations for developing a network alliance strategy, including defining the scope of the relationship and ensuring the form follows the intended functions. It provides an example case study of the Health Network of Missouri, describing its purpose, corporate structure, governance structure, voting rights, and committee organization as a network alliance between five hospital systems.
The document discusses CMS's Chronic Care Management program, which pays providers to coordinate care for Medicare patients with multiple chronic conditions. Key points:
- The CCM program pays providers $42 per patient per month to perform 20 minutes of care management and coordination activities outside of office visits.
- To qualify for CCM, patients must have Medicare fee-for-service and two or more chronic conditions expected to last over a year.
- Eligible providers must obtain patient consent and provide 24/7 access, care management, care coordination, and electronic care plans shared with other providers.
- The program aims to improve outcomes and lower costs for patients with multiple chronic conditions by encouraging coordinated chronic care management between visits
How Specialty Pharmacies Can Use Data to Drive RevenueSara Wilson
Therigy has built a proprietary suite of technology products for specialty pharmacies to deliver best-in-class patient support.
Therigy’s data analytics solutions support the complex data capture and unique reporting requirement in the specialty space.
The Beneficiary Engagement and Incentives: Shared Decision Making (SDM) Model team hosted a webinar on Tuesday, February 7, 2017. During this webinar Model team members provided an overview of the application, provided technical guidance followed by a question-and-answer (Q&A) segment.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes a presentation given by Albert Lowey-Ball on implementation of the Affordable Care Act (ACA) in California. Key points include:
- Medi-Cal enrollment expanded by 3.9 million people while Covered California enrollment reached 1.4 million.
- Provider networks are narrowing and differentiating as the healthcare marketplace consolidates among health plans, hospital systems, and medical groups.
- Implementation has been successful in expanding coverage but challenges remain around reaching certain hard-to-enroll populations and stabilizing premium increases.
- The expansion presents implications for specialty medical groups like radiology to carefully partner with dominant health plans and hospital systems.
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
Healthcare Savings Via Pharmacy Benefit Management ProgramsThe Partners Group
Optimize your employees’ drug benefit costs, while decreasing costs and simultaneously improving overall drug benefit coverage.
Pharmacy benefit costs are the fastest growing segment of national health expenditures… rising at a rate faster than hospital care and physician services combined. Learn how employers are achieving significant savings via the TPG Proprietary Pharmacy Benefit Program.
In This Seminar We Cover:
• Options for controlling health care pharmacy costs without impacting your membership.
• Overview of the latest trends in the pharmacy benefits arena and new programs that will improve members’ RX utilization and lower your self-funded prescription drug spend.
• Methods to establish true transparency into the cost of your plan’s prescription drug program and how to continuously monitor your drug costs vs. the pharmacy contract.
• Real life case studies of actual plan savings from the 2014 plan year.
• How to become eligible for a pharmacy audit completed by The Partners Group.
This Medicare-Medicaid ACO Model webinar included information on the structure of the Model, Model details including beneficiary attribution, financial methodology and quality measurement options within the Model, and an explanation of data, learning and evaluation. The state-specific development and application process, including instructions for submitting letters of intent were also discussed. This webinar was open to the general public and targeted towards interested states.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses trends in medical device regulation and innovation. It finds that while FDA approval times for novel PMA devices have improved recently, 510(k) clearance times remain much longer than historic averages. Additionally, a gap remains where medical devices are approved 3-5 years faster in Europe compared to the US. The FDA has made improvements but more work is still needed to further streamline processes and reduce review times for medical devices.
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
Making the shift to value-based care is not easy. However, a growing number of healthcare organizations are finding success leveraging Lean process improvement and health IT to reduce waste, lower costs, and improve quality.
In fact, leading health systems like Bon Secours, Prevea Health, and North Mississippi Medical Center are using these principles to improve care management processes and achieve better patient outcomes.
We have assembled these strategies into a new whitepaper. You will learn:
- How key concepts of Lean thinking can be applied to healthcare
- Why high-performing practices are using Lean to enable care team members to provide better care
- The financial advantages of a team-based, population health management approach in a value-based reimbursement system
MMS State of the State Conference: Susan Dentzer - Rationalizing Health Spend...Frank Fortin
The document discusses challenges facing Massachusetts and the US in controlling rising healthcare costs. It notes that current spending growth rates threaten Massachusetts' reforms and the nation's fiscal health. Several key drivers of higher spending are identified, including new medical technologies, chronic diseases like obesity, and low productivity growth in the healthcare sector. Solutions proposed include reducing unnecessary variations in supply-sensitive care, payment reforms like bundled payments that incentivize quality over quantity, and policies to improve prevention and management of chronic conditions.
Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
Turning Price Transparency Into a Competitive Advantage in the Age of Consume...Megan Williams
The document discusses turning price transparency into a competitive advantage under new CMS rules requiring hospitals to publicly post their standard charges. It notes that audits show significant non-compliance and price disparities for the same procedures across hospitals. The role of cost accounting data in evaluating service line and contract profitability is discussed, as are opportunities to use cost data for strategic budgeting, performance improvement, and population health management. Questions are posed about how hospitals currently set prices and whether decreases could make them more competitive.
Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker Series
Karyn DiGiorgio (University of California)
More info at: vsee.com/conference
Do you believe that all data should be encrypted Many computing p.docxmadlynplamondon
Do you believe that all data should be encrypted? Many computing professionals think this is a good idea. But a small number of computing experts feel that no data should be encrypted—that all data and software should be openly available to anyone who wants it
Post your initial DISCUSSION response and reply to discussions posted by two other students.
(Will attach discussions posted by class soon)
HCS/499 v4
Stevens District Hospital Plan
HCS/499 v4
Page 8 of 8
Strategic Planning ScenarioBackground
Stevens District Hospital is a 162-bed acute care hospital that is qualified as a not for profit facility. The hospital was originally a county-owned facility and its status was transferred to an independent facility three years ago. The hospital receives no external funding from government agencies for operations. The hospital is accredited by The Joint Commission and received reaccreditation during their triannual survey last year. The hospital has an aggressive quality management program and a low volume of medical malpractice claims. The hospital is located in Jefferson City, which is a city of 50,000 with 80,000 in the regional market. The hospital provides a general range of acute care services, including medical/surgical, rehab, and emergency care. Current Performance AnalysisMission and Vision
Our mission: To improve health by providing high-quality care, a comprehensive range of services, and exceptional service.
Our vision: Stevens District Hospital and its affiliates will be the health care provider of choice for physicians and patients. Our five year vision is to create a large, multispecialty physician practice system that would include at least six family practice physicians and specialists in cardiology, oncology, and women’s services. Currently, the hospital employs three family practice physicians, one obstetrician, one medical oncologist, and one non-invasive cardiologist. Previous Strategic Plan Review
Goal
Accomplishments
Increase market share by recruiting three family practice physicians.
The hospital was able to recruit only one family practice physician to increase primary care market this past year. The limited number of state medical school graduates makes local recruitment difficult.
Improve quality HCAHPS scores in all six criteria to a baseline of the 85th percentile.
The hospital improved HCAHPS scores in four of six criteria. Lagging elements in HCAHPS scores are inpatient patient satisfaction and primary care patient satisfaction.Market Forces Affecting the HospitalVolumes
Patients
The continued growth of chronic disease will require changes to the care management model.
Percent of Population by Age
Five Years Ago
Five Years From Now
Under 18
24
18
18 to 44
46
32
45 to 65
26
30
Over 65
4
20
More than 53 percent of residents have at least some college education, with just over 29 percent having an associate, bachelor’s, or graduate degree. More than 90 percent of residents have at least a high school diploma. ...
2023 — Focus on the Margin (Vitalware by Health Catalyst)Health Catalyst
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Direct to Employer - Dealing With Narrow Networks in the 'New Exchange World'McKonly & Asbury, LLP
This webinar was hosted by Tyler Wenger and Suzanne Sentman from McKonly & Asbury with special guest host Ernie Tsoules from Rhoads & Sinon.This presentation addressed the fact that self-insured employers are increasingly seeking to reduce employee health care costs. A new model of achieving this goal is taking hold in the market by employers contracting directly with new types of health care provider networks, commonly referred to as “narrow networks." This session explored the evolution of these new arrangements and its impact on employers, health care providers and employees. The session also addressed the key business and legal issues that are important to consider in developing these new relationships.
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/
The document discusses the evolution of healthcare quality and the marketplace. It notes that trends in civilian healthcare will increasingly impact the military health system, and that federal health programs are seen as test beds for innovations. Payment reforms like value-based purchasing, pay for performance, and accountable care organizations aim to link payments to quality outcomes and reduce costs. Quality measurement and public reporting are important tools but must be done carefully. Overall the healthcare system is gradually shifting to pay providers based on the value of care delivered rather than volume of services.
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Todd Berner: Assessment of Payer ACOs: Industry's RoleTodd Berner MD
This document summarizes key points about payers' accountable care organizations (ACOs) and the industry's role in partnering with ACOs. It finds that ACOs with commercial contracts tend to be larger and more advanced. They have more experience with pay-for-performance initiatives and other reforms. The document also discusses various strategies for ACOs to better manage costs, such as considering drug acquisition costs, utilization management, and developing care coordination programs. It notes opportunities for specialty pharmaceutical companies to partner with ACOs in areas like managing high-cost conditions and supporting patient care.
The document discusses the state of the PEO (Professional Employer Organization) industry. It notes that the PEO industry is large and growing, with $150 billion in revenue serving over 3 million employees, but current market penetration is only 2.5%. Consolidation among large players will continue. Key challenges include increasing regulatory requirements, data security and privacy risks, the need for improved risk selection and pricing discipline. Workers' compensation remains a major business challenge due to capacity issues and rising costs. Healthcare costs also continue to rise significantly. To succeed, PEOs will need to focus on risk management, financial discipline, and developing niche expertise.
CMS Core Measures Compliance: Best Practices for Data Collection, Analysis and Reporting
For many hospitals, the primary challenge with the core measure program is not achieving quality standards, but complying with the complex, time-consuming reporting process and staying current with constantly changing regulations.
In October 2014, INTEGRATED's Bill Jessee presented "Where Is Healthcare Going? And How Will We Get There?" at Iowa Hospital Association's annual meeting. The presentation focuses on the forces shaping healthcare today, the delivery system changing in response to the environment, and what this all means for hospitals and physicians.
This document discusses emerging international patient programs and the associated legal issues. It begins by outlining the context of the patient experience, noting the various stakeholders involved and how patient expectations are formed. It then outlines the possible components of an international patient program, including medical travel, telehealth, and managing foreign facilities. Common legal issues with these programs include determining which laws apply, compliance with anti-corruption regulations, health regulatory issues, and the application of HIPAA in international contexts. The document emphasizes managing patient expectations and experiences to mitigate legal risks.
This document summarizes Oregon's experience increasing primary care spending through legislative and collaborative efforts. It outlines how Oregon created a patient-centered medical home program, increased transparency of primary care spending across payers, and eventually mandated a minimum primary care spending threshold of 12% of total medical expenditures. Key lessons included starting with less controversial policies, using data to drive transparency and goals, and engaging a multi-stakeholder collaborative. The presentation recommends similar best practices for other states seeking to invest more in primary care.
Himss m healthcomm_telehealth md exec summary recommendations_formatted final...mHealth2015
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Williamson Presentation to OKAMA Oct 21-2015 - EMS in OklahomaKelli Bruer
EMS IN OKLAHOMA Today & Tomorrow was a presentation by H. Stephen Williamson, President of the Emergency Medical Services Authority (EMSA), to the Oklahoma Ambulance Association on October 21, 2015. The presentation discussed payment reform in the healthcare environment, quality initiatives for ambulance services, and the shifting priorities of the Department of Health and Human Services toward alternative payment models and value-based purchasing. It also reviewed concepts from the Institute for Healthcare Improvement like the Triple Aim framework and new rules for radical redesign in healthcare.
Similar to Strategic Management Presentation Final PPT (20)
2. Executive Summary
The goal of this report is to analyze the organizations standing, market position and
evaluate potential strategy. The changes initiated by the passage of the Affordable
Care Act has radically changed several aspects in the healthcare sector. These aspects
consisting of issues ranging from services rendered, technology and
expansion/contraction.
Key strategy points will be explored and a through review of
5. Remote
Analysis
• Healthcare Industry:
– Hospital Sector
• Hospitals are significantly
affected by the changes
precipitated by the ACA and
has made this a very fluid
market situation in recent
years.
• Unprecedented growth has
led to radical changes in
operations and is continuing
to fuel change.
Analysis Points
Economic
Social
Political
Technological
Ecological
6. Remote Environment
Economic Outlook – Improved.
- PMMC has been able to generate a profit according to internal memo
Releases from Michael Brown, CEO of PMMC. Bond rating status has
Improved according to Crain’s Business Chicago.
• Requests for this information is not available via internet or is made available to the
public. Personal requests were made to executive secretary (Elidia Vazquez) but
all request were declined.
Social – Improved
- At the local level television advertisement has begun to promote Presence’s Health
Neurology treatment service line.
- Many in roads are being into the Hispanic community by utilizing local parishes to
reach out to parishioners and improve health concerns of at risk individuals. This
demographic consists primarily of the Hispanic and Africa-American community.
Global- Non-Issue
Ecological – Fair
- According to Michael Brown, CEO of PMMC. An effort to reduce waste by improving
recycling measures is in place, and effective utilization of linen processing. The
7. Technology – Poor
- Presence Health, in general, lags behind RCMS and Rush Health. The software and
hardware is dated and not being upgraded as it should be to maintain an
operational and competitive edge.
- PMMC is using several different software programs that do not always communicate
with each other. Radiology equipment is still primarily based on cassette and film
use. Only one digital room and portable x-ray device are available.
- To become efficient and transmit information in real time, more of an investment
needs to be made in efficient diagnostic equipment and patient data recording
devices.
Political/Legal – High
- 2014 is an election year with a very unpopular President Obama in office. Political
rivals have stated that they will repeal the ACA I they regain control of the senate
and legislative branch of government. Repealing this program may once again cause
new obstacles to overcome that may affect expenses and revenue streams.
- Risk of litigation is always high, even though many reductions in the minimizing of
errors has occurred. Implementation of newer and safer practices has been
beneficial to hospital operations.
8. Hospital Comparison
• Presence Mercy
Medical Center
Licensed Beds – 293
Joint Commission Accredited
Physician's – 432
Non-for Profit hospital
Provides clinical education
opportunities for colleges
Locally recognized
• Rush-Copley Medical
Center
• 210 beds
• Joint Commission Accredited
• Physician's – 500
• Non-for Profit hospital
• Teaching/Educational Hospital
• Nationally, regionally and locally
recognized health system
9. PMMC Quality Achievements
• Key quality accolades
• Certified Primary Stroke Center by
The Joint Commission
• Accredited Chest Pain Center by the
Society of Chest Pain Centers
• Hip and Knee Joint Replacement,
Certified Gold Seal of Approval from
The Joint Commission
• Emergency Department Approved for
Pediatrics (EDAP)
• Mammography, Accredited by
American College of Radiology
• Accredited with Commendation,
American College of Surgeons’
Commission on Cancer
• "A" Hospital Safety Score
from The Leapfrog Group
• Key Line of Services
• Level II trauma center
• Behavioral health and addictions
• Maternal/Child services with level II
special care nursery
• Pediatric specialists and
neonatologists from Ann & Robert H.
Lurie Children's Hospital of Chicago
• GI care
• Cardiovascular services including
open heart surgery
• Da Vinci robotic surgery
• Joint replacement program
• Diabetes wellness center
• Occupational health and employer
services
10. RCMC Quality Achievements
• Quality Achievements
• Rated “A” Hospital Safety Score by
The Leapfrog Group
• American Heart Assoc./American
Stroke Assoc. Stroke Silver Plus
Quality Achievement Award
• Joint Commission Gold Seal of
Approval for treating;
– Joint Replacement of Hip and Knee.
– Heart Failure
– Normal Delivery and Respiratory
Distress Syndrome in the Preterm
Infant.
• American College of Radiology
designation as Breast Imaging
Center of Excellence.
• Key Service Lines
• Emergency Department Approved
for Pediatrics (EDAP).
• Cancer Treatment Center
• The only Level III Neonatal
Intensive Care Unit in the Fox Valley
• Serves as a teaching hospital to
future physicians who are attaining
Residency In Family Medicine
• Designated as a Chest Pain Center
and provides extensive cardiac
services
• Nationally recognized for
orthopedic services by The Joint
Commission and U.S. News and
World Report
11. Porter 5 Forces
Threats of New Entrants:
Several new healthcare providers have emerged who are dealing with cash paying
customers. These locations consist of same day surgical centers and walk in care
clinics. These clinics are provide service customers who have insurance that covers
this service or are cash paying customers.
RCMC opened the only hospital located within Kendall County and may now begin
to build satellite clinics to divert patients to that facility or the primary hospital in
Aurora.
12. Suppliers:
Outside contracting services have been secured to bring down operating costs by not
having to provide benefit packages to that particular employee demographic.
Financial constraints are present with the allotted budgets that have been determined
to department managers. Capital budgets are limiting the amount of vendors to
approach to receive the best service for the limited amount of money made available to
them.
Depth of specialty independent physicians is shallow. The largest and most diverse
medical group is that of Dreyer Medical Group (Advocate Health System).
Threat of Substitution:
Substitution of services is high with many options available to to insured and cash
paying customers. Similar if not better services are available to the community if they
chose to use RCMC for their care.
13. Customers:
• According to the PMMC Community Health Needs Assessment Report, the
poverty status is at 13.9%. Currently, the US Census Bureau estimates the
poverty level to be at 14.4% and with anonymous internal sources stating that
the percentage is more like 15% plus. PMMC provides a considerable amount of
care to this demographic and the Emergency Department is the primary point of
care this demographic. This repeat group of nonpaying customers is
economically taxing on the system.
• RCMC has employed two key physician groups consisting of Fox Valley
Cardiology Consultants and two longtime Pulmonary Medicine physicians.
Competitors:
• Rush-Copley Medical Center
• Cadence Delnor Hospital
• Dreyer Medical Group
• Walgreens Pharmacy
• ATI Physical Therapy Services
14. Competitor Profile
Status/Type: Non for profit teaching hospital
Financial: Rated A+ by Moody’s Financial Services. Income/debt ratio is improved
even after the completion of the newly constructed medical facility in Chicago.
Services: RCMC announced that they will be investing in a$52.7 million dollar
renovation and expansion project that will be completed in 2018.
Effective Market: RCMC provides services primarily to Kendall County and the city of
Aurora. Other cities that benefit are Plainfield and Naperville.
Technology: It has been a a key tactic for their strategy is to maintain a strong
technology foundation.
15. Competitor Summary
RUMC/RCMC
Asset Summary 2014 March 31, 2014
Cash and Cash Equivalents $ 190.2
Fixed Income Securities $ 500.0
Equity Securities, U.S. and
International
$105.4
World Asset Allocation Mutual
Funds
$69.9
Moderate
Allocation(Balanced) Mutual
Funds
$49.9
Unrestricted Endowment $50.9
TOTAL $966.3 (millions)
16. SWOT
Strength – Long-time history and commitment to the community. Recent leadership has
shown initiative to change and pursue long term goals.
Weakness – Payer mix is poor and revenue streams are limited as competition for market
share has become more intense with RCMC.
Opportunities – There are 8 MUA’s that are within PMMC’s areas and these areas could
Improve revenue streams.
Threats – RCMC could continue to expand into territory that was once traditionally
dominated by PMMC and completely lose there market share.
17. Key Drivers
The ACA is mandating policy and compliance with best practices as well as
communication and data retrieval.
Technology and digital platforms are dominating the healthcare landscape.
Expanding services and aligning with other groups and organizations are leaving very
little room for smaller competitors.
18. Strategy
Phase one
• Critical Success Factors
Controlling Costs:
• Establish a list of potential vendors for data
analytics and healthcare ERP vendors.
Existing software and hardware is dated and
a uniform upgrade needs to be implemented
to the most productive facilities first, such as
PMMC. The goal is to implement one
integrated system to improve accounting
procedures, billing accuracy, data storage
capability, and improved real time
communication.
• Integration of ERP with existing and
expanding LEAN /RIE processes.
• Customer Relationship Management
• Develop the Presence Medical Group:
• Conflict of interest is present with
maintaining relationships with
independent physicians who are
technically employees of rival
healthcare systems, principally, Rush-
Copley and Dreyer Advocate.
– Strategically eliminate and
minimize the relationships with
physicians who do not refer their
patients to PMMC for services.
– Retain and employ services of
independent physician’ that
specialize in the following areas.
• Cardiac
• Renal
• Interventional Radiology
• Obstetrics and Gynecology
• Primary Care Services
19. Sustainability and Expansion:
Phase Two
• RCMC made a strategic move to build and operate a freestanding
hospital while only providing emergency services. This action also
translated to them being the only hospital facility in Kendall County.
As population continues to grow this population base will seek out
their medical services at RCMC.
• PMMC needs to open one walk in care clinic in Kendall County to
obtain some of this market share and another clinic west of Sugar
Grove, IL to serve the rural communities that do not have easy
access to hospital services.
20. Strategy Phase TWO cont.
• PMMC needs to establish a facility on the western part of the I-
88 corridor west of DeKalb, IL to provide services that can be
performed at PMMC. Significant portions of cardiac thoracic
surgical procedures are being performed on individuals from
the Sterling, Illinois area.
Rural Communities face the burden of not having access to
healthcare services, let alone quality healthcare services.
• The strategic placement of a small facility with an available
transport team that can transfer patients to PMMC will help
increase visibility within the community and assist in capturing
more of the market. A transport team is already in place at
PMMC but it is under utilized because service area needs to be
expanded