1. William F. Cockrell FACMPE

2. About Me Started in Healthcare Management in 1981 Not long after Marcus Welby MD retired Active in MGMA FACMPE Started my company in 2007 Full time in 2010 Cockrell and Associates, LLC Strategic Planning and Marketing Patient Centered Medical Homes (PCMH) and Other New Delivery Models Data Operations and EMR Implementation Human Resources 3. Congratulations Tennessee MGMA MGMA National Survey Participation Award Winner $5,000 Education Grant 4. Presentation Objectives Review the general guidelines and elements of astrategic plan Focus on external issues affecting strategic plans 5. Is Planning Necessary and How Do You Get It Done? Marcus Welby, MD If you dont know where you are going, any road willget you there but it might not be where you really want to be. The problem is, we live in one of the most dynamic environments around. 6. Is Planning Necessary and How Do You Get It Done? The Lesson of 3s 3 days 3 months 3 years 33 years 7. Is Planning Necessary and How Do You Get It Done? The problem with the weekend nominal group process Must rely on physicians to prepare (true in any case) Rounding Getting participants there Keeping focus Avoiding dominant participants Its not bad, but it can be done better. 8. Is Planning Necessary and How Do You Get It Done? So, how do you do it? A strong leader. Internal manager / administrator Knows the organization Time is a problem Potential perceived bias External third party Independence Experience Need to learn the organization and environment 9. Strategic Planning CycleDefine Objective(s) 10. Define Objective (s) What do you want to be Bigger More specialized A player in the new delivery systems Retired 11. Strategic Planning CycleDefine Objective(s)Examine Internal Issues 12. Examine Internal Issues Done Right Time Consuming Specialty Size Physicians Interviews Age Retirement Plans Infrastructure IT Billing (ICD-10 readiness, etc.) EMR Quality Incentive Participation Health Plan Participation 13. Internal Primary Care Who are your customers Your Sweet Spot Services Diagnostics Sub Specialties Other (pharmacy, etc.) Accessibility Location Parking Patient Focus Medical Home Patient Satisfaction 14. Internal - Specialists Primary Care Who are you customers Your Sweet Spot Specialty focus only (PCPs keep their patients) Report turn around time Outcomes Cost Efficiency 15. Internal Specialists Patient Services Diagnostics Sub Specialties Other (pharmacy, etc.) Accessibility Location Parking Patient Focus 16. Strategic Planning Cycle Define ObjectivesExamine External IssuesExamine Internal Issues 17. Examine External Issues The most dynamic / moving target with many influencers Outside Players Location Facilities Office Hospital Competition Market Health Plans ACOs PCMH 18. How the Fee For Service Model is Viewed by Policy Advisors Theres a trend in youth sports. We dont keep scoreand everyone gets the same size trophy at the end of the season. Well, thats been the basic model for the healthcare system in the United States. We didnt keep track of how well providers were doing their jobs and we gave them all the same size trophies. We called it fee-for-service Will Pay-For-Performance Pay Off, Gary Young, Director of the Center for Health Policy and Healthcare Research at Northeastern University 19. ACA Enrollment Continues to Lag But Its Not Going Away The ACA will get modified, not scrapped Modern Healthcare, January 8, 2014 The U.S. Chamber of Commerce has accepted that the Patient Protection and Affordable Care Act is here to stay and, rather than continue calling for its complete repeal, will work this year to change what it sees as flaws in the 2010 law, the business group's president and CEO said Wednesday. Continued pressure to find new delivery models to drive down physician and hospital costs Medicare is already making changes independent of the ACA Commercial payers are already on board with new models Medicaid has to change 20. Medicare SGR Three Congressional Committees have combined efforts SGR Repeal and Provider Payment Modification Act Repeal SGR 23% cut in 2014 Annual Update of 0.5% from 2014 to 2018 Frozen rates from 2018 thru 2013 Cost of $126 Billion (down from $230,oo0 + Billion) Starting in 2018 Merit Based Incentive Payment System Replaces e-Prescribe, PQRS, other5% Bonuses Starting in 2018 Alternative Payment Model (25% of Medicare funds through APM) Shared Savings (ACO, etc.) Patient Centered Medical Home (PCMH) 21. Other Payers United Healthcare July 10, 2013 UnitedHealth Group on Wednesday announced that it expects to double its accountable care contracts over the next five years across employer-sponsored, Medicaid, and Medicare plans. Currently, more than $20 billion in United Healthcare reimbursements to hospitals, physicians, and other providers are paid through contracts linking pay to quality and efficiency measures. Those contracts include more than 575 hospitals, 1,100 medical groups, and 75,000 physicians nationwide. Humana May 17, 2012 Humana has begun working with providers on several new, collaborative delivery system models that already have yielded successful results, the insurer told a Senate panel Wednesday. the insurer is working toward aligning payment and care through its different accountable care organizations (ACO) and patient-centered medical homes (PCMH). 22. The Tennessee ACO Market Seven Listed by Medicare Qualuable Medical Professionals Wellmont Integrated Network AnewCare Collaborative Cumberland Center for Health Innovations, LLC Mission Point Health Partners Summit Health Solutions St. Thomas Medical Group PLLC TP-ACO, LLC Different organizations one goal Save money through quality and efficiency Also known as perform or lose out 23. Examine External Issues Location Facilities Office Hospital Competition Market Health Plans ACOs PCMH Reputation - Whats Out There About You 24. Data Sources for Patients, Payers and Providers Physician Compare Other Payer Sites Healthgrades Angies List Facebook Why Not The Best Other Sources 25. MGMA 2011 26. External Information Sources MGMA surveys for comparative data Meetings MGMA Governmental Affairs department Specialty societies 27. Strategic Planning Cycle Define ObjectivesCreate a SWOT AnalysisExamine Internal IssuesExamine External Issues 28. Create a SWOT Analysis 29. SWOT Examples StrengthsWeaknessesReputationLocationSpecialtyCostsOpportunities Lower CostsLeverage Reputation and Cost StructureThreats Competition Moving Quicker 30. SWOT Use strengths as a marketing tool Use weaknesses as a roadmap to improve Use opportunities as a roadmap to grow Use threats as a source to develop defensive oroffensive positions 31. Strategic Planning Cycle Define ObjectivesFormulate StrategyCreate a SWOT AnalysisExamine Internal IssuesExamine External Issues 32. Formulate Strategy Final Report Explain the process Separate and identifiable objectives Developed as options by the planning leader Multiple options that can be addressed individually Maintain confidentiality Vote Assignments Timelines 33. Strategic Planning Cycle Define ObjectivesFollow Up and MeasureExamine Internal IssuesFormulate StrategyExamine External Issues Create a SWOT Analysis 34. Follow Up and Measure What Clearly define individual objective and assign a leader Identify individual steps Not all or none things can often be better addressed in smaller pieces How Often Every two months objectives should be reviewed After six months - quarterly Annual full assessment rolling 3 year plan not as hard as the first if done regularly 35. Now and Future Elements of an Evolving Strategic Plan Do it yourself because others are planning for you You can design a plan that you can follow You have control over your reaction to developments Change is constant Delivery Models ACA ACO Shared Savings Etc. The need to plan and adapt is a given 36. Summary Determine whether its an internal or hired project If internal, try to look through independent eyes If hired, make sure you understand their process Follow the general outline Document everything Use reliable sources Present findings objectively Follow up and maintain 37. William F. (Bill) Cockrell FACMPE Cockrell and Associates, LLC (205) 208-0010 bcockrell@caahms.com