Organizational Development

for ACOs & PHOs

Execution Without Excuses

www.mercuryadvisorygroup.com

MERCURY ADVISORY GROUP

Helping You Build Your Provider Network Infrastructure

Initial Project Deliverable (First Meeting)

• Ideation / Agreement on goals• Operatonal Objectives • Data collaboration plan • Align the entire continuum of care• Agreement on practice standards• Commitment to active care coordination

Many of the clients with whom we work rushed to file their application and articles of incorporation before completing this critical step in the development of their network.

Without this elaboration and commitment, it will be difficult for the organization’s leaders to lead, and will impede integration and provider alignment to organi-zational goals and performance objectives.

We build your foundation with education and concensus building to create momentum for clinical, operational, financial integration and physician alignment...

Educational session an follow-on discussion to acheve consensus on ACO / PHO goals, business model, and adoption of key performance metrics for cost, quality, economic integration/shared risk, and compliance. If the organization will seek PCMH Accreditation, a gap analysis and time line development may be undertaken then or set for a return visit at a later date.

PROJECT ONE

A working weekend retreat with a task force assigned to complete the working draft of bylaws, credentialing and privi-leging criteria, policies and procedures; quality standards and corrective action plan policies and procedures, and other working documents critical to organizational development and operations. We bring model documents so that the task force can complete these assignments in the weekend retreat and have draft documents ready for implementation.

PROJECT TWO (Working Weekend Retreat)

A working general session of the membership to discuss and achieve consensus on the continuum of care. Representa-tives should be present from all stakeholder domains, including: acute care, ambulatory care, telehealth, post acute home care, and post-acute SNF. Care navigators should be present and engaged in the discussions to voice any concerns about practicability, execution of and accountability for meeting organizational goals and objectives.

PROJECT THREE (Working Weekend Retreat)

Issues Associated with Integration and Alignment

1. Physician Autonomy2. Specialization3. Functionalism4. Management5. Information Systems

PCMH Accreditation is critical to your ACO’s success for the following reasons:

• Demonstrates primary care provider commitment to triple aim goals• Ensures focused attention on activities that improve quality and reduce cost• Enhances a team-based approach to care and patient engagement• Guides the culture change needed for success in value-based care delivery

Why consider PCMH Accreditation for your ACO?

EMR data from ICD-10 is critical to ACO / PHO performance and provider align-ment. If your ACO elects the MSSP busines model, you will be required to meet Meaningful Use (MU) criteria to achieve certain incentives. Interoperability will enable your ACO / PHO to:• Report ambulatory clinical quality measures to CMS and other payors• Generate lists of patients by specific conditions to campaign engagement• Provid a summary care record for each transition of care or referral to elimi-

nate clinical, diagnostic and medication redundancies and set referral and consultation expectations for deliverable

EHR Interoperability and Networking

Making it Easier to Be in the Business of Healthcare

Development and Agreement on Practice Standards

No Cookbooks Allowed!Nip whining and complaints in the bud by engaging primary care and specialists to come up with their own, unique practice stan-dards.

We facilitate this session to engage primary care and specialists in task-oriented exercises designed to build practice standards pro-prietary to the group, adopted by consensus, and built around the capacity and technology available for use by the group.

ACO participants must agree to practice standards, including, but not limited to:

• Clinical work groups to set coordination pathways• Initial focus on conditions used for quality metrics

• Diabetes• COPD/Asthma• Congestive heart failure• CAD/Hypertension/Ischemic Vascular Disease

• Depression• Preventive health• NQF Metrics, primarily outcomes• A common coordination plan across the ACO

Care coordination within ACOs should include:

• Patient navigators, who serve as care coordinators in hospital and practices

• Integrated in multi-disciplinary workflows• Sharing care coordination plans, care coordination tasks and

secure messages in a standardized format, available online• Proactive preventive, acute, chronic and end of life care• A common language for care coordination lifecycle status

Superior execution is built on three core tenets

Operational excellence comes from informed leadership and committed team mem-bers. Leadership requires communication of vision and mission, access to useful data that enables and facilitates decision support, and organization-wide commitment to the integration and alignment of the network’s participating and affiliated physicians and other clinicians, coupled with patient activation and engagement.

Focus is set by leadership and driven a solutions orientation supported by timely access to good data, clearly articulated measurable objectives, and a culture that em-braces the intentional limitation of its range of activities, in terms of services, markets and technologies, of physical, cognitive or cultural assets, of individual or organiza-tional capabilities, or a combination of all of those to produce the triple aim goals.

The organization embraces the responsibility for development of a “living brand” that is known for integration and alignment of care delivery resources, and for its reputa-tion for sharing financial and medical responsibility for providing coordinated care to patients. The ACO’s brand is distinguished by its ability to limit unnecessary healthcare spending and maintaining better health and patient delight through its collaborative efforts.

Operationalexcellence1

Organizationalfocus2

3 Single pointaccountability

The elimination of silos in the management and de-livery of healthcare requires a cultural change from habits deeply embedded in the DNA of every ACO. To do so will take strong commitment and brutal discipline and leadership that must win the hearts and minds of the people involved in the ACO.

In order to be successful at this radical change from silo preservation to integration and alignment, the people involved must have a clear understand-ing of why the change in strategy or in culture is needed. They must also be motivated to make the change. The leadership must inspire the necessary institutional politics to make the change happen.

The leadership must be courageous and start this important work even if only a few influential partic-ipants are ready to change. In time, the others will follow or leave to find a group that is more aligned with their goals and objectives.

The first order of business is to eliminate any dysfunctional silos within the organization. This begins with seamless sharing of information

The ACO’s brand is distinguished by its ability to limit unnecessary health care

spending and maintaining better health and patient delivery through its

collaborative efforts.

The key to cultural change is to eliminate ACO silos

Making Integration Work

Resist the temptation to slot too many positions or to guarantee the representation of specific inter-ests.

Focus on individuals elected by the group who will represent the entire group structure and culture.

Give the Board substantial power so that it can act aggressively on everyone’s behalf, yet keep power balanced so that there is the option to replace an individual, if necessary.

It does not help the group for providers and share-holders to make every business decision; it inter-feres with the efficiency and does nothing to gain the advantages desired in the market.

When hiring an Administrator, seek a candidate with strong operations management and people skills. If necessary find someone to help them with contracting and marketing. The candidate must have both administrative and clinical experience and training, so that they can have empathy and see the administrative and clinical issues simulta-neously.

ACO Governance Issues12 “Must Do” Action Items for ACO Success

• Articulate the “Vision Thing” So Others Can Feel It

• Train Managers and Physicians in the Principles of Systems Thinking

• Help the Organization see Whole Processes

• Bring Customers into the Design Process: Payers, Patients, Referral Sources and Internal Customers

• Connect with the Baby Boomers and Senior Popu-lations

• Build Value-added Information Systems

• Get Everybody on Board. Sweat Equity Builds the Team.

• Balance Perspective. Broad enough to be compre-hensive, yet anchored enough to the realities of implementation

• Build an Image of Consistency. Outcomes, Qual-ity Improvement, Measurement, and Competency

• Increase the “Value” of Care -- Pay for “Care” not Data.

• Reconnect with Communities, Not only as Citi-zens, but as Economic Engines of Importance.

• Develop a New Breed of Physician Leaders

Our experts bring decades of experiences to your project and help you to do a better job of being in the Business of Healthcare

Education. The successful implementation of a ACO / PHO requires education. That education process begins and ends with the medical staff. Communications efforts concerning the changing healthcare scene in the community needs assessment, and the details about the new organization, structure and governance must be addressed and planned carefully to ensure acceptance by and align-ment of the membership at large.

Committee selection. The organization’s membership should be involved in the establishment of committees and the committees should reflect the appropriate mix of primary care, specialist and hospital-based physicians and administrative staff.

Designation of authority. It is important to establish a process by which those physicians who are involved in the ACO leadership have the ability to represent the interests of the membership. Physicians on the leadership committee must be comfortable with mak-ing decisions on behalf of other physicians. If physicians are not comfortable with making decisions and then gathering support for those decision by being advocates of the process with their colleagues, the process by which decision-making at the ACO develop-ment committee level will grind to a halt. Choose physicians leaders for this role who have earned the respect and can speak on behalf of physicians of the ACO for this role.

Creation of the integrated physician organization. As part of the ACO overall development process, physicians should initially organize themselves in a physician organization, which will allow physicians to speak with a collective voice. This is extremely criti-cal in any PHO development. This step will shorten the time frame during which a successful PHO can be created and will reduce the potential for acrimony with the hospital(s).

Creation of the ACO structure and governance. Once the physician organization issues have been decided, the ACO / PHO gover-nance structure and issues associated with the creation of the ACO should be finalized. Partnership and shared control with a hospital would be determined and recorded at this level if not previously settled.

Contracting committee. Once governance and structural issues have been settled, attention should be focused on building a con-tracting strategy and business rules for working with third-party payers.

Operational plan and budget. An operational plan and budget must be developed in order to manage day-to-day operations. This process will also assist in providing guidance concerning how much capital should be raised to launch and sustain operations for the first 90-180 days post-launch.

Raising capital and execution of documents. After the preceding steps, the ACO is ready to raise its capital and actually organize itself. In many ACOs formed to meet deadlines set by CMS, the preceding steps were not undertaken and completed. If this is the case with your ACO, these steps must be gap filled and completed. Skip this foundation-building and risk your organization’s peril. Documents must be prepared and distributed and the appropriate funds returned by the participants with the executed documents for acceptance by the ACO. Case law is already on the books for IPAs, PHOs and MSOs that did this improperly and were sanctioned by the Securities Exchange Commission. Our Practice Leader was called to testify as an expert for that case. We cannot turn a blind eye to this if you choose to set aside regulatory compliance in this step.

Preoperational planning. Prior to commencement of operations, the actual administrative team that will manage the ACO must be in place, and it must begin planning for future operations so a smooth startup of operations can occur. Recruiting personnel that will operate the ACO may be a part of this process.

Commencement of operations. After the governance issues have been settled, after the operational plan has been implemented with the appropriate personnel and after the capital has been raised, and the ACO formed, operations should be commenced. Despite the work associated with ACO formation, the real work to creating a successful ACO will be the operational aspect rather than the formation phase.

The ACO / PHO Development Timetable

Now that you have a new legal entity, it will carry its own liability for credentials vetting, and privileg-ing competencies. If you engage a generalist attor-ney who is unfamiliar with these matters, you could overlook their importance and skip mitigating these risks entirely. Often, we are hired to serve as a general counsel’s expert to gap fill the knowledge to the stan-dard of practice they may lack.

Your new entity will incur liability for:

• Ostensible agency• Respondeat Superior• Compensation and incentive arrangements• Errors and omissions• Corporate responsibility, and• Vicarious liability -- just to name a few

Before an insurer will insure you for these risks, or quote premium prices, they will want to review your standards, policies and procedures. You can approach this three ways:

1. “Go bare” and take the liability risk on the shoul-ders of the shareholders.

2. Buy insurance without showing the insurer that your ACO has mitigated the risk with proper pro-cedures, policies and standards in place, and pay exorbitant premiums - in case you get sued, or

3. We’ll help you to establish the proper vetting practices, policies, procedures, and privileging standards so that your ACO is in a better position to purchase adequate cover and mitigate risk.

Credentialing and Privileging Matters

There are industry-accepted standards of practice in place that dictate how provider credentials vetting is to be done. These include “primary source verification”. In the “old days” of IPAs, PHOs, and MSOs, the Board would read an application of a provider and the three letters of recommendation and say “We all know him/her... do we have a motion to accept?” and that was that. That is unacceptable by today’s standards.

Vetting Process

This process incorporates predefined criteria in conjunc-tion with clinical realistic, well-defined core privileges. The term core privileges refers to those clinical activities within a specialty or subspecialty that any appropriately trained, actively practicing practitioner with good refer-ences would be competent to perform. In the criteria-based core privileging approach, practitioners who meet predefined criteria are eligible to apply for core privileg-es, and those who can document additional training and experience may request special (or noncore) privileges.

Special noncore privileges nearly always correspond to one or more of the following:

• New advances in technology (e.g.,robotics, etc.)• Hi-risk / problem-prone, volume sensitive diagno-

ses or procedures that would not be automatically incorporated within the core

• Issues that occasionally cross specialty lines

Criteria-based core privileging reflects a thought process that ACO governance and quality chairs will use to decide whether to recommend privileges and staff appoint-ments for a practitioner. The approach has several other advantages that help make it the chosen method:

1. Consistency2. Flexibility3. Objective pre-screening4. Mitigation of antitrust accusations for denied ap-

plicants

While this sounds overwhelming, and time con-suming, our clients enjoy a leapfrog advantage to this because we supply all the model draft forms,

policies and procedures to be used by the ACO so that the decision-makers can simply make the necessary mod-ifications and adopt them by resolution and get busy on implementation.

Criteria-based Core Privileging Standards

Most providers have never faced real credential-ing and privileging tasks associated with man-aged care, other than completing their CAQH forms and updates. There’s far more to this pro-

cess than just approving the applications.

You’ll save time and money when we help you establish your

ACO network framework

• Exclusion / Restraint of Trade• Naked Price Fixing• Refusal to Deal• Monopoly• Monopsony• Essential Market Force

Your ACO could be found guilty of any concerted ef-fort to manipulate the market inappropriately.

There are right ways and wrong ways to go about building a competitive strategy. The ones you want to consider are those that benefit the market and offer the market choices of a better product with solid competitive advantages.

The Problem

While your attorney will tell you “what” the law says you can and cannot do, we can show you “how” to do the right thing.

We guide you through the process of “economic in-tegration” that takes advantage of the inherent char-acteristics of a “shared savings” model ACO or PHO.

You’ll save time, money and aggravation by setting up your business and contracting strategy so that you can bring value and efficiencies to the market (the pay-ers and buyers) and wrap ACO /PHO business strategies around good medicine, quality and safety consider-ations, and an organizational culture that is centered on provider collaboration, efficiencies, and savings.

The Solutions

Economic integration is a term that describes the best case scenario for sponsoring providers of an ACO or PHO to establish fee schedules and enjoy some negotiating clout with payers and healthcare buyers (self-funded employers and unions, for example). The method may vary as to the structural needs of the organization and the tax implica-tions. The formation of the ACO or PHO may be viewed as offering a new product in the marketplace.

After having built more than 200 IPAs, PHOs, ACOs, MSOs and other integrated health systems since 1993, we can show you several ways to demonstrate economic inte-gration that will enable you to meet your objectives for contracting and compliance. These include, but are not limited to:

• Your quality standards and corrective action plans• Your billing protocols• Your contracting business rules• Your operating expenses and employment practices• Stark Law implications on referrals in the network• Privity of contract matters• Provider payment from capitation proceeds• Bonus distributions• Purchase of professional liability insurance for the ACO

Understanding Economic Integration

Antitrust Concerns for ACOs and PHOs

These concerns are raised when a group of individuals join together, preserving their indi-vidual corporate separateness while functioning as a collective bargaining unit.

Under a Supreme Court decision in Broadcast Music, Inc. v CBS (441 U.S. 1 (1979)), the per se rule (i.e., the venture is in and of itself inherently violative of antitrust statutes) against price fixing does not apply if the “price fixing” involved is ancillary to the creation of a new product, and if there are obvious efficiencies and pro-competitive results flowing from the joint venture activity that could not otherwise be achieved. Additionally, the FTC has established through various letters and dicta in case law that price fixing liability can essentially be avoided altogether if, in addition to offering a new product and efficiencies, the provider share economic risk.

We show you how to set up your ACO in a way that meets the tests of clinical, admin-

istrative and financial integration

Competitive advantageWhat does your ACO do best? How do you leverage on that to be profitable? How do you improve and innovate to get ahead and stay ahead of the com-petition? There’s absolutely nothing wrong with this approach, as it’s proven to be successful and an indispensable part of a vibrant market system. Do you know how to do this? Do you need help to get started?

Comparative advantageComparative advantage on the other hand takes into account two things – different productivity levels, and scarce resources of labor or capital. In this sense, your providers could be considered pre-cious resources if they are only available through one ACO or PHO. If they participate with more than one integrated system, that strategy is no longer as strong an option upon which you can compete.

BrandingDefining your ACO’s unique promise to the market-place is critical to building a strong brand as well as maintaining and expanding relationships with patients. Translating the brand promise into a con-sistent patient experiences across points of care – both digital and traditional – helps the promise resonate with patients and drive up engagement.

Your ACO or PHO is a new business entity. How will the market come to know about its exis-tence, its value and its competitive and com-parative adgantage?

Your ACO must create the logical connections for patients and payors so that they can really understand what your brand represents

Marketing, Branding and Public Relations for ACOs & PHOs

Contracting with Payers and Healthcare Buyers

Are you ready to negotiate contracts?Our Practice Leader, Maria Todd, wrote the definitive handbook on managed care contracting, The Managed Care Contracting Handbook, now in second edition and two other leading books on physician inte-gration and network development.

She has personally guided thousands of healthcare providers and inte-grated health systems in contracting with payers, employers, exchang-es, and unions in capitated, pay-for-performance, discounted fee for service, and bundled case rate contracts since 1989. She’s available to help you negotiate or teach your team how to prepare and negotiate to better contracts with a sound strategy and system.

Network Negotiation Requires Data, Skill and Preparation

Your Business Information• ACO or PHO Description and Statistics• Your current book of business (number of patients, contracts by

age and insurer)• Statistics on current network patients by occupation and ICD-10

key diagnostic groups • Number of ACO /PHO patients currently seen in office and in

hospital per day / per week• New patients per month• Referrals processed per month• Monthly patient attrition statistics and reasons for departure• Monthly inbound referrals by insurer or other source• Average office charges and collections by procedure• Comparison of a fee range against what the contract offers• Range of average paid-to-allowed ratios by payer and plan• Range of average paid-to-billed ratios by payer and plan• Results of recently conducted patient satisfaction surveys• Cost analyses expense per visit and per active patient• Clinical outcomes data (HEDIS or SF36) (where applicable)

The Contract Draft

• Your Utilization Management Program• Their Utilization Management Program

• Your Quality Program• Their Quality Program

• Your Denials and Appeals Procedure• Their Denials and Appeals Processes

• Your marketing and brand standards• Their Marketing Collateral and Ways to Feature the ACO/PHO

• Formulary List of Drugs Your ACO Providers Prefer• Their Approved Forumlary List and Prescription Plan Details

• Your ByLaws and Participation Agreements• Their Due Process and Disciplinary Policies

• Your operations manual and SOPs• Their Provider Manual (where all the cost monsters lurk)

• Your provider roster with all active and affiliate providers• Their participating provider list (who’s already listed, competitor

analysis, market share analysis)

• Their incorporation and other legal information• The CV of their Medical Director• List of all Department Heads and Last Word Decision-makers

• Additional Clarifications• Clean Claim Definition• How long is a month for prorated payment issues

You’ll need these items on hand to negotiate network contracts Don’t set up the meeting and embarass yourself or try to fake it if you aren’t ready, trained and rehearsed. If there is a rival ACO or PHO competitor nearby, you won’t get a second opportunity to negotiate with leverage or save face.

Education and Training for ACOs and Integrated Health Systems

We offer ACOs and PHOs several op-tions for skills building and fast track development to meet your budget and time constraints.

PRIVATE COACHING SESSIONSThrough the Healthcare Business Institute, our nonprofit edu-cation foundation, we can send qualifed consultants to train at your location or ours, or to head up a strategic planning and training retreat for your Board and Members.

SEMINARS & WEBINARSYou can also elect to attend public seminars and webinars we sponsor where you can train in small classes with other providers who are looking for similar skills and solutions. We send students home with a toolkit of checklists, presenta-tion slides and other materials so they can share what they learned with your group.

WEB-BASED COACHINGWe offer clients the option to work with us face-to-face and then follow at regularly scheduled intervals each month through private tele-conference calls with managers, team leaders and the ACO’s Board of Directors. This is an excellent way to access the experts you need while only paying for time and not travel. Use the time to bounce ideas, get advice, learn best practices or innovate.

ACCREDITATION COACHNGWhether you plan to achieve accreditation as a PCMH or an

10 Ways Your ACO or PHO will Benefit from our WorkshopsACO class participants benefit from class discussions and exercises designed to:

1. Advance organizational renewal2. Engage organization culture change3. Enhance profitability and competitiveness4. Ensure health and well-being of organizations and employees5. Facilitate learning and development6. Improve problem solving7. Increase effectiveness8. Initiate and/or manage change9. Strengthen system and process improvement10. Support adaptation to change

Mercury Advisory Group’s thought leaders and experts help innovators to use knowledge, power and influence to invent the future in healthcare

Education and Training for ACOs and Integrated Health Systems

Skills training and coaching is available for:

1. Physician leadership / governance2. Credentialing and Privileging3. Care Navigators4. Telehealth coordinators5. Polypharmacy managers6. Predictive modeling & populaton health analysts7. Social media & brand engagement specialists8. Team leaders and department managers9. Managed care contract analysts & negotiators10. Marketing & branding specialists11. Disease management and care management nurses12. Chief medical officers and clinical directors13. Healthcare informaties and decision support analysts

Mercury Advisory Group offers a comprehensive group of public healthcare busi-ness educational programs that can be easily tailored to your specific needs and challenges. There is a training program to match your budget requirements and bring tremendous value to your company. Any workshop or section of a workshop can be customized just for your group and offered at your location or at our train-ing facilities in Denver, Colorado.

Hands-on Workshops

Role-based training assessments and exams can be developed for your group that are specifically tailored to the key requirements of employee job functions as well as areas requiring further skills and competency assessment. This is great for rev-enue cycle, managed care, and ACO care navigator roles, as well as for insurance billers, collectors, and front-office staff.

We’ve been conducting and developing course curricula for more than 30 years. Let us leverage our training experience and resources for your employees.

In-house Training & Workshops

We teach you the skills you need to know to succeed in the Business of Healthcare

More than 500 organizations in the USA accountable for more than 48 million lives are now involved in startup ACOs that are less than 3 out from their original incorpora-tion date. Once the ACO or integrated health system has established its corporate form, bylaws, and landed a con-tract or two, the organization has to take a serious look at business process, operations, controls, and capacity train-ing and development for those that run the day-to-day af-fairs of the business. The overall objective is to achieve a Triple Aim outcome characterized by:

1. Improving the experience of care

2. Improving the health of populations and

3. Reducing per capita costs of healthcare.

Before ACOs can take on responsibility for groups of pa-tients they first have to take responsibilities for their own cultural and organizational development. Medicare and participating insurers will generally offer financial rewards for ACOs that save money and hit quality goals for these patients. At the same time, ACOs may risk losing money if their costs run higher than expected. The idea is build a functional culture of “aligned accountability” that suc-cessfully eliminates duplication of services and facilitates patient engagement to drive preventive efforts that ulti-mately reduce the need for high-cost services such as hos-pital inpatient stays.

Registration $459Discounts for multiple registrants from the same organizationCall 800.209.7263 to Register by Phone

Workshop: Organizational Development for ACOs & PHOs

In this workshop, Maria Todd will cover:

• How ACO leadership can create a common culture and to bring personnel, processes, and policies to-gether

• How to develop a system for qualitative feedback to ACO participating physicians and employees on their performance

• How to help manage conflict between employees, between physicians, and between the ACO and pay-ers

• How to use organization development principles and processes to improve the organization’s cul-ture through interventions that are (1) planned, (2) organization-wide, and (3) managed from the top, to (4) increase organization effectiveness and health through (5) planned interventions in the organiza-tions “processes,” using behavioral-science knowl-edge.

• Ways to develop the key components of organiza-tion culture: beliefs, attitudes, values, and structures that transcend clinical affairs, adoption of technol-ogy, reimbursement contracting and negotiations, and managing to lead people.

Organizational development in an ACO must be centered on assuring healthy inter- and intra-unit relationships and helping clinicians initiate and manage the change asso-ciated with unprecedented healthcare reform initiatives, many of which were implemented without much guid-ance as to “how to get the job done”.

The ACO’s primary emphasis is on aligning relationships and processes between and among individuals and groups, between staff and clinicians, and between clini-cians and engaged patients. This is quite different than the integrated health delivery systems of the 1990s in the Clinton era for four primary reasons:

1. Access to and manipulation of predictive modeling tools that weren’t available in the 1990s

2. Access to and exploitation of the power and capabili-ties of electronic medical records

3. A demand for value-based healthcare driven by phy-sicians that use evidence-based medicine tools and reference databases

4. Accountability for cost, quality, safety, efficacy, pa-tient engagement and consumer delight

Learn How to BE a Successful ACO

Find complete details on this course at:www.mercuryadvisorygroup.com/training-education/

2014 Upcoming Dates & Locations:

Denver - July 11Los Angeles - July 14thPhoenix - July 16Fort Lauderdale - August 11

Orlando - AugustTampa - August 15Raleigh - August 25

Who should attend:ACO Administrators and Key Physician LeadersCare NavigatorsCare Coordinators

Directors of NursingSocial WorkersData AnalystsMedical Directors

Health System Directors and ManagersContract NegotiatorsHospital ExecutivesMultispecialty Group Executives

PhysiciansHealth InsurersProvider Relations CoordinatorsPhysician Leaders

The ACOs in America have already captured 14% of the market, serv-ing more than 30 million Americans. Across the nation, an estimated 45% of the population live in regions served by one or more ACOs. It’s only natural that a large percentage of our nation’s 650,000 physicians are considering their options to build or participate in an existing ACO or other integrated health system.

Explore what is involved in forming and operating an ACO or Integrated Health Delivery System

How large is the market? Is there room for another ACO?

Workshop: Integrated Network Formation

So, you want to build an ACO... Let us Help You Start Off on the Right Foot

It depends. This question is the first step you must de-fine in order to determine if another ACO would be vi-able where you want to build it.

To determine how large the market is, you must first de-fine what it is you mean by “ACO”. If you choose to de-fine “ACO” as a catch-all term for providers participating in population-oriented, value-based care delivery and reimbursement models, then the market is 150 million patients, give or take a few thousand.

An estimated 2.5 million Medicare patients (and “boom-ing”) are contracted with Medicare, another 15 million non-Medicare patients that receive care through Medi-care ACOs, and estimated 14 million patients cared for through non-Medicare ACOs that are contracted with private payers. That leaves about 80% of the address-able market.

To make the best decisions for your professional suc-cess and ongoing satisfaction, you must first know and understand your options. This comprehensive introduc-tion to the issues will prepare you now. You will learn:

1. Basic models of ACOs compared and contrasted with other managed care organizational models showing the pros and cons of each

2. How to form an ACO3. Specific steps for organizing and financing a phy-

sician-owned managed care corporation with an explanation of the complexities, expenses, and risks involved

4. How to use leverage in payer contracting in the in-tegrated network setting

5. How to avoid antitrust violations in integrated net-work negotiations

In this workshop, Maria Todd will cover:

• Clinical and Economic Integration• Physician Alignment: Taking integration to a much higher functional level• The dizzying array of payment methods and how to make sense of them• The costly payer loopholes most ACOs overlook and how to avoid them• How to analyze the payers’ terms, conditions and payment terms offered• How to analyze the market before you add another competitor to the

field• Market share is important: All about ACO branding. marketing and ad-

vertising• Contracting leverage: how to build it and use it effectively• Sorting through the dizzying array of health information systems options• Preserving physician autonomy while working as a group• The Holy Grail of Healthcare Reform: Effective Patient Engagement

11 Benefits of Attending this Class

In this workshop, participants will benefit from class discussions, a library of model forms, policies, procedures and documents you’ll need, and instructor-led exercises designed to:

1. Help you build a balanced organizational strategy: broad enough to be comprehensive, yet anchored enough to the realities of implementation

2. Help you analyze your market using proven business analyst tools and methods

3. Articulate the “Vision Thing” to make it real for stakeholders4. Develop “systems thinking” instead of building more “silos”5. Help ACO leadership see “Whole Processes”6. Help you connect with the population you are targeting7. Save hundreds of hours developing documents, policies, procedures and

forms you didn’t know you’d need8. Network with other providers who are looking for similar solutions9. Increase effectiveness negotiating with payers10. Strengthen system and process improvement11. Understand the corporate liabilities associated with credentialing and

privileging

ACO Administrators and Key Physician LeadersCare NavigatorsCare CoordinatorsDirectors of NursingSocial WorkersData Analysts

Medical DirectorsHealth System Directors and ManagersContract NegotiatorsHospital ExecutivesMultispecialty Group ExecutivesPhysicians

Health InsurersProvider Relations CoordinatorsPhysician LeadersMarketing and Social Media CoordinatorsPatient Engagement StrategistsPhysicians considering PCMH development

Public Health and Health Promotion SpecialistsConsultantsInvestors

Who should attend:

2014 Upcoming Dates & Locations:Denver - July 21

Registration $459Discounts for multiple registrants from the same organizationCall 800.209.7263 to Register by Phone

Find complete details on this course at:www.mercuryadvisorygroup.com/training-education/

600 17th Street, Suite 2800-SDenver, Colorado USAPhone: 1-800-727-4160E-mail: info@mercuryadvisorygroup.comWebsite: www.mercuryadvisorygroup.com

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Portions of this publication have been adapted from IPA, PHO, MSO Development Strategies, by Maria K Todd, and Physician Integration and Alignment: IPA, PHO, MSO, ACOs and Beyond, by Maria K Todd. Adapted and reprinted by permission of the author.

Making it Easier to Be in the

Business of Healthcare

MERCURY ADVISORY GROUP