A WIDE SPECTRUM OF AFFILIATION STRUCTURES Options are… You are in control You can reject them all New vision of “System-ness” Will be enforced by realities of each risk/reward network, And … “Value Attribution” Not by a Distant System Board and CEO Handing over the keys becomes less relevant to both sides Optional!

INCENTIVES WILL SHIFT BEHAVIOR “We do what they pay us to do.” Old World: Volume-Based “Pay-by-the-click” Encounter-based – wait for patients to need you Tertiary hospitals make the big bucks on their expensive procedures FILL THOSE BEDS! New World: Value-Based Accountable Value: Quality/ Efficiency/ Patient Engagement Tertiary hospitals and expensive procedures become Cost Centers EMPTY THOSE BEDS! Instead, let’s try keeping the community healthier. W H A T A C O N C E P T

THE POWER OF COMMUNITY NETWORKS Revenue stream of future is tied to PCPs and their patients Community hospitals – and their clinics – bring new power to affiliation negotiations Smaller community and rural hospitals have value as revenue drivers rather than cost drivers Become high-performing aligned networks for the new world: Drive functional alignment with PCPs in local service area Develop position of strength by becoming highly efficient Demonstrate value: Cost/ Quality/ Safety

“WILL” INCENTIVES REALLY SHIFT? WELL, THEY’RE SHIFTING ALREADY, SO BE PREPARED TO CROSS THE STURDY BRIDGE OVER THE CHASM FROM VOLUME-BASED INCENTIVES TO VALUE-BASED PAYMENT

“WILL” INCENTIVES REALLY SHIFT? WELL, THEY’RE SHIFTING ALREADY, SO BE PREPARED TO CROSS THE STURDY BRIDGE OVER THE CHASM FROM VOLUME-BASED INCENTIVES TO VALUE-BASED PAYMENT

How Risk will Change our World (for the better)

PROVIDERS NOW HAVE TO HAVE SKILLS OF PAYERS SYSTEM OF CARE PROVIDER-BASED DELIVERY CARE MANAGEMENT PATIENT-CENTERED MEDICAL HOMES ALIGNED PAYMENT METHODS PAYER-DRIVEN INCENTIVES PAYERS CAPITAL NETWORK DEVELOPMENT CLAIMS PROCESSING/ANALYSIS INFORMATION SYSTEMS MARKETING UTILIZATION MANAGEMENT

PROVIDER & PAYER ROLES NOW BLEND PAYERS CAPITAL NETWORK DEVELOPMENT CLAIMS PROCESSING/ANALYSIS INFORMATION SYSTEMS MARKETING UTILIZATION MANAGEMENT PROVIDERS SYSTEM OF CARE PROVIDER-BASED DELIVERY CARE MANAGEMENT PATIENT-CENTERED MEDICAL HOMES ALIGNED PAYMENT METHODS PAYER-DRIVEN INCENTIVES NEW ALIGNMENT

ABILITY TO TAKE MEASURED RISK Integrated Competencies: Actuaria l Tight Network Design Populati on Manage ment Informat ion Systems Quality Monitori ng Disease Manage ment Wellnes s Risk: take it if you want to make it