enterprise performance management & physician … … · macra-me! knitting together market forces...

The Newsletter of the Massachusetts-Rhode Island Chapter

Volume XLIV • Number 5

• Understanding Price Risk

• The Next Step in the Journey for High-Performing Healthcare Organizations: Focused Performance Improvement

• Healthcare’sUnhealthyPatientAccess

• ScalingComplexCareManagementthrough Artificial Intelligence

• Four Benefits of Segmenting YourConsumers

• HowReadyIsYour OrganizationforNew ConsumerExpectations?

The Newsletter of Newsletter of Newsletter the of the of Massachusetts-Rhode

Healthcare Financial Management Association

ENTERPRISE PERFORMANCE MANAGEMENT& PHYSICIAN PRACTICE MANAGEMENT

MM ISSUE_5.cs5_3.indd 1 9/18/17 3:54 PM

https://www.ma-ri-hfma.org/membership/members-file-distribution-area/

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On the Cover

THE MASSACHUSETTS - RHODE ISLAND CHAPTER OF HFMAGRATEFULLY ACKNOWLEDGES THE 2016-2017 CORPORATE SPONSORS

*Denotes Half Year Sponsor

PLATINUMARMS, LLC • Bank of America Merrill Lynch • BDO USA, LLP

BESLER Consulting • Bolder Healthcare Solutions (ROI) • ClaimAssist, LLCDubraski & Associates • HBCS • LogixHealth

PROMEDICAL • PwC • Simplee • TD Bank • Verrill Dana LLP

GOLDLatham & Watkins LLP • Parallon • Ropes & Gray LLP

SILVERAction Collection Agency of Boston • Baker Newman Noyes • Balanced Healthcare Receivables, LLC • BerryDunn

CliftonLarsonAllen, LLP • GE Healthcare Camden Group • Gragil Associates, Inc. • Health Management Associates, Inc.Healthcare Financial, Inc. (HFI) • Huron • Kaufman Hall • KPMG LLP • Marcam Associates • MDSMRA Health Information Services • Nuance Communications* • Optum Executive Health Resources

ParrishShaw an Advanced Patient Advocacy Co. • Phillips DiPisa • P.V. Kent & Associates P.C.The PFM Group • TriNet Healthcare Consultants, Inc. • VantagePoint Healthcare* • Withum Smith + Brown, PC

Back Row (Left to Right): Jonathan Richman, Charlie Zanazzi, Roger Price, Richard Russo.

Front Row (Left to Right): Krista Katsapetses, Gary Janko, Linda Burns, Emily Anne Nolte, Miriam Jost, Fabienne Miller

ARMS, LLC 11Baker Newman Noyes 35Balanced Healthcare Receivables, LLC 35Bank of America Merrill Lynch 15BerryDunn 12BESLER Consulting 10Bolder Healthcare Solution (ROI) 17ClaimAssist, LLC 21CliftonLarsonAllen 13Dubraski & Associates 19GE Healthcare Camden Group 34Huron 8KPMG 32LogixHealth 6Medical Record Associates 32Optum Executive Health Resources 34Parallon 33Phillips DiPisa 18PROMEDICAL 22P.V. Kent & Associates 25PwC 23Ropes & Gray LLP 7TD Bank 20TriNet Healthcare Consultants, Inc. 27Verrill Dana LLP 16WithumSmith+Brown, PC 12


https://www.ma-ri-hfma.org/corporate-sponsors/

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HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION

CONTENTS

Volume XLIV Number 5

HowReadyIsYourOrganization forNewConsumerExpectations?I by: Dan Clarin and Jason O’RiordanThe role of the individual in healthcare is rapidly transforming from passive patient to active con-sumer.

ScalingComplexCareManagementthrough Artificial IntelligenceI by: Keiron StoddarHealth systems in this country have a problem: only five percent of Americans make up more than half of all US health care spending.

Four Benefits of Segmenting YourConsumersI by: Dan ClarinWith rising competition and a changing business model, most healthcare organizations are paying increased attention to how consumers access and use healthcare services.

President’s MessageI by: Rosemary Rotty

The 2018 HFMA theme is Where Passion Meets Purpose. This year, healthcare finance profes-sionals are being encouraged to

discover—or perhaps rediscover— their passions.

The Next Step in the Journey for High-Performing Healthcare Organizations: Focused Performance ImprovementI by: Chris George, Rajan Patel

and Ryan RossHealth systems across the country for the past several years, have engaged in performance-improvement initiatives to meet margins in an increasingly challenging healthcare environment.

Healthcare’sUnhealthyPatientAccessI by: Michael Miller and Chuck HoltNationwide, medical groups are continually faced with numerous complex challenges that are limit-ing their abilities to provide timely care to all but the sickest of patients.

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HFMA Advisor is a publication of the Massachusetts - Rhode Island Chapter of the Healthcare Financial Management Association devoted to keeping membership current on national & local healthcare financial topics. Opinions and views expressed in the articles and features of the publication are those of the author(s) and do not necessarily reflect the position of the Massachusetts-Rhode Island Chapter or The National Chapter of Healthcare Financial Management Association. Articles submitted are subject to editorial changes made by the committee. Article submis-sions, comments and requests for further information and advertising rates may be forwarded to: Linda A. Burns, M.H.A., M.B.A. or Kate Stewart, HFMA Massachusetts-Rhode Island Chapter, 465 Waverley Oaks Road, Suite 421, Waltham, MA 02452, [email protected]

N e w s l e t t e r C o m m i t t e e

Linda A. Burns, MBA, MHA, Consultant, Ambulatory Care & Physician Services, Linda A. Burns, MHA, MBA Consulting & Physician PracticeKate Stewart, Attorney, Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

InsightsintoNetworkingI by: Anita Karcz,Networking is an essential part of business life today. It is rare to find someone who scoffs at its value, but common to find people who have reasons why they don’t do it.

MACRA-me!KnittingTogetherMarketForces and Provider ResponsesI by: Gary M. Janko

The annual joint conference coordinated by the Enter-prise-Performance Committee was held at the Sheraton Four Points Norwood Conference Center in Norwood on March 10, 2017.

TakeMeOuttotheBallgame...On June 13, HFMA members, family, and friends gath-ered for an evening of baseball, food, and fun.

ChapterAnnualSocialand AwardsNightandWineDinner

The Massachusetts – Rhode Island Chapter gathered at the Downtown Harvard Club to celebrate the successful conclusion of the year, to recognize a number of our members for their dedication to the organization, and to enjoy a delicious meal paired perfectly with wines on May 4.

Understanding Price RiskI by: Jason O’Riordan and Dan ClarinConsumer needs and attitudes about health and health-care services are changing due to higher out-of-pocket costs, price transparency, and low-priced competition.

31 Awards Night and Wine Dinner

The Massachusetts – Rhode Island Chapter gathered atthe Downtown Harvard Club to celebrate the successful

I by: Gary M. Janko

The annual joint conference coordinated by the Enter-prise-Performance Committee was held at the Sheraton

OFFICERS & DIRECTORS

PresidentRosemary Rotty, FHFMA

President ElectGarrett Gillespie, Esq.

SecretaryDavid Tolley

TreasurerDeb Schoenthaler

Immediate Past PresidentBeth O'Toole

DirectorsLori Burgiel

Linda Burns, MBA, MHAKimberly Carlozzi

Karen KinsellaNan JonesErik Lynch

Annamarie Monks, CHFPRobert Nelson, FHFMA, CPA

Roger PriceRichard Russo

Jennifer Samaras, CRCRJeanne Schuster. CPA

Kate StewartWilliam Wyman IV, FHFMA

Ex O�cioGerald O’Neill, FHFMAJohn Reardon, FHFMA

Rosemary SheehanJerry Vitti

CareerCorner:


https://www.ma-ri-hfma.org/about-us/board-directors/

HFMA Advisor4

ENTERPRISEPERFORMANCEMANAGEMENT&PHYSICIANPRACTICEMANAGEMENT

cale. In some areas, employers and payers have extensive new benefit packages with incentives and information portals that motivate consumers to play an active role in healthcare service decision-making . . . and consumers are doing so.

In other markets, consumer awareness and shopping be-havior is being enabled by a highly competitive provider environment, often characterized by increased ambulato-ry investment by health systems, significant freestanding outpatient alternatives, and new competitors entering the market for low-intensity services.

The capabilities of an organization to meet the needs of consumers include both:

• How the organization approaches its market through such considerations as pricing, access, and offering a patient-centric experience

• Internal capabilities to approach the market in a consumer-centric manner on an ongoing basis, such as the generation and application of insights about consumers based on deep understanding of the consumer population and its needs and wants, and leadership that puts the consumer and relevant insights on the C-suite agenda to drive strategy, planning, and service offerings.

How do we get started?The first step is top leadership commitment to a formal assessment of organizational readiness for consumer-centric healthcare. This readiness assessment provides ashared understanding of what’s required for the organiza-

The role of the individual in healthcare is rapidly transforming from passive patient to active consumer. This shift is being driven by patients’ increased financial responsibility for their healthcare costs, the availability of highly convenient and low-cost care-delivery options, such as retail clinics and virtual care, generational/cul-tural changes, and the increasing number of tools that consumers can use to compare cost and quality among providers. Consumer needs and attitudes related to health and healthcare services are changing.

According to results of a survey of hospital and health system senior executives,1 many healthcare organizations lack a sufficient understanding of consumer needs, and strategies to meet those needs. Of survey respondents:

• Ninety-six percent said that understanding patients as consumers is very important; however, only 13 percent said that their organization understands healthcare consumer needs and wants very well.

• Similarly, only 15 percent were very confident that their organization has a clear strategy and action plan for becoming more consumer oriented.

These survey findings suggest that healthcare boards and management teams need to take a hard look at their orga-nizational readiness for a more activated consumer. With identification of readiness gaps, the teams can develop and implement targeted strategies to address the gaps.

What are the Key Characteristics of Readiness?Being ready for activated consumers who shop for healthcare as they would other products and services is a function of two factors, both of which can and should be assessed (Figure 1):

1. The state of the market in which the organization operates

2. The capabilities of the organization to provide consumer-centric services

The degree of market activation varies by region or lo-

(continued on page 5)

MarketAssessment External

Howac0vatedareconsumersin

ourmarket?

Organiza0onalReadinessAssessment

InternalHowreadyisourorganiza0onfor

healthcareconsumerism?

1

2

Figure1

AssessingtheMarketandOrganiza0on

How Ready Is Your Organization for New Consumer Expectations?

ByDan Clarin and Jason O’Riordan

MarketAssessment External

Howac0vatedareconsumersin

ourmarket?

Organiza0onalReadinessAssessment

InternalHowreadyisourorganiza0onfor

healthcareconsumerism?

1

2

Figure1

AssessingtheMarketandOrganiza0on

1“Hospitals and Health Systems Struggle to Address Changing Consumer Needs, According to Kaufman Hall Survey Results.” Press Release: Dec. 7, 2015, Kaufman, Hall & Associates, LLC.


Issue 5 5


itself or is measured. Then Kaufman Hall provides its own assessment of the organization’s position and that of industry peers.

What happens next?Based on their evaluation of the identified gaps and pri-ority recommendations for filling the gaps, leaders then guide subsequent steps to build the needed competencies as identified in the assessment and deliver care based on consumer needs and wishes.

Hospitals will need answers to new questions. For example, which consumers prefer retail clinics, physician office visits, virtual visits, or other new access alternatives, and for which kinds of conditions? How will the population segments want to access primary care? “Tech-savvy immortals” will want a primary care practice that can provide fast, electronic answers to their basic health questions; a “family planner” consumer will want a practice focused on pediatrics with 24/7 access.

The readiness assessment provides a well-informed starting point in leadership’s understanding of the market, its level of activation, and the organization’s readiness to address same. ❏

Copyright 2017, Kaufman, Hall & Associates, LLC. Reprinted with permission.

tion now and going forward. It does so through:

• Evaluating levels of market activa-tion with patient shopping and consumerism, and internal capa-bilities for more consumer-centric healthcare delivery

• Identifying gaps related to consumer-readiness criteria, and comparing the organization’s readiness to selected industry peers

• Providing recommendations regard-ing priority gaps to address and the prioritization rationale

Figure 2 illustrates the overall approach and key activities of an assessment con-ducted by Kaufman Hall. This readiness assessment is composed of in-depth quan-titative and qualitative analysis of orga-nizational and market data, documents, interview findings, within-the-industry and outside-the-industry case examples, and comparative benchmarks based on consumerism-focused interactions with organi-zations nationwide.

Assessment of the organization’s capabilities and mar-ket position relative to what’s needed is visualized for the leadership at a high level through a readiness grid (Figure 3). Each dimension or parameter in this grid has specific criteria against which the organization measures

(How Ready Is Your Organization for New Consumer Expectations? - continued from page 4)

Figure2

ConsumerReadinessAssessment:ApproachOverview

CurrentStateMarket-Facing

Ac>ons/Outcomes

CurrentStateInternalCapability

CurrentState LeadingPrac>ces

LeadingMarketPrac>cesin

ConsumerStrategy

LeadingPrac>cesinConsumer-Centric

Capability

GapstoAddress

Priori>zedAgenda

Discovery:• Whataretheelementsof

readinessasitrelatestomarket-facingac4vi4es,andinternalcapabili4es?

• Howdowedescribe,rate,andmeasuretheorganiza4on’scurrentstate?

Compara>veprac>ces:• Whataretherelevant

prac4ceswithregardtoconsumer-readymarketac4onsandorganiza4onalcapabili4es?

• Whatarethecompara4vein-industryandout-of-industryprac4ces?

Priori>za>on:• Recommenda4ons

regardingprioritygapstoaddressalongwithpriori4za4onra4onale

Assessment:• Summaryoflevelof

readinesscomparedto“consumer-ready”criteriaandselectindustrypeers

• Qualita4veandquan4ta4vedescrip4onofrelevantgaps

Gaps Priori>es

StrategicPricing

Consumer-CentricAccess

Pa3ent-CentricExperience

RelevantProducts,Services,andBundles

ConsumerInsightsGenera3on

ConsumerInsightsApplica3on

Organiza3on

Leadership

UnpreparedOrganiza3on Consumer-CentricOrganiza3on

Organiza(onalselfassessmentKaufmanHallassessmentIndustrypeers

Marke

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ons

andOu

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za3on

al

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Figure 3 Readiness Assessment Grid

Figure 2. Organizational Readiness Assessment: Approach OverviewSource: Kaufman, Hall & Associates, LLC

Figure 3. Readiness Assessment GridSource: Kaufman, Hall & Associates, LLC

Figure2

ConsumerReadinessAssessment:ApproachOverview

CurrentStateMarket-Facing

Ac>ons/Outcomes

CurrentStateInternalCapability

CurrentState LeadingPrac>ces

LeadingMarketPrac>cesin

ConsumerStrategy

LeadingPrac>cesinConsumer-Centric

Capability

GapstoAddress

Priori>zedAgenda

Discovery:• Whataretheelementsof

readinessasitrelatestomarket-facingac4vi4es,andinternalcapabili4es?

• Howdowedescribe,rate,andmeasuretheorganiza4on’scurrentstate?

Compara>veprac>ces:• Whataretherelevant

prac4ceswithregardtoconsumer-readymarketac4onsandorganiza4onalcapabili4es?

• Whatarethecompara4vein-industryandout-of-industryprac4ces?

Priori>za>on:• Recommenda4ons

regardingprioritygapstoaddressalongwithpriori4za4onra4onale

Assessment:• Summaryoflevelof

readinesscomparedto“consumer-ready”criteriaandselectindustrypeers

• Qualita4veandquan4ta4vedescrip4onofrelevantgaps

Gaps Priori>es


HFMA Advisor6


Health Care’s Greatest ChallengeHealth systems in this country have a problem: only five percent of Americans make up more than half of all US health care spending.1 This cost comes from the frequency at which patients of this five-percent group go to emergency departments and require admittance into hospitals. Coined “super-utilizers”, these individu-als are those with the most complex care needs. They have chronic conditions, mental health issues and, frequently, poor socioeconomic statuses.

Due to the complexity of their conditions, super-utilizers require support from more than just a single

provider. But where single providers are failing, inte-grated health models that coordinate care across many providers are having success reducing super-utilizers’ utilization rates.2 For example, “health coaches” (or “care navigators”) can call individuals to see how they are doing, while a social worker simultaneously works to plan events that connect them to a community for social support.

Unfortunately, these services begin to fall apart as health systems or payers start to provide them to an increasing number of patients. Think about the social worker responsible for scheduling transportation for a patient whenever a ride to an office visit is needed.


Scaling Complex Care Management through Artificial Intelligence

By Keiron Stoddart

Payment BundlingCreates Opportunities for

Innovative Delivery Approaches

Call us. Our analytics provide valuable insights into the use of ancillary studies.

For more info on our Expert Coding and Billing services,visit www.logixhealth.com or call us at 781.280.1736.

105For 2017, CMS bundles all typical ancillary services into the observation

comprehensive APC 8011, which reimburses at $2,221.

1 Bara Vaida For Super-Utilizers, Integrated Care Of-fers A New Path. Health Affairs 36, no.3 (2017):394-397 doi: 10.1377/hlthaff.2017.0112

2 ibid.


Issue 5 7


Four Benefits of Segmenting Your Consumers

ByBy Dan Clarin


With rising competition and a changing business model, most healthcare organizations are paying in-creased attention to how consumers access and use healthcare services. Insights gained from the right fact-base are proving critical to attractingpatients—and then engaging and maintaining them—under both fee-for-service and fee-for-value arrangements. Data related to purchasing attitudes, motivations, and behaviors have moved from nice-to-know to need-to-know business intelligence.

Why is Segmentation Important?Healthcare consumers are not homogeneous. They

have different needs, wants, attitudes, and behav-iors related to healthcare decision-making and use. Based on how these needs and attitudes are ex-pressed or acted upon, individuals can be grouped into segments, which then can be addressed in different ways.

Foundational information, including attitudes and motivations, can be obtained through a variety of consumer-insight techniquesand applications. Interviews, focus groups, and surveys commonly are used to glean information directly from individual patients. For example, one organization used focus


HFMA Advisor8


groups, a local market quanti-tative consumer survey, and a statistical clustering analysis to assess consumer attitudes toward healthcare. Consum-ers were then characterized and sorted into the follow-ing segmentsbased on those results:

• Sick and savvy: Less interested in health and wellness, but can navigate the health system

• Family planners: Take pro-active approach by plan-ning and leading a healthy lifestyle

• Wellness advocates: Regu-larly exercise and eat well; listen to the doctor

• Engaged high-risk: Un-healthy and seek best options for care; willing to try new ideas

• Tech-savvy immortals: Reasonably healthy but don’t go to the doctor until very sick

See Figure 1 for more details.

Data relative to each group can be mined for ap-plications, such as differentiated care-delivery strategies and messaging, as described later. Under-standing patient attitudes by segment allows orga-nizations to better serve and motivate their patient populations.

Taking a segment-specific approach can achieve four business imperatives: improved patient engage-ment, appropriate consumer-centric access, relevant products and services, and successful reach and mes-saging. A brief description of each follows.

Improved Patient EngagementPatient engagement is required for both the clini-cal and business success of managing a population’s health. It enables an organization to help shape healthy behaviors, ensure the right level of care

Figure 1. Example of Consumer SegmentationNote: Shares of population and spending are examples only, and intended to illustrate the importance of understanding both measures, overall and comparatively.Source: Kaufman, Hall & Associates, LLC, and Cadent Consulting Group, LLC

+ Maximize revenue cycle performance

+ Improve cash flow and reduce AR rates

+ Reduce bad debt and increase self pay recovery

+ CMS compliance

+ Improve quality rates

+ Optimize outpatient reimbursement

+ Planning and budgeting

+ Cost accounting for new reimbursement models

+ Contract analysis

+ Physician and service line analytics

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(Four Benefits of Segmenting Your Consumers - continued from page 7)

Sick and Savvy Family Planners

Wellness Advocates Engaged High-Risk Tech-Savvy Immortals

Share of Pop: 15%Share of Healthcare Spend: 25%





Reasonably healthy but doesn’t go to doctor until very sick

Less interested in health and wellness, but can navigate the health system

Takes proactive approach by planning and leading a healthy lifestyle

Regularly exercises and eats well; listens to the doctor

Unhealthy and seeks best options for care – willing to try new ideas

Printer, this is graphic to accompany article by Dan Clarin, Four Benefits of Segmenting Your Consumers Figure 1

Example of Segmentation of Consumers

File Name: Graphic for HFMA Article D Clarin Four Benefits … v2


Issue 5 9

I remember my first HFMA- MA and RI meeting in 1998, the year I became a member. My employer, UMass Memorial Healthcare, recommended that I join, and over the years, I attended education meetings on topics that pertained to my role. After a few years, I became involved with the Enterprise Performance Management (EPM) committee, first, assisting in developing the annual meeting agenda, then, presenting at a conference with a coworker, and, recently, requesting leaders in my own organization to participate by speaking at many of the conferences.

The 2018 HFMA theme is Where Passion Meets Purpose. This year, healthcare finance professionals are be-ing encouraged to discover—or perhaps rediscover— their passions. It’s a process that requires self-reflection and determining the answers to questions such as: What motivates me to do my best? And, how and where can I make the biggest difference? By getting involved at the Chapter level, it will allow you to participate in many in-depth conversations with industry experts who face constant challenges. Pursuing one’s passion is an endeavor that demands our best. Finding that point where passion meets purpose is rewarding.

My involvement with the members and the leaders of the Chapter over the past several years has provided me an unmatched experience. I started volunteering with the Chapter and I realized how important it was to continue the legacy of the HFMA- MA and RI Chapter by staying involved as an active volunteer. I have gained numerous friends and contacts through my years in leadership; and, I ask that each of you consider joining a committee to help us continue our Chapter’s high performance. Your insight and energy is important in bring-ing fresh and new ideas to the committees, and leadership is welcomed.

A tale as old as time - we work in a challenging and highly regulated environment. As healthcare finance leaders, we are closely following the U.S. Senate and House versions of the reform legislation. The Affordable Care Act is under review and the proposed change to federal Medicaid funding is a concern to hospitals and other healthcare providers. A concern is that it can lead to an unstable and poorly funded healthcare indus-try with an increase of the uninsured. Insurance-market issues have caused many health plans to withdraw causing more consternation. HFMA allows us to remain in step and often ahead of the curve of the legislative changes.

Attending the ANI meeting in Orlando in June reminded me of the passion and desire of a community of healthcare finance executives’ collective goal to enhance the delivery of healthcare. The significance of our effective collaboration to enhance the delivery of healthcare was evident. Thank you to Beth O’Toole for an amazing year. Notable accomplishments for the chapter were four Yerger awards, the first Women’s Leadership event at the JFK library, and 1.5 days of Revenue Cycle meeting with great social and networking opportunities.

I am honored to be President of the Massachusetts-Rhode Island Chapter and excited for the new year. I look forward to hearing from you on where your passion meets your purpose!

Sincerely,

Rosemary Rotty, FHFMA

Sincerely, Sincerely,

Rosemary Rotty, FHFMARosemary Rotty, FHFMA


HFMA Advisor10

PHYSICIANPRACTICEMANAGEMENTENTERPRISEPERFORMANCEMANAGEMENT&PHYSICIANPRACTICEMANAGEMENT


utilization, and direct individuals to the best type andsite of care.

A segment-specific approach can be used to ensure the delivery of customized, and thus more effective, care-management strategies. With the “engaged high-risk” segment identified earlier, for example, new care-management approaches might include-home visits, access to “nurse lines,” and telephone calls for medication reminders for patients with congestive heart failure ordiabetes. For the “fam-ily planners” and “tech-savvy immortals,” new strategies might be developed for meeting patients’ basicprimary care needs through “virtual check-ups” versus in-office services

Appropriate Consumer-Centric AccessAs healthcare services continue to shift to ambu-latory and virtual services, hospitals and health systems can use segment-based insights to address access issues for more activated healthcare con-

sumers. A new generation of consumers expects to engage anduse virtual and physical services in new, more flexible, and integrated ways.

Offering a variety of access alternatives will draw more traffic to the hospital or health system and increase the organization’s relevance to consumers. Location of providers and services in the market, and the form and function of the access alternatives-can be critical differentiators. Multichannel health-care offerings will be needed for specific consumer segments, with access pointsincluding web, mobile, telephone, email, clinic, physician office, and inpa-tient and outpatient facilities.

For example, a wide variety of patient-facing ap-plications should be considered for a “tech-savvy” segment. These might include new online tools and apps that offer information on facilities, ser-vices, and prices, along with the ability to schedule appointments, check bills and medical records,



Issue 5 11


and “chat” with physicians and nurses. Automated assistance with navigation and way-finding, within and outside the four walls of the facility or system, is another example of functionality to be considered to help meet this group’s needs and preferences.

Relevant Products and ServicesProactive consumer-driven organizations will have a diverse complement of relevant products and ser-vices distributed over abroad geography that appeal to different customer groups.

For example, one health system recently developed a consumer insights-driven access strategy for pri-mary care services. The strategy focused on design-ing a delivery system to address the needs of target populations, and identifying the message that would be most effective with individual patient segments. The health system determined that its continued delivery models forprimary care would be physician offices and walk-in clinics staffed by nurse practitio-ners (NPs) and physician assistants (PAs).

However, to enhance patient experience and en-gagement, the system also would develop a virtual visit offering, provide telephone and online health navigator services, and co-locate ancillary services at primary care offices which have the highest pro-portion of patients with chronic health conditions (a higher-risk segment).

Successful Reach and MessagingHow do consumers want health systems to reach and communicate with them? What type of messag-ing will be most successful? Understanding a con-sumer’s behaviors and attitudes helps health systems know what type of message likely will produce the desired response.

For example, with “healthy skeptic consumers,” areas of focus for the health system described earlier could include online messaging about the system’s affordable and convenient walk-in clin-ics, education related to free preventive care under




HFMA Advisor12

PHYSICIANPRACTICEMANAGEMENTENTERPRISEPERFORMANCEMANAGEMENT&PHYSICIANPRACTICEMANAGEMENT

ment tool or other methods, allow health systems to identify “reachable” groups and individuals within defined consumer segments—and thus target seg-ment-specific needs with tailored messages. Looking into the near future, it is easy to see the logical end of undifferentiated messaging on healthcare “bill-boards.” ❏

Copyright 2017, Kaufman, Hall & Associates, LLC. Reprinted with permission.

(Endnotes)

1 Dan Clarin as quoted in Butcher, L.: “Consumer Segmentation Just Hit Health Care. Here’s How it Works.” H&HN, March 8, 2016

the Affordable Care Act, and proactive messaging about the option to see NPs and PAs.

Putting Segmentation into PracticeAs with most insight-generation techniques and their applications, segmentation is most effective when focused on central, highly impactful busi-ness issues, and is particularly helpful when the issue(s) span the entire market. Segmentation is an especially valuable tool to drive effective action on issues such as low-acuity service access, and outpa-tient service lines where choice and “shop-ability” across a wide-ranging patient base are increasing. Consumer insights can be applied to specific chal-lenges, such as planning an ambulatory strategy or reworking any offering that needs to be more consumer-oriented than it has been in the past.1

Further, predictive modeling techniques, whether enabled through a Customer Relationship Manage-

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GAIN CONFIDENCE



Issue 5 13


What happens when that the same social worker is called upon to coordinate rides for tens or even hun-dreds of patients? Efficient coordination of drivers, destinations, and schedules quickly becomes intrac-table. In addition, which of them is keeping track of whom, when and where rides are needed? How many social workers, nurses, or care navigators will be needed as this population grows?

Herein lies the greatest healthcare challenge. Super-utilizers are costing our health systems too much money, and these costs can be reduced with integrated health models. However, with the human resources available to health systems already stretched so thinly, the only way to meet the demands of the health system is to augment human resources with true artificial intel-ligence and machine learning systems.

Thinking about Patients as State ModelsIn order to understand how artificial intelligence assists and enhances integrated health models, it is first neces-sary to think of patients as combinations of their physi-cal health, mental health, and behavioral states where

within each state, patients are either stable or unstable. Note that in this context, a behavioral state refers to a patient’s ability to habitually follow his/her physician-prescribed care plan.

This is the basic framework that guides the implemen-tation of artificial intelligence in integrated health models and, in a sense, is simply a generalization of how integrated health models already function. For example, picture the care navigator who coordinates the care plan for a diabetic patient with the diabetic’s endocrinologist and nutritionist, but does so only after noticing the patient’s blood glucose measurements are higher than normal. In this example, the observing care navigator saw the patient’s health state go from stable to unstable (increasing blood glucose values), and coordinated an intervention to get the patient back to a stable state with the result being the avoid-ance of costly emergency treatment and possible admis-sion. Figure 1 is a visual representation of the patient state model framework.

Just as the coach had to determine that his patient’s (continued on page 14)

Figure 1: The Patient State Model Framework

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(Scaling Complex Care Management through Artificial Intelligence - continued from page 6)


HFMA Advisor14

PHYSICIAN PRACTICE MANAGEMENTENTERPRISE PERFORMANCE MANAGEMENT& PHYSICIAN PRACTICE MANAGEMENT

health state went from stable to unstable before he could intervene accordingly, it is the goal of artificial intelligence, i.e., an interactive learning machine model, to “automatically” do the same thing. In the context of integrated health models, an ideal artifi-cially intelligent system should (a) know the status (stable or unstable) of all three patient states so that it will detect and predict status changes, and (b) in the event a patient has an unstable status, coordinate and assist in interventions enabling the patient to return to a stable state as quickly and efficiently as possible.

An artificially intelligent system that has these abilities effectively becomes a member of the care team and a core piece of the integrated health model. Health care teams assisted by artificial intelligence will not spend their time on problem identification and simple inter-ventions but instead can focus their efforts on the more complex care problems. Think back to the example of the number of social workers needed to provide transportation to hundreds of patients. An artificially intelligent system can automatically coordinate trans-portation for patients allowing social workers to work on more challenging problems such as helping patients with poor socioeconomic sttuses determine the best way they can take advantage of medication reimburse-ment programs. (continued on page 15)

Implementing Artificial Intelligence as a Member of a Health Care TeamThe health care team that is augmented by artificial in-telligence (AI) can manage the lives of more complex care patients than a team without artificial intelligence. However, the question still remains as to how artificial intelligence can accomplish its tasks. Exhibit 1 out-lines the possible roles and responsibilities with AI as an active member of the patient’s care team.

As an example, Senscio Systems’ artificial-intelligence experts decided to apply patented AI technology to complex care management. The first step was to build a platform to collect the data needed for the “AI Care Team Member” to accomplish the scope of respon-sibilities AI would have in an AI-augmented health care team. This led to the development of an at-home health management device that reminds patients to take their medications, measure their vital signs, eat their meals, and do all the other things they need to do to manage their conditions. The solution is a large touch-screen monitor dedicated to complex care management (“Care Station”). The Care Station is the interface between a patient and the AI framework. For as long as a patient is interacting with his Care Station, the AI engine knows how well that patient is adhering

Entity Responsibilities

Artificial Intelligence Identify patient loss of control (stable —> unstable)

Coach patients through pre-established self-management interventions

Coordinate communications of patient statues to other members of the care team

Schedule patient food and transportation needs

Health Coach or Care Navigator Train patients on health management

Provide the personal touch some interventions need

Primary Care Physician Identify interventions to complex care problems

or Specialist Prescribe treatment

Coordinate care with other physicians

Exhibit 1: Responsibilities of the AI Augmented Health Care Team



Issue 5 15


to his self-management responsibilities and how those tasks are affecting his vital measurements and other indicators of health, both physical and mental.

It is through this relationship between patient and the Care Station that the AI care team member keeps track of a patient’s states, identifies loss of control, coaches the patient through self-management behaviors, and coordinates such interventions and states to other

members of that patient’s care team so that they can intervene when necessary. The AI learns the patient’s behaviors over time and anticipates changes, both posi-tive and negative, and adjusts its reporting and recom-mendations pursuant to the patient’s established care plan. Figure 2 depicts the relay of information from patient to Care Station to AI framework to care team.


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Figure 2: The relay of information from Patient to Care Station to AI engine to Care Team.



HFMA Advisor16


A Case Study: AI Today and BeyondSenscio Systems’ AI platform is currently used in the management of chronic obstructive pulmonary disease (COPD). Patients with COPD are prone to COPD flare-ups that, in the short term, cause hospitalizations, and in the long run decrease lung function. Fortunate-ly, if monitored and managed closely, COPD flare-ups can be contained and treated at home. In this case, the AI care team member identifies these flare-ups, notifies care team members of their occurrence, and coaches patients through breathing exercises, productive cough-ing, and additional medications. Preliminary results indicate that the AI care team member significantly reduces the rate of hospitalization in this population.

The potential for AI as a care team member is un-bounded. Take the following natural extension of the use of AI in COPD management, for example. A medication commonly prescribed to manage COPD flare-ups is prednisone. Prednisone, however, can have an adverse effect on the blood-sugar levels of patients with diabetes. Since patients with COPD commonly

Keiron Stoddart is Chief Data Scientist, Senscio Systems, Inc. www.sensciosystems.com..

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have diabetes, it is important to know when the management of these two chronic conditions is work-ing against each other. The AI platform is that team member that brings this dynamic to the attention of the other care team members.

It is this kind of “connecting of the dots” that inte-grated health models must perform in order to provide the care necessary to manage any patient with complex care needs. And it is only artificial intelligence that can efficiently manage the vast combination of data necessary to coordinate effectively the dance over the population of patients that need and deserve this performance. ❏



Issue 5 17


Health systems across the country for the past several years, have engaged in performance-improvement ini-tiatives to meet margins in an increasingly challenging healthcare environment. These initiatives have primar-ily focused on improving performance across multiple, vertical work streams (e.g. labor, non-labor, revenue cycle, etc.) and allowed many organizations to meet short-term goals. However, financial pressures have continued to increase as more organizations fail to meet their budgets. They need to perform at significantly higher levels to meet their target-margins and sustain their missions. To respond effectively to this chal-lenge, a health system must become a “high-performing

organization,” achieving top decile/quartile perfor-mance across its entire operation. The consequences of not accomplishing this may be dire. To illustrate, the number of total hospitals in the U.S. decreased from 7,156 in 1975 to 5,564 in 2015 (Statista). This is a 22% decrease, and many healthcare pundits have projected another major wave of hospital closures for several years running.

In a competitive market, there are both inputs to, and products of, success. These can often appear blurred to the outside observer. Leaders of high-performing


The Next Step in the Journey for High-Performing Healthcare Organizations:

Focused Performance ImprovementBy

Chris George, Rajan Patel and Ryan Ross


HFMA Advisor18


organizations recognize the dif-ferences between the two and are thinking differently about performance improvement – fo-cusing on managing a more dis-crete number of strategic levers (inputs) that drive the many products of success (outputs). Leaders of these organizations generally steer their organiza-tion with several key guiding principles:

• Capital Capacity: multi-year integrated strategic financial plans that match cash flow with expendi-tures; capital structure allowing for venture capital (e.g., acquisitions, innovation investments); measurement of individual business units’ segment performance to inform capital allocation.

• The patient must be at the center of the organiza-tion’s operations;

• The organization’s culture must attract and develop a workforce that recognizes success is a journey, not a destination, and thrives in challenging and changing environments;

• Innovation must be ingrained throughout the orga-nization, in areas as diverse as clinical care adop-tion, care model structure, information technology, patient access, and payment contracting; and

• The organization must have a market strategy that differentiates it from competitors and links mission/vision/values to tactical planning and operations.

Laying the FoundationThe Exhibit nearby depicts a conceptual framework for high-performing organizations. In this framework, Mission, Vision and Values serve as the foundation upon which the infrastructure is built, tying closely to operations and supporting the five core competen-cies: Patient-Centered Care, Operations, People and Culture, Financial Stewardship, and Strategic Market Position. For high-performing organizations, these are more than mere buzzwords or committee names. They represent capabilities these organizations manage rigor-

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(The Next Step in the Journey for High-Performing Healthcare Organizations: - continued from page 17)

High-Performing Organization Framework


Issue 5 19


ously and enthusiastically – throughout all levels of the organization – each with measurable goals, objectives, metrics and stakeholder engagement/communication mechanisms. These competencies are designed to work together in a synergistic and mutually enforcing manner to achieve higher performance. This requires bold and decisive action beyond the “business-as-usual” perfor-mance improvement of the last few years.

Infrastructure: The Building FrameworkIf Mission/Vision/Values are the foundation, infrastruc-ture is the framework upon which high performance is built. The challenge for many health systems is that their infrastructures have grown organically over time as the result of legacy systems, which has limited their abilities to operate at a high level. High-performing organizations do not limit themselves based on legacy infrastructure; instead, they build their framework for the challenges of today. Consider these real-world examples:

• A health system in the Northeast that was formed through the affiliation of three separate hospitals found itself with duplicative physical plants and (continued on page 20)

service lines within close geographic proximity. This service configuration and cost structure were not economically sustainable within the new market realities, so the system took a methodical and analytical approach to rationalizing services to consolidate services and address excess capacity. The moves were not without organizational and community resistance, but the status quo hindered the organization from competing with well-capital-ized nearby health systems.

• A health system in the Southeast expanded its focus on innovation beyond its successes in quality, safety, and cost containment by focusing on inno-vation around patients’ needs outside the hospital walls. The tactics involved opening new satellite locations, some staffed only with advanced practice providers, centralized call-scheduling, same-day appointments, and innovative approaches to a patient-centered medical home (PCMH) that dras-tically reduced emergency department (ED) visits for at-risk patients. (For one PCMH patient, the change was from 17 ED visits in one year to only one the next.)

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(Crossroads between Physician Productivity and Burnout - continued from page 18)(The Next Step in the Journey for High-Performing Healthcare Organizations: - continued from page 18)


HFMA Advisor20


Core Competencies: Five Reinforcing Synergies of High PerformanceFor many organizations, strategic planning sessions result in exhaustive lists of goals with loose links to formulated strategies and operations, and excessive dashboard metrics with little understanding of their true interdependencies. High performers prudently link strategy with operations and create focused dash-boards that promote accountability, transparency and sustainability.

For example, one large multi-hospital health system in the West wanted to assess the community needs in each of its 10 hospital markets to guide population-health efforts. It created a list of 40 metrics, including morbidity and mortality rates across numerous diseases. However, a statistical regression analysis revealed that over 80% of variation in community health status could be related to a single metric – the obesity rate. This rev-elation ultimately changed how the system allocated its efforts and deployed its strategies in each community. The same type of thoughtful, analytical approach can

be applied to each of the five core competencies identi-fied in the Exhibit.

Patient-Centered CarePatient-Centered Care, as defined by the Institute of Medicine (IOM), is “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” It engenders an empathy and emo-tional connection between patient and provider. This type of care should ultimately result in brand loyalty bonds at least as strong as those seen in other industries (think Apple, Mercedes and Starbucks).

High-performing organizations place significant empha-sis on factors important to patients such as access and convenience, timeliness of care, bedside manner, and care navigation through complex care settings (e.g., clinic, outpatient, inpatient, and post-acute). Although industry surveys have hundreds of patient satisfaction measures, high-performers tend to focus most of their

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Issue 5 21


efforts into managing to two key telling measures:

• What is your overall satisfaction with your health system?

• Would you recommend to family and friends?

These organizations then build care models, processes, and culture around this end-result, rather than manag-ing to hundreds of individual survey questions.

OperationsHigh-performing organizations seek continual improve-ment, not just sustained performance or “fire drill” reactions to unexpected deteriorating margins. They understand that positive results, when properly chan-neled, snowball into even greater results over time. It is hardwired into their processes and cultures. These orga-nizations often augment industry-standard best practices with their own developed best practices around staffing, workflow and care management. They establish com-mittees, not for the sake of having committees, but to make decisions, elevate recommendations to leader-ship and track progress. Key principles are supported by

leadership and include:

• Accountability (Vision, approach and performance are shared.)

• Transparency (Initiatives are embraced.)

• Collaboration (Multi-disciplinary teams work to-gether.)

• Improvement (Philosophy and mindset of seeking ways to improve continuously.)

• Sustainability (Results are lasting.)

For example, many health systems have implemented labor productivity and vacancy management processes within their organizations. However, they struggle to continuously improve performance and in many cases see performance deteriorate. High-performing organiza-tions foster a culture of continuous improvement and actively seek to improve routinely labor-productivity performance by changing business processes and cross-training personnel to handle multiple functions. Setting higher standards conituallyallows health systems to bet-ter address their operating and fiscal challenges.


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People and CulturePeople are at the heart of every organization – espe-cially in healthcare. High-performing organizations create a culture that encourages high achievers to stay and develop their skills. This can be in the form of col-laborative approaches to patient care, training people in lean practices, executive coaching and other human resources strategies specific to the goals and culture of that unique organization. These organizations derive more from their people, and their people derive more from themselves, than they originally thought possible. Other examples of these people strategies include:

• Goal setting that is specific, measurable, attainable, relevant and time-based;

• Continual feedback and coaching, rather than only at designated year-end reviews;

• Latitude for cross-training, skill development and professional and personal growth; and

• Strong and transparent leadership with clear lines of authority and defined (and aligned) decision-making processes.

Financial StewardshipFinancial stewardship is the most outward sign of high performance, and it drives access to new capital. Cer-tainly there are still real disconnects within the U.S. healthcare system between quality care and financial performance. Yet, high-performers focus on optimizing patient care rather than short-term financial gains from economic disconnects. Not only is it best for the patient and the right thing to do, but leaders of these organiza-tions know that capital will ultimately follow value creation, even in the often slow-to-transform health-care industry.

These organizations not only develop dashboards with quantitative financial ratios, they develop best-practice processes and parameters around financial competen-cies. Examples include:

• Capital Capacity: multi-year integrated strategic financial plans that match cash flow with expendi-tures; capital structure allowing for venture capital (e.g., acquisitions, innovation investments); measurement of individual business unit segment performance to inform capital allocation.

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Issue 5 23


covered lives, total lives cared for (in some capacity) in a given year, total cost of care per life, readmission rates, and patient satisfaction, among others. They are devel-oping presentations to payers and other stakeholders to articulate this value, and, in turn, gaining tangible advantages over competitors in the markets they serve.

Next Steps in the JourneyAchieving higher performance is a health system’s jour-ney – not its destination. This challenge takes into ac-count factors beyond the organization’s history, location in affluent vs. economically challenged communities, prior administrative decisions, and workforce chal-lenges. The rapidly evolving healthcare landscape and the increasingly limited time and resources available to health system leaders demand a more focused approach to rethinking performance improvement. ❏

• Operating Statement Performance: management structure and accountability for key performance drivers to achieve budget objectives; robust manage-ment reporting structure.

• Key Ratio Performance: external peer benchmark-ing; performance data at department levels; measure-ments for improvements in departmental perfor-mance (e.g., patient throughput, LEAN, Six Sigma).

Strategic Market PositionHealth strategy is the tie that binds the core competen-cies described above and links Mission/Vision/Values to tactical plans. Its ultimate objective is growth and value-positioning with stakeholders, particularly payers. A health organization that either is indispensable to formation of any major network in a market or dem-onstrates to payers value-creation above its peers will differentiate itself in the market and fuel future growth.

High-performers are developing next-generation strate-gic value-propositions to payers, beyond the customary inpatient market share and standard quality measures. They are measuring metrics such as market share across various care settings (e.g., ambulatory, clinic, online),

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HFMA Advisor24


organizations struggle with inefficient and sometimes misaligned processes and protocols that limit their ability to deliver timely access to clinical care. Efforts to address delays in access that do not address core issues further challenge an organizations ability to be successful by often focusing on symptoms rather than on the essential processes and protocols that drive specific behavior. The keys to addressing meaningfully challenges to timely patient access must go beyond traditional incentives to providers and more fully focus organizational efforts to create efficient, patient-friend-ly processes and protocols that effectively balance the needs of patients.

Signs and Symptoms of Unhealthy Patient Access Whether or not you believe your organization has issues with access in your medical group, your leaders should be engaged to determine the extent to which you are experiencing these common symptoms of un-healthy patient access:

✓ Does your organization experience significant variation in volumes of patients during morning sessions and afternoon sessions?

✓ Do ambulatory volumes consistently vary on differ-ent days of the week, such as Mondays and Fridays?

✓ Do you employ clinical staffs such as nurse practi-tioners or physician assistants that are not practic-ing at the top of their licensures?

✓ Are there providers in your medical group that only allow scheduling to occur through “their” nurse (or other trusted staff)?

✓ Do you have clinical specialties that are booked months in advance, but have low productivity benchmark scores?

✓ Have your patients been grading your organization with low or inconsistent patient satisfaction scores?

✓ Are provider-related meetings and committees scheduled during regular patient care hours?

If you answered “yes” to one or more of the above com-mon symptoms of unhealthy access, then chances are you have a material opportunity for both operational and also financial improvement. Resolving the under-

Nationwide, medical groups are continually faced with numerous complex challenges that are limiting their abilities to provide timely care to all but the sickest of patients. Efforts to identify and address these complex challenges can often lead to conflict resulting from dif-ferent perspectives between providers and management. Often, this is a result of each constituent incorrectly focusing on the problem’s symptoms and not on the root cause. This article explores several of the more common symptoms of “unhealthy patient access,” but at its core, when patients cannot receive care in a timely manner, the root cause is because of insufficient scheduling op-tions. When organizations take the time to determine the root causes of why they cannot provide timely sched-uling options for their patients, they begin to understand better and to strengthen the fundamental organizational elements required to achieve successful patient access. A key differentiator among organizations that successfully improve patient access and those that do not is how the organization addresses the issue of why there are insuffi-cient options for patients to be seen in a timely manner.

Insufficient scheduling options make it difficult for patients to see their providers and often result in long delays for care. This is a growing strategic problem from both a patient-satisfaction perspective and a financial perspective. As the industry migrates toward outcomes-based payment, timely access to ambula-tory care becomes a central component of managing quality-outcomes and ultimately driving down total medical expense. While the key to improving care and managing the high cost of healthcare is to reduce the necessity of high-cost services, the effort required to proactively deliver the preventive care necessary to manage effectively quality and outcomes in the ambulatory environment is often compromised due to inefficient and misaligned processes. Without strategic and focused attention addressing the root causes of these delays, timely access to care will only worsen.

In a perfect world, each medical group would have well-designed and coordinated clinical services and protocols, supported and enhanced by efficient op-erational processes that seamlessly match demand to supply. These clinical and operational services would work together to provide timely and convenient care, effectively reward quality, and ultimately produce superior outcomes at a lower cost. In reality, many


Healthcare’s Unhealthy Patient AccessBy

Michael Miller and Chuck Holt


Issue 5 25


nurse triage protocols

• Automated notifications of appointments and text alerts to remind patients of upcoming appoint-ments

• Multi-channel patient access capabilities to offer and promote patient self-scheduling through the use of Web portals, mobile apps, etc.

To ensure success in your organization, you must be disciplined and focused in your approach, rather than taking on everything at once. This will require educa-tion and appropriate tools to implement and measure improvement. As organizations consider embarking on a journey to improve patient-access, there are several guiding principles that should be established early in the process to help ensure project success:

• Key Performance Indicators (KPIs) should be un-derstood, measured, and communicated through all levels of the medical group, from front-desk clerks through physician leaders, and each cohort should understand their individual roles and abilities to impact specific KPIs

• Be disciplined in your approach – do not try to fix everything at once

• Patients’ experience and outcomes should be the core-driver behind process change

• Educate leaders and boards to achieve understand-ing

• Maintaining the status quo is likely to cause loss of patients and market share as competing organiza-tions invest in providing a patient-centric access experience ❏

The views expressed herein are those of the author(s) and not necessarily the views of FTI Consulting, Inc., its management, its subsidiaries, its affiliates, or its other professionals.

lying reasons behind these symptoms will help focus your organization on the key fundamental principles and processes required to consistently deliver timely access for patients. Behind each symptom is typically some combination of a history of misaligned or misin-terpreted goals and priorities, communication break-downs, and other cultural challenges.

Focus Efforts to Achieve Desired OutcomesIf your ambulatory operations are not achieving the outcomes you require as a health system, consider how the areas listed below might be leveraged to positively contribute to the health of your organization:

• Transparency in goals and performance across all levels of the medical group

• Standardized appointment types and durations that support standardized care protocols

• Coordinated care-teams managing quality measures for panels of patients

• Uniform scheduling workflows, questionnaires, and

Michael Miller, Senior Director, Health Solutions, FTI Consulting, [email protected] Holt, Managing Director, Health Solutions, FTI Consulting, [email protected]

About the Authors

(Healthcare’s Unhealthy Patient Access - continued from page 24)


HFMA Advisor26


he or she is from or commenting on what his name tag says is a good next step: “I see you are from Bartsville. That’s close to Merida; some friends of mine live not far from you. I haven’t been down there for a while. How long did it take you to drive up here today?”

Another avenue is asking about their position or orga-nization: “What do you do at ABC Hospital? How long have you been there? We are having issues with XYZ. Is this some-thing you have dealt with?”

After your initial OMG, you may find some people at the event that you know. While you should definitely chat with them, do not hang onto them. You both want to meet people you do not know. Therefore, saying “Nice to see you; I’ll let you circulate,” to a col-league is expected.

As you think about walking into a room filled with people you do not know, you are probably asking yourself: Why can’t I just network online? While using LinkedIn should be an essential part of your network-ing program, face-to-face encounters are a critical part of reinforcing and growing your network.

Selecting EventsIf you are reading this, you are an HFMA member, and HFMA events should be at the top of your list. You should also attend events of other healthcare executive organizations and of those groups representing specific industry segments like hospitals or physician practices. You’ll primarily want to attend those where you have some affinity or connection through your position and background. If you are looking for a career shift to an-other segment of the market such as senior care, make sure you add events from those segments to your list. National and regional events from the same organiza-tions you attend locally will offer an expanded pool of people with whom to connect. If you feel as if the usual local industry events you attend are getting stale, shake things up a bit by attending an alumni event or a non-provider organization such as one focused on health-care technology companies.

Networking is an essential part of business life today. It is rare to find someone who scoffs at its value, but common to find people who have reasons why they don’t do it. As a healthcare executive search firm, ZurickDavis are retained by clients to find leaders and interim leaders for their organizations, and we often find candidates for desirable positions through the in-tersections of our networks and theirs. We would like to share with you some of our insights about network-ing in today’s professional world.

Why Network?The answer is similar to that of the question, “Why exercise?” Because it will help keep you healthy - pro-fessionally. Most of us do not look forward to a session at the gym or taking a run. We do it because we make it a priority and a habit. Take the same approach to networking, and make it happen.

Unless you have a specific goal, such as finding a new position, it can be hard to motivate yourself actively to spend time networking. However, it is critical to con-tinuously expand your network with new contacts and to stay in touch with existing contacts, not just when you are looking for a job.

OMG!Walking into a room filled with people you don’t know is the hardest part of networking. Just remember, most of the people who are walking into that room are feel-ing the same raw terror as you are. Do not be afraid to walk up to someone and introduce yourself.

The next hurdle: What to say? Asking someone where (continued on page 27)

Insights into Networking By

Anita Karcz, M.D., M.B.A.

CAREERCORNER

Career Corner: HFMA Advisor is pleased to offer this edition of Career Corner feature. We welcome readers’ comments and questions about career development top-ics and will work to address questions in future issues. Linda A. Burns, MHA, MBA and

Kate Stewart, Esq., co-editors, HFMA Advisor


Issue 5 27

ENTERPRISE PERFORMANCE MANAGEMENT& PHYSICIAN PRACTICE MANAGEMENTPHYSICIANPRACTICEMANAGEMENT

league. If geography is an issue, a quick phone call to catch up may be a better option.

Net GainWhat you will find as you do more networking is that you will start to enjoy getting to know people whom you otherwise would not have crossed paths. We tend to think of networking as a task and forget the human connections like sharing Red Sox stories, travel tips for Italy, or restaurant recommendations. Network for your professional health, but do not forget to have fun! ❏

Be Organized • Take enough business cards, and then tuck some

extra ones in your pocket. • Give yourself enough time to get there early with-

out traffic and parking angst. • Silence your phone. • Do not drink alcohol. A glass of water or soda is a

good prop. • Write brief notes to yourself on the back of a

person’s business card to remind yourself of their background or what you discussed. By the end of a busy event after meeting several people, you may have forgotten details about specific conversations you had early in the event.

Follow-upThis is where most people drop the ball. Make sure you follow-up with everyone with whom you spoke. Ask to connect on LinkedIn and send a brief personal note with your connection request or send a personal email follow-up. This is where your business card notes are invaluable prompts for what to include in your message.

Consider using an online contact management system. Many of these companies offer a free service for per-sonal use. You send email from this system and can cre-ate reports by geography or other parameters. It is easy to sort by the last date of contact so you can contact people you have not connected with in a while. You can create tasks: reminders to connect to a colleague on a particular date. You can also add background information such as those little scrawls on the business card and the event where you met.

One-on-One MeetingsMost of your follow-up contacts will be via email and LinkedIn, but sometimes a one-on-one meeting is best. Think about your goal for an in-person meeting since these can be very worthwhile, but are time-intensive. Let’s say you met someone at an event with whom who you had common ground — past workplaces, connec-tions, where you grew up. Suggest coffee in a conve-nient location at a time that works best for you both. Meeting someone near his-her workplace or home signals your respect for his time. Not everyone will be able to meet given other demands of life. Set yourself a task in your contact management system to touch base at a more convenient time.

The primary use of one-on-one meetings is to keep-up with your contacts. Set a schedule to have an early breakfast or a lunch once every 1-2 weeks with a col-

Anita Karcz, M.D., M.B.A. is Senior Vice Presi-dent at ZurickDavis, a retained executive search firm exclusively serving health care organizations. The ZDmd division specializes in recruiting physician leaders; the ZDinterim division places interim executives to assure strategic momentum and leadership continuity. www.ZurickDavis.com @ZurickDavis

About the Author

CAREERCORNER

(Insights into Networking - continued from page 26)


HFMA Advisor28



By Gary M. Janko, MPASenscio Systems, Inc.

The annual joint conference coordinated by the Enterprise-Performance Committee (Roger Price and Krista Yablin Katsapetses, Co-Chairs) and the Physician Practice Management Committee (Gary Janko, Chair) was held at the Sheraton Four Points Norwood Conference Center in Norwood on March 10, 2017. The theme of the conference combined the issues of the impact of Medicare Access and Children’s Health In-surance Program Reauthorization Act (MACRA) on physicians, hospitals, and health systems.

Keynote speaker, Ryan Hamilton, Senior Vice President, Population Health, at Cerner opened the program. His address, “Regulation, Com-petition, Evolving Networks, and Population Health,” set the stage for the balance of the program day. He predicted:

• MACRA will remain and be untouched,• Accountable Care Organizations (ACOs) will continue and ac-

count for 40% of the population by 2020,• Medicaid will be changed to require more personal responsi-

bility, block grants, and State level empowerment over policy.

Hamilton noted that the continued move from “volume to value” will create the fundamental demand to manage patients longitudinally over time, rather than simply on the volume-based episodic basis that has been predominant in nearly every market. Provider networks will be held responsible for health status over time, i.e., the health of a defined population. His experience in the developed world is that even coun-tries with national health are facing the same challenges in achieving effective population management and the goals of Institute of Health-care Improvement’s “Triple Aim.”

Helping to accelerate the transition to value based systems is the grow-ing acceptance of narrow networks and the perceived price advantage in the insurance marketplace. But, Ryan warned notions of population health management will fail, if patients’ behaviors are not changed. Providers and patients must be in sync and both must be engaged in the process. A key challenge for management is knowing how to stratify the population for which they are at risk, delineating responsi-

MACRA-me! Knitting Together Market Forces and Provider Responses

bilities among the care team continuum, creating visibility before the patient is “in the door”, and knowing when to engage the patient.

According to Hamilton, none of this can happen without robust analytics, near real-time intelligence, and engaging consumers where they live. Home care, which can be a relatively inexpensive substitute, has been underutilized, seen as the “end of the line,” rather than the beginning.

Mark Toso of TriNet Healthcare Consultants introduced the next panel, “MACRA Perspectives: Options and Interpreting the Rules.” Yael Miller, Senior Policy Director at the Massachusetts Medical Society, presented a detailed analysis of MACRA requirements and program milestones (aka: deadlines), opportunities, and penalties. Notably, Miller pointed out the general lack of understanding in the physician community, but also noted the resources available to support closing the gaps among awareness, knowledge, understanding, and action. Unfortunately, 80% of physicians remain unaware of MACRA requirements and, when con-fronted, can only be characterized as “deer caught in the headlights.”

Caroline Piselli, Managing Director, Health Industries Advisor at PwC, concluded the MACRA panel addressing the challenges facing hos-pitals and health systems with her talk, “Trump Administration and Implications for Healthcare.” Predicting the what, where, and how the new administration will address the ACA was not an easy task. Nevertheless, Piselli outlined three likely outcomes: 1. repeal without replacement; 2. repeal and replace; or 3. rebrand and fix. There will be increased cost and business pressures on payers, providers, brokers, pharma-life science companies and new entrants with increased op-portunity for technology firms to reduce costs and to focus on transpar-ency solutions. Regardless, the shift of the industry to a value-focus will remain on value-based care which is not dependent on Washington, D.C. A final recommendation is to focus on business models that bring providers closer to the consumer, because “consumerism” will continue the pressure towards transparency and convenience.

Deborah Pike, Vice President, Kaufman Hall & Associates, followed by covering “Mergers and Affiliations: Regional and National Trends.” Pike addressed the changing business models in the move from volume to value in the overall schema of population health. She predicted that

Congratulations!The Massachusetts-Rhode Island Chapter of HFMA congratulates two members on their recent certification as a Certified Healthcare Financial Professional:

If you’re interested in learning more about certification and how the Chapter can assist you, please contact John Reardon ([email protected]) and visit the Chapter’s website at https://www.ma-ri-hfma.org/membership/certification-information/

Erin Finn, CHFPChief Financial OfficerBrookhaven at LexingtonLexington, Mass.

Vanessa Wong, CHFPSr. Analyst, Finance & Business OperationsBeth Israel Deaconess Medical CenterBoston


https://www.ma-ri-hfma.org/events/certified-members-list/

Issue 5 29

market changes will require both financial and intellectual capital. As a result of this need, mergers and acquisitions will continue at an acceler-ated rate with 6

enterprise performance management & physician … … · macra-me! knitting together market forces...

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