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Options are… You are in control You can reject them all New vision of “System-ness”

A WIDE SPECTRUM OF AFFILIATION STRUCTURES. Optional!. Options are… You are in control You can reject them all New vision of “System-ness” Will be enforced by realities of each risk/reward network, And … “Value Attribution” Not by a Distant System Board and CEO

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Options are… You are in control You can reject them all New vision of “System-ness”

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  1. A WIDE SPECTRUM OF AFFILIATION STRUCTURES Optional! • Options are… • You are in control • You can reject them all • New vision of “System-ness” • Will be enforced by realities of each risk/reward network, • And … “Value Attribution” • Not by a Distant System Board and CEO Handing over the keys becomes less relevant to both sides

  2. INCENTIVES WILL SHIFT BEHAVIOR • “We do what they pay us to do.” • Old World: Volume-Based • “Pay-by-the-click” Encounter-based – wait for patients to need you • Tertiary hospitals make the big bucks on their expensive procedures • FILL THOSE BEDS! • New World: Value-Based • Accountable Value: Quality/ Efficiency/ Patient Engagement • Tertiary hospitals and expensive procedures become Cost Centers • EMPTY THOSE BEDS! • Instead, let’s try keeping the community healthier. • W H A T A C O N C E P T

  3. THE POWER OF COMMUNITY NETWORKS • Revenue stream of future is tied to PCPs and their patients • Community hospitals – and their clinics – bring new power to affiliation negotiations • Smaller community and rural hospitals have value as revenue drivers rather than cost drivers • Become high-performing aligned networks for the new world: • Drive functional alignment with PCPs in local service area • Develop position of strength by becoming highly efficient • Demonstrate value: Cost/ Quality/ Safety

  4. “WILL” INCENTIVES REALLY SHIFT? WELL, THEY’RE SHIFTING ALREADY, SO BE PREPARED TO CROSS THE STURDY BRIDGE OVER THE CHASM FROM VOLUME-BASED INCENTIVES TO VALUE-BASED PAYMENT

  5. “WILL” INCENTIVES REALLY SHIFT? WELL, THEY’RE SHIFTING ALREADY, SO BE PREPARED TO CROSS THE STURDY BRIDGE OVER THE CHASM FROM VOLUME-BASED INCENTIVES TO VALUE-BASED PAYMENT

  6. How Risk will Change our World (for the better)

  7. PROVIDERS NOW HAVE TO HAVE SKILLS OF PAYERS • PROVIDERS • SYSTEM OF CARE • PROVIDER-BASED DELIVERY • CARE MANAGEMENT • PATIENT-CENTERED MEDICAL HOMES • ALIGNED PAYMENT METHODS • PAYER-DRIVEN INCENTIVES • PAYERS • CAPITAL • NETWORK DEVELOPMENT • CLAIMS PROCESSING/ANALYSIS • INFORMATION SYSTEMS • MARKETING • UTILIZATION MANAGEMENT

  8. PROVIDER & PAYER ROLES NOW BLEND • PROVIDERS • SYSTEM OF CARE • PROVIDER-BASED DELIVERY • CARE MANAGEMENT • PATIENT-CENTERED MEDICAL HOMES • ALIGNED PAYMENT METHODS • PAYER-DRIVEN INCENTIVES • PAYERS • CAPITAL • NETWORK DEVELOPMENT • CLAIMS PROCESSING/ANALYSIS • INFORMATION SYSTEMS • MARKETING • UTILIZATION MANAGEMENT NEW ALIGNMENT

  9. ABILITY TO TAKE MEASURED RISK Risk: take it if you want to make it

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