structuring our network (insert network name and/or location)
TRANSCRIPT
Structuring Our Network(insert network name and/or location)
Nature of our networkExisting legal relationships among our network partners (contractor/subcontractor, partnership, MOU, … )•Verbal agreement to work together•Letters of support for ACL – MOU
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Nature of our networkNext step(s) to further develop the capability of our network:
•Mapping our service capacity•Advance work before December 6 meeting to show three alternative structures!•Geographic boundaries – member territories
– Legal advice may be needed for that
•Service lines– Packages, contributions of each to package – directly or through
subcontracts
•How money would flow?•Who wins individual contracts? How not to compete with each other?
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Our network as a community assetFeatures that appeal to our customers
• Language/culture• Location – meet them where they
are• Community settings of comfort • Flexibility• Reputation – excellence• Outreach/creating awareness• We listen to consumers• Supporting caregivers• Connectors to comprehensive
services in community
Features that appeal to contracting organizations
• We’re in the home• Experience • Geographic coverage• Multiple interventions• Wraparound and follow-on
services• Know the community &
resources• Language & culture
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Our network as a community assetThe next action(s) we will take to develop the image and influence of our network:•Board members•Joining boards and committees for healthcare orgs•Attending & presenting at healthcare conferences•Menu of services & business case statements•Educating healthcare about messaging to community•Educating community to message to healthcare
– What you said…what they heard
•Common IT•Collateral •Formal agreement and ability to enter into contracts together and separately, where appropriate
Organizational issues we need to address
• Structure – principles for collaboration– Coop-etition– Subcontracting
• Mission statement, goals, etc.• Credentialing standards – RFA• Quality management and uninviting members• Rapid learning, CQI• Consider need for TPA, MSO, fiscal agent – and who• IT, IT, IT
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Our network as a business enterpriseEntities that can bill for services
• All doing list-bills to CMS• AltaMed & Jewish Home bill
Medicare• All can bill case rate• Most do Medi-Cal billing• Private insurance for ADHC
Consider MSO/TPA – negotiate with existing entity for back-office support
Price for value & volumeAssets for capitation & cashflow
Entity/entities that can receive and distribute payment
• Anyone but public entities
Our network as a business enterpriseSpecial requirements we must meet to secure and deliver on a contract•HIPAA compliance plan & business associate agreement•Audit requirements operationalized for contractor’s standards
– Timeliness, turnaround, etc.
•Secure communications•Arrangement for referrals•Definitions•Quality tracking agreement – 2-way data/commitment•Face time to ground the intervention and operate it
Our network as a business enterprise
Action steps(s) we will take to strengthen the business capability of our network:•IT•Survey members for capacity along all of the dimensions above•Operationalize SharePoint - Ami
– Collaborative contact list, shared documents, surveys
•Get Capital! •One-stop-shop infrastructure•Business plan – cost to have a network office & infrastructure
– Dues?
•Branding – developing collateral
InsightsOur biggest insight(s) from Structuring Our Network is/are… •Finding where phase 1 is at and what next step should be
•Best practices are a way of pulling together our strengths•We have to prepare, work the relationships with healthcare•Healthcare partners have to understand their role in success
•A structure is needed to really get started – something official to move us beyond being just a collaborative•We need a service menu with pricing•Bundling /package of services for an array – e.g., fall prevention, safety – a la Waiver
•This is a great outline and very timely for us.•We’re building the plane as we’re flying it!!
Action Steps Next Month• Meeting on December 6 to begin to formalize• Standardization/defining our services– What are we offering?
• Keep reviewing IT systems• Survey members for capacity along all of the
dimensions above• Operationalize SharePoint - Ami– Collaborative contact list, shared documents, surveys
• Branding – developing collateral
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Parking Lot (Issues for later, additional questions for speakers)
• List here
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