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Fee-for-value leader Dr. Beauregard joins CMG

October 10, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , , , , , , , , ,

 

George Beauregard, D.O., has joined Cambridge Management Group (CMG) as a senior adviser. Dr. Beauregard has been a leader in moving hospitals and physicians into the new world of fee-for-value care.

He has 20 years of experience in private practice in internal medicine and vast experience with pay for performance; performance- and risk-based contracts involving commercial and Medicare payers; EMR/HIT implementation, and Accountable Care Organization and Bundled Payment development.

In his recent role as senior vice president and chief clinical officer for the PinnacleHealth System, based in Harrisburg, Pa., he worked closely with the clinical and administrative leadership to help PinnacleHealth achieve enterprise- wide success in successful CMS Accountable Care and Bundled Payment initiatives; quality and performance improvement; clinical integration, and HIT optimization. This helped lead CMS to welcome RiverHealth ACO, of which PinnacleHealth is a founding member, into the 2014 Medicare Shared Savings Program.

Prior to joining PinnacleHealth, in September 2012, Dr. Beauregard was president and chief medical officer of Southcoast Physicians Network, in Massachusetts.  His leadership helped gain Southcoast admission into the 2013 Medicare Shared Savings Program.

Before that, he was co-founder, in 1996, of Primary Care LLC, the largest independent community-based primary-care-physician network in eastern Massachusetts. Dr. Beauregard guided a merger of that entity with Tufts Medical Center in 2005 to form the New England Quality Care Alliance (NEQCA), where he then served as chairman of the board for four years. He also was trustee of Tufts Medical Center Physicians Organization Inc.

George Beauregard is a graduate of the University of New England College of Osteopathic Medicine. He has been awarded Diplomate Certificates by the American Board of Internal Medicine and the National Board of Osteopathic Medical Examiners.

 

Aetna and Conn. hospital groups to market co-branded ACO

September 16, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , , , , , , ,

 

aetna

The old-fashioned Aetna headquarters in Hartford.

Hartford, Conn.-based health insurer Aetna plans to market a co-branded Accountable Care Organization with Hartford Healthcare and the seven-hospital Value Care Alliance.

Plan participants will pay lower costs for receiving care from Hartford Healthcare and Value Care Alliance’s total of 13 hospitals,  with their more than 3,500 doctors  and 39 emergency-room and urgent -care locations.

James Cardon, M.D., chief clinical integration officer for Hartford Healthcare,  “This agreement is one more advance in our shift from fee-for-service care, where physicians are paid for the number of things they do, to value-based care, where physicians and other providers are paid for the quality of care they deliver.”

Hospitals in the ACO will be  Griffin Hospital, in Derby; Middlesex Hospital, in Middletown; St. Vincent’s Medical Center, in Bridgeport; Danbury Hospital; New Milford Hospital; Norwalk Hospital; Hartford Hospital, The Hospital of Central Connecticut,  Southington and New Britain; Midstate Medical Center, in Meriden, William H. Backus Hospital,  in Norwich, and Windham Hospital.

Changing pediatric care through clinical integration

September 1, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

 

Robert Meyer, chief executive of Phoenix Children’s Hospital, discusses how clinical integration is changing pediatric care.

He says: “Twenty-four months ago, Phoenix Children’s Hospital launched a bold initiative to create a first-of-its-kind pediatric clinically integrated organization, or PCIO — a value-based approach to improving care and controlling costs.”

“The clinically integrated organization is different from the ACO  {Accountable Care Organization} in that an ACO is limited to a product offering from a contractual perspective, i.e., Medicare. Clinically integrated organizations can operate in multiple platforms, including Medicare, Medicaid and commercial products. This model’s flexibility allowed us to provide the best possible care specifically focused on children.”

“As we built the infrastructure of our clinically integrated organization, we recognized that 92 percent of all care interactions occur outside the hospital, requiring a proactive approach to patient care. Our PCIO, the Phoenix Children’s Care Network, is a collaborative and integrated system of care encompassing general pediatricians, pediatric specialists and sites of service, including Phoenix Children’s Hospital and the hospital-owned urgent care and surgery centers. The PCCN is governed by physicians, the majority of whom are independent.”

 

More systems eye entering insurance business

July 22, 2015by Robert Whitcomb in Uncategorized tagged , , , , , ,

 

northcarolina

In western North Carolina’s mountains.
One large health system in North Carolina is ready to launch a Medicare Advantage plan, and two others  in the Tar Heel state are mulling the pros and cons of becoming a payer. Cone Health, a $1.4 billion health system in Greensboro,  has received a state license to sell health insurance, and it’s in the process of receiving approval from the the Centers for Medicare and Medicaid Services to offer Medicare Advantage plans to seniors.

Modern Healthcare reports that “Health systems are increasingly jumping into the insurance space. Even though costly information technology and complicated actuarial predictions are large hurdles, organizations view health plans as the missing piece to the population health puzzle. If people in a hospital system’s service area are willing to go to those providers for care, why not offer the coverage to pay for it and keep the healthcare dollar local?””Cone Health runs a Medicare Accountable Care Organization called Triad Healthcare Network, which earned more than $10.5 million in shared savings in its first year. The early success of that ACO gave executives confidence that they could move to the more aggressive, capitated Medicare Advantage structure, in which the federal government pays private insurers lump sums for each member.”

Meanwhile, Mission Health, a $1.4 billion hospital network based in Asheville, is looking into entering the insurance business, though so far anyway,  the  system would prefer to build partnerships with established insurors rather than get into the business directly.

And Charlotte-based Carolinas HealthCare System, the largest system in the state, with almost $5 billion in annual revenue (PDF), also has no immediate plans to build a commercial insurance business.

But, Modern Healthcare reports, “Carolinas is changing how it works with insurers. The system was the first in the state to create a narrow-network product with Blue Cross and Blue Shield of North Carolina, the state’s dominant insurer. Carolinas is also participating in bundled payment programs with local employers, where Carolinas receives a fixed amount of money for certain cardiovascular procedures.”

Physicians and marketers must better align themselves

May 31, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

 

Competition for patients is at an all-time high and reimbursement systems are rapidly changing, which makes healthcare institutions, physicians and marketers increasingly nervous. So it’s more important than ever for physicians and marketers to align around a common agenda for business growth.

However, marketers and physicians too often struggle to understand each other’s objectives and constraints, as we at Cambridge Management Group (CMG) have  found again and again in our work across America.

“Physicians wonder why the marketers’ efforts aren’t getting them more appointments. And marketers complain that the physicians’ focus on complex cases doesn’t produce good blogs,” said corporate anthropologist Andrea Simon, Ph.D., founder and chief executive of Simon Associates Management Consultants (SAMC). “Rather than butting heads, these two groups need to team up, so that they can effectively acquire new healthcare customers.”

With that goal in mind, a webinar will outline a process to help create much more productive physician-marketer partnerships.

The free, hour-long session — How The Physician-Marketing Partnership Leads To New Patients — starts at noon, EDT, on Friday, June 12. It’s just the latest webinar in the Healthcare Innovation: Trends from the Trenches series, created by Simon in 2013. To register now, please click here.

Besides Ms. Simon, the hosts will be Linda MacCracken and Timothy Crowley, M.D. Both are national leaders in physician and healthcare institution alignment and marketing. Ms. MacCracken has collaborated closely with  Cambridge Management Group on various projects, as has Dr. Crowley, who has been a CMG senior adviser.

Ms. MacCracken is a strategist focused on physician-aligned patient engagement. She is heading innovation for Accenture Provider Health’s Customer Relationship Management program and teaches marketing to physician executives at Harvard University’s T.H. Chan School of Public Health.

She has worked in and with health systems to increase patient volumes, open networks and boost customer engagement, as an independent consultant and as chief marketing/strategy officer at Solucient/Thomson Reuters/Truven Health Analytics. Ms. MacCracken has led teams to achieve such results as boosting market share by 15 percentage points, lifting a health system to #1 in its market from #3, boosting physician-engagement ratings to the top 10 percent nationally and launching profitable services that exceed targets.

She is a frequent speaker at such national forums as those run by the Society of Healthcare Strategy and Marketing.

Dr. Crowley, an internist and expert in physician-network development and management, is president of Pinnacle Health Medical Group, in Harrisburg, Pa.

Healthcare organizations call upon Dr. Crowley to turn around and optimize the financial performance of struggling employed physician groups suffering unsustainable losses. His extensive experience in both the fee-for-service and capitated-risk-reimbursement systems is valuable to organizations trying to manage the “pivot” from fee for service to capitated risk reimbursement in their nascent Accountable Care Organization development efforts.

Since taking the Pinnacle post last year, his achievements there have included raising the average percentage of physicians’ contract work hours actually spent in front of patients to 90 percent from 59 percent; increasing new-patient visits by 20,000, and cutting the “loss’’ per physician to zero from $100,000.

Dr. Crowley’s experience in creating and developing the Cardiovascular Institute at the Beth Israel Deaconness Medical Center, in Boston, helps systems contemplating similar models with their high-margin specialists.

As senior vice president at Caritas Christi HealthCare, Tim Crowley was directly responsible for more than 400 employed physicians and a total of 1,200 practitioners in the system. In a single year, his leadership and innovative methods significantly contributed to turning around the system from a $50 million loss to a $30 million operating gain.

 

The PCMH or ACO route for a practice?

April 9, 2015by Robert Whitcomb in Uncategorized tagged ,

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Here’s some guidance on whether a practice should go the Accountable Care Organization or the Patient Centered Medical Home route.

 

Experts applaud ‘Next Generation’ ACO’s

March 12, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , , , ,

 

applause

Experts applauded the Centers for Medicare & Medicaid Services’ “Next Generation” Accountable Care Organization (ACO) plan, which asks participants to take on more financial risk in return for more  potential reward. The aim is to move away from fee for service to capitation as payers push healthcare industry toward a value-based reimbursement system.

“It’s a real effort to move away from shared savings or limited risk models. On both counts it’s an important step,” said Mark McClellan, M.D., a former CMS administrator,  told FierceHealthcare.

Larry Kocot,  a visiting fellow in the economic-studies program at the Brookings Institution, agreed. “I do think CMS should be credited for thinking creatively to extend the model to meet the needs of providers no matter what stage they are at within the ACO program,” he told the news service.

Farzad Mostashari, M.D., former national coordinator for health- information technology, told Clinical Psychiatry News Digital Network that the new model will likely suggest how CMS will structure other ACO’s.  “This is directionally, absolutely where the Medicare Shared Savings Program (MSSP) is headed.”

“We are hopeful the changes they proposed and the comments received that they will make the MSSP program more accessible and more friendly to a number of providers,” said Kocot, who also served as a senior administrator of CMS.

FierceHealthcare reported that Kocot said he’d like the CMS to establish a ”fourth track that would lead to full capitation. He recommends tracks that reflect a continuum of ACOs that may begin with little risk and end with the full capitation model.”

Mixed story at pioneering pediatric ACO

February 23, 2015by Robert Whitcomb in Uncategorized tagged ,

 

The Partners for Kids pediatric Accountable Care Organization — serving some 300,000 Medicaid-eligible kids in Ohio, reduced costs over  five-year study period ending in 2013. Yet, improvements in quality were merely modest, says Kelly Kelleher, M.D., lead author of the study recently published in Pediatrics. ”Other organizations hoping to replicate some of the success of a program like Partners for Kids may have trouble doing so unless they forge regional partnerships,” reports Hospital & Health Networks.

“We had really good partnerships with the state Medicaid office and the managed care plans in doing this,”  Kelleher, who is also vice president of community health services at Nationwide Children’s Hospital in Columbus, told H&HN “People without those relationships are going to struggle to do this because the margins are a lot narrower with children.”

 

 

 

 

 

 

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