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StrategyDriven Enterprises Extends its Advisory Services into the Healthcare Industry, Partners with Artower Advisory Services

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StrategyDriven Enterprises LLC and Artower Advisory Services, LLC partner to provide healthcare industry executives and managers with Affordable Care Act mandated Quality Assurance Performance Improvement (QAPI) program consulting services.
 
 
Healthcare ConsultingStrategyDriven Enterprises, LLC and Artower Advisory Services announced a partnership that will expand the regulatory compliance services of both companies. The relationship combines StrategyDriven’s leading experience in quality assurance and performance improvement regulatory services with Artower’s healthcare industry expertise.

“Healthcare industry leaders must find cost effective ways to meet the new quality assurance and performance improvement mandates of the Affordable Care Act,” explains Nathan Ives, StrategyDriven’s Chief Executive Officer. “We believe by leveraging experiences from other industries that for decades have complied with similar mandates, healthcare executives can not only meet and exceed these ACA requirements, but do so in a highly cost effective manner.”

“We are excited about the opportunity to combine StrategyDriven’s capabilities with Artower’s healthcare industry experience,” asserts Scot Park, Artower’s Chief Executive Officer. “This partnership will create out-of-the-box products and provide advisory services that enable healthcare organizations, both large and small, to rapidly achieve cost effective compliance with the ACA’s mandates while simultaneously driving improved patient care.”

The StrategyDriven / Artower team provides healthcare industry leaders with an array of actionable performance improvement and regulatory compliance support in the areas of:

  • Self-assessment programs
  • Corrective action programs
  • Organizational performance monitoring programs
  • Risk assurance programs

About StrategyDriven

StrategyDriven provides executives and managers with the planning and execution advice, tools, and practices needed to create greater organizational alignment and accountability for the achievement of superior results. We believe a clear, forward-looking strategy, translatable to the day-to-day activities of all organization members, is critical to realizing success in today’s fast paced market environment. Not only does a compelling, well-executed strategy align individuals to common goals, it ensures those goals best serve the company’s mission.

At StrategyDriven, our seasoned business leaders deliver real-world strategic business planning and tactical execution best practice advice – a blending of workplace experience with sound research and academic principles – to business leaders who may not otherwise have access to these resources.

StrategyDriven refers to the family of organizations comprising StrategyDriven Enterprises LLC. For more information, please visit www.StrategyDriven.com.

About Artower Advisory Services

Headquartered in Willoughby, Ohio, Artower Advisory Services’ professionals support healthcare industry leaders throughout the United States. The Artower team has expertise in senior housing, aging services, post-acute/long-term care, and behavioral health. Several of our senior professionals previously held leadership positions within major healthcare organizations. Artower’s project teams work collaboratively across disciplines to deliver greater value through improved outcomes, integrated delivery, and lower cost. For more information, visit www.ArtowerAdvisory.com.

Achieving Organizational Alignment within Healthcare Organizations

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StrategyDriven Organizational Alignment WhitepaperCo-authors Nathan Ives, StrategyDriven Principal and Scot Park, Artower Principal, released a new white paper on organizational alignment and performance improvement for the healthcare industry. The paper describes how best practices in measuring organizational performance in the nuclear power industry can be applied to healthcare providers facing the daunting challenge of concurrently increasing production, efficiency, and quality – all while reducing operating costs. The Value-Based Performance Improvement Model© is an affordable approach that healthcare providers can use to develop a Lean Six Sigma style performance measurement system.

StrategyDriven recently formalized an alliance with Artower Advisory Services to deliver Value-Based Performance Improvement services to healthcare providers and are looking forward to helping these organizations realize the critically important economic benefits created through the use of this new performance improvement model.

Download a copy of Aligning Healthcare Organizations: Lessons in improved Quality and Efficiency from the Nuclear Power Industry by clicking here.

About the Authors

Nathan Ives, StrategyDriven Principal is a StrategyDriven Principal, and Host of the StrategyDriven Podcast. For over twenty years, he has served as trusted advisor to executives and managers at dozens of Fortune 500 and smaller companies in the areas of management effectiveness, organizational development, and process improvement. To read Nathan’s complete biography, click here.

Scot Park is a Principal and co-founder of Artower Advisory Services. He has spent the past two decades serving the Healthcare Industry with a focused on Aging Services, Senior Housing and Post-Acute/Long-Term Care. Scot holds a BA in Economics with concentrated studies in Public Administration from John Carroll University. To read Scot’s complete biography, click here.

Using Healthcare Performance Management as a Business Strategy

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Explore how Healthcare Performance Management (HPM), combined with self-insurance, can empower organizations not only to better manage their governance, risk and compliance exposures, but also to deliver bottom-line business value to a company.

By applying the right people, processes and technology to those three focus areas, HPM can empower companies to execute a powerful business strategy that can reduce healthcare costs while also improving employees’ health outcomes.

The first step rests with how companies choose to deliver health benefits to their employees. While every organization’s healthcare plans differ, for example UCLA benefits offers custom packages for each employee, there are two ways coverage can be provided: through fully insured plans, in which they purchase coverage from an insurance company, or through self-insured plans, in which they directly cover employees’ healthcare expenses.

Self-insurance recently has become the option of choice for a majority of the workforce. In 2008, the nonprofit Employee Benefit Research Institute (EBRI) found that 55 percent of workers with health insurance were covered by a self-insured plan. The decision to self-insure has been embraced enthusiastically by large corporations – 89 percent of workers employed in firms with 5,000 or more employees were in self-insured plans in 2008.

By self-insuring, employers can control the costs of providing health benefits to their employees because it allows them to:

  • Obtain more specific information about their actual healthcare expenditures.
  • Control costs, because instead of paying health insurance premiums that typically rise 9 to 10 percent per year, they can pay for routine expenses such as doctor visits, procedures and prescription drugs through a self-insured plan, obtaining lower-cost catastrophic or “stop-loss” policies to cover major medical events.
  • Enable better “human capital management” by recognizing in advance what types of health events are emerging in their covered population in time to help employees avoid a catastrophic event.

An HPM strategy has profound implications for senior management in the three critical areas of governance, risk and compliance. This manifests itself in the following ways:

  • Governance requires the active engagement of business units beyond human resources – strategic planners, financial and operations executives, and the IT group.
  • Self-insured firms must manage their own risk, so access to real-time data that is tied to the plan is imperative.
  • Although corporations have dedicated resources to compliance activities, an HPM system is automated and therefore can deliver those required reports as an ancillary function. This way, organizations can generate the necessary documentation for auditors, regulators and others without devoting valuable resources to that single function.

Governance, Risk, and Compliance Management Strategies for Self-Insured Health Plans: How Senior Executives Can Use Healthcare Performance Management as a Business Strategy explores how HPM, combined with self-insurance, empowers organizations to better manage their governance, risk and compliance exposures, and delivers bottom-line value to the company.

Click here to download a complimentary copy of this Healthcare Performance Management Institute report.

Want to learn more?

Listen to our recent StrategyDriven Editorial Perspective podcast interview with George Pantos, Executive Director of the Healthcare Performance Management Institute during which we discuss how companies can keep their current health plans in light of the recently passed healthcare legislation and under what circumstances they may wish to do so.

Podcast: Play in new window | Download (Duration: 19:57 — 27.4MB)

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Healthcare Mergers: An Emerging Crisis

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Advocates of the president’s health care reform package have expressed alarm over a wave of mergers spurred by the new law.

Johns Hopkins Medicine, for instance, is snapping up hospitals in the Washington, D.C.-area, a move it describes as “driven largely by health care reform, which demands an integrated regional network.”

Johns Hopkins is not alone. Many established actors in the health care industry – including insurers, brokers and providers – are searching for ways to increase their market clout.

That’s bad news for ordinary patients, who will be forced to pay ever more for their care as the level of competition in the health care marketplace dwindles.

It’s easy to see why competition drives down costs. When insurers or health care providers have to battle one another to attract customers, they must differentiate themselves by charging lower prices or providing better service.

But if an insurer dominates a marketplace, it can raise prices and lower service standards with impunity.

Many insurers and providers are already taking steps to limit competition. Consider ‘most favored nation’ (MFN) clauses, which insurers use to prohibit hospitals or doctors from charging competitors less. Insurers claim that these discounts are necessary to help them secure the best possible deal.

Unfortunately, it’s the “best possible deal” for the insurer — not ordinary patients. The ‘low’ prices included in these MFN clauses are often based on artificially high price quotes from the provider. In some cases, insurers have actually agreed to increase what they’ll pay so long as other insurers are forced to pay even more.

Patients, of course, lose. The favored insurer passes along artificial cost increases directly to their customers, while disadvantaged competitors have to charge even higher premiums to continue offering access to offending providers. Many insurers simply exit a market once a rival negotiates an MFN.

Such an exit can be disastrous. According to an American Medical Association study, two or fewer health insurers control more than 70 percent of the market in 24 states. And if a competitor is foolhardy enough to try to work around an MFN, then the dominant insurer can simply force its rival out of the market.

A case in point is TheraMatrix, a small Michigan company. In 2005, TheraMatrix contracted with Ford Motor Co. to provide physical therapy services to its employees. TheraMatrix cut Ford’s costs by nearly half – saving the company millions of dollars. Last year, Ford expanded the program to cover 390,000 employees and retirees nationwide.

Everyone was happy – except Blue Cross Blue Shield of Michigan (BCBSM), which handled the administrative side of Ford’s insurance plan.

As TheraMatrix added other automakers to its customer base, BCBSM dropped the company from its medical provider network, which covers most Michiganians. BCBSM also threatened to revoke its other customers’ hospital discounts if they carved out their physical therapy benefits and contracted with TheraMatrix to provide them.

Blue Cross wrote that TheraMatrix’s operations were “competitive and damaging not only to BCBSM’s financial interests, but also to its business relationships.”

In other words, BCBSM would not allow its customers to shop around for better deals. And it would try to bully TheraMatrix out of business.

Such anti-competitive behavior harms employers and patients alike. Further consolidation of insurers and providers could make things worse.

Over the last 10 years, employer-provided health insurance premiums have more than doubled. Premiums for the most popular employer-provided plans are projected to increase by another 10 percent next year.

If businesses are to stop runaway medical costs, they’ll have to take control of their benefits. They can do so with the help of a new business strategy: ‘Healthcare Performance Management’ (HPM).

HPM uses powerful software to show companies where their health plan dollars are going, and where opportunities for savings exist.

For instance, HPM analysis of employee medical and prescription claims data might show that a company is spending too much on brand-name prescription drugs and that alternatives like generics could help it save millions.

Unsurprisingly, insurers don’t want to share this data with businesses. After all, if a company can’t pinpoint exactly how it’s spending its health dollars, it will be less likely to question premium hikes. Nor will it be able to find efficiencies, as Ford did, by cutting the insurer middleman out of the equation.

In many parts of the country, big health insurers have enjoyed virtual monopolies. Unburdened by real competition, they’ve abused their powers while businesses and their employees footed the bill.

HPM empowers businesses to inject competition into the healthcare marketplace and fight back against decades of cost increases. Employers should take advantage.

Additional Information

In addition to the invaluable insights George shares in this StrategyDriven Editorial Perspective article are the resources accessible from his website, www.HPMInstitute.org.   George can be reached at [email protected].

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About the Author

George Pantos is Executive Director of the Healthcare Performance Management Institute, a research and education organization dedicated to promoting the use of business technology and management principles that deliver better and more cost-effective healthcare benefits for employers who provide health insurance coverage for employees and their dependents. To read George’s full biography, click here.

Be Good to Your Employees and They Will be Good to You

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The recession we have been experiencing over the past few years has created a strong upper hand for employers across many industries. Because getting a job has been very difficult, many employers have taken advantage of the climate and chosen to offer their employees less in the way of income and benefits.

In my experience, this strategy is a short-term solution and a short-sighted approach that will lead to reduced profits and poor company morale.

Companies show how much they care about their employees when they offer and pay for a part of every employee’s health, dental and vision coverage.

For example, we had an employee whose husband was going through cancer treatment at the time our company was searching for a new insurance policy. At the time, we employed over 550 people and could save tens of thousands of dollars on new healthcare. The only problem we had was that most insurance carriers wanted to exclude our employee’s husband from the new policy, thus leaving him with COBRA or no healthcare at all. This was unacceptable to us, so we kept the policy we had and paid the additional premium until the cancer treatment was complete.

This example is part selfless and part selfish. All of our employees knew why we had made the choice to stay with our healthcare provider, and that helped to improve our corporate culture and further showed how much we care about our employees.

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About the Author

Daryl Wizelman is a leadership, corporate culture, emotional intelligence, life planning and work/life balance visionary. Daryl combines his inspiring story with some practical tools which can be implemented immediately to improve the lives, careers and companies that he touches. Daryl spends his time speaking, consulting and motivating companies, associations, professional athletes, sports teams and individuals all over the world. To read Daryl’s complete biography, click here.