Case Study: Transforming an IPA into a Clinically Integrated Network – Three Levers for Success
Background With only a quarter of early ACOs producing savings sufficient to share in them and uncertainty over how quickly the industry will transition to value-based reimbursement, many hospital leaders have been reluctant to make the investments required for success under value-based care. However, tremendous clinical and financial gains may be in store for organizations […]
Case Study: Cutting Physician Network Losses
Background The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. For most of these communities, the system was the sole source of care. Though the clinics were of substantial size (they employed […]
Case Study: Developing a Clinically-Integrated PHO to Align an Employed Physician Network and Independent Community Physicians
Background A large multi-specialty physician group (wholly owned and operated by a four-hospital health system) took a 25-percent upside/downside risk as a percent of premium on 6,000 Medicare Advantage (MA) patients. After realizing losses of over $1 million the first year, they determined tighter alignment with key independent specialist groups was necessary to better manage […]
Case Study: Developing a Strategy for a Rapidly-Growing Physician Network
Background A two-hospital system in the Midwest had a 45-provider employed network that had grown tremendously over three years. Much of that growth was unplanned and primarily based on reactions to competitor actions and physician demands. The result: Practice losses were exorbitant. The management team was focused on day-to-day issues and putting out fires. Multiple executives […]
Case Study: Creating a Successful Oncology Co-management Relationship
Co-management agreements can be mutually beneficial to hospitals and physicians. They can improve quality, reduce cost, and provide financial benefits to participating physicians. However, proper execution is required to realize these benefits. We recently worked with a client to implement an oncology co-management program and have translated our experience into the tips below. Background A […]
Case Study: Interim Management for an Employed Physician Network
Background Our Midwestern hospital client had a rapidly-growing employed physician network. The network was multi-specialty and was deployed to expand the hospital’s footprint in outreach markets. Developing the group culture and increasing physician engagement, however, were becoming increasingly challenging. The group lacked a solid infrastructure and didn’t have sufficient dedicated resources to support the practices […]
Case Study: Ambulatory Strategy with a Focus on Responding to a Larger Competitor Moving Into the Market
Background Our client was an independent, 250+ bed hospital, located 20 minutes from a large metropolitan area in the Midwest. The hospital was experiencing intense pressure from three tertiary competitors located in the nearby metro area. Each was pursuing an ambulatory strategy that placed physicians, outpatient services, and ancillaries in our client’s primary service area. […]
Case Study: Defining an Appropriate Affiliation Strategy for an Independent Hospital
Our client, a standalone 200-bed hospital located in the eastern U.S., had experienced reasonable financial success over the last decade as an independent provider in a rural community. Faced with the challenges of reform, an aging facility and an aging medical staff, the board felt it would be wise to explore affiliation options. However, the board lacked a process for strategically identifying what type of affiliation would best position the hospital for the future and who would be the best partner.
Case Study: Alignment Strategy for a Medical Community with Both Employed and Independent Physicians
In 2009, our hospital client — a 175-bed hospital in Southeast– had a largely independent physician base and a handful of employed physicians. There was no alignment strategy to guide its relationships with either group. With HSG’s assistance, the hospital grew the employed group from eight providers to 40 over a three-year period. The resulting downstream revenue turned a -2 percent margin in 2009 to a +4% margin in 2012.
Case Study: Strategic Planning for a Rapidly-Growing Employed Physician Group
The number of physicians employed by a 300+ bed hospital in the Midwest had grown from 30 to 120 over a three-year period. While this growth was driven by a strategic initiative to increase alignment with the community physicians, the group that the physicians were put into lacked any formal infrastructure or identity. As a result, the hospital had a large group of physicians that were essentially operating as independent practices – so much so that many physicians in the group didn’t know who the other physicians in the employed group were.