Strategic Growth and
Business Relationships
Course Three – June 7
Presented by
Patrick Gauthier
Overview
Learning Objectives
1. Review Causes and Conditions
2. Discuss Strategic Implications for
Business Development
3. Review Options
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Affiliation, Association
Joint Venture, Strategic Partners
Merger
Acquisition
4. Open Discussion
The New Business Environment &
Your Business Architecture
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Vision
Business Plan
Leadership
Communication
Transformation and
Innovation Drive
Marketing
Payer/Patient and
Funding Mix
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Business
Operations
and
Process
Business
Strategy
Hardware, Software,
Networking
Health Information
Exchange
Data Analysis & Metrics
Communications
infrastructure
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Business
Infrastructure
and IT
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Management
Staffing
Workflow and
Business Process
Managed Care
Functions
Billing and Revenue
Mgmt
Integration
Causes and Conditions
• Discontinuity and Disruption (P. Druker)
• Instability (A. Toffler)
• Decay and Irrelevance (G. Hammel)
• Tipping Point (M. Gladwell)
• Strategic Inflection Point (A. Grove)
• Value Migration (A. Slywotzky)
• Disruptive Innovation (C. Christensen)
Causes and Conditions
Meaningful
Use
Parity
ACOs
For the
unprepared,
The Winds of
Change can
appear
chaotic and
as disruptive
Causes and Conditions
Block
Grant
Meaningful
Use
ONC Certified
EHR
Health
Insurance
Exchange
ACOs
DSM-V
PCMH
ICD-10
Reform
Parity
Medicaid
Expansion
Integration
HIPAA 5010
…or they can appear as a dynamic, interdependent series of incremental
improvements to our health care and health
insurance systems.
The difference is preparation.The difference
is planning.
Planning Makes the Difference
• Knowing what each
successive wave entails
allows you to deliberately
sow the seeds of your
organizational change
Reforms
• MH and SUD services will be included in basic benefit
packages. Essential Benefits will be defined and mandated.
• All plans in the health insurance exchange will be required to
adhere to the provisions of the Wellstone/Domenici Parity and
Equity Act.
• Medicaid enrollees, including newly eligible childless adults,
will receive adequate health coverage, including MH/SUD
coverage.
• MH/SUD will be included in chronic disease prevention
initiatives.
Reforms
• MH/SUD workforce included in workforce development
initiatives.
• Prevention and treatment providers to be eligible for
community health team grants aimed at supporting medical
homes.
• Expanded Medicaid coverage for all Americans below 133
percent of the federal poverty level (est. 16 million)
• Health insurance exchanges created for individuals and small
employers to pool risk and purchase insurance (est. 16 million).
Accountable Care Organizations
Structure, Governance and
Shared Savings
IT Infrastructure and
Data Management
Long-Term
Care
Home
Care
& Hospice
Public
Health
Population
Health Home
Rx & Lab
Primary
Care
Mental
Health
Substance
Use
Disorder
Hospital
& Rehab
Surgical
& Specialty
Parity Impact
• By various estimates, at least 120 million people PLUS
all those that become insured via Medicaid expansion
and Health Insurance Exchanges including small group
and individual policies = an additional 32 million
• 82 million are in self-insured plans
• CHIP and Medicaid managed care plans
• 460 health insurers and 120 Managed Behavioral
Healthcare Organizations (MBHOs)
Then & Now
Private
Insurance
Publicly-Funded
Treatment
DOI
State
Agencies
Employers
Brokers
10% 25%
75%
90%
Insurance
Managed
Care
Networks
Federal
Agencies
Health
Insurance
Exchanges
Medicaid
Managed Care
Plans
32+ Million
Uninsured
Counties
and Cities
Corrections &
Courts
Managed
Care
Prevention
Networks
Housing &
Jobs
Standards
& Science
What to Expect
• Need for interoperable, certified information systems and
Meaningful Use of health information
• Managed care and utilization review
• Medication Assisted Treatment (MAT)
• ACOs and Patient-Centered Medical Home (health
home) models
• Population Health Mgmt
• Care/Case Mgmt
• Standardization and normalization of data, terms and
tools
What to Expect
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Attention to Multiple Chronic Conditions
Focus on integration and innovation
Electronic billing (electronic data interchange - EDI)
Competition
Affiliations, joint-ventures, and partnerships
Shared services
Reporting of quality, outcomes and financial data
Opportunities for…
• Implementation of certified information systems
(EHR)
• Vertical integration (“one-stop shop”)
• Horizontal integration (strategic partnerships)
• New approaches to reimbursement like Global
Payments
• New populations to serve
Strategic Implications
• Re-visit your Vision and Mission
• Include your Board
• Honestly Appraise the Political, Economic
and Technological Forces
• Re-Assess SWOT
• Establish contemporary goals and
objectives
Goal-Setting
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Specific
Measurable
Attainable
Relevant
Time-Based
BHAG
• The term Big Hairy Audacious Goal
("B-HAG") was originated by Jim Collins
and Jerry Porras in their 1996 article
entitled Building Your Company's Vision.
• A B-HAG encourages companies to define
visionary goals that are more strategic and
emotionally compelling.
Examples of a B-HAG
• Amazon: Every book, ever printed, in any language, all
available in less than 60 seconds.
• Disney: To be the best company in the world for all
fields of family entertainment.
• Ford: "Democratize the automobile."
• Google: Organize the world's information and make it
universally accessible and useful.
• Microsoft: "A computer on every desk and in every
home.”
• Twitter: To become "the pulse of the planet."
Strategic Questions
• What are your strategic goals and
objectives TODAY?
– Survive? Maintain? Thrive?
– To offer a full continuum of care
– To expand geographically and open new
locations
– To reach new populations
– To innovate new services
Strategic Questions
• What are your strategic goals and
objectives TODAY?
– To implement cutting-edge technology and
participate in Meaningful Use of health
information
– To align with a local hospital and join an ACO
– To participate fully in Pay-for-Performance and
excel in Quality Improvement
– To integrate with MH and Primary Care
Strategic Questions
• What are your strategic goals and
objectives TODAY?
– To join a more powerful network of providers
– To influence public policy
– To hire MDs and NPs and focus on Medication
Assisted Treatment
– To strip away non-essential services and focus
on your core competencies
– To be acquired
Next Step:
Assessment
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Assess Business and Strategic Plans
Leadership Team
Assess Board
Assess Staffing
Assess Performance
Assess Financials
Assess IT Infrastructure
Assess Partnerships and Alliances
Assess Market
Next Step:
Planning
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Business Plan
Strategic Plan
Marketing Plan
Contingency Plan
IT Plan
Implementation Plan
Product/Service Development
Joint Venture, Partnership, Alliance
Staffing Plan (Recruitment & Retention)
Basics of Strategic Planning
• Vision – what will you
become?
• Mission – how will you
become what you envision?
• Goals – what incremental
achievements will enable you
to satisfy your mission?
• Objectives – what tactical
steps will enable you to meet
your goals?
Execution
– Commit capital and develop a budget
– Address outsourcing and the need for periodic expertise
– Commit to Performance Mgmt
Execution
– Keep distractions and competing priorities to a
minimum
– Hold people accountable
– Align efforts so time and energy are not wasted
– Provide reinforcements, encouragement and rewards
(recognition)
Execution
– Become Learning Organizations
– Innovate and grow from your Core Competencies
– Encourage some risk-taking, experimentation and
tolerate mistakes
Living with the Tension
Tension will exist between:
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Markets
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Paradigms: past, present and future
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People vying for roles
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Short and long term needs
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Profits and investments in the future
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The team and the individual
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Dissent and agreement
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“Business” and “Recovery”
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The “way we’ve always done it” and innovation
The challenge is one of making the tension
creative and productive
Leadership Traits and Qualities
The Corner Office
Adam Bryant
Leadership Traits and Qualities
The Corner Office
Adam Bryant
Leadership Traits and Qualities
The Corner Office
Adam Bryant
Leadership Traits and Qualities
The Corner Office
Adam Bryant
Leadership Traits and Qualities
The Corner Office
Adam Bryant
Affiliation & Association
• Preferred Provider Networks (PPN)
• Management Services Organizations (MSO)
• Administrative Service Organizations (ASO)
• Independent Provider Associations (IPA)
• Accountable Care Organizations (ACO)
• Health Maintenance Organization (HMO)
Joint Venture & Strategic
Partnership
• Vertical Integration
– Unify the production supply chain under one roof (single owner)
– Each “link” produces a market-specific service that satisfies a
common need
– Examples? Professional Education + Prevention + Treatment
+ Case Mgmt + insurance
• Horizontal Integration
– Strategy for increasing market share by merging with or
acquiring like companies in adjacent markets
– Unifying marketing capabilities
Merger
• Usually a function of Horizontal
Expansion or Horizontal Integration
• Serves the purpose of dominating
markets
Acquisition
• “Buy-Out”
• “Take-Over”
• Either Vertical or Horizontal
Thank You. Questions?
Patrick Gauthier
Director
pgauthier@ahpnet.com
888-898-3280 x.802
www.ahpnet.com
www.behavioralhealthtoday.com