Waypoint is a healthcare consulting firm focused on delivering custom solutions that integrate best practices and clinical expertise, led by experienced professionals like Jim McCoy and Brett Kirstein. They emphasize clinical integration, population health management, and accountable care organization (ACO) initiatives to improve quality, efficiency, and patient experience. Their collaborative approach aims to redefine patient engagement and streamline operations for healthcare organizations, resulting in significant improvements in cost and care delivery metrics.

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.
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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
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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.
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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.
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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
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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.
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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
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8. EXECUTIVE
BRIEFINGS
Waypoint professionals work with your team to deliver custom solutions that
reflect experience, best practices and an independent point of view.
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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
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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
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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.
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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.
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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.
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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
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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.
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