Whats it all about, Archie? also known as Weve got to get out of - - PowerPoint PPT Presentation

“What’s it all about, Archie?”

also known as

“We’ve got to get out of this place”

NYS Council for Community Behavioral Healthcare Annual Meeting – December 6, 2016

Gerald J. Archibald, CPA Partner, Co-Practice Leader for Healthcare/Tax-Exempt Practice The Bonadio Group 646-343-0249 / 585-750-6776 / garchibald@bonadio.com

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“You say you want a REVOLUTION”

• Healthcare reform initiatives will require the

following “Seven C’s”:

• Cooperation among providers
• Collaboration with others
• Competition for service referrals
• Compensation allocation among providers
• “Conflict-Free Case Management” results in

care coordination with a more intensive scrutiny

• n identifying the most appropriate and cost-

effective site of care

• Convergence of provider activities resulting in

shared services, mergers, and affiliations

• Contracting transition from fee for service to

value-based performance metrics and outcomes

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Why?

• Healthcare spending out of control for the

better part of 50 years

• Federal, State, and County government

legislators are saying “NO MAS”

• Government regulators are intently focused on

intentional fraud and abuse (criminal), and unintentional errors and omissions (civil)

• System fragmentation to delivery integration is

the primary objective

• Fee for service volume transition to Value-

Based Payment (VBP) outcomes is the method selected for driving integration and shared savings

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Why?

• …Did Xerox, after developing the

personal computer, decide not to produce and market it?

• …Did Kodak develop the first

prototype digital camera and decide not to produce and market it?

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Why?

• …Did the Department of Health

create 25 Performing Provider Systems, effectively giving healthcare systems the ability to build monopolies?

• …Did Beacon Health Strategies

acquire Value Options in the Behavioral Health Management service sector?

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Why?

• …Did we elect Donald Trump as President?
• As Nobel Laureate Bob Dylan said more

than 50 years ago, “THE TIMES, THEY ARE A-CHANGIN’ ” And for the past 8 years of the Obama administration, there have been… “SIGNS, SIGNS, EVERYWHERE THERE’S A SIGN”

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Menu of options provided by NYS DOH in its VBP Road Map

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What?

• …Does the election of Donald Trump mean

for future healthcare reform and delivery changes? Right now, all I can say is the present and future state will be a “BALL OF CONFUSION”

• …Does Republican Party control of the

House, Senate, and Executive branch mean for healthcare providers? “I’M A BELIEVER” that Donald Trump, as a New York resident, will provide a certain level

• f protection to New York State during his

administration…may take a lot of prayer and luck

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What?

• …Is the preferable structural option for

Community Based Organizations’ (CBOs) Boards and Management Teams

• Generally, one of the following:

a) “THE WAY WE WERE” b) “I CAN’T GET NO

SATISFACTION”

c) “GET OFF MY CLOUD” d) “LEADER OF THE PACK”

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Structural Options for CBO Contracting

“YES, THERE ARE TWO PATHS YOU CAN GO BY, BUT IN THE LONG RUN…”

• Autonomy and Direct Contracting with payors
• Independent Provider Associations (IPAs)
• Participation in an IPA of IPAs
• Joining a Captive IPA of an MCO
• Joining a Captive IPA of a Health System
• Joining a Captive IPA of a BH Management

Company

• Various alternatives for participation with

Performing Provider Systems, Accountable Care Organizations, and other Regional Provider Networks

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How do we proceed?

• “WE MAY NEVER PASS THIS WAY AGAIN”
• Assuming participation in or formation of an

IPA is the preferred strategy, do the following:

a)

Identify and assess IPAs operating in your geographic service area

b)

Engage competent legal counsel

c)

Discuss possible collaborations and participation with “like-minded” providers

d)

Consider a regional geographic network that covers more than five counties, except for New York City metro area

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How do we proceed?

• Develop working relationships with key

Department of Health personnel

• Discuss the possibility of forming an IPA in

collaboration with a Health Home and/or a PPS

• If you cannot develop an IPA with a group of

providers, you are most likely a candidate for acquisition

• Develop relationships with the appropriate

leadership at the Health Systems in your geographic service region

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How do we proceed?

• Evaluate the performance of Accountable Care

Organizations in your geographic region

• Learn from providers in other states, most

notably California, Massachusetts, and Connecticut

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When?

• “YESTERDAY”
• “THESE ARE THE GOOD OLD DAYS”
• “HELLO, IT’S ME”
• “OPERATOR, COULD YOU HELP ME

PLACE THIS CALL”

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When?

• “LIGHT MY FIRE”
• “HELTER SKELTER”
• “I’VE SEEN FIRE AND I’VE SEEN

RAIN”

• “IN THE YEAR 2525”

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When?

• Board and Management strategic alternatives

must be evaluated

• Being flexible and nimble in decision-making

processes will be extremely important

• Need to develop a Plan A and a Plan B based
• n future uncertainties

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When?

• “WE DIDN’T START THE FIRE”
• “REGRETS, I’VE HAD A FEW”
• “YOU CAN CHECK OUT ANY TIME

YOU LIKE, BUT YOU CAN NEVER LEAVE”

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When?

• Remember, since the Cubs just won the

World Series after more than 100 years, Murphy’s Law applies now more than ever…

• Anything that can happen, will happen…
• The fundamental challenge for Behavioral

Health providers and all Community Based Organizations is on the following slide…

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When?

• Your mission, should you decide to accept it…
• BH / CBO provider challenges include, but are

not limited to, the following:

• Can we trust anyone in the government and/or

Managed Care Organization (MCO) payment sectors?

• Cash flow will be a key to survival, which means

that Revenue Cycle perfection must be the goal.

• Service quality and, more importantly, achieving

measurable service outcomes will be increasingly important

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When?

• Your mission, should you decide to accept it…

(continued)

• BH / CBO provider challenges include, but are

not limited to, the following (continued):

• Demonstrated cost effectiveness in service

delivery is essential (e.g., MLTCPs).

• For smaller providers, the ability to access and

demonstrate high levels of technology sophistication and financial reporting accuracy is a requirement. If you don’t have it, get it!

• Management and Board leadership and

processes must be at a “Best Practice” level.

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When?

• Your mission, should you decide to accept it…

(continued)

• BH / CBO provider challenges include, but are

not limited to, the following (continued):

• Private sector fundraising and development must

be pursued to fill the gap resulting from government reform.

• Board and Management must be willing to close,

restructure, or innovate with respect to deficit producing programs and/or services.

• Your decision-making processes must be flexible

and nimble, with a willingness to accept “shared responsibility while minimizing financial risk”.

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When?

• Your mission, should you decide to accept it…

(continued)

• BH / CBO provider challenges include, but are

not limited to, the following (continued):

• Last, but certainly extremely important, is to

develop your strategic positioning with respect to the following “relatively new players”:

• Performing Provider Systems
• Accountable Care Organizations
• Managed Care Organizations
• Behavioral Health Management Companies
• Independent Provider Associations
• Regional Provider Networks aka Management

Service Organizations (MSO)

• Is there a need for an “upstream” or “downstream”

merger / acquisition?

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There is a pervasive challenge for all BH providers

• The fundamental question that every provider

should already have addressed and continue to address is…

• Is there a need for an “upstream” or

“downstream” merger / acquisition / affiliation with one or more other providers?

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Top 10 Action Steps

• Develop a clear strategy with an

alternative back-up plan

• Never sign an exclusive contract with

any party related to Fee For Service

• r VBP

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Top 10 Action Steps

• Identify your “high cost” individuals

based on 2015 and 2016 claim submissions

• Determine the number of emergency

room visits were generated by the individuals you serve for 2015 and 2016

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Top 10 Action Steps

• Determine the number of hospital or

rehab center inpatient admissions generated by the individuals you serve for 2015 and 2016

• Develop collaborative working

relationships with the FQHCs and

• ther primary care networks in your

geographic service area

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Top 10 Action Steps

• Develop the technology infrastructure

to enable a maximum utilization of telehealth / telemedicine services

• Develop a collaborative relationship

with each of the Performing Provider Systems in your geographic service area

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Top 10 Action Steps

• Participate in at least one VBP /

performance incentive contract in 2017 without assuming any downside financial risk

• Evaluate all opportunities for cost

efficiency including, but not limited to, the following:

a)

Clinical productivity standards

b)

Maximize the amount of salary / benefit cost tied to clinical revenue production

c)

Consider outsourcing all functions that do not represent core competencies (e.g., Information Technology, Human Resources, Billing and Financial Reporting, Compliance)

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Top 10 Action Steps

BONUS:

• Develop and / or expand your efforts

in private sector fundraising and grant funding

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Always Remember

• “THE EMPEROR HAS NO CLOTHES”
• If there are no shared savings, the

conceptual logic of VBP arrangements collapses immediately

• In the event there are no shared savings,

there is no financial benefit

• As Kodak and Xerox found out the hard

way… success in many respects depends upon being in the right place at the right time with the right decision

Thank You!