Serving Hospitals and Health Systems
Attune Healthcare brings value to hospitals and health systems through its expertise in both integration and facilities design
Financial and clinical integration
Integration & Financial Stability (click to enlarge)
In 2009, CMS issued a Road Map(1) for restructuring the Medicare fee-for-service purchasing system, as a value-based payment system. The Road Map revealed the CMS plan to achieve the Triple Aim: CMS would create provider competition by public reporting of performance on national quality and cost benchmarks, and reward lower cost and improved quality by value-based payment arrangements. And, CMS concluded that models of care based on physician and facility integration are fundamental to meaningful improvements in cost and quality. In 2015, bipartisan support of MACRA (Medicare Access and CHIP Reauthorization Act) effectively secured Medicare’s position on value-based payment policy.
In the commercial sector, large purchasers of insurance are demanding value-based payment as a way to reduce costs and increase quality. The consequence is, that even if “Obama Care” should be repealed, the US healthcare system will continue to move towards predominantly value-based payment arrangements.
To meet the challenge of payment change, hospital executives must develop a competitive market strategy based on clinical and financial integration with physicians, and a tactical plan for transition to predominantly value-based reimbursement. A hospital’s path to peak financial performance will include the following steps:
- Develop and implement an integrated model of care to optimize data and work flows between physicians and hospitals
- Introduce Alternative Payment Models (APMs) that incentivize employed physicians with the right mix of value-based objectives and productivity to maximize ROI from employed physician practices
- Offer APMs to the independent physicians in the integrated care model to promote improvements in cost and quality, and
- Provide support to the independent practitioners in the integrated care model to enhance their probability of success, thereby securing their allegiance to the hospital, and the referrals they can provide.
Attune Healthcare is skilled in developing integrated care models to manage the riskiest populations, including Medicaid, dual-eligible Medicare-Medicaid populations, and state employees. We have developed and guided clients through the implementation of integrated models that meet and exceed competitive cost and quality benchmarks. Attune can identify cost drivers and work with your leadership team to develop an integration model that enables your organization and referring physicians to remain profitable as you transition to value-based payment arrangements.
We have a track record of success creating profitable Alternative Payment Models for hospitals, SNFs, specialists, behavioral health providers, and primary care practitioners. Our APMs for independent physicians meet the financial objectives of the practices, and increase their loyalty and commitment to the integrated organization. Our solutions encompass the health system’s wider strategy and focus specifically on approaches that drive services into the system while helping both the practices and the system to achieve overall financial success. And, we understand how to craft the correct balance of incentives in productivity, cost, and quality to deliver top performance by employed practitioners.
Attune also provides hands-on guidance to your management team during implementation to ensure that the model is realized as designed. We assist in definition of data flows and work processes, and translate them into protocols, policies, and procedures. We lend our expertise to the definition of your performance reporting needs. And, we develop training programs and assist in implementing them, if desired.
Manage High-Risk Populations (click to enlarge)
Working with Attune Healthcare Partners, you can expect a systematic approach to the development and implementation of an integrated model of care that is customized to meet your hospital system’s needs. Integrated models from Attune are designed to create financial success in the near term, and support your system as your achievements in managing populations and risk grow.
Alternative Payment Models designed by Attune have proven to be extremely successful, with annual shared savings ranging from $3,000 to over $50,000 paid per individual primary care provider, even in Medicaid. And, the retained savings to the system can fund expansion of community services that enrich ties to providers and patients.
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- Centers for Medicare and Medicaid Services, 2009 Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program. Retrieved May 3, 2016 from URL https://www.cms.gov/Center/Special-Topic/Quality-of-Care-Center.html.
Related Case Studies
Facility Planning and Conceptual Design
Using the authority given to it by the Deficit Reduction Act of 2005, CMS has implemented a value-based payment policy for Medicare providers. CMS summarized its approach in its pivotal white paper, the “Road Map” to value-driven healthcare:
- Financial and clinical integration between physicians and hospitals is required to produce net improvements in cost and substantial improvements in quality
- Public reporting of provider performance stimulates provider competition, and
- Value-based payment will reward performance improvements.
In 2010, the Affordable Care Act provided the authority to broaden its value-based policy. Under it, CMS is promoting provider integration to achieve better health for entire communities. Focused on whole communities, CMS is using valued-based payment to encourage Medicare and Medicaid providers to integrate with behavioral health, public health, and community-based resource providers. As a result, public expectations are shifting about the hospital’s community role; public perception is broadening to a hospital role in which seamless handoffs to community resource organizations that are fostered by integration is an expectation.
Patient expectations for the care they receive are changing too. At the member level, increased member cost-sharing in benefit plans and changes in consumers’ expectations of convenience in the digital age, are driving patient demand for availability of virtual care and 24-hour access to information.
CMS’ focus on value based payment is also influencing private payment policy. In the commercial insurance sector, large purchasers are touting value-based payment as a way to reduce their healthcare costs. In sum, our healthcare system has profoundly changed, and there is no turning back from the move towards value-based payment, the integration needed to achieve cost reduction under it, changing consumer preferences in healthcare services, or shifting public expectations in the hospital’s role in community health.
Changes in the Hospital’s Community Role (click to enlarge)
To assure financial success in a value-based environment, hospital executives will need:
- An integrated model of care between physicians and the hospital that uses information technology to compete in a predominantly value-based payment system
- Alternative Payment Models in which integrated providers share joint clinical and financial accountability, with compensation that is balanced between productivity, quality, and cost
- To shift from an inpatient-centric network of services, to services that are predominately ambulatory-based, and meet consumer demand for convenience and service availability where people live, work and play
- To address changing expectations in the role that hospitals play in community health, and
- To develop a strategy and facilities plan that incorporate solutions to all of these needs.
To address these challenges, Attune Healthcare Partners offers a range of services that complement traditional facility strategy, planning and design. They include:
Strategies to Expand Hospital’s Geographic Reach
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Lean Efficiencies in Planning
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Changing Consumer Demands (click to enlarge)
- Transformation Planning: This form of planning goes beyond traditional techniques like demographic studies, competitive analyses, market feasibility studies, and community needs assessments. Transformation Planning incorporates business strategies needed for success under value-based payment, and considers their impact on facility sizing, siting, configuration, and capital investment planning. Transformation Planning may include any of the following services, depending on the individual client’s needs:
- A review of the organization’s most recent competitive analysis of its market that focuses on competitive pressures related to value-based reimbursement and provider integration
- Facility-supported care models integrating medical, behavioral, public health, and community resource providers
- Technology networks that support virtual care, on-demand data sharing, and real-time clinical decision support
- Alternative Payment Models (APMs) that reward providers for the value of the services they deliver
- Workforce transformation to ensure efficient use of staff
- Use of Lean principles to create efficiencies in data and process flows
- Changes in facilities based on patient preferences for where and when they obtain services (ex. freestanding surgery centers, urgent care centers, and retail “quick care” centers)
- Strategies to extend the hospital’s geographic reach and that address the pressure from value-based reimbursement to provide the right level of care at the right time, and deliver services closer to home, such as:
- Transition of rural critical access hospitals into Community Based Ambulatory Care Centers, and
- Development of “microhospitals” in larger metropolitan areas that treat low acuity patients where patients may not have easy access to acute or emergency care – typically with 8 – 12 beds – these microhospitals are a cost effective alternative to freestanding Emergency Departments because they are designed to provide access to comprehensive care as part of a broader hospital network, and
- Strategies that open the door to new patient populations, such as international patients with concierge and hotel services integrated into the program.
- Land and Facility Evaluations: Attune can provide: analysis of land for acquisition and its suitability for a particular service expansion or relocation; in-depth evaluation of a specific facility for the purpose of performance improvement; and evaluation of a facility’s physical condition and suitability for an intended purpose. Typical services include impact of current zoning regulations, potential for rezoning, adequacy of parking capacity, and suitability analysis with consideration of changing demographics and market competition. We are cognizant of the importance of confidentiality in these evaluations and adept and preserving it.
- Demand Management: We assess future demand for services considering tactics that improve quality and reduce total costs. These tactics could decrease acute hospital bed days and emergency room visits, and increase volume of low-acuity services.
- Space Programming: Because we use market demand analysis to guide detailed space planning, and evolving models of care and technology in space programming, hospital operations can be easily modified to adapt to a changing future.
- Consumer-Driven Functional Planning: We employ research-based surveys to determine consumer preferences and increase knowledge of the client’s health system. This research allows us to create conceptual designs and space plans that optimize ROI on new and repurposed facilities.
- Master Planning: Attune Partners will work with your leadership team to define “critical success factors” to guide planning. These factors are unique to your organization because they reflect your strategic, competitive, financial, and capital investment goals. Critical success factors provide an objective point of reference for decision-making, and enhance criteria for alternatives selection in conceptual design and facility plans. We support you through the decision-making process, and facilitate board presentations to help you enable wise decisions.
- Training for Implementation: We collaborate with your team as they prepare staff to implement new care-delivery models, patient and data flows, and new technologies. We support your staff in program development and customize training programs to client needs.
Our facility plans are adaptable and ensure efficiency and high-quality outcomes at reasonable costs; and they reflect the financial realities of changes in the healthcare system. Attune partners understand that the shift to decentralization requires health systems to meet patients when and where they want services, and we know how that should influence the design of new and repurposed facilities.
Attune partners are skilled in developing and implementing integrated models of care to improve cost and quality, and our facility plans and client successes reflect it. Our technology strategies support care efficiency and patient preferences for convenience. Our designs reflect our expertise in provider and community integration, and support new roles for hospitals within their communities. We create up-to-date strategies and plans for high-performance facilities that withstand the test of time.