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The Impact of the American Health Care Act on Children’s Hospitals: Preparing for the Road Ahead Throughout his campaign and early administration, President Trump has promised to repeal “Obamacare.” Now, 105 days into his term, he is one step closer to dismantling the Affordable Care Act (ACA) with the passage of the American Health Care Act (AHCA) by the House last week. While there are still many unknowns for the next wave of healthcare reform, decreased funding for Medicaid will be a core component. To date, little discussion has occurred about the impact of the potential spending cuts and programmatic changes on pediatric care.

The underlying premise of the reductions would be to roll back Medicaid expansion and reduce spending on newly insured adults who previously did not have insurance – without any specific eligibility implications for children. However, the sheer magnitude of expected funding cuts, coupled with the shift in responsibility to states that will exhibit variability in how they respond, increase the likelihood of consequences for children who need care. For children’s hospitals, who disproportionately serve children in need of care, there are a handful of options for how to react to the likely changes ahead.

In this paper, we discuss the implications of the AHCA on children’s hospitals and what they can do to prepare for the road ahead.

The Academic Health Center: Delivery System Design in the Changing Health Care Ecosystem The Chartis Group has been privileged to facilitate the meetings of the Blue Ridge Academic Health Group since 2011. Its 2017 report considers how academic health centers (AHCs) should size their delivery systems to support their educational mission.

Performance Transformation: An Undeniable Requirement in Uncertain Times While uncertainty permeates the healthcare landscape due to the current political climate and potential regulatory and reimbursement changes, provider organizations across the country agree that a focus on performance is essential under any future market scenario. To meet the requirements of the current and future market, high-performing organizations must realize and sustain levels of clinical, operational and financial performance that transcend those previously conceived of and achieved. During this time, many organizations are going “back to basics” to more sustainably address longstanding, foundational issues associated with access, cost, quality and the patient experience. At the same time, those that have made more significant progress or feel they have exhausted traditional means are seeking the next frontier in improving performance.

The Art of Execution: Moving the Organization from Planning to Performance Implementation is often depicted as the natural next step or phase in a project, with the assumption that strong leadership teams have the requisite project management skills to just “get it done.” While this may be true, it also minimizes the very real challenges and risks that can delay, if not derail, successful execution and hinder an organization’s ability to achieve lasting change.

In this paper, we examine what it takes for organizations to effectively transition from planning to performance, in a way that advances their capabilities and positioning, and illustrate how a proactive, disciplined and comprehensive approach to change management is key to setting the path for ongoing, sustainable success.

Powering Physician Practice Performance: Advanced Measurement and Benchmarking As market demands for greater quality, service and value continue to escalate, physician practices must continually reset the performance bar while navigating unprecedented economic and organizational challenges. Significant, ongoing and sustainable practice performance improvement requires a disciplined approach to managing and measuring operational, financial and clinical outcomes. With data more readily available through enterprise electronic medical records (EMRs), improved integration between front- and back-end systems, and advancements in measurement methodologies, benchmarking has become an effective enabler of data-driven practice performance improvement.

In this paper, we highlight the key success factors for effective utilization of analytics, benchmarking and measurement and illustrate how an integrated and structured approach, powered by well-defined metrics and meaningful targets, can drive physician practice performance improvement.

Is Your Medical Group Hitting the Mark? Medical groups are the linchpin of hospital and health system operations, the core of the clinical enterprise, and the indispensable driver of success. With increasing size, scale and scope, today’s medical groups wield greater impact on healthcare delivery and performance than ever before. Leading health systems recognize that medical group capabilities and leadership are critical to transforming care delivery and cost structure in an environment of shrinking revenue and increased risk. Across the country, effective physician-health system partnerships are achieving remarkable results in clinical outcomes, cost management, access and capacity, and patient and provider experience — and are positioning themselves for success in an increasingly cost-sensitive and value-based market. Only by optimizing medical group clinical, financial and operational performance, and fostering aligned, committed and accountable physician leadership, can health systems and physicians together address the complexities and challenges facing today’s healthcare providers.

In this white paper, we highlight the characteristics of a successful medical group while providing actionable steps to assess your group's current performance and develop a focused approach for improvement.

The Next Strategic Imperative: Rethinking Revenue Cycle Transformation For many organizations, the tidal wave of change in a relatively short period of time has made it even more challenging to manage — let alone adapt and improve — the most fundamental attributes and indicators that drive performance. Within provider organizations, senior leadership has been appropriately focused on enterprise strategy development and execution, with emphasis on provider consolidation, EHR implementation, physician alignment, population health and consumerism. Concurrently, investments to support revenue cycle transformation have been neglected in most organizations. As a result, the majority of revenue cycle operations models are not well suited for today’s realities. Successfully addressing these imperatives will demand a revenue cycle that is fundamentally different. The key question for health system leaders is, “What can be done within the revenue cycle space to keep up with the current operational demands, while simultaneously positioning us ahead of future demands?” In order to be successful, healthcare providers will need to establish an integrated view of the organization’s entire revenue ecosystem.

Rural Relevance 2017: Assessing the State of Rural Healthcare in America The uncertainty surrounding the future of the ACA/AHCA will likely continue to be unsettling for rural providers – especially when the potential for changes in legislation threatens financial viability and stability. The Chartis Center for Rural Health (CCRH) and iVantage Health Analytics have devoted significant resources to evaluating the state of the rural health safety net and modeling the impact of potential policy changes on rural providers. In this state of uncertainty, the Rural Relevance Study offers a unique lens into the state of rural healthcare, the value the safety net provides, and the opportunities for the future.

Eyes Wide Open: Does Your EHR Implementation Program Address the Critical Risks to the Enterprise? For most health systems, the decision to implement an electronic health record (EHR) represents one of their largest capital expenditures, likely second only to investments in acute care facilities. It also commonly signifies one of the most prominent single annual expense line items for a typical provider. Implementing an EHR can bring significant benefits but involves high risk. Delays are costly, and the initial investment is at risk if adoption does not occur. Further, potential disruptions include physician dissatisfaction, revenue cycle leakage and revenue degradation, and long-term capacity and throughput challenges. These disruptions can have long-ranging implications on organizational performance.

Despite the enormous scale of this investment, once the decision has been made to proceed with implementation, many organizations fail to develop the necessary oversight and review processes to ensure a successful EHR Implementation.

Is Your IT Strategy Failing You? Health systems are going through a period of dynamic change. New business models and nontraditional partnerships are forcing organizations to look for better ways to deliver innovative capabilities faster and more efficiently, and value-based care is driving health system leaders to focus on outcomes.

It should be the golden age of innovation in health delivery, with IT providing the platform for change — yet it isn’t. Despite additional investments in technology, most healthcare organizations are seeing IT fall short in articulating and driving meaningful change. Some organizations may be dabbling in virtual care or implementing telehealth; but it is against an enabling — rather than a strategic — framework. Orchestrating that change starts with thinking strategically about IT: how it supports business innovation, how investment aligns with corporate initiatives and collectively, how IT provides tangible value.

Transforming Network Strategy: How Payors Can Drive Long-term Value With the current batch of limited network products in the market today, many payors have achieved short-term victories in the cost-containment game. However, there are significant shortcomings with many of the narrow network products currently in the market that, if not resolved, will limit their impact to drive value in the market over the longer-term. Challenges remain for consumer decision-making both at the time of purchase and at the point of care, including understanding which providers are in or out of network. Additionally, current determinations of network inclusion/exclusion are highly reliant on unit price rather than drivers of long-term total cost and value such as utilization and quality measures.

In this paper, we share two significant focal points for payors to address these shortcomings, evolving the design and accessibility of narrow and tiered network products in support of longer-term sustainability. We also describe the opportunities for payors to reinforce the repositioning of network design as a key strategic differentiator, including realignment internally—in how payors are organized—as well as externally—in how payors relate to providers.

Allocating Capital: A Billion Dollar Conundrum The health system of the future will look very different from today’s; its capital planning and investment process will also need to be different. Health systems must extend their investments beyond the traditional bricks and mortar networks of hospitals, ambulatory centers and physician offices to reach patients through new technology-enabled channels of service delivery. Successful providers will develop a robust and dynamic planning process to facilitate decision-making regarding the prioritization of assets and capabilities, and optimize the use of capital.

On the Frontline

High-Impact Ambulatory Operations

Case Study: University of Alabama-Birmingham

A highly reliable and efficient ambulatory operations model is a critical dimension of transforming care to increase quality, reduce costs and improve patient and provider experience in today’s healthcare environment. Leading provider organizations are developing capabilities to support a seamless, system-wide approach to interacting and communicating with patients beyond an episode or appointment; providing timely and convenient access to services and information across the continuum; and helping patients navigate to the right services for their care needs and preferences. This “next generation” performance supports growth and retention, optimal use of capital, cost-effectiveness and patient engagement – all of which are critical in both traditional payment models and the evolving value-based environment.

Making the Paradigm Shift to an Enterprise-Wide Approach to Population Health

Case Study - Mayo Model of Community Care

Health systems across the United States have started their journeys toward population health management and the future of accountable care. Models of population health management include patient-centered medical homes and private sector accountable care organizations (ACOs). Other models include public sector efforts, such as Physician Group Practice Transition Demonstrations, Medicare Health Care Quality Demonstration Programs, Beacon Communities, Medicare Shared Savings Program, and Pioneer ACOs. As a result, health care organizations often have pockets of population health initiatives that lack an enterprise-wide strategy. The next steps are to build on these efforts, leverage the learnings from these experiences, and incorporate the initiatives into an overarching framework and a road map for the future.

This paper outlines the current challenges many organizations face when implementing an enterprise solution and describes how to transition from existing siloed initiatives. Additionally, it provides a real-world application of a population health transition as seen at the Mayo Clinic.

“Next generation” performance supports key success drivers which are critical in both traditional payment models and the evolving value-based environment.

In The News

  • Modern Healthcare Recognizes The Chartis Group as a Best Place to Work
  • Trumpcare Hits Children's Hospitals Hard
  • Children’s hospitals could lose billions in funding under AHCA and may need to change their care models
  • The AHCA is Causing Concern Among Children's Hospitals
  • Mary Jo Morrison Featured in Healthcare IT News
  • Forbes Recognizes The Chartis Group as a Top Consulting Firm for 2017
  • Glenda Owen and Todd Bankhead Join The Chartis Group

The Chartis Group Named One of the Best Places to Work in Healthcare for 2017

The Chartis Group has been selected by Modern Healthcare as one of the 2017 Best Places to Work in Healthcare. The complete list of this year’s 100 winners, in alphabetical order, is available here.

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Trumpcare Hits Children's Hospitals Hard

The nation’s children’s hospitals may see a harsh reduction in funding and reduced care for their patients should the American Health Care Act, also known as Trumpcare, replace the Affordable Care Act, new analyses show. "While only approximately one-fifth of Medicaid spending is for children, about half of Medicaid and CHIP [Children’s Health Insurance Program] enrollees are children, even following Medicaid expansion for lower-income adults in many states,” a new report from the Chartis Group says.

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Children’s hospitals could lose billions in funding under AHCA and may need to change their care models

Although the fate of the Republican House plan to repeal and replace the Affordable Care Act is still unclear, a new analysis says children’s hospitals will face massive funding cuts under the legislation and may have to change their care models to survive.

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Children's hospitals concerned over coverage cuts, bottom lines from AHCA warranted, Chartis Group study says

Study points to decreased funding for Medicaid as underlying reason; More than half of children's hospital's patients are insured by Medicaid.

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Real-world advice on analytics for value-based care

From the big picture of communication strategies to the details of data governance, LifeBridge Health shows that analytics is an iterative journey.

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The Chartis Group Recognized as one of America’s Best Management Consulting Firms

The Chartis Group, a national advisory services firm dedicated to the healthcare industry, is ranked among the top one percent of consulting companies in the U.S. by Forbes for the second year in a row. In addition to Health Care & Life Sciences, The Chartis Group was selected as a top firm in Strategy, IT Strategy, Digital Transformation and Organization consulting.

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The Chartis Group Adds Glenda Owen and Todd Bankhead to Revenue Cycle Leadership Team

New principals bring deep expertise critical to addressing today’s demand for a fundamentally different revenue cycle

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