Serving Physicians and Clinician Organizations
Attune Healthcare brings value to physicians and clinician organizations through its expertise in both integration and facilities design.
Establishing Integrated Models of Care
Clinical & Financial Integration (click to enlarge)
The Medicare Access and CHIP Reauthorization Act (MACRA) authorizes a value-based payment policy for physicians. MACRA pushes physicians into integrated relationships through Alternative Payment Models (APMs) in order to earn higher reimbursement. CMS research indicates that a well-designed model of care underlying APMs is the chief factor for practice success in achieving savings and higher reimbursement.
The influence of CMS’ value-based payment policy goes beyond Medicare. In the commercial sector, large purchasers of insurance are demanding value-based payment as a path to reduce premium costs. Practices are becoming more accomplished at demonstrating quality; the tougher challenge is delivering higher quality within cost targets. To meet the challenge of financial success in a value-based payment world, practices will need:
- A practice strategy for the transition to value-based payment (APMs)
- An integrated model of care to meet cost targets and practice goals
- A Service & Revenue Transition Plan to enable the practice to maintain profitability while transitioning to a predominately value-based contract mix
- An operational implementation plan to manage the change in day-to-day work processes
- Adjustments to the practice’s internal compensation plan to align practitioner incentives with the Service & Revenue Transition Plan, and
- An Alternative Payment Model Position Statement for value-based contracting with payers that reflects practice leadership’s goals and appetite for risk.
Attune’s strategists, clinicians, and healthcare planners are skilled in helping physicians achieve financial success under value-based reimbursement through integrated models of care. Our services include:
- Value-Based Practice Strategy: We start with an assessment of your competitive market. We analyze your revenue sources, patient population and risk, plans for practice growth, and resource needs for your value-based transition and success. We help your leadership team to identify the factors you deem critical to practice success, including relationships with hospitals and other groups, to set a practice strategy that meets your needs.
- Care Model Development: We work with you to define your optimal model of care, employing best practices, efficient data flows, and staff working to the top of license/certification to produce consistent, high-quality care at a competitive cost. Attune can help you to define effective coordination between specialists, primary care, behavioral health providers, and the facilities partnering with you.
- Service and Revenue Transition Plan: Attune will help you analyze your current contracts and offer tactics to improve financial performance on them. We can help you identify specific approaches to maintain profitability during transition from fee-for-service to value-based contracts. And, we will help you to define target populations and implement methods that will maximize your return on new value-based contracts.
- Implementation Support: Attune offers hands-on implementation support, providing protocols, tools, and population-specific approaches that improve patient engagement and reduce total cost for your value-based contracts. We guide you in testing and finalizing data flows and work processes, and translate them into job descriptions, policies, and procedures. We’ll develop training programs, train the trainers, and assist them in implementing training. Last, we’ll help you to define performance reporting needs and parameters, and upon request, to analyze results.
- Internal Compensation Incentives: We will assist in identifying modifications to your internal compensation plan that will align individual practitioner compensation with your value-based contract objectives.
- APM Position Statement: Our team will work with your leadership to develop your position on do’s and don’ts in contracting with payers. The Statement is aligned with the factors you deem critical to practice success, and allows leadership to objectively consider risk provisions in advance of actual contract negotiations.
We deliver a clear-cut strategy and an effective, customized model of care for integration leading to financial success in value-based contracts. Our integration models and Alternative Payment Models are structured to produce financial wins and quality improvement in the near term, and support further improvement as your sophistication grows in managing populations and risk. We’ll provide implementation support to meet your needs and leave your team fully ready to take control. Our team will also guide you in defining reporting that supports active analysis and management of clinical and financial performance.
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The shift to “value-based” payment or Alternative Payment Models (APMs), is the single largest financial challenge to physician practices today. The objective of value-based payment is to deliver a specific set of services to a patient population within a budget, while achieving selected quality benchmarks.
The strategies to meet this objective are fundamentally different than the tactics for financial success under a Fee-For-Service payment scheme. CMS-published research on value-based payment to Medicare providers concludes that clinically integrated care models are necessary to achieve sufficient cost reductions to fund shared savings.
Value-based payment policy is changing the competitive landscape in practice. The Bipartisan Budget Act of 2015 introduced a payment provision called “site neutrality.” It reduces Medicare reimbursement for hospital-owned physician practices located off the hospital’s campus, to match reimbursement for non-hospital-owned practices. Site neutrality levels the playing field between practices.
Value-based payment policy is also driving changes in the structure of physician office buildings and the mix of services being offered by practices. The Affordable Care Act (the “ACA” or “Obamacare”) promotes efficient, cost-effective treatment, and the medical home model of service and convenience. This policy is driving practices towards high-tech ambulatory facilities in which services are under one roof, and patients can have multiple appointments, all in one visit. These facilities are often close to patients’ homes and more convenient to reach. Changing patient preferences for when and where they receive healthcare services are also influencing service mix and the bottom line of medical practices. For example, changes in consumers’ expectations of convenience in the digital age, and increased patient cost-sharing in benefit plans, are driving patient demand for 24-hour access to information and availability of virtual care.
In short, the shift to value-based reimbursement and changing patient preferences requires competition on the basis of population costs, care quality, and patient convenience. This is motivating physician leaders to reevaluate their practice strategy, model of care, and practice facilities.
These changes present a challenge and an opportunity. A practice strategy that considers value-based payment and changing consumer preferences can increase revenues and profitability. To meet this financial challenge, practice leadership teams will need:
- A customized practice strategy that meets leadership’s objectives, and tackles changing trends in payment, market competition, technology, and patient preferences
- An integrated model of care between group practitioners and selected partner groups or facilities to compete on the basis of cost in a predominantly value-based payment system
- New services or facilities to take advantage of the shift from an inpatient-centric network of services, to services that meet consumer demand for convenience and service availability where people live, work, and play, and
- A facilities plan to implement strategies that impact the physical location, service mix, technologies, and operations of the practice.
Attune Healthcare’s strategists, healthcare planners, and clinical advisors are adept at evaluating practice resources and opportunities, and helping leadership make wise choices to strengthen the financial position of their practice. Our skills in strategy development, clinical integration, and facility planning put Attune in a unique position to help practice leaders select and implement new services and operations to achieve financial success in the evolving healthcare environment. These services include:
- Practice and Market Strategy: We begin with a fresh assessment of your market, potential patient base, and competition. We analyze your current revenue sources and patient population characteristics, including risk, sub-populations, and demographic trends. We consider the group’s plans for practice growth, and its preparedness for value-based contracts. We help leadership to define the objectives that effect practice options for growth and profitability. The strategy incorporates the factors that you judge to be critical to practice success, including relationships with hospitals, critical vendors, and other groups. Attune will formulate a plan to meet leadership’s goals in light of changing trends in healthcare and your service area.
- Value-based Revenue Transition Plan: Attune will help you analyze your current contracts and offer tactics to improve financial performance on them. We provide specific advice and tools to maintain profitability during transition from fee-for-service to value-based contracts. And, we’ll help you to target populations and implement methods that will maximize your return on new value-based contracts.
- Services Expansion: Our approach to planning for new or expanded services is grounded in the market evaluation and a customized strategy for your practice. Examples of new services include, but are not limited to:
- Facilities serving patient preferences for location and convenience (examples include: a high-tech ambulatory facility in which all services are under one roof and available in a single visit; freestanding surgery centers; urgent care centers; and treatment centers for specialty care like cancer care)
- Strategies that extend the group’s geographic reach, such as transition of retail space or rural critical-access hospitals into Community Based Ambulatory Care Centers, and
- Strategies that open the door to new medical specialty or surgical specialty patient populations—for example, international patient treatment with concierge and hotel services integrated into the overall program.
- Facility Planning: A services expansion plan may include any of the following facility planning services:
- Transformation Planning:
- Care models employing best practices, efficient data flows, and staff working to the top of license/certification to produce consistent, high-quality care at a competitive cost
- Technology networks that support virtual care, on-demand data sharing, and real-time clinical decision support
Workforce transformation to ensure efficient use of staff, and
- Use of Lean principles to create efficiencies in data and process flows.
- Land and Facility Evaluations: Attune incorporates changing consumer tastes and changes in payment incentives into its analyses of land for acquisition and its suitability for services expansion or relocation. Attune can provide 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. This may include analysis of the impact of current zoning regulations, the potential for rezoning, adequacy of parking capacity, and/or analysis of suitability in light of changing demographics or market competition. And, Attune is experienced in preserving confidentiality in these sensitive circumstances.
- Demand Management: We are experienced in assessing the impact of tactics used to improve quality and reduce total costs in our analyses of demand. The impact of quality improvement and cost reduction tactics may decrease acute hospital bed days or emergency room visits, and could increase low-acuity services.
- Space Programming: We use market demand analysis to guide detailed space planning, and evolving models of care and technology in space programming. This allows hospital operations to be easily modified to adapt to our evolving healthcare system.
- 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: We work with your leadership team to define “critical success factors” that guide planning. These factors are unique to the organization because they reflect your strategic, competitive, financial, and capital investment goals. They provide an objective point of reference for decision-making, and criteria for selection of alternatives in conceptual design and facility plans.
- Training for Implementation: We collaborate with your team to prepare staff to implement new care-delivery models, patient and data flows, and new technologies. We also customize training programs to client needs, and collaborate with your staff on program development.
- Transformation Planning:
Attune delivers a clear-cut strategy and an effective, customized path leading to financial success in value-based contracts and service expansion. Our facility plans help ensure care efficiency and high-quality outcomes at reasonable costs; and they reflect the financial realities of our changing healthcare system. Attune’s technology strategies support care efficiency and patient preferences for convenience, and we provide implementation support to meet your needs and leave your team fully ready to take control. At Attune, we create up-to-date strategies and high-performance facilities that withstand the test of time.