WayPoint Firm Credentials

LEADERSHIP“WayPoint’s leadership reflects that rare breed of well-rounded individuals who

can execute. They aren’t afraid to put their fingers on the keyboard. They don’t

just describe the work, they break it down into logical steps and do it. Together

we produce outcomes.”

David Bradshaw, MHMD Chief Information, Planning & Marketing Officer

“It has been a very rewarding opportunity to work with WayPoint; one that has

been marked with good physician communication, trust, and integrity.”

Tom Wall, MD, Medical Director, Triad HealthCare Network

Waypoint professionals work with your team to deliver custom solutions that

reflect experience, best practices and an independent point of view.

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Jim McCoy, Managing Director Jim brings a wealth of healthcare experience to WayPoint, particularly in improving

quality, safety and patient experience through clinical integration. He’s worked with

clients ranging from integrated health care systems and large medical groups to

hospitals and various specialty providers.

Prior to starting WayPoint, Jim gained direct industry experience through multiple roles

at Texas Health Resources, including Director of Market Management and Assistant

Administrator responsible for strategic planning and core operational functions. During

this time, Jim developed and managed a large multi-specialty physician independent

practice association. Jim has also served in leadership roles at Ernst & Young’s Health

Sciences Advisory Practice. Jim has led a long list of initiatives, including:

· Patient centered medical home (PCMH) and related incentive programs

· Innovative population management payer contracting relationships

· Inpatient quality and safety incentive programs

· Accountable Care Organization start-up

· Medicare Shared Savings Program participation

· Strengthening health information technology and population management infrastructure

· Hospital and medical group operational efficiency and profitability studies

· Hospital and medical group revenue cycle and pricing strategies

· Managed care negotiations and payment dispute resolution

· Transaction support including fair market value assessments

· Due diligence including financial and market projections

· New business formation, mergers and acquisition support services

· Strategic planning, including market studies and financial projections

· New facility and service line planning

· Real estate and major capital expenditure planning

· Physician compensation plan development

· Claims dispute resolution and litigation support

· Clinical integration

· Operational restructuring to support an accountable care organization (ACO)

· Physician alignment

Jim graduated from the University of Texas at Austin and earned his MBA in Finance at

the University of Texas at Arlington. He lives in Fort Worth with his wife and two sons

and is active in a variety of DFW-area community groups, including:

· American College of Health Care Executives

· Dallas Fort Worth Health Industry Council

· Alumni – Cook Children’s Health Care System “Experience the Mission” Program

· First Tee of Fort Worth – current board member and instructor

· West Side Little League

· Fort Worth Texas Exes Chapter – past president

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Brett Kirstein, Managing Director Brett has served the healthcare industry in a consulting capacity for the past 24 years.

During that time, he’s led all types of engagements in leadership roles including:

· Partner, Arthur Andersen Healthcare Consulting, where he led the Revenue Cycle Practice for the

Southwest region

· Vice President, Hitachi Consulting, where he shared in the leadership of the Finance Business

Solutions Practice

· President, Revenue Cycle Solutions, where he founded a professional services firm to serve his

healthcare clients at a more strategic level

· Managing Director of WayPoint

Brett’s consulting approach has always been to impact results through measurable

process improvement, strategy articulation and technology implementations. In

addition to supporting large integrated health systems, academic medical centers and

not-for-profit acute care systems of all sizes, he has worked extensively in long term

care for several regional and national chains. Most recently, Brett has led initiatives

including:

· Drafted and submitted the Medicare Shared Savings Program application for three of the largest

ACO’s nationally

· Supported the start-up and operations of a hospital system led ACO with 60,000 covered lives

· Implemented population health management technology tools including claims based risk

stratification and physician intelligence tools as well as an HIE

· Supported hospital and physician efforts to create a clinically integrated network

· Led strategic initiatives to redesign the clinical improvement process as well as physician

incentives in the areas of quality and safety and specialty service lines

· Managed-care contract analysis and negotiations

· Implemented enterprise wide labor management technology including time and attendance and

scheduling

· Supported various revenue cycle redesign initiatives including CBO planning and outsourcing

evaluations

· Led pre- and post-merger integration planning and implementation for $2B long term care

company

· Led various process improvement engagements including payables, payroll, accounting, clinical

risk management and business development

Brett is a 20-year CPA in the State of Texas and graduated from the University of Texas

at Austin with a BBA and MPA in taxation. He lives in Dallas with his wife and two

children and volunteers in various community efforts and professional organizations.

Most recently, he was the past Chair of the Board for Head Start of Greater Dallas and

is a current board member of Educational First Steps.

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CLIENTS“WayPoint has become a part of our team. They understand the people on our

team and the functions they provide. No matter what the issue is, they help us

articulate a better vision and execute it into action.”

Chris Lloyd, MHMD CEO

“Waypoint is highly responsive and very much hands-on in their approach.

Because they had similar experience with other ACOs, their guidance through

the application process was a comfort to us. You’re not getting buzz words,

you’re getting expertise that drives results.”

Chief Operating Officer, Regional Market Leading Health System / ACO



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RECENT CLIENT EXPERIENCE

CLI

ENT

OB

JEC

TIVE

S

WayPoint has vast experience in Population Management, Clinical Integration and ACO initiatives. Readiness assessment, design and implementation experience includes:

• ACO / CIN / PCMH start-up activities

• Innovative value based payer contracting relationships

• Population health management technology implementation- Analytics to identify at risk patient populations- Analytics to improve provider performance and measure quality

• Care management people, process and technology resource deployment

• CMS Medicare Shared Savings Program participation

SOLU

TIO

NS

For a variety of clients WayPoint has assessed existing clinical integration resources and incentive structures while supporting leadership to develop market-specific capabilities in following implementation areas:

• Enterprise scope, structure, governance and leadership

• Provider network composition and development

• Reporting tools and processes

• Care team incentives

• Health information technology resource plans

• Staffing plans and operating budget estimates

Specialized resources were identified in order to:

• Promote clinical process improvement

• Identify population-specific health needs and high-risk patients

• Deliver disease management programs / coordinate care

• Enhance patient access, communication, and engagement

RES

ULT

S

• PCMH implementation in 12 months (100 physicians+ certified to date)

• CMS Medicare Shared Savings Program ACO approved

• Multiple commercial payer ACO contracts

• Named one of Becker’s “100 ACOs to Know”

• Included in 29 MSSP ACOs achieving shared savings

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SERVICES “WayPoint accelerates our programs. Our PCMH was up and running in a

year. An ACO application could take 3 years, yet MHMD and WayPoint did it in

three months. Readiness assessment is vital. We couldn’t have done it without

WayPoint.”

Keith Fernandez, MD, MHMD President & Physician in Chief

“We value WayPoint’s frank assessments and one-on-one approach. They

haven’t been a single engagement for us but a valued on-going partnership.”

Chief Financial Officer, Regional Market Leading Health System



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STRENGTHEN STRATEGY

WayPoint strengthens each client’s strategy with a collaborative approach, combining qualitative and quantitative analysis to align incentives and improve performance. Successfully meeting today’s challenges requires integration strategies such as medical homes, population health, and clinical integration assessment and implementation.

We quickly identify key issues, focus on priorities and develop custom solutions within a shorter period of time. Our strategy services include: • Integration strategies

- ACO readiness assessment, design and implementation- Medicare Shared Savings Program participation- Population Health / Clinical Integration / Medical Home

• Market studies and financial projections• New facility and service line planning

IMPROVE CLINICAL PROCESS

WayPoint has deep experience across the hospital, physician and payer industry sectors. Clinical process improvement models that align incentives between the hospital system and physicians must be developed in order to reduce costs and maintain or improve quality.

We have successfully executed a wide range of population health, clinical integration and ACO initiatives that support the following: • Improve quality, efficiency and patient experience• Integrate the diverse skills and resources of physicians,

administrators and other clinicians• Effectively engage physician leadership• Respond to market-based transparency needs

STREAMLINE OPERATIONS

WayPoint has worked in nearly every operational area of hospital and physician organizations. We apply this experience provides to identify areas of opportunity, and then design, launch and support operations improvement programs that make more efficient use of resources and improve financial performance.

Operational review areas include: • Governance• Clinical service lines• Management services• Common and interoperative technology platforms• Alternate reimbursement and incentive model formats• Payer contracting relationships and opportunities

MAXIMIZE REVENUE AND PROFIT

Reimbursement model changes are fundamental drivers of healthcare transformation. End-to end rethinking of the healthcare organization is required in order to efficiency and quality.

We have worked with a wide range of organizations to maximize revenue and growth in areas such as: • Managed care contracting• Service line development• Incentive model design• Pre/Post Transactional integration• Revenue cycle management

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EXECUTIVE BRIEFINGS



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Success Factors of Clinical Integration

1. Historic ModelCare is fragmented by

service line and specialty. Siloed protocols and pathways with little

coordination.

4. BreakthroughPopulation management

including evidence-based medicine protocols, risk

stratification and disease management across

the continuumof care.

Payer/provider alignment and integration maximizes care quality and clinical process improvement.

Data shared demonstrates value, quality and clinical process improvement.

Provider integration is achieved with collaborative physician-led clinical process improvement.

CIN/ACO members engage with onboarding and navigation resources that clearly define services and how to access them.

Patients are engaged and supported with education, care coordination, expanded access and network navigation support.

Messaging is consistent from health benefit plan enrollment to the physician’s office.

Value-based economic incentives are developed to allow providers to share financial success.

Operating Principles

Evolving Integration Efforts

Clinical Process Improvem

ent

Governance

A local representative organization, inclusive of quality physicians and the hospital, responds to and manages the changing industry.

Support resources in place to ease administrative burdens and address barriers to small practice adoption and compliance.

Leadership is multi-specialty physician-driven with a strong

primary care foundation.

Evidence-based medicine protocols and quality

measurement goals are consistent in clinical

practices.

Care is coordinated with physicians, hospitals and

other care continuum providers outside of

primary care.

Clinical data reporting demonstrates quality and

clinical process improvement achievements.

Beneficiaries are engaged to improve compliance with

preventive care and chronic disease management.

Healthcare resource efficiencies through

standards consistentwith clinical quality

improvement objectives

2. TransitionalCare is coordinated across specialties and care sites.

Protocols and pathways continue to be based withina given setting of care such

as hospital or inpatient rehabilitation facility.

3. AdvancedSeamless transition in care between relevant

settings and specialties. Protocols and pathways are

based on service lines across providers instead

of a single settingof care.

Providers integrated across the continuum of care work

collaboratively in active clinical process improvement

to improve quality of care.

WayPointHC.com15

ACO Growth andEarly Positive Results

Reduced spending by 2.5%

57%

I N D U S T R Y

A C A D E M I C

Inpatient admissions reduced by 2.5%

57%

I N D U S T R Y

A C A D E M I C

31%

Improvements in population health

I N D U S T R Y

A C A D E M I C

31%

29%

Improved access

I N D U S T R Y

A C A D E M I C

31%

14%

Fewer emergency department visits

57%

I N D U S T R Y

A C A D E M I C

Readmissions reduced by 9.7%

I N D U S T R Y

A C A D E M I C

29%

13%

Increased preventive services

I N D U S T R Y

A C A D E M I C

31%

29%

Improved satisfaction

I N D U S T R Y

A C A D E M I C

23%

14%

Outpatient services increased by

13.2%

7.4%

reduction in potentially preventableinitial admissions

21% 23%of hospital and health systemsdo not plan to create or join an

ACO in the forseeable future

of hospital and health systems notyet part of an ACO plan to create

or join one by the end of this year

Rizzo, Ellie; “7 Latest Findings about ACOs,” Becker’s Hospital Review, January 15, 2014

Punke, Heather; “Early ACOs, Medical Homes Show Outcomes, Cost Improvements: Study, “ Becker’s Hospital Review, January 10, 2014

Punke, Heather; “5 things to know about the early Medicare ACOs,” Becker’s Hospital Review, January 8, 2014 WayPointHC.com

5 things to know about ACOs that joined the program before fall 2012:

Large, nonprofit teaching hospitals were the typical hospital participants

Little difference in performance on quality metrics between participating and nonparticipating hospitals

Hospital referral regions tended to have larger populations and more Medicare spending per beneficiary

Patients were more likely to be white, older than 80 years old with higher incomes than other Medicare beneficiaries

Patients had 5.8% lower total costs of care ($7,694) than patients not in an ACO ($8,164) at the baseline

61% 61%

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Clinical Integration and Process ImprovementNetwork physicians, hospitals, and other care continuum providers work collaboratively in active clinical process improvement programs across service lines and specialities to define, establish, implement, monitor, evaluate and periodically update the processes of:

A. Evidence-based medicine• Promote clinical practices consistent with evidence-based

medicine protocols and quality measurement goals. • Deploy locally adopted, nationally accepted, validated clinical

measures for performance, efficiency and patient experience.• Establish priorities consistent with evidence-based medicine

principles and potential clinical quality impact.• Apply principles across the ambulatory and inpatient

care continuum to include wellness, prevention, diseasemanagement and interventional clinical activities.

• Take into consideration unique local health needs,process limitations and resource limitations.

B. Beneficiary engagement• Identify unique health needs of the assigned population

through clinically integrated health information technology that identifies individual health risk factors and facilitates the application and management of appropriate disease management resources.

• Monitor gaps in care aimed to prevent adverse unintendedconsequences (including barriers to access, underutilization,overutilization for medically complex/difficult to treatpatients) and to improve patient compliance withpreventitive care and chronic diesase magangement.

• Train, educate and register members on patient access andinformational tools as applicable such as a patient portal,online scheduling, educational resources, wellness resources,e-prescribing, etc.

• Promote shared decision making around unique needs andvalues through defined, proactive visit planning and careplanning resources while communicating clinical informationand knowledge to patients and families.

• Maintain written patient clinical information access,communication and consumer safety policies.

C. Care coordination• Establish, maintain and monitor structured relationships with

physicians, hospitals and other care continuum providers outside of the primary care setting.

• Employ clinically integrated health information technologyresources to assist with clinical decision-making andperformance monitoring at the point-of-care for carecoordination and at the population and individual level forcoordinated and managed care transitions.

• As an extension of physician-led care teams, promote carecoordination through care coordination staff working underdefined care coordination standards (example: admissionguidelines, discharge summary guidelines, medicationreconciliation, rehabilitation protocols and post-acuteplacement guidelines).

D. Conservation of healthcare resources• Collectively assume accountability for quality, cost and

patient experience.• Monitor and control utilization of healthcare services that are

designed to benefit the consumer through controlling costsand assuring quality of care, resulting inimproved outcomes.

• In concert with protocols establish, maintain and monitorcompliance with clinical resources standards (ex: drugformulary standards and medical devicevendor standards).

E. Clinical data reporting• Establish and maintain transparent internal and external

reporting standards on quality, outcomes and cost metrics. • Monitor gaps in care and barriers to care.• Internally monitor progress against inpatient and outpatient

quality standards.• Through clinical data sharing and reporting, externally

demonstrate quality and clinical processimprovement achievements.

• Maintain balanced incentives that align incentives andreward demonstrated clinical process improvement aroundquality, efficiency and patient experience.

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Patient Engagement and the ACOGetting patients to actively participate in their health is key to the ACO’s success. Yet patient engagement is difficult as the conventional American thinking of “doctor knows best” has created an environment where the patient is a passive participant. Health benefit plan purchasers in particular are skeptical, and sometimes confused, about the ACO’s ability to engage, educate and motivate members to achieve compliance with disease management and wellness programs.

This points to a need to redefine what it means to be an “engaged” patient. It’s not just about making annual well check appointments; it’s a continuous focus on health promotion matched to individual needs over time across a variety of caregiver touch points. Communication and education efforts need to help the ACO patient navigate the provider network, access wellness resources and participate in disease management programs. These efforts should focus on making it easier for patients to utilize the system appropriately through proactive on-boarding and outreach.

Commercial ACOs are complex organizations that aggregate provider and payer resources to deliver a wide range of disease management, wellness programs and administrative support services to patients and employer groups. Overlap is common. To mitigate confusion, health plans and providers must intentionally develop unified procedures and educational materials that create a seamless experience for the patient from benefit plan enrollment to the physician’s office. To realize full health benefit potential, the physician-led care team must be knowledgeable about available disease management and wellness programs. Further, the physician must affirm and support the patient’s decision to participate.

Those ACOs who successfully streamline access to health and wellness programs, in concert with proactive physician-led teams, will achieve the best outcomes and derive significant competitive advantage. Given the size and complexity of many ACOs, “streamlining” can only be achieved by a sustained focus on the following fundamental process and service areas:

• Easy access and use by members• Clarity on services included• Clarity on who provides the service• Consistent messaging from enrollment to the

physician’s office• Reporting against expectations

The successful ACO will see its environment through the eyes of its patients and empower them to actively engage and maintain their health.

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Driving a Higher Level of Service and Results Through ACO Member OnboardingThe successful ACO will see its environment through the eyes of its patients and empower them to actively engage and maintain their health. Given the size and complexity of many ACOs, this first requires educating and motivating ACO members through proactive onboarding, outreach and navigation resources to manage relationship and value expectations.

Many consumers are skeptical of ACOs because they are largely unproven. This challenge can be countered by demonstrating a higher level of service and results through physician-driven outreach and proactive services. As a starting point, sustained focus should be given to the following process and service areas:

· Easy access and use by ACO members

· Clarity on care management services, including how and where to access services

· Emphasize the importance of activating a medical home relationship

· Consistent messaging across the ACO

· Reporting to demonstrate services and value

Consistent messaging from enrollment to the physician’s office is critical to managing beneficiary expectations and avoiding information overload. First, engage employers before open enrollment with marketing materials that demonstrate results, payer/provider integration, physician-led care teams and proactive member support. Begin setting patient expectations at open enrollment with educational materials. Then deliver on expectations by proactively onboarding ACO members with orientation materials and navigational resources that clearly define what services are available, how to access those services and activate the medical home relationship. Train, educate and register members on patient access and informational tools such as a patient portal, online scheduling, wellness programming and e-prescribing. A centralized Member Communication Center is recommended to ensure consistent messaging and easy access.

To reinforce consistent patient care and avoid conflicting care management information that may erode compliance, physician leadership should be coordinated around care programs:

· Clarify roles and hand-offs where duplication or multiple options exist with defined processes for transitions in care.

· Consolidate customer service and referral functions (such as call centers) where management resources are strongest.

· Remove barriers that make it difficult for the market to associate a service offering as being seamlessly delivered by the ACO.

And finally, report against expectations and demonstrate the ACOs services and value with a standardized reporting package that includes member experience surveys, clinical quality data, care management program enrollment and financial utilization data. Help consumers and employers connect the dots between care management programs and results.

WayPoint Healthcare Advisors has unique experience in providing solutions that align payers, physicians, hospitals and clinical services. We believe that ACO member onboarding is only the start of an ongoing process to achieve patient engagement. How the ACO successfully deploys patient engagement will be addressed in the June issue of WayPoint Coordinates.

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Build a Technology Roadmap for Your ACOThe pressure for data has never been higher. Despite always being at the center of many healthcare improvement initiatives, data has mostly told us about past activities: utilization patterns, cost per case, volume information, profit and loss, etc.

If you are operating an accountable care organization or considering alternative payment models, that type of data still provides useful information but the desired dataset has grown exponentially. Now we want to know things before they happen. I am reminded of a Tom Cruise movie from 2002, Minority Report. The story was based on a group of people referred to as “Pre-Cogs.” They would predict crimes before they happened so the police could arrest the person before the crime occurred. Today, technology is

racing towards a similar model where chronic conditions and episodic care are predicted using complex algorithms based on historical and concurrent clinical and demographic information. Conceptually, this sounds great but before your organization dives in with both feet, spend the time to craft a thoughtful technology plan or selection process that prioritizes necessary tools, required datasets and support services.

Planning and Organization Requirements Build Vendor Selection Implementation

Planning

Activities · Validate timing and

objectives · Identify Selection

Steering Committee · Identify business and

IT SMEs and schedule interviews

· Develop charter, as necessary

· Begin vendor research · Identify other

organizations with experience

· Identify internal evaluation team

· Identify project risks/barriers

Activities · Create current state

technology architecture · Create desired data flow · Document interface

needs and concerns · Define “must haves”/

basics · Build preliminary

requirements (technical and functional)

· Identify “lost functionality” from current custom applications

· Document prelim security issues

Activities: · Finalize vendor research · Send requirements for

initial response · Develop demo scripts · Develop evaluation

methodology · Review initial vendor

responses · Avoid “sales pitch” · Create vendor short list · Hold vendor demos/

visit reference sites · Consider vendor

development roadmap

Activities · Finalize vendor selection · Develop cost model · Develop implementation

plan · Develop communication

plan

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Current efforts among technology vendors to develop risk-based predictive models are fast and furious. Because of this, it is more important than ever to fully understand the vendor development roadmap and the dataset requirements to ensure everything works as the demonstration suggests. Integrating data has always been a challenge; however, the increasing desire to integrate concurrent clinical information from a physician’s electronic record has complicated the process even more. It may sound easy to pull in medications from the patient record but depending on how frequency and dosage is entered into an electronic system, this can be very difficult. Additionally, knowing whether the prescription is filled and the patient is taking the medication as prescribed is another factor that is optimal to know. This is just a single example of the many clinical data points that today’s applications require to make accurate risk assessments. Even if you figure out how to do this for one electronic medical record, another may raise completely different interface concerns. Many of the new EMRs are storing data in the cloud and possibly limiting your access to data. If you are in the middle of negotiating a new agreement, pay close attention to data access and ensure you will have access for a reasonable fee or no fee at all.

Most vendors have great demonstrations. Most don’t highlight weaknesses or real-world challenges to extracting and using data. This is a good time to be a skeptic and challenge the process. There are great tools to assist your organization in taking on risk or just dipping your toe into the value-based payment world. Just make sure you think about the following high level steps:

1. Form a selection team and follow a process.

2. Seek out those that may have blazed the trailbefore you.

3. Build realistic requirements and a vision for whatyou want to accomplish.

4. Challenge the demo and really explore data issuesand interfaces.

5. Develop a realistic timeframe and plan for interimsuccesses.

6. Understand the difference between current andplanned functionality.

7. Dedicate the right amount of resources to besuccessful.

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