Overview

1. Strategic Growth and Business Relationships Course Three – June 7 Presented by Patrick Gauthier Overview

2. Review Causes and Conditions Discuss Strategic Implications for Business Development Review Options Affiliation, Association Joint Venture, Strategic Partners Merger Acquisition Open Discussion Learning Objectives

3. The New Business Environment &Your Business Architecture • Vision • Business Plan • Leadership • Communication • Transformation and Innovation Drive • Marketing • Payer/Patient and Funding Mix Business Strategy Business Operations and Process • Management • Staffing • Workflow and Business Process • Managed Care Functions • Billing and Revenue Mgmt • Integration Business Infrastructure and IT • Hardware, Software, Networking • Health Information Exchange • Data Analysis & Metrics • Communications infrastructure

4. 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

5. Causes and Conditions Meaningful Use For the unprepared, The Winds of Change can appear chaotic and as disruptive Medicaid Expansion Reform ONC Certified EHR Health Insurance Exchange Parity Block Grant PCMH HIPAA 5010 ACOs DSM-V ICD-10 Integration

6. Causes and Conditions Block Grant Health Insurance Exchange DSM-V ACOs ICD-10 PCMH Meaningful Use Reform Medicaid Expansion HIPAA 5010 Integration Parity ONC Certified EHR …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.

7. Knowing what each successive wave entails allows you to deliberately sow the seeds of your organizational change Planning Makes the Difference

8. 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

9. 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). Reforms

10. Accountable Care Organizations Structure, Governance and Shared Savings IT Infrastructure and Data Management Long-Term Care Home Care & Hospice Public Health Hospital & Rehab Population Health Home Rx & Lab Surgical & Specialty Primary Care Substance Use Disorder Mental Health

11. 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) Parity Impact

12. Then & Now Private Insurance Publicly-Funded Treatment Federal Agencies DOI State Agencies Employers Counties and Cities 75% - 90% 10% -25% Brokers Corrections & Courts Managed Care Insurance Health Insurance Exchanges Prevention Networks Managed Care 32+ Million Uninsured Medicaid Managed Care Plans Housing & Jobs Standards & Science Networks

13. 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

14. 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 What to Expect

15. 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 Opportunities for…

16. 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

17. Goal-Setting • Specific • Measurable • Attainable • Relevant • Time-Based

18. 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.

19. 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."

20. 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

21. 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

22. 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

23. 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: Assessment

24. Business Plan Strategic Plan Marketing Plan Contingency Plan IT Plan Implementation Plan Product/Service Development Joint Venture, Partnership, Alliance Staffing Plan (Recruitment & Retention) Next Step: Planning

25. 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?

26. Commit capital and develop a budget Address outsourcing and the need for periodic expertise Commit to Performance Mgmt Execution

27. 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)

28. Execution Become Learning Organizations Innovate and grow from your Core Competencies Encourage some risk-taking, experimentation and tolerate mistakes

29. Living with the Tension Tension 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

30. Leadership Traits and Qualities The Corner Office Adam Bryant

31. Leadership Traits and Qualities The Corner Office Adam Bryant

32. Leadership Traits and Qualities The Corner Office Adam Bryant

33. Leadership Traits and Qualities The Corner Office Adam Bryant

34. Leadership Traits and Qualities The Corner Office Adam Bryant

35. 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)

36. Joint Venture & Strategic Partnership • Vertical Integration • Unify the production supply chain under one roof (single owner) • Each “link” produces a market-specific servicethat 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

37. Merger • Usually a function of Horizontal Expansion or Horizontal Integration • Serves the purpose of dominating markets

38. Acquisition • “Buy-Out” • “Take-Over” • Either Vertical or Horizontal

39. Thank You. Questions? Patrick Gauthier Director pgauthier@ahpnet.com 888-898-3280 x.802 www.ahpnet.com www.behavioralhealthtoday.com