Case Studies

Facilitation of Health System Board Retreat focusing on Medicare Advantage

HES Advisors was engaged to lead a three-day Executive Board Retreat for a New England based, multi-hospital health system. The engagement included the development of the agenda and working directly with the system's CEO in the preparation of pre-Retreat reading materials as well as identification and coordination of guest speakers. The retreat objectives were defined as:

  • Raising awareness of the changing Medicare landscape and the probable impact for health care providers
  • Identifying the challenges and opportunities the System needs to consider in risk-sharing arrangements
  • Identifying Strategic Objectives to employ in evaluating opportunities
  • Identifying potential follow up activities for Board Committees' Work plans in 2017

In order to meet the retreat objectives, a thoughtful approach to developing the agenda ensued. HES Advisors collaborated with the CEO in the preparation of presentation materials used by the CEO to kick-off the meeting and level-set the agenda and objectives. A principal of HES Advisors served as a keynote speaker and presented an Environmental Assessment including the trends and implications for providers in the local and national market.

HES Advisors, through its professional relationships, coordinated presentations by thought leaders in various disciplines including experts in Medicare, actuarial, provider and payer arenas. HES Advisors guided a dynamic planning session with the Board utilizing discussion groups and facilitated conversation. The retreat was deemed successful by all participants and the conclusions reached at the retreat led to the formation of a Board Task Force to oversee the development of the System's Medicare Strategy.


Development of Multi-System Alliance

HES Advisors was engaged by a group of five like-minded, high-quality, low-cost hospital systems that desired to form a geographically dispersed network to pursue collaborative activities. The network contemplated how they could cooperate to achieve the goals of the Triple Aim:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

HES Advisors led the Alliance through four key phases: Foundational Development, Organization and Business Plan Design, Formation, and Operations. Through each phase, HES Advisors worked with each System's executive teams and through a Committee structure to identify key steps, perform relevant analyses and engage advisors and attorneys as needed.

The Alliance initially provided a format for the identification and development of synergistic opportunities for reducing each member's operating costs where economies of scale could be achieved in targeted clinical and non-clinical areas. Additionally, a key objective of the Alliance was to identify best practices among Alliance members to enhance each Alliance member's efficiency, cost and quality position for population health management initiatives. Finally, the Alliance identified the potential for innovative payer contracting arrangements.

The Alliance has been extremely successful in shared services initiatives, with a return on investment of approximately $8 returned for every $1 spent. Likewise, payer contracting efforts have resulted in accountable care payments and shared savings. HES Advisors has transitioned Alliance operations to a CEO and dedicated staff. HES Advisors continues to serve as strategy consultant to the Board of the Alliance and to support the CEO in implementing key aspects of the strategy.


Population Management Initiative Design and Implementation

Phase 1:  HES Advisors worked with its client, a major East coast based Academic Medical Center, to re-design its population management initiative serving the uninsured and homeless within its market.  HES Advisors was asked to assess whether the care management model that the Medical Center was looking at implementing would be able to address the Medical Center’s dual goals of increasing access to care for those in most need while reducing the unit cost of providing that care.  Additionally, HES was asked  to develop the resource requirements and cost savings estimates of implementing such a model. 

HES consultants formed a close team relationship with members of the Program Unit focused on revamping the Population Management Initiative (PMI).  HES Advisors led the Team’s thorough assessment of the environment in which the care management model would be working as well as analyses of the resources available to operate the model and a review of the patient population to be managed.  HES Advisors made several recommendations to enhance the care management model.  The major recommendations included the specific design and application of a risk stratification methodology to ensure that the Program’s limited resources could be applied to the largest volume of high cost and most complex patients to obtain the cost containment goals.  HES Advisors also made several operational recommendations to enhance the workflow within the Program.  HES Advisors recommendations were contained within a business plan that defined the model, the resources and the cost savings that could be expected if implemented successfully. 

Phase 2:  After a hiatus of 3 months, HES Advisors was engaged again to assist Program Management in the implementation of the model.  As a result of changes in the resources available to operate the Program as originally designed, HES Advisors recommended additional refinements to the risk stratification model and to the care management staffing model to increase administrative efficiency and to better focus on identifying impactable patients.   HES also provided recommendations regarding  the integration of the care management model within two designated PCMH’s – one for complex patients with no behavioral health involvement and one for patients with significant behavioral health involvement.  HES Advisors also designed  a Physician Pay for Performance (P4P) approach that could be integrated into the Population Management approach allowing for incentives to participating physicians for enhanced engagement with the Program, improved quality and reduced costs.   HES Advisors developed an interactive model for the Program that could provide insight to cost savings and impact to physicians through scenario development. HES Advisors then provided the client with detailed data and analysis, identifying specific areas to target cost savings as well as studies of the cost effectiveness of the physician network.  Reporting templates were developed to provide cost and utilization data compared to benchmarks to the physician community as well as detailed medical cost performance reports for internal management purposes.  HES Advisors worked with the Program Management to document the workflows for several key care management and enrollment processes and to provide further documentation of the programs key attributes. HES Advisors has provided the client with series of concrete initiatives that going forward can result in cost savings as well as provide increase access to care for those in most need. 


Strategic Roadmap for the Development of an Integrated System of Care

HES Advisors was engaged to assist a Midwest based, 500-bed community hospital in the development of a strategic roadmap towards becoming an Integrated Health System.  The Integrated Health System was to include ownership and management of a health plan.  Two significant questions on the mind of Senior Management  and the Board of Trustees concerned how profitability and market share for the Health System could be enhanced and how the current assets of the Health System might be deployed as the Integrated Health System would take on more and more risk for the populations it served. 

HES Advisors conducted an environmental assessment to determine the System’s overall market position and key success factors required for operating as an Integrated Health System.  Additionally, HES performed a comprehensive gap analysis to determine to what extent the Health System’s current assets would need to be enhanced to operate successfully as an Integrated Health System.  Detailed financial proformas were developed to model the impact on the Health System’s profitability and market share. 

With this foundation, HES defined the sequential steps necessary to assume financial risk and manage the cost of care and quality for a population.  A tactical 5-Point plan was recommended for the hospital to maximize revenue and profitability while gradually expanding risk positions needed to operate as an IHS.  Hospital leadership has incorporated the detailed roadmap into its strategic plan to guide its progression towards an Integrated Health System.

Acquisition Support for UK-based Private Equity Firm
Our Client sought to make a significant investment in the US health care industry, focusing on the delivery of technology and services to commercial and government health plans. We assisted in the evaluation of alternative strategies to enter the health plan market, and provided support in the evaluation, negotiation and execution of an acquisition that resulted in the privatization of a $1.4B market cap technology enterprise. We assisted in identifying and delivering financing and strategic partners, and conducting due diligence on the technology platform and market opportunities of the target company. In conjunction with Bain Consulting, we participated in over 40 customer interviews, developed white papers on emerging technologies, and assisted in lining up credit facilities for leveraged portion of purchase. Our work continues in assisting in the investigation of follow-on acquisitions and business development opportunities.

Strategic Alternatives for a Publicly-Traded Healthcare Staffing Enterprise
HES Advisors assisted a nationally-focused, mid-sized healthcare staffing company to identify and determine the best strategic alternatives for improving shareholder value within its Healthcare Division. Under a tight 60-day deadline, HES worked collaboratively with a partner to assess synergies between the Company’s Healthcare and Government contracting divisions. We successfully reviewed the Company’s operations, evaluated the Division against key performance indicators and industry benchmarks, determined its competitive strengths and weaknesses, and assessed key market dynamics that would impact the Division’s ability to achieve future success. With this information as a foundation for decision making, we framed the opportunity for the Division to improve its market position, and identified the investment value and changes that would be required in management focus, sales/marketing, organization and operations in order to seize the opportunity. We concluded with an assessment of the Company's ability to be successful in achieving the desired outcome within timeframe established by the Strategic Planning Committee of the Board of Directors. We facilitated the Board’s deliberation as it determined the most desirable strategic alternative.

Market Growth and Product Diversification Strategy for EU-based Global Publisher
Our Client, a global information services and publishing company with operations in 35+ countries, sought to enhance the revenue growth and product mix of one of its health information divisions. We successfully provided strategic planning, an acquisition roadmap, due diligence and advice on business development and partnership opportunities.

Financial Enhancement Plan for a Growing Health Plan
Our Client required assistance in design and execution of a financial turnaround plan. We provided intensive assistance with staff on the ground for six months. We analyzed the root causes for significant financial losses that were incurred, including analysis of medical costs, operations, and revenue challenges. Upon identification of ten areas of specific impact, we developed and executed a Financial Enhancement plan that included Medical claim and PBM audits, re-contracting of hospitals, physician fee-schedule adjustments and significant medical payment policy adjustments. A Balanced Scorecard performance management system was introduced, as well as a business intelligence system for detailed metrics for operational reporting and analysis. Our Client achieved successful turnaround in first year, with significant margin expansion forecasted.

Series A Financing for Growth Stage Healthcare Data Mining Firm
HES principals assisted a leading privately-held clinical data mining and information services company build its initial business prospectus and strategy for achieving a successful Series A venture financing.

Product Positioning and Business Development Campaign for an Early Stage Maker of Consumer Health Portals
Our Client offers a consumer care management toolkit to third party payors and sought effective entry to the healthplan market, including product development and market acceptance. The team of HES Advisors provided input into positioning and product design strategy, and assisted in exposure of the Client’s toolkit to multiple payers through interactive Roundtable sessions held across the country (Las Vegas, Orlando, Washington DC). Our consultants conducted surveys of health plan executives to identify their needs in engaging health plan members in their own health care, and provided input to the marketing and sales efforts of our Client to achieve national exposure and momentum in the offerings to the health plan market.

Care Management and Medical Cost Control Strategy for State Government
HES principals led an interdisciplinary team of actuaries, policy specialists, data analysts and procurement specialists in assisting a USD$2B government-operated Medicaid health plan in developing a new Care Management program and medical cost control methodologies.

Business Development and Commercialization for Worker's Compensation technology startup
A technology startup in the worker's compensation field engaged HES principals to assist in development of a sales and marketing strategy; implementation of its first customer pilot; identification of new product opportunities; and general management assistance. This six-month engagement led to the successful development of a sales pipeline, marketing collateral and business relationships for the company with several new customer prospects.

Merger Facilitation in Revenue Management Industry
Our team was engaged by two provider-owned collection entities to facilitate the exploration of a combination of the two companies. The engagement was developed in a phased manner to allow for the parties to get to know each other as well as to view the opportunities and challenges of a combined business. We were able through our approach to test the value the owners perceived of a combination; identify the criteria for structuring the arrangement and to model the economics of the combined companies as well as to suggest a legal structure through which each agency's respective owners could maximize their equity investment.

Physician Demand Analysis and Medical Staff Development Plan for Community Hospital
For a mid-sized community hospital, we conducted a physician demand analysis that led to the validation of physician recruitment needs and the acceptance of a medical staff development plan by the Hospital's Board and Medical Staff. The unique methodology took into account not only changing community demographics and current medical staff demographics but also integrated, known productivity factors of physicians by age and sex. It also included feedback from physicians and other key stakeholders regarding expected biomedical advances and physician retirement plans. The plan now serves as the framework the hospital uses to adapt as the marketplace changes. The plan helps to ensure that the hospital's physician recruitment strategy is aligned with the organization's overall business strategy and is defensible to challenges by outside parties.

Medical Group Practice Development & Launch
We were engaged by a group of physicians to identify a group practice model that would result in a managed care competitive multi-specialty medical group. We evaluated and took inventory of potential group partners. Together with legal counsel we designed the method for merging the various practices into the group practice chosen model, e.g. developing the corporate and governance structure, management model and necessary legal documents. We developed comprehensive business, marketing and financing plans and managed the start-up of the newly formed group, e.g. forming the management services company, obtaining start-up financing, and hiring the CEO. We continued to serve as an advisor to the medical group's Board and CEO.

Business Divestiture and Re-Positioning
Our team was asked by a Midwestern based PHO with 18,000 risk lives to identify the cause of its declining financial position and to recommend strategies to secure its future. Following a 30-day financial and operational review, which included on-site interviews, audit of controls and policies and procedures in claims payment and medical management processes and development of the PHO's first actuarial analysis; we determined the multiple factors causing the financial decline and recommended three alternative strategies. Our preferred recommendation was for the PHO to exit the risk contracting business and re-position for non-risk PPO contracts. Following Board approval of our recommendation we worked with counsel to develop the PHO's liquidation plan and were actively involved in the liquidation of the PHO providing ongoing claims oversight and payer negotiation strategies as the business unwound.

Board and Management Retreat/Meeting Facilitation
We have designed and facilitated strategic planning and issue-specific retreats for organizations that have included medical groups, academic medical center senior level management teams and their direct reports, as well as Boards of Directors of hospital and healthcare related companies. Our approach is organized to deliver custom tailored events, and management of all content related activities for the retreats. Retreats range from half-day sessions to several days depending on client preference. We design, manage and evaluate retreat sessions to give clients the results they need to expect.

Integration of Two Faculty Practice Plans
We were engaged by three separate parties, an academic medical center, a specialty hospital and a faculty practice plan, to assist in analyzing the feasibility of integrating two faculties into a single faculty practice plan. The process we used sought first to gain commitment to a mutual set of goals and desired outcomes recognizing the different values placed on the integration by each party. Once commitment to the goals and desired outcome was obtained we set about developing the organization and economic models that could lead to a successful integration of the practices.

Business Assessment and Strategy Development for Multi-state Healthcare Provider
HES principals were engaged by a large multi-state healthcare organization to develop a strategic plan, stipulated as part of the merger agreement of two organizations that came together to form the new integrated contracting entity. Our process included the management of the planning process at both the Planning Committee and Board level and solicitation of a broad base of membership input. Following the development of an environmental assessment and development of a consensus view of the core mission of the organization, we assisted the Planning Committee in the development of a Vision and Values Statement as well as the identification of strategic goals, success measures and tactics for strategy execution. The Board and membership unanimously accepted the Plan and the entity is in the process of implementing the second phase of strategic tactics.

New Revenue Model for a Trade Association
HES principals conducted a strategic assessment of a hospital trade association's data repository. Our goal was the development of a business plan that would increase the value of the repository to member and non-member customers and create a recurring revenue stream for the entity. Our process included conducting an analysis of current products, services and workflow; identifying customer data and information needs and expectations; benchmarking of competitors products and pricing; a technology review; the development of business requirements on a go-forward basis and the operational, human and financial requirements for success. We provided internal management with a road map outlining the specific steps to be followed for implementation success and coached staff as needed during the execution phase.

Purchasing Collective Feasibility Study
We conducted an operational assessment of a for-profit group purchasing subsidiary of a hospital trade organization. We conducted an environmental assessment, interviewed key customers and reviewed industry benchmarks to determine core competencies. Based on this we defined critical success factors and recommended alternative scenarios for improved positioning and profitability.