Emerging Organization Market Analysis
One of the most complex challenges for physician and hospital leaders are to determine what vehicle will be the most appropriate for their marketplace. Each market is unique and requires complete analysis prior to embarking upon the development of an enterprise to assist the community in their delivery of health care in a changing environment. Some markets are yet to be affected by managed care, but their service areas are experiencing changes, which is necessitating the reorganization of medical staff, the development of an independent physician organization (IPA) or physician-hospital organization (PHO) or the determination of the feasibility of a fully integrated medical group. OakRidge will meet with principal parties to evaluate the current situation in the physician community including ascertaining competitor status, as well as evaluating the hospital delivery systems. In addition, we evaluate employer and payor needs and make determinations and recommendations on feasibility and cost of the development of delivery models for the community.
Board of Directors Development
As new enterprises are developed to respond to the changes in the healthcare marketplace, physicians are being required to assume new responsibilities and take on roles not inherent to them. Many potentially successful organizations fail, due to the inability of the Board of Directors to plan, develop and inspire a reasonable vision for the organization.
OakRidge Consultants assist physicians and hospital leadership to learn to work together in a new way. Physicians learn during two day retreats how to be a Board member, the responsibilities involved in that role and the inherent conflicts that will arise in their positions as a physician leader. Real life skills are shared with the physicians in a setting where they can learn to think and act as a visionary for their organization.
Boards of Directors walk away from the retreats with the understanding of how to work together toward common goals, resolve conflicts stay on track and accomplish the work necessary as a cohesive governing group.
IPA/PHO Formation/Financial Turnaround
Few consulting companies have the personnel available who have “real life” experiences in developing, running or turning around fiscally troubled IPA/PHOs into successful enterprises. OakRidge Consultants possess the experience necessary to work with newly formed entities or turn around situations. Our consultants, are able to be on your site and involved in your operations. By understanding operations and your particular needs, our consultants can assist your management team in developing the support systems necessary to run a successful enterprise in this complex market.
Developing a new management structure not only requires forward thinking, it requires an ability to build an organization that will support an evolving market as well as growth, capitalization and sustained operations will be success factors inherent to MSOs that are built to navigate quickly in the changing marketplace.
High-level strategic thinking is on the beginning of building an organization. Private funding through capital placement offerings can cost the organization as much as it can sometime raise in one stock offering. This does not have to be the case. OakRidge Consultants can offer referrals to law and accounting firms that understand the challenges healthcare providers are under to be able to build and sustain their management operations.
Health Plan Contracting
Whether your needs are for a short term stand-in contractor or for an educator on “how to risk contract,” our consultants can help satisfy your needs. We have experience in all areas of payor (HMO, PPO, Self-Funded) contracting. Most OakRidge consultants have healthplan and provider contracting work experience and we will be happy to assist your organization in completing their contracting goals or in learning how to maximize their value in contracting.
IPA and Provider Contracting
Physician/Provider contracting is vastly different from health plan contracting and should be treated as a different area of expertise. Physicians, hospitals and other ancillary providers are being requested to be at financial risk for certain portions of the healthplan contract. It is imperative for physicians and other providers understand the responsibilities involved in this type of contracting. Frequently, physicians, hospital and ancillary providers sign contracts without the full understanding of the implications or risk involved with the endeavor. Understanding the value of negotiating language, rate and responsibilities in a contract can be the difference between success and failure for the IPA, physician, hospital or ancillary provider.
Provider Relations and Physician Education
One of the most challenging aspects of this changing healthcare market is the ability to keep the physician network informed of the changes and fully educated on how to administrate the ever changing healthplan benefit structures. OakRidge Consultants have been the principal author and developer of many medical group/IPA Provider Reference Manual and have assisted groups in the formal development of ongoing education programs for their provider networks.
Utilization Management and Quality Improvement
Developing and maintaining an efficient and state of the art utilization management department is not an easy task. To attain healthplan delegated status, the group must be able to demonstrate compliance with HCFA, NCQA and other regulatory agency requirements. Building a department that can adapt to the ever-changing menu of requirements of the governing bodies sometimes requires outside assistance. This assistance can be as defined as, one-time audit preparation, education on case management or claims review or full development of a department that meets regulatory approval. Quality Improvement is also an area that can benefit from the assistance of OakRidge Consultants including the development and completion of quality audits, credentialing or staffing. By building a department that complies with NCQA standards, the IPA or medical group can benefit from streamlined operations and greater freedom from healthplan oversight.
Accounting/Financial System Design and Implementation
Tracking of important financial data is one of the success factors for all parties in the delivery of healthcare. It is important to build and run a department that assures their constituencies that Generally Accepted Accounting Principals (GAAP) are employed in the accounting and finance areas of operations. The development of a meaningful financial package to assist the Board of Directors and Management Team are important tools to assist your decision makers in moving an organization forward. OakRidge will assist in the design, development and implementation of a sound financial program for your companies successful future. Let us assist your group in the preparation for healthplan financial audits which outcomes could result in the group attaining or continuing with a healthplan contract or by becoming delegated for claims payment and fiscal management of the groups healthplan revenues.
Emerging or existing organizations may have experienced rapid growth in their operations, resulting in shortages of the organization’s staffing resources. Staffing shortages and operational growth can prevent your organization, from developing and memorializing policies and procedures that are so important for the entity’s success. Consistency is a challenge, when you have rapid growth, increasing staff and continual fine-tuning to maximize your organization’s potential. You also need to assure that staff are consistently following the corporation’s policies and protocols when performing their duties. In addition, your organization will be subject to healthplan and other regulatory oversight which will require the review of written policies. Let OakRidge operationally orient consultants, assist your enterprise in the development of customized policies and procedures, which will allow you to focus on the business at hand.
Health Plan Audits
Preparing for healthplan audits, whether they are routine or for initial business consideration, are important to the success of the entity. Payers are subject to significant oversight from regulators, governmental agencies and quality improvement entities. They must assure their oversight agencies that compliance to regulations are being met even when the function are delegated to a hospital, IPA, or PHO. Preparing for multiple audits simultaneously, can be a labor intensive project, taking your time away from key duties of your management members. Let OakRidge assist you in completion of necessary filing for healthplan audits. We streamline the process, prepare binder for audits and assist your staff in completing a process that can be laborious, cumbersome and time taking.
Recruitment of the right candidate takes time, expertise and an acute understanding of the positions. Many times the timing of vacancies in key positions are inopportune, leaving an organization scrambling for the “skill-set” needed to keep your organization running on an interim basis. OakRidge offers interim solutions to executive placement and can assist in both the developmental and replacement phases of an organization’s needs.
The landscape continues to evolve, successful organizations, continue to analyze their organization’s structure and the effectiveness of that structure. Many times, the productivity levels drop off within an organization and management is challenged with issues revolving around staffing, level of staffing and quantity of staff. A fresh look by seasoned professionals can add insight on increasing productivity, determining appropriate staffing levels, or staff reorganization to maximize efficiency. OakRidge can assist your organization in assuring that your team is working at its potential and that it is organized to adapt to the changes within the industry.
Human Resource Services
Whether your organization is in transition from PPMC, PHO or other 3rd party management arrangement to an independent entity, start up or you are in need of additional help, in the development or revamping of Human Resource policies and procedures, we can help. OakRidge can assist in the coordination, development and organization of your new or existing Human Resource department. Personnel issues can become time consuming and complicated in the changing environment of the healthcare industry. Our personnel expertise will help you develop your organization for optimal productivity.