Emory prefers to align independent PCPs through its clinically integrated network. When that is not possible, Emory is growing existing practices and acquiring or starting up new practices.
Atlanta-based Emory Healthcare launched its clinically integrated network of physicians in 2012 and quickly realized the system needed to strategically grow the primary care component of the network.
“As an academic medical center, we tend to have more specialists than primary care physicians, which is a challenge if you are trying to develop an ACO strategy,” says Lori McLelland, Emory’s executive director, market development.
Currently, only about 170 (8 percent) of Emory’s approximately 1,600 employed physicians are primary care physicians (PCPs). Although Emory has the largest number of PCPs among the health systems in its market, it has a low overall percentage of PCPs compared to specialists. Some of Emory’s competitors boast triple the percentage of PCPs.
To prepare for population health management, Emory used an intensive market development approach to identify where and how to best expand its PCP presence across its large service area (15 counties within 35 miles). The effort is already paying off. As of January 2014, Emory has acquired one additional strategic PCP practice and is in talks with several other practices, McLelland says. New practice sites have also been identified.
A high-level market development team is in charge of overseeing Emory’s PCP growth approach. The team includes the system CEO, hospital CEOs, the clinically integrated network president, strategic planners, market development leaders, clinical practice and physician leaders, and the faculty practice CEO.
The team, which meets three times a month, reviewed various types of data to pinpoint the best zip codes for possible PCP growth (see the exhibit below).
The team then determined the best approach for building a PCP presence in these zip codes. This four-month process—which was led by McLelland; Judy Belt, corporate director, strategic planning office, Woodruff Health Sciences Center, Atlanta; and Maureen Haldeman, vice president of operations at Atlanta-based Emory Clinic—involved a number of important steps:
Identify the key zip codes. A subset of the market development team broke Emory’s service area into 15 geographic areas with 140 zip codes, based on proximity to a system hospital, population density, travel patterns, and other factors.
Then to narrow the field even further, the team used a color-coded chart (see exhibit below) to identify the geographic areas that showed the most promise in terms of PCP growth. For each of the 15 geographic areas on the chart, the team scored factors such as population, percentage of Emory PCPs, percentage of Medicaid or self-pay patients, the main competitor, and the number of hospitals in the area.
Based on this directional data from the chart, the market development team was able to recommend one of three strategies for the 15 areas:
From this exercise, the team narrowed the field from 15 geographic areas to four priority areas. Those four first-priority focus areas included 50 zip codes, down from the original 140.
To further narrow the list of zip codes, leaders reviewed a number of data points, including:
After reviewing these data points, the team narrowed the list from 15 to eight target zip codes. The team then used a free tool, melissadata.com, that provides a detailed visual map of streets (similar to Google Maps) to help identify where they wanted to be within each zip code. They also vetted locations with the physician liaison team.
Select the best alignment strategy for each target zip code. Emory’s market development team had several strategies to choose from to align PCPs in each target zip code. But not all options were viable in every market. “Geography really mattered,” Belt says.
Emory’s preferred strategy is to align independent PCPs through its clinically integrated network. Based in part on the approach taken by Illinois’ Advocate Health Care, Emory’s network encourages a partnership with physicians around improving quality and costs. “It is a solution that allows us the opportunity to expand the network while allowing physicians to remain independent,” Belt says.
A second alignment strategy is to acquire new practices or patient-centered medical homes (PCMHs), although that is not realistic in areas with few PCPs. In those zip codes, Emory may employ physicians and develop a start-up practice, PCMH, or an Emory “storefront” with primary care, specialty, and imaging services.
Yet another option is to grow existing practices by adding mid-level providers and extending hours.
Determine timeline. To help determine the phasing of Emory’s PCP strategy, the market development team designed a matrix (see the exhibit below) to assess key locations in each zip code according to certain criteria, such as:
Answers to these questions helped Emory’s market development team assign each location to a particular rollout phase on the system’s PCP alignment timetable (June-August 2013, September 2013-February 2014, or March-August 2014).
Develop pro forma assumptions. Belt worked with Emory’s business development team to identify the ideal mix of providers at each new start-up site. They determined that in five years, they wanted to have three physicians and two advanced practice providers at each site. They also worked with Emory’s operational and facilities experts to estimate rent and capital requirements at new practices.
During the pro forma discussions, several key issues arose. For example, would each PCP site need to breakeven? Historically, practices at Emory had to generate a bottom line. “But we had to ask if that made sense for primary care—that was a new concept for Emory,” Belt says.
The market development team also had to determine which of Emory’s hospitals would be responsible for funding initial losses. “We didn’t want losses funded at the corporate level because there needed to be some accountability, but there was some geographic overlap among system hospitals,” Belt says.
Another issue was downstream revenue to the hospitals—should it be considered in evaluating the internal rate of return? “In the end, we were conservative and didn’t include downstream revenue in the internal rate of return, but we did disclose an estimate of the downstream revenue so people would understand the potential,” she says. Belt believes this conservative approach helped senior leaders feel confident about the pro formas, which made it easier to gain the capital and FTEs needed to support the initiative.
After doing this analysis, Emory estimated the total capital investment of the PCP strategy at $20 million over five years, from 2014 to 2018. This included the addition of eight new FTEs, including physician liaisons and a physician recruiter, to help roll out the strategy.
McLelland and Belt offer this advice for developing a PCP alignment strategy:
Enlist the CEO to lobby key board members. Emory’s system CEO met with the board at the start of the process to ensure they understood the rationale for the PCP alignment strategy and would be prepared to approve the capital investment required.
Interview stakeholders early on. At the start of the project, Belt and McLelland met with market development team members individually and asked them for their views on the following questions:
They presented the results of the interviews at the first market development team meeting, which helped all the members to understand the diverse opinions on the team.
Realize it’s OK to say “no” to some opportunities. This might include saying “no” to a specialist seeking employment if saying “yes” takes the focus away from the primary care strategy. The same is true of primary care practices seeking employment that are located in low-priority areas.
Give yourself at least three to six months to roll out a physician alignment strategy. “You not only need time for the data pull and analysis, but you also need time for buy in and getting everyone on the same page,” says McLelland.
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Interviewed for this article: Judy Belt, corporate director, strategic planning office, Woodruff Health Sciences Center, Atlanta; Lori McLelland, executive director, market development, Emory Healthcare, Atlanta.
This article is based on interviews and a presentation at the Society for Healthcare Strategy and Market Development (SHSMD) conference in September 2013.
The Claro Group: Partnering for Performance Improvement
In this Business Profile, Larry Volkmar, a managing director in the performance improvement
practice at The Claro Group, discusses key strategies for improving
clinical and financial performance.
Deloitte: Taking Data Analytics to the Next Level
In this Business Profile, Christine Santos, chief of strategic business analytics for
Providence Health Services and Chris DeBeer, principal at Deloitte
Consulting LLP explain the value of enterprise data analytics.
PatientMatters: A Patient-Centered Financial Experience
In this Business Profile, Sheila Schweitzer, founder and CEO of PatientMatters, offers insights
on ways hospitals and healthcare systems can address rising patient
Cerner RevWorks: Helping Providers Boost their Bottom Line
In this business profile, Jason Rawlings, vice president ambulatory
and revenue cycle for Cerner talks about leveraging third-party
management services to improve revenue cycle health.
The Claro Group: Transforming Clinical Documentation Improvement
In this business profile, Tim Marshall, managing director at The
Claro Group, discusses the value of rethinking and retooling clinical
Ontario Systems: Maximizing Self Pay Collections
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Building a Clinically-Integrated Network
As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs.
Winning in the Post-Acute Marketplace
Read more about factors contributing to the changes in the post-acute marketplace and what it means for manufacturers, physicians, clinicians, patients, and post-acute facilities as they anticipate the transition to the second curve.
Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy?
Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Adding Value to Physician Compensation
Today’s concerns about physician compensation are the result of the changing healthcare environment. The transition to value is slow, but finally becoming a reality. Proactive hospitals want to ensure that provider incentives are properly aligned with ever-increasing value-based demands.
This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
This publication identifies and outlines the necessary characteristics of a fully-functioning clinically integrated network (CIN). What it doesn’t do is detail how hospitals and providers can participate in the value-based care environment during the development process.
One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Therapy: Benefits at All Levels of Care
Nearly half of all Medicare beneficiaries treated in the hospital will need post-acute care services after discharge. For these patients, a stay in an inpatient rehabilitation facility, skilled nursing facility or other post-acute care setting comes between hospital and home.