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

“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 on 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 2 2

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 3 3

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? 4 4

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? 5 5

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” 6 6

Menu of options provided by NYS DOH in its VBP Road Map 7 7

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 of protection to New York State during his administration…may take a lot of prayer and luck 8 8

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 ” 9 9

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 10 10

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: Identify and assess IPAs operating in your a) geographic service area Engage competent legal counsel b) Discuss possible collaborations and c) participation with “like - minded” providers Consider a regional geographic network that d) covers more than five counties, except for New York City metro area 11 11

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 12 12

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 13 13

When? • “ YESTERDAY ” • “ THESE ARE THE GOOD OLD DAYS ” • “ HELLO, IT’S ME ” • “ OPERATOR, COULD YOU HELP ME PLACE THIS CALL ” 14 14

When? • “ LIGHT MY FIRE ” • “ HELTER SKELTER ” • “ I’VE SEEN FIRE AND I’VE SEEN RAIN ” • “ IN THE YEAR 2525 ” 15 15

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 on future uncertainties 16 16

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 ” 17 17

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… 18 18

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 19 19

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. 20 20

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”. 21 21

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”: o Performing Provider Systems o Accountable Care Organizations o Managed Care Organizations o Behavioral Health Management Companies o Independent Provider Associations o Regional Provider Networks aka Management Service Organizations (MSO) o Is there a need for an “upstream” or “downstream” merger / acquisition? 22 22

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? 23 23

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 or VBP 24 24

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 25 25

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 other primary care networks in your geographic service area 26 26

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 27 27