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Structuring Our Network (insert network name and/or location)

Structuring Our Network (insert network name and/or location). Nature of our network. Existing legal relationships among our network partners (contractor/subcontractor, partnership, MOU, … ) Verbal agreement to work together Letters of support for ACL – MOU. Nature of our network.

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Structuring Our Network (insert network name and/or location)

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  1. Structuring Our Network (insert network name and/or location)

  2. Nature of our network Existing legal relationships among our network partners (contractor/subcontractor, partnership, MOU, … ) • Verbal agreement to work together • Letters of support for ACL – MOU

  3. Nature of our network Next step(s) to further develop the capability of our network: • Mapping our service capacity • Advance work before December 6 meeting to show three alternative structures! • Geographic boundaries – member territories • Legal advice may be needed for that • Service lines • Packages, contributions of each to package – directly or through subcontracts • How money would flow? • Who wins individual contracts? How not to compete with each other?

  4. Our network as a community asset Features that appeal to our customers Features that appeal to contracting organizations We’re in the home Experience Geographic coverage Multiple interventions Wraparound and follow-on services Know the community & resources Language & culture • Language/culture • Location – meet them where they are • Community settings of comfort • Flexibility • Reputation – excellence • Outreach/creating awareness • We listen to consumers • Supporting caregivers • Connectors to comprehensive services in community

  5. Our network as a community asset The next action(s) we will take to develop the image and influence of our network: • Board members • Joining boards and committees for healthcare orgs • Attending & presenting at healthcare conferences • Menu of services & business case statements • Educating healthcare about messaging to community • Educating community to message to healthcare • What you said…what they heard • Common IT • Collateral • Formal agreement and ability to enter into contracts together and separately, where appropriate

  6. Organizational issues we need to address • Structure – principles for collaboration • Coop-etition • Subcontracting • Mission statement, goals, etc. • Credentialing standards – RFA • Quality management and uninviting members • Rapid learning, CQI • Consider need for TPA, MSO, fiscal agent – and who • IT, IT, IT

  7. Our network as a business enterprise Entities that can bill for services Entity/entities that can receive and distribute payment Anyone but public entities • All doing list-bills to CMS • AltaMed & Jewish Home bill Medicare • All can bill case rate • Most do Medi-Cal billing • Private insurance for ADHC Consider MSO/TPA – negotiate with existing entity for back-office support Price for value & volume Assets for capitation & cashflow

  8. Our network as a business enterprise Special requirements we must meet to secure and deliver on a contract • HIPAA compliance plan & business associate agreement • Audit requirements operationalized for contractor’s standards • Timeliness, turnaround, etc. • Secure communications • Arrangement for referrals • Definitions • Quality tracking agreement – 2-way data/commitment • Face time to ground the intervention and operate it

  9. Our network as a business enterprise Action steps(s) we will take to strengthen the business capability of our network: • IT • Survey members for capacity along all of the dimensions above • Operationalize SharePoint - Ami • Collaborative contact list, shared documents, surveys • Get Capital! • One-stop-shop infrastructure • Business plan – cost to have a network office & infrastructure • Dues? • Branding – developing collateral

  10. Insights Our biggest insight(s) from Structuring Our Network is/are… • Finding where phase 1 is at and what next step should be • Best practices are a way of pulling together our strengths • We have to prepare, work the relationships with healthcare • Healthcare partners have to understand their role in success • A structure is needed to really get started – something official to move us beyond being just a collaborative • We need a service menu with pricing • Bundling /package of services for an array – e.g., fall prevention, safety – a la Waiver • This is a great outline and very timely for us. • We’re building the plane as we’re flying it!!

  11. Action Steps Next Month • Meeting on December 6 to begin to formalize • Standardization/defining our services • What are we offering? • Keep reviewing IT systems • Survey members for capacity along all of the dimensions above • Operationalize SharePoint - Ami • Collaborative contact list, shared documents, surveys • Branding – developing collateral

  12. Parking Lot (Issues for later, additional questions for speakers) • List here

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