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