Healthcare Reform and Your Organization

8/12/2019 Healthcare Reform and Your Organization

1/4

Health reformis here.

Are you prepared?


2/4

Health reformis here.

How is your health organization positioning for

transformation of our health care system from

provider centric to patient centric / driven health care?

Health reform is here addressing unsustainable healthcare cost

trends, unacceptable quality and poor health status. Financial

pressures from federal and state budget deficits coupled with

increasing health care costs reflected in health benefit premi-

ums is driving an agenda for change through new health benefit

programs and value-based financial reimbursement programs.

These include outcome based incentive programs, bundled

payments and financial risk transfer through global budgets and

shared risk savings. In addition, financial pressures are contrib-uting to fee for service reductions and penalties to advance the

health reform agenda. The national agenda for transformation

of our health and health care delivery system of achieving Better

Health, Better Health Care and Lower Cost is being led by states,

payers and health system leaders with new models of care that

span the continuum of care requiring collaboration and new stra-

tegic alignments. Alignment of financial incentives with financial

risk transfer is contributing to the transformation.

What are your strategic and business initiatives

to improve the health of your community and

the population you provide health services to?

Investments in health information technology EMR/EHR andhealth information exchange supported by Meaningful Use

dollars has been a catalyst for change. The transformation focus

is on care of the chronic care patient leveraging data from new

health information EMR/EHR and interoperability capabilities

utilizing predicative analytics, outreach and engagement and clin-

ical integration processes to better manage care through health

promotion, prevention, early detection and treatment, avoiding

hospital admissions, readmissions and emergency room visits.

The exchange of health information is supporting new collab-

orative and strategic relationships with health care providers,

behavioural health providers and community based organizations

improving coordination of care along the continuum.

What does this mean for your health organization relative

to managing margins, positioning your organization within

your market and identifying opportunities for innovation?

The emerging catalysts for continued transformation of the

health care system are new reimbursement and health benefit

programs that will challenge hospitals margins and financial

performance. There is recognition that the transformation will

require investments in pilot projects along with reinvestments,

innovation and change in programs and services. The Afforda-

ble Care Act supported by the CMS Medicare and Medicaid

Innovation Center is now offering multiple pilot initiatives to test

new programs. New York State, building on its HEAL (HealthCare Efficiency and Affordability Law) capital grants programs,

engaged a Medicaid Redesign Team to assist in developing what

has been approved - A Plan to Transform the Empire States

Medicaid Program. First year results from the two-year effort

by the Medicaid Redesign Team demonstrated cost savings

supporting a request for a Medicare Waiver to fund start up and

transformation of the health delivery system. New York State is

awaiting approval for their request of $10 billion ($2 billion per

year for five years) to support continued investment in the new

population health driven system.

Transformation and innovation requires investment in start up,

new programs and initiatives, and pilot projects. Thus, govern-

mental program initiatives continue to be available through theCMS Medicare and Medicaid Innovation Center, New York State,

and from HITECH for information technology investment. In

addition, there are other potential sources of funding including

payers, technology companies, community-based organizations,

and private foundations who recognize the need for managing

the transformation. Collaborative relationships are developing

through shared leadership with measurable outcomes support-

ing the transformation.

What strategic business initiatives are you leading, collaborating

on, or planning as your health system positions for a population

based model? Have you accessed available funding to support

the investment(s)?

How robust is your plan to position for the new health and healthcare system?

Are you accessing funding resources to support transformation and innovation?


3/4

CMS Medicare and MedicaidInnovation Center initiatives:

ACO Programs

Bundled Payments

Comprehensive Primary Care Initiative

Financial Alignment Initiative

FQHC Advanced Primary Practice Demonstration

Graduate Nurse Education Demonstration

Health Care Innovation Awards

Independence At Home Demonstration

Initiative to Reduce Avoidable Hospitalizationsamong Nursing Facility Residents

Innovation Advisor Program Medicaid Emergency Psychiatric Demonstration

Medicaid Incentives for thePrevention of Chronic diseases

Million Hearts

Partnership for Patients - Community-based Care Transitions Program

State innovation Models initiative

Strong Start for Mothers and Newborns

Plan to transform theEmpire States Medicaid program:

Primary Care Expansion

Health Home Development Public Hospital Innovation

Hospital Transition

New Care Models

Expand the Vital Access Providerand Safety Net Provider Program

Capital Stabilization for Safety Net Hospitals

Collaborative programs(regional, payer, business, community)

As industry leaders we recognize the economic reality that is and

will continue to occur requiring a shared vision for a transformed

patient-centric and patient-driven health system. The requirement

will be continuation of balancing margin with mission while pre-

paring for the new system from a position of strength. Positioningfor the future will require new strategic alignments, collaborations,

program and process changes, and cultural changes. These all

entail greater financial risk and requirements for funding of change.

Freed Maxick understands the impending changes,

and through the experience of its Healthcare Leadership

Team is prepared to assist you with:

Strategic, market, financial and business planning for the health

system or a specific health initiative positioning the health care

system as a key provider in the new health delivery system

Understanding and modeling financial, qualityand operational impact from new and emerging

value-based reimbursement programs

Developing business proposals to access outside funding

for investment in the health care transformation

Performance improvement relative to growth, revenue,

efficiency of operations and capital management

Program / project management

Financial

&Quality

Financial Quality

Information technology,value purchasing,

new strategic alignmentsMarke

t

Position for

a value

(financial

& quality)

based

health

system.

Optimize

margins

Clinical and operationalperformance improvement

Process

EnablingInfrastructure

Infrastructure

VALUE

Do you have a strategic roadmapto lead, communicate and

measure performance?

What does this meanfor your organization?

Where is your organization in positioning for a

transforming health care delivery system? Within

your market, will you be the health system leader,

a partner in an emerging system, a niche provider of services or a contracted service providing access

along the continuum of care?

How is your health system positioned for the emerging

value-based payment programs including incentives,

bundled payments, and financial risk transfer?

What is your organization doing to access outside

funding sources and programs (e.g. CMS Medicare

and Medicaid Innovation Center, NY HEAL program,

anticipated Medicare waiver funding, other payers,

private foundations, community based organizations

and businesses)?


4/4Freed Maxick Healthcare is the brand under which Freed Maxick CPAs, P.C. provides services to its clients. Square logo, FreedMaxick, and Trust Earned. are trademarks of Freed Maxick CPAs, P.C.

FREEDMAXICK.COM

Leadership

Consulting Services Practice Leader

25+ years experience, including 15 years with Big 4 firm

5+ years experience as a hospital CFO

Lloyd Arakelian, CPA, FHFMA

[email protected]

716.332.2701

Alan Gracie, CPA

[email protected]

716.332.2676

Assurance & Exempt Tax Services Practice Leader


2+ years experience in hospital finance organization

HEALTH SYSTEMS & HOSPITALS

Jack Sieber, CPA

[email protected]

716.332.2738

Strategy & Performance Improvement Leader


5 years experience in hospital finance

3 years experience in senior managementposition with large payor

3 years experience with proprietarylong-term care chain

Ryan Grady, CPA

[email protected]

716.332.2787

Assurance and Exempt Tax

Process and internal control enhancement

12 years experience, including 6+ with Big 4 firm

HEALTH SYSTEMS & HEALTH PLANS

Carol Cassell

[email protected]

716.332.2752

Strategy & performance Improvement Leader

32+ years experience including community-

based planning, innovation, health information technology, and 3 years with Big 4 firm

17 years executive leadership in community, tertiary andgovernment Health Systems including hospital, long-term

care, home care, ambulatory surgery, physician practices

12 years executive leadership of a

Health Plan and related Foundation

Healthcare Practice Leader

25+ years experience serving proprietary andnot-for-profit clients in the senior living industry

Steve Holt, CPA

[email protected]

716.332.2633

John Kropski, CPA

[email protected]

716.332.2635

Long-Term Care Practice Leader

30+ years experience,including 5 years with Big 4 firm

3 years as financial executivein private enterprise

LONG-TERM CARE & SENIOR LIVING,

HOME HEALTH, HOSPICE & OTHER PROVIDERS

PHYSICIAN PRACTICES

Shawn Frier, CPA, CFE, [email protected]

716.332.2652

Physician Practices Leader

20+ years experience, including 2 years with Big 4 firm and 15 years providing strategic direction for physician practices

President New York State MedicalGroup Management Association(Past President of Buffalo Chapter)

Documents

Healthcare Reform and Your Organization