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Navigant Healthcare Pulse Point

Tue, 21 May 2013 16:08:00 -0500

Many of the key features of the Affordable Care Act (ACA) take effect beginning January 1, 2014. The primary catalyst driving reform is the development in each state of a Health Benefit Marketplace (formerly known as “Exchanges”) designed to enable individuals and employees of small employers to compare health insurance plans and select coverage.

A whitepaper written by Navigant Healthcare's Cristine Vogel and contributing authors Catherine Sreckovich, Casey Nolan, and Cheryl Duva titled, "Hot Zones in the Health Market: Finding Value and Advantage in the Health Benefit Marketplace " addresses the complexity in the Marketplace design and the competitive landscape unique to each state. The "Hot Zone" analysis, developed by Navigant, segments the nation into areas with the greatest potential for increased market share and competitive advantage. This article helps providers and health plans to understand factors affecting their markets and suggests steps for both to not only remain viable competitors but to become market leaders.

Navigant Healthcare is positioned to help providers, health plans and state governments become market leaders. We invite you to read the white paper and other related articles about the Marketplace. As always, we welcome your comments and the opportunity to continue the conversation with you.

Navigant Healthcare Pulse Point

Tue, 15 Jan 2013 13:58:00 -0600

Hospitals, physicians, and payers are facing greater pressure than ever to deliver more value for the dollar. The stakes are high. A variety of factors – increased patient costs and competition, required reporting systems and incentive programs, state reforms, and value-based reimbursement and purchasing programs – are playing a predominant role in causing healthcare providers to view the delivery of value to patients as a strategic priority.

Healthcare reform makes delivering value more important than ever for payers and providers. HFM Magazine’s December 2012 cover story written by Navigant Healthcare’s Michael Nugent titled, “Delivering Value to Multiple Stakeholders 2013 and Beyond,” highlights the four strategies for payers and providers. Strategies that can help payers and providers give their customers more value for the dollar as healthcare reform emerges over the years. Whether an organization is a payer or provider, each entity should at least start the value identification process in the following areas: measure the value delivered, create value through performance improvement, package and price value for optimization, and organize for value through new legal entities, employed medical groups, or both. The role of finance is also highlighted as a critical role in value measurement, pricing, and creation for both payers and providers.

Despite an increasingly competitive and complex marketplace, the time to act is now. We invite you to read this article and other related thought leadership by Michael Nugent, including "Implementing Clinical and Financial Collaboration Between Payers and Providers" (in HFM’s October 2012 issue) where he shares his perspectives on what it takes to move healthcare payment reform from concept to reality.

Delivering Value to Multiple Stakeholders 2013 and Beyond

Tue, 04 Dec 2012 00:00:00 -0600

In this article for Healthcare Financial Management, Navigant’s Michael Nugent highlights the fours strategies that can help payers and providers give their customers more value for the dollar as healthcare reforms emerge over the next few years. To deliver greater value, top payers and providers should: Measure the value they deliver to their business partners and customers; create value through continuous performance improvement; package and price value to optimize their margin, mission, and market share; and organize for value through legal entities, employed medical groups, or both.

Navigant’s Paul Zhang, Celia Deng, Wei Sun, and Zhiyi Tong co-authored an article for IN VIVO (November 2012) titled “Tales of Three Medical Device Markets in China"

Fri, 30 Nov 2012 00:00:00 -0600

Navigant’s Paul Zhang, Celia Deng, Wei Sun, and Zhiyi Tong co-authored an article for IN VIVO (November 2012) titled, “Tales of Three Medical Device Markets in China.” The article discusses that for device companies, China is proving to be a market replete with both immediate opportunity and significant risk. Paul, and his co-authors, present three specific case studies of different device markets – coronary stents, orthopedic implants, and ultrasound systems – and explain the strategies that large companies are using to compete in each of these product areas. Through their analysis of these companies’ efforts, they are were able to identify general strategies that will serve other device companies looking to introduce products into these and other clinical areas in China. Quick wins can be had in China, but long-term commitment and constant adaptation are the rules for sustainable success.

Outlook for Independent Community Hospitals: Uncertain

Fri, 16 Nov 2012 00:00:00 -0600

Navigant Healthcare’s Scott Clay writes an article for hfm titled, “Outlook for Independent Community Hospitals: Uncertain.” The article, co-authored with Peter Bruton, Managing Director for RBC Capital Markets’ New York, discusses the impact of today’s challenging financial healthcare environment on leaders of independent community hospitals as they consider whether or not they can continue to be “stand alone” healthcare delivery systems. Clay and Bruton cover six indicators and warning signs that stand-alone hospitals should take into consideration and share next steps for success as these community hospitals undergo external assessment of potential partners for future alignment. Clay and Bruton emphasize that “to be successful, a consolidation must bring value to both parties of the transaction, the community hospital should be mindful of the limitations it brings to the transaction just as the prospective partner should be mindful of the value the community hospital offers its market.”

Post-Acute Care Providers Can No Longer Be the Last Leg of the Continuum Relay Race

Thu, 15 Nov 2012 00:00:00 -0600

Read “Post-Acute Care Providers Can No Longer Be the Last Leg of the Continuum Relay Race,” an article co-authored by Navigant’s Donna Cameron and Rich Bajner for Accountable Care News. The article emphasizes that, in order to manage care across an episode, acute and post-acute care providers must work together in a different way, they must develop new relationships and infrastructure to improve quality outcomes and reduce overall cost. According to the authors, “Successful systems with a progressive view of redesigning healthcare will embrace their journey to innovate in collaboration with their post-acute partners...Those systems that implement creative strategies to recalibrate the continuum of care will be rewarded by lower cost, improved quality and enhanced patient satisfaction.”

Who’s in the Driver’s Seat? Physician Compacts Help You Steer Your Practice

Wed, 31 Oct 2012 00:00:00 -0500

Navigant Healthcare’s Rick Weymier writes an article for MGMA Connexion titled, “Who’s in the Driver’s Seat? Physician Compacts Help You Steer Your Practice.” The article emphasizes that successful change within the healthcare delivery system will continue to rely on physicians as the core component and that “success depends on the clinical skills of physicians and the intangible factors that support the success of physician practices.” Rick identifies physician behavior as a key intangible factor and explores the a physician compact which “represents physician expectations to support the mission and vision of an organization.”

MGMA Connexion is the medical practice management profession’s leading magazine, providing in-depth coverage of key industry topics and advice for group practice professionals.

Medicaid Managed Care Program Management: The Next Generation

Wed, 31 Oct 2012 00:00:00 -0500

Navigant Healthcare’s Anne Jacobs served as a speaker at the 2012 MHPA Annual Meeting. Throughout her presentation titled, “Medicaid Managed Care Program Management: The Next Generation,” Anne discussed the expectations of Medicaid Health Plans, the findings from a Navigant-administered plan survey, value based purchasing and how today’s approach to the Medicaid environment is not sustainable. Click here to access Anne’s presentation deck for more information. The theme for this year’s annual meeting was “A Pivotal Time for Medicaid Health Plans.” The meeting provided the perfect opportunity to participate in thought-provoking sessions and hear from compelling speakers on the topics of healthcare reform realities, dual eligibles, quality improvement and improving access to care to meet the diverse needs of today’s Medicaid population.

Medical Loss Ratio in Group Markets: Will Many Plan Participants Receive Rebates?

Tue, 25 Sep 2012 00:00:00 -0500

Recent data indicates that $700 million in medical loss ratio (MLR) rebates will be going to only a small percentage of participants. The burden of rebate distribution lies with employers and, as a result, employers have numerous determinations to make and important considerations during the rebate distribution process. Navigant’s Sonya Kwon and Melissa Hulke co-authored this article with Wayne Jacobsen, partner at O’Melveny & Myers.

Navigant Healthcare Pulse Point

Fri, 29 Jun 2012 00:00:00 -0500

Read Navigant Healthcare’s Pulse Point, a publication highlighting real time perspectives from the healthcare industry. This recent edition features information on the Supreme Court ruling on the 2010 Federal Healthcare Law as well as links to relevant articles on hospital cost pressures, Health Benefit Exchanges, healthcare reform imperatives, and Medicare and Medicaid services. The Court’s decision to uphold the mandate reinforces the fact that healthcare reform has been and is being driven by market dynamics and economic change. Bottom line: the market is moving and these economic issues will persist regardless of regulatory and legislative decisions. Only the speed and form of transformation will be impacted by judicial legislation and regulatory events.

Hospital Cost Pressures Will Accelerate Whatever the Fate of PPACA

Mon, 25 Jun 2012 00:00:00 -0500

Since the 2010 passage of healthcare reform legislation, formally known as the Patient Protection and Accountable Care Act (PPACA), a frequent prediction is that hospitals will undergo a major business model shift that will make cost and expense reduction the economic driver of healthcare service provision. However, Alex Hunter says that although PPACA may accelerate this trend, cost compression has been the major force in provider operations for well over a decade – and it will continue to be so, no matter what the U.S. Supreme Court ultimately decides about the law’s fate. Even if the Court strikes down all or part of PPACA as unconstitutional, hospitals of all sizes will still face consolidation, cost compression, expanded technology and physician alignment as major forces transforming the healthcare marketplace.

How Will Hospital-Physician Alignment Affect Profit, Performance?

Thu, 17 May 2012 00:00:00 -0500

Click here to view.

Ronald Vance, managing director of Navigant Healthcare and Michele Molden, executive vice president and chief transformation officer of Piedmont Healthcare featured in Becker’s Hospital Review article entitled, “How Will Hospital-Physician Alignment Affect Profit, Performance?”. The article highlights Vance and Molden’s recent presentation at the Becker’s Hosptial Review annual meeting regarding the implications of hospital-physician alignment for profit and performance. The author includes quotes and examples from the presentation as well as, various other articles related to hospital-physician alignment.

Physician Acquisition: What to Avoid After the Deal is Complete

Wed, 18 Apr 2012 00:00:00 -0500

This article by Navigant Healthcare’s Mark Driscoll and Anthony Long, published by hfm Magazine, considers the challenges of physician practice acquisition and the need for hospitals to take necessary steps to ensure that the transaction leads to successful integration. After a hospital acquires a physician practice, relations can become strained between the parties in any of the following four areas: (1) Governance and decision-making, (2) Technology, (3) Payment structures, and (4) Emotional factors related to the acquisition. The authors also include case examples and warning signs of trouble in hospital-physician group relationships.

Health Benefit Exchanges: Preparation for Hospitals

Fri, 23 Mar 2012 00:00:00 -0500

The overarching goal of health care reform is to transform the system of today into one that will deliver more affordable, value-added services with demonstrable results. The Affordable Care Act (ACA) begins to address this transformation and expands access to health coverage to millions of Americans.

Implementation of the ACA is a significant undertaking by all stakeholders in the healthcare industry especially providers, health plans and various agencies within state government. The Exchange will not only be the mechanism for the purchasing of health coverage but it will also be the vehicle that is likely to accelerate the delivery system transformation. This article provides a brief overview of the requirements of the Exchange and how hospitals can begin to prepare for the Exchange and the broader impacts of the ACA.

This white paper discusses how Exchanges impact hospitals and other providers as well as the broader healthcare system.

Children’s Hospitals and the Changing Healthcare Environment

Fri, 23 Mar 2012 00:00:00 -0500

It is a changing, uncertain and sometimes difficult health care environment. Competition and consolidation reduced state budgets and rapid Medicaid changes and implementation of the Patient Protection and Affordable Care Act (ACA) create new challenges, as well as opportunities, for providers. To better understand how these issues are playing out in children’s hospitals across the county, Navigant conducted 12 semi-structured interviews with executives from leading organizations representing a wide variety of hospitals. This whitepaper summarizes the results of the discussions, and provides context for the concerns expressed by children’s hospital leadership during these interviews.

Although children’s hospitals are facing many of the same economic and regulatory pressures as other health care providers, children’s hospitals have a special set of issues. Children are simply not “little adults”. The physiological and developmental differences between children and adults dictate specialized approaches, care, expertise, equipment and diagnostic capabilities.

This white paper discusses today’s environment of children’s hospitals and the impact of state and federal healthcare reform.

Loss of Exclusivity Road Map

Fri, 23 Mar 2012 00:00:00 -0500

Navigant was engaged by a medium sized pharmaceutical company to develop a product LOE (loss of exclusivity) roadmap to guide the brand strategy and tactics and provide the best opportunity for achieving the brand goals. The brand was a key financial asset for the client that operated in a highly genericized market with very little product differentiation. The Navigant team developed a comprehensive LOE overview and developed a strategic plan for the brand by engaging and focusing a large cross-functional client team on future considerations that was previously “off their RADAR”.

Monitoring the Shift to Managed Care

Mon, 27 Feb 2012 00:00:00 -0600

Cheryl Duva and Tamyra Porter presented at the 5th Annual World Congress Leadership Summit on Medicaid Managed Care. Duva and Porter will discuss topics around “Developing solutions to reform-driven challenges, implementing best practices to improve overall performance in the new era of healthcare.”
The speakers discuss:
•   Making the case: Why monitoring is important
•   Opportunities: From the perspective of Medicaid agencies and health plans
•   From compliance to performance improvement: Compliance monitoring is critical, but leading organizations must leverage monitoring efforts to proactively improve performance
•   Monitoring effectively: Developing the right processes, people, tools and organizational structure
•   Reaping the rewards: Effective monitoring helps states earn value (value-based purchasing)

Americans Still Seen Pinching On Health Care This Year

Thu, 16 Feb 2012 00:00:00 -0600

Alex Hunter was quoted in a Wall Street Journal article titled, “Americans Still Seen Pinching On Health Care This Year”. The article discusses the continued negative impact that the recession has had on hospital volumes and how unemployment is increasingly resulting in patients without health coverage and more expensive out-of-pocket costs. The article points out that some believe that “we’re getting closer to the bottom of the trough” and are “increasingly optimistic that we are in the early stages of a slow recovery in healthcare service utilization.” Alex Hunter makes the point however, that he thinks the recession will continue to have a negative impact on volumes. He notes that “US unemployment – which slid to 8.3 percent in January – still remains inflated.”

Top 10 Cited Risks Under Bundled Payment

Wed, 01 Feb 2012 00:00:00 -0600

Richard Bajner, Eric Logue and Cliff Frank write an article for hfma titled, “Top 10 Cited Risks Under Bundled Payment.” The article discusses the new challenges for hospital finance leaders as they develop their organizations’ bundled payment methodology and outlines the 10 most frequently cited risks among hospital finance leaders. For example, lack of regular data updates, DRGs with lots of post-acute activity, the potential for a competitor to develop a gain-sharing model on services/specialty here a lot of your physicians split, and several readmissions spread across many physicians.

Breaking Even Under Medicare Bundled Payments

Wed, 01 Feb 2012 00:00:00 -0600

This hfma article titled, “Breaking Even Under Medicare Bundled Payments,” authors Bajner, Logue and Frank discuss the importance of hospitals and physicians selecting the right bundles in order to emerge successful from CMS’s bundled payment pilot. The article focuses on Centers for Medicare & Medicaid Services bundled payment models two and four, as well as demonstrates the need for hospitals and physicians to understand the potential risks as well as the benefits of participating in these CMS demonstration projects.

To Integrate or Not?

Thu, 01 Dec 2011 00:00:00 -0600

Jeffrey Gorke writes an article for Connexion, a publication of the Medical Group Management Association. The article, entitled “To integrate or not?”, discusses the pros and cons of physician/hospital integration and what physicians should consider before making the leap to integrate including, access to capital, potential for improved income and benefits, hospital administration, and limited managerial control. Connexion is a publication that provides in-depth coverage of key industry topics and advice for group practice professionals.

Integration Effort Helps Steer Cardiology Practice in a Positive Direction

Thu, 01 Dec 2011 00:00:00 -0600

Jim Palazzo wrote an article for Leadership, a publication of the Healthcare Financial Management Association. The article, entitled “Integration Effort Helps Steer Cardiology Practice in a Positive Direction” discusses the acquisition of Cardiologists L.C. by St. Luke’s Hospital in Cedar Rapids, Iowa. Palazzo discusses the efforts to become more patient-centric and the tactics used to improve the four struggling areas identified by hospital leaders and practice physicians: decision-making, culture, operational efficiency and communication.

5 Guidelines for Pursuing a Practice Acquisition

Tue, 08 Nov 2011 14:32:00 -0600

Anthony Long and William Cherry wrote an article entitled, “5 Guidelines for Pursuing a Practice Acquisition”. In this article, Long and Cherry discuss what they feel are the five most important guidelines to consider before finalizing any deal to acquire a physician practice. They touch on the strategic, financial, operational, legal and regulatory ramifications that must be adequately addressed. Their five steps include: (1) Evaluate existing capital and prioritize opportunities, (2) Understand the practice’s financial solvency, (3) Review regulatory changes, (4) Assess impact and resulting opportunities, and (5) Do the homework.

Aligning Managed Care Contracts, Compensation Plans, and Incentive Models

Tue, 01 Nov 2011 16:44:00 -0500

In this article entitled, “Aligning Managed Care Contracts, Compensation Plans, and Incentive Models,” author Michael Nugent discusses how providers of all sizes are exploring a variety of new third-party payment models with public and private players and how the models have significant implications not just for providers’ revenue stream, but also for how they structure physician compensation and incentives. Nugent also discusses three tangible problems that are emerging with internal compensation and incentive models including: insufficient funding sources, inadequate incentive levels and a focus that considers compensation before patient concerns.

Bridging Employed Physician Compensation Plans Into a Value-Based World

Wed, 07 Sep 2011 14:00:00 -0500

In this article, featured in Healthcare Strategy Alert!, author Ronald Vance discusses the importance of the move from volume-driven to value-driven compensation in the healthcare market. He touches on lessons from current compensation planning, wRVUs and base plus performance and mentions that pure salary plans generally lack sufficient accountability for minimum work standards and do not provide motivation for above-minimum work standard performance. Vance believes that the time to begin designing compensation plans that recognize and reward the desired behaviors is now. Waiting to act risks an even more abrupt and challenging path to shared risk in the next phase of healthcare reimbursement reform.

Balancing IP & OP Reimbursement Increases to Maximize Margin Opportunity

Thu, 01 Sep 2011 00:00:00 -0500

In an article for the HFMA Payment & Reimbursement Forum entitled, “Balancing IP & OP Reimbursement Increases to Maximize Margin Opportunity,” co-authors Richard Bajner and Eric Logue discuss inpatient/outpatient reimbursement increases and balancing margins across inpatient and outpatient services. Logue and Bajner outline and answer questions regarding the ability of hospitals to balance margins and prioritization of inpatient or outpatient unit reimbursement increases. They also touch on questions surrounding volume trends, price sensitivity, rates position versus market and competitive pressures.

Budget Planning Under Payment Reform

Fri, 01 Jul 2011 00:00:00 -0500

In this article featured in HFM Magazine, author Michael Nugent discusses the challenges of, and the recommendations for, budgeting for top-line growth in a post-reform environment for providers and healthcare finance executives. Nugent touches on the most common budget-related questions asked by healthcare CFOs and the difficulties in making budget projections. Nugent also provides recommendations for succeeding in a post-reform world with various case studies that provide support for his ideas. Nugent suggests that healthcare CFOs update their budgeting process, anticipate different scenarios and take a team-based approach.

Culture Clash: The Impact of Culture on Physician-Hospital Integration

Fri, 01 Jul 2011 00:00:00 -0500

Mark Hirschfeld and Robert Moss (both formerly Paragon Health), write an article for hfm magazine entitled, “Culture Clash: The Impact of Culture on Physician-Hospital Integration”. In this article Moss and Hirschfeld discuss the five key steps that hospital and physicians should take, while undertaking a merger, to avoid a culture clash that could derail the integration initiative. Those five key steps are: (1) Clearly identify who the physician and hospital leaders will be, (2) Form a small, agile work team to manage the transition, (3) Communicate with staff every step of the way, (4) Be sensitive to feelings of uncertainty that staff may experience as a result of the change, and (5) Implement a clear, ongoing process to promote cultural alignment.

For Better, Not Worse

Wed, 01 Jun 2011 00:00:00 -0500

In this article featured in Trustee Magazine, authors David Burik and Monte Dube discuss how market forces are pushing mergers which are in turn increasing benefits for smaller communities providing one example of the on-going merge between Camden-Clark Hospital and St. Joseph's Hospital in Parkersburg, WV. Cost savings and access to capital are just a few of the benefits of hospital mergers. According to Burik and Dube, merging is complex and comes with obstacles, but when done correctly, can provide significant community, strategic, financial and clinical benefits.

Obtain all Necessary Documentation for Outpatient Therapy Claims

Sun, 01 May 2011 00:00:00 -0500

Obtain all necessary documentation for outpatient therapy claims May 2011 In this article Sharon Bolarakis, a coding and compliance consultant, emphasizes the importance of obtaining all necessary documentation to assist in appeal letters for payment. Bolarakis provides detailed checklists as guides to assist therapists in documenting the medical necessity of all outpatient therapy. She also provides examples of therapy codes and a checklist for re-evaluation of services. This in-depth article shows the intricacies of coding and potential ways to decrease outpatient therapy denials.

Payment Reform: Complexities to Consider

Fri, 01 Apr 2011 00:00:00 -0500

Payment Reform: Complexities to Consider April 2011 In this article featured in HFM Magazine, author Michael Nugent discusses the concerns of providers and payers regarding payment reform. Nugent touches on barriers to payment reform, the need for common ground between payers and providers so that they can work together to achieve payment reform. Nugent provides characteristics and principles that support payment reform efforts that encourage providers and payers to put patients first and seek ways to reward top providers for strong performance.

Pulse Winter 2011

Wed, 23 Feb 2011 00:00:00 -0600

This issue of Pulse – devoted to accountable care – provides vital information needed to navigate through all the changes. John Schmitt’s article on “The Horn of the ACO Unicorn” is aptly titled because it focuses on the most distinctive feature of ACOs: the promise of patient centered care. Ron Vance examines a true pocketbook issue: how to adapt employed-physician compensation plans as the market moves from fee-for-service to outcome-based reimbursements. Caroline Kolman examines a crucial component of ACOs’ promise of greater efficiency: supply chain management. In addition, we’ll offer a preview of the new authoritative book on ACOs by Marc Bard, M.D. and Mike Nugent, a link to Alex Hunter’s tips for transitioning to ACOs, as well as the latest client news and upcoming events on timely industry issues.

Answers to the Top Six Frequently Asked Questions about Physical Therapy Services

Sat, 01 Jan 2011 00:00:00 -0600

In this article, Sharon Bolarakis provides detailed answers and tips regarding the top six most frequently asked questions regarding various physical therapy claims. She advises on Medicare outpatient billing services, certification, physician involvement in ordering services for patients, what is meant by the term “qualified professionals” and Medicare reimbursement in unusual cases. She also offers advice on the use of therapy codes and checking other payer policies.

Documenting Split-Shared Visits in the Hospital Setting

Mon, 01 Nov 2010 00:00:00 -0500

In this article Sharon Bolarakis features information about documenting split-shared visits in hospital settings when physicians share the work of a patient’s visit with a nonphysician provider (NPP). The utilization of NPPs is cost-effective process for physician practices because it saves money when NPPs do the majority of work when sharing patient care with a physician. She provides CPT and CMS guidelines for shared visits, information to obtain the full reimbursement allowed in a shared visit situation and information about reimbursement differences between CMS and Medicare. She also touches on rules for reporting inpatient split-shared visits and details regarding the guidelines that do not allow shared visits when reporting certain consultation codes.

Health Reform: Sustaining a Culture of Success

Fri, 18 Dec 2009 00:00:00 -0600

Writing in Navigant Perspectives on the Credit Crisis, Navigant's Brian Fuller, Lisa Bard Levine and Casey Nolan discuss the implications of maintaining the health care status quo versus some type of health care reform becoming law. The authors begin with a look at the current state of the U.S. health care system circa late 2009, including the fact that U.S. health care outcomes are no better than that of other industrialized countries despite the significantly higher amount of money the U.S. spends on health care. If reform did not pass, the authors see the status quo characterized by low quality and cost increases driven by technology and inefficient payer systems as unsustainable. If health care reform passed, the authors predicted a material shift in terms of access, cost, quality, and prevention and wellness, with the degree to which each is affected to be determined by the specifics of the law. The authors close with steps health care players can take regardless of whether reform was passed and in what form, including focusing on clinical integration and preparing for bundled payments.

What Will Replace the Failing Hospital Medical Staff Structure?

Mon, 01 Dec 2008 00:00:00 -0600

This article in Spectrum by Navigant's John McHugh and Kara O'Connell explains how one hospital system (Borgess Health in Michigan) changed its relationship with its physicians by changing the structure of the medical staff. The authors argue that seeking solutions to the failing medical staff structure should be one of the most important issues on hospital leaders' strategic radar. They discuss three major shifts in healthcare: the increased availability of capital, a heightened focus on quality, and hospital-physician economics. Using the Borgess Health example, the authors illustrate how a more effective medical staff structure, coupled with a new system strategy and vision can produce positive results�in the case of Borgess Health, a 19.2% decrease in observed mortality over two years. The article outlines five actions to get a staff restructuring started (understand goal differences, start a dialogue and keep it going, evaluate available structures, and monitor key metrics.

The Return of Risk Sharing: An Exploration of Four Emerging Corridors of Hospital-Physician Risk

Fri, 01 Aug 2008 00:00:00 -0500

In this issue of Alert to Health Systems, Navigant's David Burik, Trent Green, Nathan Kaufman, and Casey Nolan examine how potential changes to health care payment approaches could cause renewed interest in hospital-physician integration. The authors look at four new corridors of hospital-physician integration: (1) quality improvement and cost savings incentive programs that are exempt from current Medicare physician self-referral law; (2) clinically integrated contracting vehicles; (3) acute care episode (ace) or health system-physician �bundling� demonstration projects; and (4) medical home primary care models. Each corridor is discussed in detail and the authors offer several ways to prepare. The authors end with several potential scenarios for how these issues play out in the future, including the expectation that some combination of these four corridors will become permanent additions to the market.

Unlocking Potential: Using Data to Support Payment Policy for Home- and Community-based Services and other Residential Services

Thu, 30 Jun 2005 00:00:00 -0500

This Navigant white paper by Heather Brown-Palsgrove, which is first in a series, explores the collection of cost and other relevant data as the first step in assessing and developing provider reimbursement rates for home and community-based services (HCBS) and other residential services. The author explains the benefits of collecting the data, discusses eight types of data to collect, and suggests avenues for obtaining that data. The eight types of data include: historical costs, provider revenues, salary and wage rates, staffing hours, service units, provider capacity, client assessments, and outcome measures. The author concludes that agencies can improve the quality of data they collect by defining the relevance of the data collection, understanding the different sources, considering the capabilities of providers, and developing a sound collection process.

Hospital Consolidation Outlook: Surviving in a Tough Economy

Sat, 14 Apr 2012 07:38:51 -0500

In this article for Healthcare Financial Management, Navigant's Jason Lineen and Chris Myers discuss the expected rise in hospital consolidation as these organizations position themselves to survive the current economic environment. The authors discuss the traditionally local nature of hospitals and the small market share (15%) held by the largest hospital systems and look at past trends in hospital consolidation driven by the advent of managed care for insights that might be relevant for the future. Overall, the authors predict a new wave of hospital consolidation driven by economic necessity. However, rather than merging to create scale to gain leverage with payers, the authors state that the rationale for hospital mergers needs to be much broader than the ability to negotiate better managed care rates. Beyond sheer economic survival, this next wave of consolidation will be driven by the need for improved efficiency and expense reduction. The authors end with several actions hospitals should consider before beginning any conversations about mergers and acquisitions (M&A), including understanding the entire M&A life cycle and evaluating the range of potential M&A partners and the likelihood of M&A activity in a given market.

Pay For Performance - Steps for States

Sat, 14 Apr 2012 07:38:52 -0500

This white paper discusses the role of pay-for-performance (P4P) programs as they gain acceptance in the healthcare industry and state Medicaid programs. The paper presents a four-step model to guide P4P program design: (1) determine state objectives and goals; (2) determine types of performance measures; (3) develop program methodology; and (4) develop a performance evaluation plan. Each step is discussed in detail and the papers provides tools and key questions to ask at each stage. For example, the paper provides potential performance measures based on objectives and goals and the target population, as well as a matrix of potential financial and non-financial incentives and penalties. However, the paper concludes with a cautionary note stating that P4P is just one part of any effort to improve quality and should not be considered a panacea for healthcare quality and access challenges.

Innovations in Healthcare Finance: Lessons from the 401K Model

Sat, 14 Apr 2012 07:38:51 -0500

In an article for Healthcare Financial Management, Navigant's Jason Lineen and Chris Myers note that employers facing ever larger health insurance cost increases are approaching a tipping point that makes the current employer-based health insurance model unsustainable. The authors note that the current situation resembles the cost pressures that caused employers to abandon traditional defined benefit pension plans for 401(k) plans. The change has already begun as employers shift more of the costs of employment-based health insurance to employees through high-deductible health plans with a savings option (HDHP/SO) also known as consumer directed health plans (CDHPs). Meanwhile, financial services firms and other providers are introducing private-sector solutions to capitalize on the ailing and misaligned healthcare financing system. Innovations, such as health savings accounts (HSAs) and online health shopping portals, are designed to health individuals become better informed health care consumers, a development that is likely to lead to individuals as �price-sensitive payers� who can shop around for services based on cost and quality.

Payment Change, HFM Magazine, April 2010

Sat, 14 Apr 2012 07:38:52 -0500

In this article for Healthcare Financial Management, Navigant's Michael Nugent focuses on how healthcare organizations can prepare themselves for a future of significantly slower spending growth in the wake of the new health care reform law. To that end, Nugent presents three options for these organizations: (1) reflect on lessons learned from past spending cuts; (2) chart a course for the payment reform journey; and (3) learn from early adopters: accountable care organizations. For example, Nugent provide three potential scenarios for payment reform and what each means for healthcare organizations. He also breaks down the role healthcare finance leaders can play in accountable care, while also suggesting that having a role in connecting payment and care can make the CFO's efforts much more rewarding.

Platte Valley Medical Center Case Study

Sat, 14 Apr 2012 07:38:52 -0500

This case study focuses on the work Navigant Consulting did to help the leadership of Platte Valley Medical Center in Brighton, Colo., determine whether to renovate, replace in place, or build a new hospital on a greenfield site. As a 58-bed acute care hospital in a rapidly growing suburb of Denver, the hospital faced an operational capacity challenge. Given the space limitations of the current site, the hospital decided to relocate to a new facility chosen because of its size, its proximity to planned retail and business establishments and housing development. The Navigant team helped to answer several important questions involving the size of the new facility, its location, and what the bed complement should be. The team also provided a range of services to help the hospital make this decision, including strategic facility and master planning, strategic marketing planning, and delivery system planning.

Getting Paid For Prevention: Physicians Facing Coding Challenges

Sat, 14 Apr 2012 07:38:50 -0500

This article in the American Medical Association's American Medical News highlights the practical challenges health insurers and physicians face when encouraging preventive care among patients. Although health insurers are offering incentives to persuade members to see doctors regularly for "well visits" and to manage chronic illnesses, the reality of billing codes, physician payments and appointment scheduling often get in the way of effective preventive care efforts. For example, patients often need help with acute care issues during a preventive care visit, which can lead to confusion and payment disputes between insurers and physicians. The article quotes Navigant's Andy Zarick, MD, who offers advice for physicians on how to handle those types of situations while also meeting patient needs. For example, as insurers institute more physician pay for performance, Dr. Zarick suggests that physicians create their own system to track and document their work managing patients with chronic illnesses. Even though many physicians offer preventive counseling to chronic patients as a matter of course, they don't necessarily document that work.

Navigant Consulting Alert to Health Systems - Beyond the "Pay Me More" Strategy

Sat, 14 Apr 2012 07:38:51 -0500

Long-Term Care Rebalancing

Tue, 12 Feb 2013 16:14:32 -0600

In this white paper, Navigant's Katie Hayman, Leslie Lawson, Yvonne Lutz Powell, and Catherine Sreckovich discuss the importance of rebalancing long-term care to achieve a more equal balance in funding and capacity for facility-based and community-based long-term care services and supports.

Keeping the Health Care Sampling Gains Going

Sat, 14 Apr 2012 07:38:51 -0500

In this chapter for the book, Monitoring & Auditing for Effective Compliance, edited by John E. Steiner, JD, Navigant's Catherine Sreckovich and Bo Martin explore how government regulators, health care managers, consultants, and others have improved statistical sampling in the U.S. health care industry to meet the government's need to reasonably oversee its payments for health care services. Because the large volume of government payments for health care claims cannot be reviewed in detail, the government needed to find a way to make sure these payments are reasonable and fair using statistical sampling. The authors discuss how changes in health care funding, utilization review policies, laws, court cases, government regulations and field practices led to changes in the characteristics of what is sampled and the methods of sampling. They go on to evaluate the effectiveness of statistical sampling in health care by government regulators and by provider, non-government payor and other health care entities and to make suggestions for future improvements.

Strategies for Cardiologists in the Face of Health Care Reform

Tue, 12 Feb 2013 16:17:58 -0600

In an article in Cardiology Magazine, Alex Hunter discusses lessons learned from physician-hospital integration models that cardiologists should consider in the face of healthcare reform.

Six Bold Predictions About the Looming Health Reform

Tue, 12 Feb 2013 16:16:56 -0600

In this article for Boston NPR News, Dr. Marc Bard, chief innovation officer in Navigant's healthcare practice and author of the book, "Accountable Care Organizations: Your Guide to Strategy, Design and Implementation" predicts the next major phase of healthcare reform.

Click here to read.

Survival Strategies for Community Hospitals

Tue, 12 Feb 2013 16:19:11 -0600

In an article in Trustee Magazine, David Burik discusses the increased uncertainly and volatility in the healthcare industry. In response to this uncertainty, community hospital boards are examining their strategic direction and realizing that the usual options are no longer viable. This article examines the market forces that will change the way in which community hospitals and health systems will operate in the coming years and provides insight into some of the strategic options community hospitals might consider in response.