Issue link: https://beckershealthcare.uberflip.com/i/856453
82 Executive Roundtable About Conifer Health Solutions Conifer Health Solutions brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide to help strengthen their financial and clinical performance. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Annually, the company manages more than 24 million unique patient interactions, more than $29 billion in net patient revenue and more than $22 billion in medically managed spend. Conifer Health also provides technology and health management services to support care management for nearly 6 million lives. For more information, visit ConiferHealth.com or follow @ConiferHealth on Twitter. Q: How do you work with your broader organization to ad- dress and manage leakage within the system? AE: Hospital leaders need to compile, monitor and track physi- cian volume by type of service and payer. One of the key man- agement philosophies that I adhere to is that "you can't man- age what you can't measure." If leakage is identified, hospital leadership needs to be actively involved in meeting with the physicians to understand why the leakage occurred and what steps, if any, leadership can take in conjunction with the physi- cians to eliminate the leakage. SF: We try to measure leakage the best that we can to under- stand who is being diverted out of network. That information can be difficult to get. The most direct way is to look at your own patient population where you have full capitation, at-risk lives. We look at the reasons why they're being diverted and then try to have a customized solution around each of the root causes. There's nothing easy about it, and it requires diligence. TH: Honestly, this is an area of opportunity that we just started to focus on for our health system. The first step in the process is to analyze existing physician referral patterns at a service level to identify where leakage is occurring. While acknowledging it is a challenge to change existing referral patterns, sharing this information with the physicians and identifying the reason for leakage is an important next step. Organizations may succeed in keeping more patients in the system if we can show the phy- sician that we can eliminate any operational barriers, provide them with a more efficient workplace, and provide higher qual- ity and a better patient experience than our competitors. Q: What role does the CFO play in contributing to strategic decisions around broadening integrated delivery networks and/or entering value-based reimbursement models? AE: The role of the CFO has changed over the years; from simply managing and accurately accounting for the financial resources of an organization to more of a strategist involved in proactively identifying growth and new revenue opportuni- ties. Once new opportunities are identified, the CFO is critical in scoring the impact of the new initiatives and more importantly is best positioned within the organization to understand the rip- ple effect these decisions will have on the organization's financ- es. I've always felt that the CFO has dual roles. On one hand, the CFO needs to ensure that the finances of the organization run smoothly, [accounts receivable] is collected, employees get paid, vendor payments are processed, etc., yet they also need to constantly think of ways to innovate and be thought leaders in identifying new sources of growth and revenue for their or- ganizations. SF: The CFO needs to focus on what it means to be an inte- grated delivery network. In the '90s, when risk became a pop- ular topic, many organizations didn't pay attention and were damaged as a result. Now the reimbursement models are more complicated. This requires very sophisticated modeling and the financial aspects of the organization to be tuned into the risk and rewards of the models. TH: While it is still very important for the CFO to have efficient and effective financial operations, the role of today's CFO is evolving as the leader for business operations, performance improvement, and strategic growth. This is particularly import- ant in a healthcare industry experiencing constant regulatory change and consolidation. As the strategic advisor to the CEO, the CFO must be focused on growing market share organically and through M&A activities as well as increasing the number of covered lives managed through its clinically integrated network or accountable care organization. Q: What are the biggest disrupters in the healthcare indus- try that you feel are here to stay? AE: The increasing role that managed care organizations will have with Medicaid and Medicare cannot be underestimated in terms of the additional requirements imposed on healthcare systems. But, while we are familiar with those requirements, there are other disrupters that many other systems have not yet embraced. For example, the use of technology and smart phones for access, scheduling, follow up, prescription refills and bill paying seems to expand every day. At a recent confer- ence that I attended, I saw a dozen different vendors offering apps that will integrate with EMR systems and allow patients the friendly access they are used to seeing from their banks. This will raise the service level that patients expect to receive from their providers. Healthcare systems will need to find a way to cater to these increased demands to attract customers. SF: I think disrupters continue to be smaller more retail-orient- ed organizations like ASCs, urgent care centers and radiology centers. Those organizations have for a very long time been able to take away business from larger organizations because of their convenience and ability to provide a quality service quicker and at a lower cost. They're also attractive to insurance companies. Those will continue to be disrupters in the industry. I don't see them going anywhere. TH: The continuous attempts by federal and state governments to reform the healthcare provider and insurance industry seg- ments to improve quality and lower costs.n