© TIGI 2012 All rights reserved How Healthcare Reform Impacts Your Business Today Gunter Wessels, Ph.D., MBA Partner, Practice Principal, TIGI [email protected] @gunterwessels Sam O’Rear, M.A. BA Senior Partner, Founder, TIGI [email protected] @TIGI_Inc www.tigi.net June 27, 2012
How Healthcare Reform Impacts Your Business Today
Jan 17, 2015
As most of us await the Supreme Court decision on health reform, and one thing is certain: a repeal of Healthcare Reform will not reinvigorate sales nor reverse spending cuts. The time to understand and integrate the many regulatory changes of October 1, 2012, into your company’s mission is NOW.
With these slides, you can expect to learn:
The key elements of provider-focused healthcare reforms, including:
ACOs
Value Based Purchasing
Bundled Payments
IT incentives
How to recognize and evaluate the process of project justification
The connection between performance metrics, organizational initiatives, reform implications and your solutions
Actionable Recommendations
With these slides, you can expect to learn:
The key elements of provider-focused healthcare reforms, including:
ACOs
Value Based Purchasing
Bundled Payments
IT incentives
How to recognize and evaluate the process of project justification
The connection between performance metrics, organizational initiatives, reform implications and your solutions
Actionable Recommendations
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© TIGI 2012 All rights reserved
How Healthcare Reform ImpactsYour Business Today
Gunter Wessels, Ph.D., MBAPartner, Practice Principal, TIGI
[email protected]@gunterwessels
Sam O’Rear, M.A. BASenior Partner, Founder, TIGI
[email protected]@TIGI_Inc
www.tigi.net
June 27, 2012
© TIGI 2012 All rights reserved
Evaluate the key elements of provider-focused healthcare reforms, including:
•ACOs•Value Based Purchasing•Bundled Payments•IT incentives
Recognize and evaluate the process of project justification.
The connection between performance metrics, organizational initiatives, reform implications and your solutions.
Recognize that you need to build the business case for your solutions, in the current healthcare environment.
Objectives
© TIGI 2012 All rights reserved
Project Delays/Deferrals
Financing Hurdles
Customer Cost Reductions
Implications of Reform
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The Budgeting Process
Evaluation of ProjectsFinancial viability, resources and reserves
Cost
Funding DecisionFinancial viability, resources and reserves
ManagementMedical staff
Public Image, competitive positioning
Project Implementation and ReportingProject funds sourcingForecast generation
Measure developmentBudget adjustment
Project initiationProblem
Alternatives and resources availableCost information
Benefit informationPrior performance benchmarking
Risk projection
© TIGI 2012 All rights reserved
Evolution of Healthcare Delivery Management
Utilization Management Quality Management Population
Management
Payer Focus:
• Referral Management• Prior authorization/pre-certification• Concurrent Review• Discharge Planning• Case management • Retrospective Review/Appeals• Pharmacy Management
Payer Focus:
• Clinical Quality Indicator Monitoring
• Credentialing and Re-credentialing
• Delegation Oversight
Payer Focus:
•Wellness Programs• Demand Management• Disease Management
© TIGI 2012 All rights reserved
Patient Protection & Affordable Care Act 2010
Reform is Creating Turmoil and OpportunityReform Elements:Insurance Reform• Controversy: Individual and State Mandates• Constitutional Challenge
Delivery-System Reform• Limited Controversy: Quality-based payment
Core Provisions• Value Based Purchasing• Accountable Care• Bundled Payments• Continuation of Health IT
© TIGI 2012 All rights reserved
Volume Changes
Elective Procedure Volumes Down 1-5% Nationally
Non-Elective Procedure Volumes Steady
A survey of more than 375 acute care hospitals found inpatient volumes down 2.2% and outpatient volumes down 1.1% for April. Inpatient surgeries were up 3%, outpatient surgeries were up 3.5%,
and births were up 1.1%. ER visits fell 1.8%
“ “
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More Granular Data About Disease & Procedures
ICD-10 Coding system and EMR/EHR• Implementation Accelerated, And Then Delayed• Part of Meaningful-Use Stage 2• Automated Core-Measures Reporting• Automated PQRI Reporting Capture• Enhanced Analytics
Useful for Comparative EffectivenessCMS Innovation Institute, and Comparative Effectiveness NIH research (ARRA 2009)
Useful for Cost EffectivenessIndependent Payment Advisory Board- (IPAB) Repealed by the House...in Limbo
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Cascading Consequences for Suppliers
Provider Consolidation
Supplier Consolidation
Pricing Pressure Intensifying
ROSI (Return on Sales Investment) Becomes More Challenging
Less Executive Decision-Maker Access
More Complex Interactions (committees, approvals, delays, etc)
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What Providers Are DoingIntegrating Clinical Mission, Operational Effectiveness, and Financial Performance
• Building a strong infrastructure for their medical policy
• Focusing on enhancing their application of EBM (evidence-based medicine)
• Engaging the physicians in a collaboration model supported by the EMR design
• Committing to marketing initiatives that will build their brands
• Learning how to price services for alternative revenue models involving risk
• Evolving to missions of prevention as well as intervention
• Reviewing use and application of technologies to balance asset utilization w/attaining the clinical mission
© TIGI 2012 All rights reserved
Framing Reform in ContextKey Words in Healthcare ManagementCore Measures Improvement
Disease ManagementBenchmarking
Patient Flow ImprovementLeveraging ITShared Governance and AlignmentReducing Process Variance
Patient Satisfaction ImprovementPatient and Employee Experience
Coding and Charge CaptureMargin Erosion and Reimbursement TrendsAccounting for Severity and Complexity
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Success as a Supplier in This TerrainYour Solution Must Link To One Of The
5 Hurts Of Healthcare ExecutivesRevenue
Operational Efficiency
Quality & Safety
Regulation & Compliance
Competition
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Recommendations for Suppliers
Focus Your Sales & Marketing Teams onto The Five Hurts
Frame Solutions with the Three Dimensions of Value:
Clinical
Operational
Financial
Search & Discover Service Line Management, and Their Unique Set of Hurts
Demonstrate to Your Customers How Your Solutions Will Increase Their Flexibility
Recognize That Some Customers Understand Their Market Better Than Others and Want to Collaborate
Trust That Your Marketplace is Growing and That Your Services Are Increasing in Value
© TIGI 2012 All rights reserved
Upcoming EventsWebinars:
July: 5 More Medical Device Strategies Doomed to Fail in 2012
To Register: http://www.tigi.net/webinar-calendar
Open Enrollment, 1 Day Workshop:
TIGI and MassDevice Present, TIGI Bootcamp 2012The Changing Healthcare Buying Environment: Adapting to the New Normal, August 22 in Boston
To Register: http://www.tigi.net/the-changing-healthcare-buying-environment/
© TIGI 2012 All rights reserved
Thank You
Gunter Wessels, Ph.D., MBAPartner, Practice Principal, TIGI
[email protected]@gunterwessels
Sam O’Rear, MA, BASenior Partner, Founder, TIGI
[email protected]@TIGI_Inc
www.tigi.net
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