Payer–Provider Partnership Implementation
Cost and Quality Improvement |
Business Performance Management |
Executive Facilitation
"We like McQueen Consulting; they get it, and know how to help us."
– a Major US Health System
Shared risk and ACO models imply new types of business partnerships – often far from business as usual. Population management programs only influence cost and clinical drivers with strong physician support and adoption. New operating models often imply a major shift in roles – from competitor to business partner.
Our powerful four-point program maximizes value for our clients and helps manage through the powerful shifts that occur between payer and provider:
- Neutral "Switzerland" – We are in a position to raise questions and suggest solutions when our clients may not be able to do so. Through active facilitation of the core team and stakeholders, we reduce implementation risk, stay on track and help make decisions in a timely fashion.
- Hospital Program Cost Reduction – Based on data findings, specific cost targets (e.g., beginning with "low hanging fruit") are prioritized for initial work group activities. Benchmarks are established based on a combination of best practices and what is deemed achievable within a 90 to 120-day period.
- Medical Practice Effectiveness – We bring deep expertise in physician engagement and alignment. We understand the critical role physician leaders play in driving change in the clinical setting. Our co-creation methodology ensures significant physician input and strong commitment to project goals.
- Methodology Enhancement – We are respectful of your intellectual property and the fact that you already know how to get work done. We add value through a thoughtful assessment of your methodology and suggest ways to accelerate adoption and adherence to contract objectives in a new setting (e.g., introduction of Rapid Cycle Implementation™ methods).
Major Health System: Redefining Care Delivery – Medicare ACO
CHALLENGE
A Major Health System and several Physician Groups had eight weeks to apply for a MSSP. Significant organizational and business model differences made achieving an acceptable governance and shared savings structure unlikely. McQueen Consulting was tasked with guiding the four stakeholders through these discussions to ensure an on-time application and commitment to the new ACO model.
APPROACH
We utilized Rapid Cycle Implementation™ to provide a forum for participants to safely share their points of view. We sought and found common ground (in this case concern over aggressive pricing by an integrated health system). Leaders agreed to a time and emotionally intense process that built trust and ensured tough decisions were made quickly. Strong and impartial facilitation was seen as critical to success. The teams addressed their organizational options (legal, financial and structural), solicited stakeholder input and drove to agreement by the deadline.
RESULTS
The ACO application was submitted two days in advance of the deadline with the enthusiastic support of all parties. The new model of physician management – with health system support – is a blueprint for future collaboration.
"It would have taken us two years to achieve what we did in two months."
Accountable Care Collaboration at a Major Payer and Healthcare Provider Rapid ACO Start Up and Collaborative Team Building
CHALLENGE
A Major Healthcare Provider and Major Payer System were tasked to rapidly establish an ACO organization to realize aggressive financial, utilization and quality goals. As market share continued to be lost, the Provider and Payer needed McQueen Consulting to quickly align both organizations on an initial set of clinical improvement interventions. The two organizations needed to transition from a conflict-based, zero sum relationship to one based on collaboration and openness.
APPROACH
McQueen Consulting was first charged with facilitating individual and group relationships between the two organizations to ensure more collaborative behaviors of transparency and teamwork, focusing on a common high ground. A process to integrate provider and payer clinical improvement and program leadership models, approaches and tools was established, as well as a collaborative prioritization process involving both clinical and administrative leadership.
RESULTS
In just 90 days, McQueen Consulting was able to build a single, high performing integrated team to co-create and co-develop the initial clinical improvement initiatives to realize the ACO goal. The Provider and Payer collaboration identified, scoped and designed six interventions including Patent Centered Medical Home, ER Diversion and Integrated Discharge Planning. Reduced costs, improved clinical quality and enhanced patient and physician satisfaction are among the top benefits for both the Provider and Payer.
As a result, Provider leadership launched a Physician Engagement Strategy to begin to process of addressing the complex change issues with clinical leaders.
The goals of the strategy are to build awareness of the ACO goals and align physician behaviors and practices with ACO objectives, and have physicians actively endorse the new ACO model.
Major Health System: A Race to Quality and Efficiency – Hospitalist Redesign
CHALLENGE
A Major Health System was tasked to increase the quality and financial impact of their hospitalist program. Patient to physician ratios, length-of-stay and avoidable emergency department admissions were 25-35% above benchmarks.
Hospitalists suffered from low morale and with no effective leadership forum, were largely unaware of how to contribute to system quality and cost goals.
APPROACH
Through a 90-day Rapid Cycle Implementation™, McQueen Consulting helped orchestrate a turnaround. The physician-led process addressed many improvements in the hospitalist program including a strong commitment to hospitalist leadership development and major redesign of incentives. Site visits were used to create a shared understanding of the possibilities. A baseline of key metrics was developed to help track the before and after impacts of the changes.
RESULTS
Early in the program, the Health System saw a significant increase in patient satisfaction, lower lengths of stay, earlier discharges, decreased readmission rates and inappropriate admissions and massively improved hospitalist satisfaction.
- Reduction in hospitalist patient ratios from 19 to 14:1
- 0.25 days initial reduction in med/surg LOS
- Increase in revisits to 3,000
Insights
Feedback
"I particularly valued the thought-partnership and hands-on approach to building our Business Performance Management group."
"My team talked to our customers, went on great site visits and came back with literally hundreds of new ideas—they took the best, stepped up, dealt with very tough organizational issues and pushed to implementation—with little prodding from me." - SVP, Cancer Research Center
"The most enjoyable and rewarding aspect of my job is helping patients and their families. Now I can spend time with patients and assist with their needs. In 25 years of nursing I have never seen anything like this." - Nurse, Community Hospital
"One of the best consulting partnerships I have worked with." - SVP, Integrated Health System
"I particularly valued the thought partnership and hands-on support for building our own Business Performance Management organization..."
- COO, Major Blues Plan
"McQueen Consulting helped us drive a step function improvement in business results."
- CEO, Major Blues Plan
"I always felt on the outside — now I feel part of the care team." - Patient Spouse
"RCI was a very successful experiment and has since led to improvements in operations and leadership—I am ready to do it again."
- Cancer Research Center
Organizations We Have Helped
We work hand in hand with each company to ensure their problems are addressed and fixed in a timely fashion.