overview

Overview

Strategic Growth and Business Relationships

Course Three – June 7Presented by

Patrick Gauthier

Learning Objectives1. Review Causes and Conditions2. Discuss Strategic Implications for

Business Development3. Review Options

– Affiliation, Association– Joint Venture, Strategic Partners– Merger– Acquisition

4. Open Discussion

The New Business Environment &Your Business Architecture

Management Staffing Workflow and

Business Process Managed Care

Functions Billing and Revenue

Mgmt Integration

Business Infrastructure

and IT

Business Operations

and Process

Business Strategy

Vision Business Plan Leadership Communication Transformation and

Innovation Drive Marketing Payer/Patient and

Funding Mix

Hardware, Software, Networking

Health Information Exchange

Data Analysis & Metrics Communications

infrastructure

Causes and Conditions

• Discontinuity and Disruption (P. Druker)• Instability (A. Toffler)• Decay and Irrelevance (G. Hammel)• Tipping Point (M. Gladwell)• Strategic Inflection Point (A. Grove)• Value Migration (A. Slywotzky)• Disruptive Innovation (C. Christensen)

Causes and Conditions

ACOs

Parity

ReformMedicaid Expansion

Health

Insurance

Exchange

Meaningful Use

ONC CertifiedEHR

HIPAA 5010

ICD-10DSM-V

PCMH

Integration

Block Grant

For the unprepared, The Winds of Change can appear chaotic and as disruptive

Causes and Conditions

Meaningful Use

ONC CertifiedEHR

Parity

Reform

Block Grant

Medicaid Expansion

Health Insurance Exchange

ACOs

PCMH

Integration HIPAA 5010

ICD-10

DSM-V

…or they can appear as a dynamic, inter-dependent series of incremental improvements to our health care and health insurance systems.

The difference is preparation.The difference is planning.

Planning Makes the Planning Makes the DifferenceDifference

• Knowing what each

successive wave entails

allows you to deliberately

sow the seeds of your

organizational change

Reforms

• MH and SUD services will be included in basic benefit packages. Essential Benefits will be defined and mandated.

• All plans in the health insurance exchange will be required to adhere to the provisions of the Wellstone/Domenici Parity and Equity Act.

• Medicaid enrollees, including newly eligible childless adults, will receive adequate health coverage, including MH/SUD coverage.

• MH/SUD will be included in chronic disease prevention initiatives.

Reforms

• MH/SUD workforce included in workforce development initiatives.

• Prevention and treatment providers to be eligible for community health team grants aimed at supporting medical homes.

• Expanded Medicaid coverage for all Americans below 133 percent of the federal poverty level (est. 16 million)

• Health insurance exchanges created for individuals and small employers to pool risk and purchase insurance (est. 16 million).

Accountable Care Organizations

Population Health Home

Structure, Governance and Shared Savings

IT Infrastructure and Data Management

Public Health

Home Care

& Hospice

Rx & Lab

Primary Care

Mental Health

Substance Use

Disorder

Surgical & Specialty

Hospital & Rehab

Long-Term Care

Parity Impact

• By various estimates, at least 120 million people PLUS all those that become insured via Medicaid expansion and Health Insurance Exchanges including small group and individual policies = an additional 32 million

• 82 million are in self-insured plans

• CHIP and Medicaid managed care plans

• 460 health insurers and 120 Managed Behavioral Healthcare Organizations (MBHOs)

Then & NowPrivate

InsurancePublicly-Funded

TreatmentFederal

Agencies

State Agencies

Counties and Cities

Insurance

Managed Care

Employers

Networks

Brokers

DOI

Managed Care

Networks

Corrections & Courts

Prevention

Housing & Jobs

Standards & Science

75% -

90%

10% -25%

32+ Million Uninsured

Health Insurance Exchanges

Medicaid Managed Care

Plans

What to Expect• Need for interoperable, certified information systems and

Meaningful Use of health information• Managed care and utilization review• Medication Assisted Treatment (MAT)• ACOs and Patient-Centered Medical Home (health

home) models• Population Health Mgmt• Care/Case Mgmt• Standardization and normalization of data, terms and

tools

What to Expect

• Attention to Multiple Chronic Conditions• Focus on integration and innovation• Electronic billing (electronic data interchange - EDI)• Competition• Affiliations, joint-ventures, and partnerships• Shared services• Reporting of quality, outcomes and financial data

Opportunities for…

• Implementation of certified information systems (EHR)

• Vertical integration (“one-stop shop”)• Horizontal integration (strategic partnerships)• New approaches to reimbursement like Global

Payments• New populations to serve

Strategic Implications

• Re-visit your Vision and Mission• Include your Board • Honestly Appraise the Political, Economic

and Technological Forces • Re-Assess SWOT• Establish contemporary goals and

objectives

Goal-Setting

• Specific • Measurable • Attainable • Relevant • Time-Based

BHAG

• The term Big Hairy Audacious Goal ("B-HAG") was originated by Jim Collins and Jerry Porras in their 1996 article entitled Building Your Company's Vision.

• A B-HAG encourages companies to define visionary goals that are more strategic and emotionally compelling.

Examples of a B-HAG• Amazon: Every book, ever printed, in any language, all

available in less than 60 seconds. • Disney: To be the best company in the world for all

fields of family entertainment. • Ford: "Democratize the automobile." • Google: Organize the world's information and make it

universally accessible and useful. • Microsoft: "A computer on every desk and in every

home.” • Twitter: To become "the pulse of the planet."

Strategic Questions

• What are your strategic goals and objectives TODAY?– Survive? Maintain? Thrive? – To offer a full continuum of care– To expand geographically and open new

locations– To reach new populations – To innovate new services

Strategic Questions• What are your strategic goals and

objectives TODAY?– To implement cutting-edge technology and

participate in Meaningful Use of health information

– To align with a local hospital and join an ACO – To participate fully in Pay-for-Performance and

excel in Quality Improvement– To integrate with MH and Primary Care

Strategic Questions• What are your strategic goals and

objectives TODAY?– To join a more powerful network of providers– To influence public policy– To hire MDs and NPs and focus on Medication

Assisted Treatment– To strip away non-essential services and focus

on your core competencies– To be acquired

Next Step: Assessment

• Assess Business and Strategic Plans• Leadership Team• Assess Board• Assess Staffing• Assess Performance• Assess Financials• Assess IT Infrastructure• Assess Partnerships and Alliances• Assess Market

Next Step: Planning

• Business Plan• Strategic Plan• Marketing Plan• Contingency Plan• IT Plan• Implementation Plan• Product/Service Development• Joint Venture, Partnership, Alliance• Staffing Plan (Recruitment & Retention)

Basics of Strategic Planning• Vision – what will you

become?• Mission – how will you

become what you envision?• Goals – what incremental

achievements will enable you to satisfy your mission?

• Objectives – what tactical steps will enable you to meet your goals?

– Commit capital and develop a budget– Address outsourcing and the need for periodic expertise– Commit to Performance Mgmt

Execution

Execution

– Keep distractions and competing priorities to a minimum– Hold people accountable– Align efforts so time and energy are not wasted– Provide reinforcements, encouragement and rewards

(recognition)

Execution– Become Learning Organizations– Innovate and grow from your Core Competencies– Encourage some risk-taking, experimentation and

tolerate mistakes

Living with the TensionTension will exist between: Markets Paradigms: past, present and future People vying for roles Short and long term needs Profits and investments in the future The team and the individual Dissent and agreement “Business” and “Recovery” The “way we’ve always done it” and innovation

The challenge is one of making the tension creative and productive

Leadership Traits and Qualities The Corner Office

Adam Bryant

Leadership Traits and Qualities The Corner Office

Adam Bryant

Leadership Traits and Qualities The Corner Office

Adam Bryant

Leadership Traits and Qualities The Corner Office

Adam Bryant

Leadership Traits and Qualities The Corner Office

Adam Bryant

Affiliation & Association• Preferred Provider Networks (PPN)

• Management Services Organizations (MSO)

• Administrative Service Organizations (ASO)

• Independent Provider Associations (IPA)

• Accountable Care Organizations (ACO)

• Health Maintenance Organization (HMO)

Joint Venture & Strategic Partnership

• Vertical Integration– Unify the production supply chain under one roof (single owner)– Each “link” produces a market-specific service that satisfies a

common need– Examples? Professional Education + Prevention + Treatment

+ Case Mgmt + insurance

• Horizontal Integration– Strategy for increasing market share by merging with or

acquiring like companies in adjacent markets– Unifying marketing capabilities

Merger

• Usually a function of Horizontal Expansion or Horizontal Integration

• Serves the purpose of dominating markets

Acquisition

• “Buy-Out”• “Take-Over”• Either Vertical or Horizontal

Thank You. Questions?Patrick Gauthier

Directorpgauthier@ahpnet.com

888-898-3280 x.802www.ahpnet.com

www.behavioralhealthtoday.com