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Strategic Growth and Business Relationships Course Three – June 7 Presented by Patrick Gauthier. Overview. Review Causes and Conditions Discuss Strategic Implications for Business Development Review Options Affiliation, Association Joint Venture, Strategic Partners Merger Acquisition

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slide1
Strategic Growth and Business Relationships

Course Three – June 7

Presented by

Patrick Gauthier

Overview

learning objectives
Review Causes and Conditions

Discuss Strategic Implications for Business Development

Review Options

Affiliation, Association

Joint Venture, Strategic Partners

Merger

Acquisition

Open Discussion

Learning Objectives
the new business environment your business architecture
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
causes and conditions
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
causes and conditions1
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

causes and conditions2
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.

planning makes the difference
Knowing what each successive wave entails allows you to deliberately sow the seeds of your organizational changePlanning Makes the Difference
reforms
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
reforms1
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
accountable care organizations
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

parity impact
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
then now
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

what to expect
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
what to expect1
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
opportunities for
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…
strategic implications
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
goal setting
Goal-Setting
  • Specific
  • Measurable
  • Attainable
  • Relevant
  • Time-Based
slide18
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.
examples of a b hag
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."
strategic questions
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
strategic questions1
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
strategic questions2
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
next step assessment
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
next step planning
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
basics of strategic planning
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?

slide26
Commit capital and develop a budget

Address outsourcing and the need for periodic expertise

Commit to Performance Mgmt

Execution

execution
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)

execution1
Execution

Become Learning Organizations

Innovate and grow from your Core Competencies

Encourage some risk-taking, experimentation and tolerate mistakes

living with the tension
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

slide30
Leadership Traits and Qualities

The Corner Office

Adam Bryant

slide31
Leadership Traits and Qualities

The Corner Office

Adam Bryant

slide32
Leadership Traits and Qualities

The Corner Office

Adam Bryant

slide33
Leadership Traits and Qualities

The Corner Office

Adam Bryant

slide34
Leadership Traits and Qualities

The Corner Office

Adam Bryant

affiliation association
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)
joint venture strategic partnership
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
merger
Merger
  • Usually a function of Horizontal Expansion or Horizontal Integration
  • Serves the purpose of dominating markets
acquisition
Acquisition
  • “Buy-Out”
  • “Take-Over”
  • Either Vertical or Horizontal
thank you questions
Thank You. Questions?

Patrick Gauthier

Director

[email protected]

888-898-3280 x.802

www.ahpnet.com

www.behavioralhealthtoday.com

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