Scalable Services for Sustained Success in Value-Based Care

Most physicians go into medicine to help patients, not to run a business. Yet the demands of running a successful practice — and a thriving medical group — are increasingly business focused. That’s why our services are designed to address those needs, so physicians can focus on patients. Our staff is completely dedicated to ensuring our physicians’ success. Our comprehensive services enable a strategic shift from a fee-for-service to a fee-for-value reimbursement model. The structure and extent of SHM’s administrative and corporate management services are discussed and developed with each potential client/partner or group, based on their specific needs. Below is a summary of the work we have done with Summit Medical Group, but not all of these services would be applicable to new partners.

Operations Management

SHM Operations Management begins with a thorough diagnostic assessment of a medical group from a patient-centric point of view. Then, we recommend how to best clinically integrate staff, technology, workflow standards, and real estate. This process involves off-site data collection and on-site visits from a team of experts.

SHM Operations Management begins with a thorough diagnostic assessment of a medical group from a patient-centric point of view. Then, we recommend how to best clinically integrate staff, technology, workflow standards, and real estate. This process involves off-site data collection and on-site visits from a team of experts. Our assessment focuses on a variety of areas:

  • Governance, including leadership structures and committees
  • Patient access, convenience of care, and increasing consumer demands
  • Care team availability and utilization, including scheduling protocols, office workflow standards, and physical space configurations
  • Use of Electronic Health Record (EHR) from point of entry to point of payment
  • Productivity and quality of staff and ancillary services
  • Practice performance dashboards and metrics compared to national benchmarkst
  • Clinical model, composition of practices, and potential need for consolidation or expansion

Once the assessment is completed, we work with the group’s physicians to prioritize recommended operational changes. SHM’s methodologies and leadership framework are very portable and scalable. Of course, each situation is unique and will require different recommendations in several key areas:

  • Staff performance and training – We work closely with you to establish the optimum staff ratios. We can also assist with recruiting, hiring, and training new staff members, and with performance and productivity evaluations.
  • Technology and supporting infrastructure – Our IT leadership team focuses on efficient use of practice management tools and electronic health records, including data integration with ancillary applications and external systems. We also evaluate telecommunications, including call center management and triage. We streamline processes to gain efficiencies and maximize revenue. The SHM IT team provides vendor management and best practices for our partners.
  • Systems and processes – A standardized approach to workflows is key to a well-run group. Depending on your needs, we can manage scheduling; onboarding; budget development and management; risk and compliance management; and business intelligence.
  • Strategic real estate development – Our goal is to maximize revenue per square foot. We evaluate everything about your offices, from the ground up, to identify economies of scale and scope, such as whether several single practices could be consolidated. If you’re looking to expand, we can advise you on the best methods for financing new space. Should you decide to build, we also assist with market analysis, real estate negotiations, renovation, design, and development. When consolidating several practices in one space makes sense, we can oversee that process as well.

 

Organizational Structure and Governance

We believe that medical care is optimized in a model that is physician-led and professionally managed. As a physician-led organization, we are uniquely positioned to help our partners set up an effective organizational structure with physicians at the helm.

We believe that medical care is optimized in a model that is physician-led and professionally managed. As a physician-led organization, we are uniquely positioned to help our partners set up an effective organizational structure with physicians at the helm.

Under SHM management, physicians continue to guide policy and have a voice. The owners of SHM are the physicians themselves. Our focus is on patient care, rather than on filling hospital beds or satisfying public shareholders. We recommend that medical groups adopt a dual leadership model consisting of physician leaders and management. This core leadership structure would typically include a Clinical Council, which brings together physician chiefs and administrative leaders in all core functions.

Leadership Development
We collaborate with our partners to help them work effectively within our leadership and governance structure. Physicians who want to be more involved in their group’s business and administrative structure are encouraged to form or join committees to take part in decision-making.

Decision-Making and Communication
Our approach to management is team based, and governance is provided by consensus. We typically integrate a clinical management team and an administrative team into the management group to train and initiate best practices.

The greatest strengths in our organization are how we lead through our governance structure, how we recruit physicians, integrate them into the medical group’s culture and create an ingrained culture that’s both stable and effective.
Jeffrey Le Benger, MD,
CEO/President, Summit Health Management and
Chairman/CEO, Summit Medical Group

Population Management

SHM has the expertise, infrastructure, services and track record you need to transition your practice to a clinical model that will successfully achieve value-based outcomes. For this care model to work, investments must be made to support high-risk and rising-risk patients.

SHM has the expertise, infrastructure, services and track record you need to transition your practice to a clinical model that will successfully achieve value-based outcomes. For this care model to work, investments must be made to support high-risk and rising-risk patients. SHM has invested over $50 million in population health management. Over the past four years, we have developed multiple programs that work together to allow medical groups to lower costs while simultaneously improving outcomes and patient experience. We offer services such as provider education and support, provider engagement, patient engagement strategies, quality management, business intelligence, and clinical informatics.

Care Management is Key
We work with partners to tailor the care management approach, using a risk stratification system that targets interventions based on the needs of your patient population. As is widely known, a medical group’s 5% sickest patients will generate 50% of the cost. In order to address potential health issues early and boost compliance, we have developed training and programs for nurses and social workers to prepare them to serve as complex care managers. They focus on areas where we can lower avoidable utilization, and improve patient outcomes. This typically applies to patients with multiple comorbidities, hospitalizations, and compliance issues. Care managers evaluate a patient’s social needs and support system, pill burden and use of high-risk medication, and health literacy. Interventions may involve educating the patient about their condition, scheduling a consult with a clinical pharmacist, referring them to community services and more.

Strategic Clinical Programs
Depending on the current size and needs of your group, we can help you launch and manage a host of strategic clinical programs to enhance care and reduce costs. In our experience with SMG, we successfully instituted a complex system of services over a decade or so.

 

Quality Reporting and Clinical Intelligence
In a value-based healthcare environment, it’s essential that providers have access to information to help them understand their performance and adjust their practices as needed. We have perfected methods for obtaining highly accurate quality reporting and clinical intelligence. And we can show you how to optimize the EHR so that it’s relevant at the point of care.

 

 

Our population health data repository unifies disparate internal and external data sources to provide a clear picture of your patient population. At the macro level, we make sure you keep track of things like how many patients are eligible for a particular quality measure. At the micro level, you will know who has, and has not, had a specific test or vaccine.

Physician Management

We believe the multispecialty group practice is the ideal setting for a physician in today’s practice environment. Of course, a practice is only as good as its physicians.

We believe the multispecialty group practice is the ideal setting for a physician in today’s practice environment. Of course, a practice is only as good as its physicians. In order to attract and retain the best physicians for a medical group, SHM advocates what’s right for the doctor and the patient:

  • Providing fair compensation within a value-based framework that promotes quality care
  • Giving physicians a voice in how the group is run
  • Fostering an environment that promotes a sustainable work-life balance
  • Reducing and simplifying administrative tasks to allow physicians to focus on patient care

Physician Compensation
We have developed compensation methodologies that provide primary care physicians with security, encourage appropriate productivity, and promote quality medical care. Set by the physicians who sit on our physician compensation committees, compensation is designed on a fee-for-value model. Compensation is determined consistently and transparently, in alignment with the strategic plans of a specific medical group.

SMH has developed a Unified Provider Incentive Program (UPIP), which gives physicians the opportunity to earn a bonus based on their individual performance on value-based metrics agreed upon by the payers and medical groups. Designed to incentivize providers to give the right care, UPIP has sophisticated metrics for bonusing. Physicians are assessed and bonused according to criteria such as utilization, quality, patient experience, timeliness and accuracy of record keeping, and reduction of drug spend.

Performance Dashboards
SHM has easy-to-use provider performance dashboards that include reporting on measures such as practice management, quality, utilization, capacity, RVUs – all of the things a group needs to monitor regularly. The dashboards are specific to a particular medical group, but individual physicians can drill down to see their individual data.

Recruitment and Retention
In expanding SMG to a group of 700+ providers, we have refined our recruitment capabilities and we bring that learning to our partners. SHM has a mechanism for sourcing the right candidates so we don’t waste a lot of our clinicians’ time interviewing people who won’t meet their needs. We have recruited across nearly every specialty and require candidates to visit a group twice and meet with a wide array of physicians and people. Because the fit has to be perfect, we make sure we know what both the practice and the prospect are looking for. As a result, very few of the candidates we extend an offer to turn us down. Our voluntary turnover rate is very low, and many of our physicians have been with us for one or two decades.

Credentialing
Our team has extensive experience in credentialing, and we can advise on best practices. With SMG, delegated credentialing helps expedite payment and reduces the incidence of charges being contested by payers. The SMG team is contracted and approved by payers to develop an in-house credentialing process that meets NCQA guidelines. There, the team has established policies and acquired the necessary in-house software to monitor, track and verify provider information. Depending on the agreement with a new partner, we can work toward administering the entire credentialing process or simply be the repository of each physician’s CV, license, diploma, and board certifications and package that information to the payer.

Revenue Management

SHM Revenue Cycle Management services cover advising on contracts, billing, getting claims out the door, and obtaining payment. We track the patient visit from scheduling to bill payment. Our registration, authorization, and the pre-service processes are centralized, enabling us to scale large volumes of patients and reduce turnaround time.

SHM Revenue Cycle Management services cover advising on contracts, billing, getting claims out the door, and obtaining payment. We track the patient visit from scheduling to bill payment. Our registration, authorization, and the pre-service processes are centralized, enabling us to scale large volumes of patients and reduce turnaround time.

Coding Compliance
Accurate coding is vital to the success of a medical practice. Not only does compliance assist in avoiding penalties and payer investigations, but accurate coding also has a direct benefit to the medical practice as it ensures that coding and documentation accurately reflect what occurs during patient visits. SHM is committed to coding compliance and has a suite of proprietary tools, along with a team of certified coders and auditors who monitor patient records for compliance, and provide personalized coding training to physicians based on their particular specialty and practice patterns. We perform bell-curve analysis to show patterns of physician behavior as compared to other physicians in the practice and to peers outside the group.

Regulatory Change Management
With our vast experience in the healthcare industry, we recognize that the regulatory landscape is constantly evolving. These changes, which include an increasing number of rules, guidelines and restrictions on physicians’ practice of medicine, can be overwhelming to even the most sophisticated of physicians. We constantly monitor these regulatory changes on a federal, state and local level. Given SHM’s connection to so many physicians, we use our strength in numbers to offer a voice to physicians to weigh in on important legal and regulatory matters. We work with practices under our management to identify key individuals who can work with regulators directly. Once regulatory changes are made, we are able to quickly mobilize to make necessary changes to ensure compliance with the changing regulatory landscape.