National HFMA Update

Transcription

1 National HFMA Update Joseph J. Fifer, FHFMA, CPA President and CEO, HFMA 2015 Annual Spring Conference Arkansas Chapter April Agenda Leading the Financial Management of Health Care Delivering Value Across Traditional Boundaries Promoting Price Transparency Creating Successful Partnerships with Physicians 2 1

2 Realignment Is Erasing Traditional Healthcare Boundaries Driven by demands for care transformation, the healthcare industry is realigning at an an unprecedented pace. SHARED GOAL The Triple Aim framework was developed by the Institute for Healthcare Improvement in Cambridge, Mass. ( 3 HFMA Changes Health Care OUR MISSION Leading the financial management of health care OUR VISION HFMA will bring value to the industry as the leading organization for healthcare finance 4 2

3 HFMA Services Carry Benefits Across Healthcare Boundaries Our core membership of financial professionals comes together with other healthcare leaders through the wide array of services HFMA offers. HFMA SERVICES FINANCIAL PROFESSIONALS MEMBERSHIP CAREER DEVELOPMENT AND CERTIFICATION CONTINUING EDUCATION OTHER HEALTHCARE LEADERS SMALL GROUP-FOCUSED INTERACTIONS INFORMATION ANALYSIS AND PERSPECTIVE STANDARD SETTING/ GUIDANCE DEVELOPMENT ORGANIZATIONAL PERFORMANCE IMPROVEMENT VIRTUAL AND FACE-TO-FACE NETWORKING 5 HFMA Affinity Groups: Driving Change Through Collaboration Year 1 Year 2 Year 3 Academic Medical Center CFOs Physician focused group TBD Strategy Executive CFOs Payer focused group (tentative) TBD Physician Practice Executive Council Health Economics Professionals Council 6 3

4 Agenda Leading the Financial Management of Health Care Delivering Value Across Traditional Boundaries Promoting Price Transparency Creating Successful Partnerships with Physicians 7 Value Is Driving Realignment Today 4

5 Beyond Traditional Mergers & Acquisitions An emphasis on value-focused acquisition and affiliation strategies An understanding that different needs require different approaches The emergence of new organizational combinations A blurring of lines between competitors and collaborators The need to change governance and organizational structures as systems change 9 Acquisition & Affiliation Report Research Methodology Interviews with subject matter experts in strategic consulting, capital formation, & legal/regulatory issues Survey of HFMA senior finance executive members Site visits and interviews AllSpire Health Partners (Penn. & N.J.) Dignity Health (multistate, Calif. headquarters) Froedtert Health (Milwaukee) HealthPartners (Minneapolis/St. Paul & Wisconsin) New York-Presbyterian Hospital (N.Y. metro area) North Shore-LIJ Health System (N.Y. metro area) SSM Health Care (Midwest) 10 5

6 Value Advisory Group and Sponsors 11 High Level of Interest in Acquisitions and Affiliations Source: HFMA Value Project Report,

7 Options Range Across Many Degrees of Integration Low Degree of Integration High Joint Venture Affiliation Collaborative Management Services Agreement Sale of Minority Interest Joint Operating Agreement Sale of Controlling Interest Change of Corporate Member Merger Consolidation Sale/Acquisition Less Than Fully Integrated Fully Integrated Source: Kaufman Hall 13 Multiple Models Are Being Pursued Source: HFMA Value Project Report,

8 Mergers Occur Between Financial Equals Mergers and acquisitions are occurring more frequently between organizations that are both financially strong Driven by strategy more than financial need Financially weaker organizations are more attractive if they possess other strategic assets: market position, affiliated physician networks, outpatient clinics, good payer mix Significance of not-for-profit/for-profit status of potential partners is diminishing Appetite for hospital-heavy acquisitions is diminishing 15 Multiple Drivers Include Population Health Management Source: HFMA Value Project Report,

9 Realize that Some Collaborative Partnerships May Not Stick Non-merger collaborations have the potential to add scale without ceding control. They can facilitate: Group purchasing activity Greater efficiencies in back-office functions Sharing of operational and clinical best practices Forming accountable care structures for risk-sharing But is there enough glue? These arrangements often have yet to consider: Decisions about which services should be provided by which organization Control over clinical decision-making Integrated financial bottom line for the partnership 17 Value-Focused Physician Strategies 9

10 New HFMA Value Report Focus: Critical Role of Physicians Alignment and employment options Compensation and incentives Financial support and sustainability of the physician enterprise Physician leadership and governance structures Population management capabilities Alignment and Employment Options 20 10

11 Mix of Employed and Non-Employed Physicians in Hospital and Health System Networks 21 Physician Availability Often Limited 22 11

12 Physician Employment: Lessons Learned Employment does not equal alignment Clear and consistent communication is critical Know your needs and have strategy in place from the start Consider employment needs beyond physicians 23 Compensation and Incentives: Common Issues and Concerns Productivity will remain part of compensation for employed physicians. Quality and efficiency metrics will be increasingly important. The challenge: defining metrics sufficiently valid to support decisions affecting physician incomes. Development of team-based care approaches may require compensation and incentives tied to both organizational and individual goals. Financial incentives are insufficient to ensure physician commitment to change practice patterns and care delivery

13 Changes in Productivity Following Physician Employment 25 Strategies to Manage Financial Support of Employed Physicians Measure and benchmark performance Hold physicians accountable for costs Recognize importance of smooth onboarding and credentialing process Balance employed specialists with adequate primary care network

14 What Do Financial Leaders Want From Physician Leaders? Skills Financial Management Change Management Strategic Thinking Quality Improvement Performance Measurement Collaborative Decision Making Percentage of Senior Financial Executives Ranking Skill As Important Source: HFMA Value Project Report, Opportunities to Foster a Sense of Ownership Among Employed Physicians Physician-led councils Leadership development programs Process improvement initiatives 28 14

15 CMS Seeks to Propel Industry Forward Today, for the first time, we are setting clear goals and establishing a clear timeline --for moving from volume to value in Medicare payments. Our first goal is for 30% of all Medicare provider payments to be in alternative payment models by Our goal would then be to get to 50% by Our second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value; at least 85% in 2016 and 90% in HHS Secretary Sylvia Burwell Sylvia Burwell. Progress Towards Achieving Better Care, Smarter Spending, Healthier People. HHS blog, Jan. 26, Agenda Leading the Financial Management of Health Care Delivering Value Across Traditional Boundaries Promoting Price Transparency Creating Successful Partnerships with Physicians 30 15

16 Realignment Can Raise Red Flags 31 People and Media Are Speaking Out Do the deal and prices go up 30%. Quality, too. Yeah...right Reference pricing? That won t solve anything. Hospitals will just shift the cost elsewhere. Health systems are carving up the geography! 32 16

17 Our Payment System Was Not Designed for Price Transparency Historically, charges have served a wholesale function Only recently have prices been viewed as retail Without transparency, neither consumers nor hospitals could compare hospital prices With thousands of items, the chargemaster is not transparency-friendly and not reflective of price 33 Would this be a reasonable pricing system for buying a truck? Yet, that is the system hospitals and doctors are REQUIRED to use

18 The Time Is Right for Transparency In a system where... Charges are primarily used as a factor in a payment calculation Actual prices are essentially invisible to the consumer, and Charges have little relationship to the service being acquired change is inevitable! We all contributed to this situation hospitals, physicians, payers, the business community, and even patients. We all need to work together to fix it! HFMA Resources hfma.org/dollars 36 18

19 HFMA Price Transparency Task Force 37 Task Force Report Clarifies basic definitions that are often misused Sets forth guiding principles Establishes roles for payers, providers, others Reflects consensus of key stakeholders hfma.org/dollars 38 19

20 Price Information Resource for Consumers Describes how to request price estimates, step by step Clarifies what estimates include Explains in-network and out-of-network care Defines key terms Available for posting on your website at no charge hfma.org/transparency ahaonlinestore.org Hardcopies available for purchase in bulk at a nominal price through AHA s online store 39 Best Practices for Medical Account Resolution Joint effort of HFMA and the Association of Credit and Collections Professionals Goal: to improve both the efficiency of the revenue cycle and the patient experience Best practice workflow and accompanying white paper are available on the HFMA website. hfma.org/dollars 40 20

21 Best Practices for Patient Financial Communications hfma.org/communications Bring consistency, clarity, and transparency to patient financial communications: in the ED at the time of service outside the ED in advance of service Outline steps to help patients understand: cost of services their insurance coverage individual responsibility. Include a framework for measurement to determine compliance. 41 Patient Financial Communications Training Agenda for live training on site for your patient access staff Slide deck that can be customized Sample financial policies Coaching guidelines hfma.org/dollars 42 21

22 Recognition Signifies Commitment to Community Recognition demonstrates commitment to best practices in patient financial communications Based on HFMA review of an application and supporting documentation All provider organizations may apply Recognition valid for two years Adopters may use the phrase Supporter of the Patient Financial Communications Best Practices in their marketing materials Makes a strong statement to your community hfma.org/dollars 43 Agenda Leading the Financial Management of Health Care Delivering Value Across Traditional Boundaries Promoting Price Transparency Creating Successful Partnerships with Physicians 44 22

23 HFMA Efforts to Engage Physicians and Physician Practices Physician Practice Executive Affinity Group Partnerships with other associations that include physicians, physician practice executives, and staff as members: American Association for Physician Leaders (formerly ACPE) Medical Group Management Association 45 Publications and Educational Offerings Featuring Physician Practice Perspective Value Project Report ANI Programs Webinars MAP Award 46 23

24 Physician Practice Resources Web Page 47 What we have before us are some breathtaking opportunities disguised as insoluble problems. John Gardner Secretary, U.S. Department of Health, Education, and Welfare,

25 Logic will get you from A to B. Imagination will take you everywhere. - Albert Einstein Joseph J. Fifer, FHFMA, CPA President & CEO HFMA jfifer@hfma.org Follow 50 25