Strategy, Value-Based Care & Cost Reduction

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class="page-template-services"> <section id="single-service-hero" class="hero services-hero"> <div class="custom-container"> <div class="left-content"> <h6> Services </h6> <h1 class="h1 hero-title"> Strategy, Value-Based Care & Cost Reduction<span>.</span> </h1> <div class="hero-content"> <p>Pinnacle’s strategy team is a recognized leader in healthcare policies, operations, cost reduction, and transitional leadership services. We partner with healthcare organizations nationwide including hospitals, medical groups, and ambulatory surgery centers (ASCs) to develop effective and proven healthcare strategies for long-term performance, growth, and sustainability. Because of the ever-evolving market for healthcare services, organizations often struggle to remain competitive. Developing effective strategies, aligning with physicians, and perfecting operational efficiencies are critical elements to facilitating the success of healthcare providers. Pinnacle specializes in helping healthcare organizations address these and other complex challenges. Our team helps clients to create sustainable business strategies that achieve and sustain robust clinical, operational, and financial results. From promoting physician engagement to eliminating unnecessary supply chain spending, Pinnacle partners with clients to devise effective solutions.</p> </div> </div> <div class="right-content"> <img src="https://askphc.com/wp-content/uploads/2024/06/shutterstock_2357193485.jpg" class="attachment-large size-large wp-post-image" alt="Pinnacle team members discussing Strategy, Value-Based Care & Cost Reduction" decoding="async" fetchpriority="high" srcset="https://askphc.com/wp-content/uploads/2024/06/shutterstock_2357193485.jpg 918w, https://askphc.com/wp-content/uploads/2024/06/shutterstock_2357193485-300x200.jpg 300w, https://askphc.com/wp-content/uploads/2024/06/shutterstock_2357193485-768x512.jpg 768w, https://askphc.com/wp-content/uploads/2024/06/shutterstock_2357193485-150x100.jpg 150w" sizes="(max-width: 918px) 100vw, 918px" /> </div> </div> </section> <section id="single-service-content" class="page-section "> <div class="container-fluid"> <div class="row justify-content-center"> <div class="col-lg-3 col-md-12 p-0 "> <div class="sidebar"> <h3 class="sidebar-title"> Pinnacle Provides: </h3> <ul class="services-list"> <li class="sidebar-item"> <a class="" href="#pinnacle_provides-01"> Physician Alignment </a> </li> <li class="sidebar-item"> <a class="" href="#pinnacle_provides-02"> Service Line & Strategic Planning </a> </li> <li class="sidebar-item"> <a class="" href="#pinnacle_provides-03"> Physician Enterprise Operational & Financial Assessment </a> </li> <li class="sidebar-item"> <a class="" href="#pinnacle_provides-04"> ACO & Value-Based Care Solutions </a> </li> <li class="sidebar-item"> <a class="" href="#pinnacle_provides-05"> ASC Development & Management </a> </li> <li class="sidebar-item"> <a class="" href="#pinnacle_provides-06"> Physician Preference Cost Reduction </a> </li> <li class="sidebar-item"> <a class="" href="#pinnacle_provides-07"> Transitional & Interim Leadership </a> </li> </ul> </div> </div> <div class="col-lg-9 col-md-12 "> <div class="content-column"> <div class="list-item"> <h2 class="white-with-dots" id="pinnacle_provides-01"> Physician Alignment </h2> <p><h3>Overview</h3> <p>Pinnacle regularly assists our clients with enhancing physician alignment, whether through transactional support, mergers and acquisitions, or other operational structures. A variety of factors impact physician alignment, ranging from organizational culture to market dynamics and reimbursement. Given the ever-changing healthcare environment, even small changes in Medicare policy can have dramatic implications for healthcare organizations – both operationally and financially. Pinnacle’s team reviews these changes daily to provide clients with impact analysis and strategic recommendations for responding to updates in the Medicare fee schedule, work relative value units, or other CMS policies and regulations. Likewise, as our clients consider a transaction, we assist with the critical step of evaluating potential impacts to revenue. While many organizations are precluded from reviewing payor rates for other entities due to anti-trust or confidentiality concerns, Pinnacle acts as an independent third party who understands payor contracts and their implications. Because of this understanding, we can provide clients with meaningful analysis comparing historical and forecasted metrics such as volumes and reimbursement. These types of analyses and our extensive experience with physician alignment enable Pinnacle to provide excellent service to our clients in support of their arrangements.</p> <p><img decoding="async" width="952" height="410" class="aligncenter size-full wp-image-237" src="https://askphc.com/wp-content/uploads/2024/06/shutterstock_701020606.jpg" alt="" srcset="https://askphc.com/wp-content/uploads/2024/06/shutterstock_701020606.jpg 952w, https://askphc.com/wp-content/uploads/2024/06/shutterstock_701020606-300x129.jpg 300w, https://askphc.com/wp-content/uploads/2024/06/shutterstock_701020606-768x331.jpg 768w, https://askphc.com/wp-content/uploads/2024/06/shutterstock_701020606-232x100.jpg 232w" sizes="(max-width: 952px) 100vw, 952px" /></p> <h3>Example Projects</h3> <p>Pinnacle’s team of experts lend support to clients across a spectrum of issues associated with physician alignment. From the planning phase to assessing key changes in real time, our professionals work closely with healthcare organizations to meet key objectives. This area of work can involve a variety of factors and settings, including:</p> <ul> <li>The process involved with provider arrangements <ul> <li>Development</li> <li>Negotiation</li> <li>Implementation</li> </ul> </li> <li>Employment agreements</li> <li>Professional services agreements</li> <li>Hospital quality and efficiency programs</li> <li>Joint ventures</li> <li>Co-management agreements</li> <li>Foundation models</li> <li>Mergers & acquisitions</li> <li>Compensation guarantees and subsidies</li> <li>Value-based organizations & ACOs</li> <li>Cost savings arrangements</li> <li>Development of tailored objectives <ul> <li>Clinical integration</li> <li>Patient satisfaction</li> <li>Quality metrics</li> </ul> </li> <li>Impact analysis</li> <li>Reimbursement (black box pricing) analysis</li> </ul> </p> </div> <div class="list-item"> <h2 class="white-with-dots" id="pinnacle_provides-02"> Service Line & Strategic Planning </h2> <p><h3>Overview</h3> <p>Pinnacle provides valuable insights and expertise in evaluating the clinical, structural, governance, and business requirements of our client’s various service lines. Given factors such as ongoing changes to reimbursement and the industry’s focus on cost and quality, healthcare organizations are under tremendous pressure to operate service lines that are both highly competitive and efficient. From provider engagement to procurement protocols, our experience helps our clients to achieve their service line objectives both financially and operationally. This insight extends to high-profile services lines. These service lines are highly competitive and often include cardiovascular care, neurosciences, oncology, nephrology, and orthopedics. Because revenue for these services is a critical factor to many organizations’ success, careful planning and management is warranted. Our team works with numerous types of clients and across multiple provider specialties to develop and sustain effective and efficient service delivery.</p> <h3>Example Projects</h3> <p>Pinnacle supports our clients across the numerous facets associated with service line planning and management. These subject areas often include:</p> <ul> <li>Market and service area assessment</li> <li>Contract renegotiation or renewal</li> <li>Competitor analysis</li> <li>Service line improvement and expansion</li> <li>Service line development creation</li> <li>Centers of excellence</li> <li>Benchmarking assessment</li> <li>Feasibility studies</li> <li>Staffing review</li> <li>Compensation planning</li> <li>Volume and reimbursement assessment</li> <li>Expense and profit margin analysis</li> <li>Management fee review</li> <li>Quality metric selection and review</li> <li>Contract evaluation</li> <li>Protocol, procurement, and procedure review</li> </ul> </p> </div> <div class="list-item"> <h2 class="white-with-dots" id="pinnacle_provides-03"> Physician Enterprise Operational & Financial Assessment </h2> <p><h3>Overview</h3> <p>Pinnacle’s physician enterprise team engages in the full spectrum of client support beyond simply medical practice advisory services. We assist clients with developing and maintaining an efficient medical practice with high-level performance in a complex operating environment. Pinnacle’s experienced professionals provide operational, administrative, and managerial leadership to physician enterprises which allows them to leverage our depth and breadth of industry knowledge and experience. At the same time, these clients can simultaneously promote an environment focused on the delivery of high-value clinical care through superior operational performance. Likewise, our medical practice advisory team can set up, assess, or provide ongoing or transitional practice management services. These services can range from the development of a practice plan to providing fractional leadership to a practice to guide through a transition or to serve as a long-term practice leader. Regardless of our role, Pinnacle’s ultimate goals in working with our physician enterprise clients are to improve care, mitigate risk, and optimize revenue.</p> <h3>Example Projects</h3> <p>Pinnacle works with our clients to tailor the depth of our integration to meet the specific needs of each organization. The level of engagement ranges from high-level and supervisory services to the on-site placement of an administrator who can manage all aspects of our clients’ operations. By working with our clients in this manner, we allow them to access expert advisory and leadership resources on a short-term or ongoing basis. The types of support our team provides include:</p> <ul> <li>Interim to ongoing medical practice administration</li> <li>Interim to ongoing medical practice management</li> <li>Medical practice assessments</li> <li>Medical practice leadership coaching</li> <li>Coding & revenue cycle assessment and optimization</li> <li>Provider & staff coding education</li> <li>Information system assessment and coordination</li> </ul> </p> </div> <div class="list-item"> <h2 class="white-with-dots" id="pinnacle_provides-04"> ACO & Value-Based Care Solutions </h2> <p><h3>Overview</h3> <p>Pinnacle understands that achieving success in the healthcare industry begins with a deep understanding of the rules and an eye on the ever-emerging opportunities from Medicare’s value-based care programs. To help our clients navigate this dynamic environment, Pinnacle evaluates all the models, identifying opportunities and mitigating risks thus enhancing their client’s value-based care strategy. Whether it is preparing the applications for the various program, supporting organizational structure development or ACO leadership, Pinnacle is there for you. Now more than ever, your success in the value-based care industry relies heavily on selecting the correct plan or plans amongst Medicare, Medicaid, the Commercial Carriers and Advantage Plans and beyond. Pinnacle’s VBC team navigates their clients through the rapidly changing industry complexities by evaluating client makeup, developing comprehensive strategies, executing them, and continually evaluating and adjusting them to bring our client’s vision to life. Our VBC clients range from healthcare providers to VBC entities looking for best practices and process improvement to health systems, health plans and healthcare service organizations exploring risk-based programs or looking for growth opportunities in new markets. Pinnacle, with their expansive healthcare knowledge base, advanced predictive modeling, and leadership with proven repeatable success, wants to help you evaluate, select, and implement the right value-based care program(s) for your organization.</p> <h3>Example Projects</h3> <p>Pinnacle’s VBC team skillfully engages stakeholders and implementation teams through project development, strategic roadmaps, and program execution. Top performing healthcare organizations work with Pinnacle on various VBC initiatives, including:</p> <ul> <li>Value-based entity strategic planning and execution</li> <li>Value-based care contracts and negotiation</li> <li>Health policy interpretation</li> <li>Value-based care analytics and platform solutions</li> <li>ACO program and operations management</li> <li>ACO applications</li> <li>Value-based care positioning</li> <li>Go-to-market strategies for products & platforms</li> </ul> </p> </div> <div class="list-item"> <h2 class="white-with-dots" id="pinnacle_provides-05"> ASC Development & Management </h2> <p><h3>Overview</h3> <p>Pinnacle assists clients including medical groups and hospitals by developing, syndicating, and managing ambulatory surgery centers (ASCs). Our team understands that ASCs often offer certain benefits over inpatient surgery, including lower costs, consistent quality and efficiency, more predictable scheduling, and high patient satisfaction. Our ASC clients include single-specialty ASCs, multi-specialty ASCs, single-owner ASCs, and multi-equity partner organizations. In addition, Pinnacle also engages in models that include participation in equity or that are limited to management fee only structures. We recognize that the steady growth in the ASC market continues to transform healthcare delivery given certain advantages they afford both providers and patients.</p> <h3>Example Projects</h3> <p>As the industry continues to produce innovations in care delivery, Pinnacle’s strategy team assists ASC clients in several contexts:</p> <ul> <li>Market analysis</li> <li>Facility design and patient flow</li> <li>Strategic and competitive analysis</li> <li>Proforma development</li> <li>Services & specialty recommendations</li> <li>IT and equipment selection</li> <li>Imaging resources</li> <li>Outpatient network development</li> <li>Regulatory assistance</li> <li>Syndication</li> <li>Oversight of management and personnel</li> <li>Revenue cycle support</li> <li>Supply chain & product selection</li> <li>Payor negotiation</li> <li>ROI monitoring and reporting</li> </ul> </p> </div> <div class="list-item"> <h2 class="white-with-dots" id="pinnacle_provides-06"> Physician Preference Cost Reduction </h2> <p><h3>Overview</h3> <p>Pinnacle provides the expertise which enables our clients to effectively contract, review, and manage physician preference implants. Our custom approach integrates hospital culture by engaging and facilitating collaboration between hospital executives, surgeons, materials management, value analysis teams, and operating room staff. The resulting partnership streamlines vendor management and cost savings achieved through contract negotiations. Our dedicated team has the clinical and operational resources our clients need to effectively review products with constantly changing protocols. We maintain a large proprietary database of physician preference items to drive cost reduction activities while aligning physician participation. Pinnacle works closely with our clients on this physician involvement through a variety of arrangements including gainsharing, value-based entity set up and design, co-management, and other programs that participate in shared savings. Our expertise enables us to set expectations and manage relationships with approved suppliers such that (i) contract terms are regulated and (ii) cost savings are achieved and improved during initial negotiations and beyond.</p> <h3>Example Projects</h3> <p>Pinnacle’s process results in improved performance data and the ability to anticipate issues and manage – rather than administer – contracts. In the role of contract manager, we ensure that contracts and contracting procedures are used to execute our clients’ strategic goals. Our services simplify the cost reduction process by delivering items including:</p> <ul> <li>Benchmarking <ul> <li>Pricing</li> <li>Utilization</li> </ul> </li> <li>Clinically focused proprietary database</li> <li>Surgeon profiles</li> <li>Vendor negotiations</li> <li>Enforcement of contract compliance</li> <li>Support for implant formulary implementation</li> <li>Administration of OIG compliant gainsharing agreements</li> <li>Contract term and invoice pricing audit</li> <li>Supplier correspondence & management</li> </ul> </p> </div> <div class="list-item"> <h2 class="white-with-dots" id="pinnacle_provides-07"> Transitional & Interim Leadership </h2> <p><h3>Overview</h3> <p>Pinnacle assists clients anticipating or responding to a change in executive management by providing transitional leadership services. These services include interim CEO services, permanent CEO recruitment, and post-transition strategic planning. By providing all three services in a deliberate, coordinated, and cost-effective manner, Pinnacle helps hospitals bridge the transition from one leader to another. We first effectively “bridge” between leaders through the placement of an experienced interim CEO. Next, our team assists with identifying qualified candidates for the permanent CEO position. Finally, Pinnacle facilitates a “warm handoff” and provides ongoing support (as needed) via the interim CEO creating the foundation of a strategic plan prior to the new CEO’s start date. By linking leadership in this manner, our clients can keep the organization advancing, engaged, and focused on achieving its goals.</p> <h3>Example Projects</h3> <p>Pinnacle’s transitional leadership projects involve three key aspects, each with their own value in maintaining consistent, successful results for our clients. Examples of the services involved with each of these phases include the following:</p> <ul> <li>Interim CEO Services <ul> <li>Placement of experienced interim CEO</li> <li>Leadership transition</li> <li>Operational oversight</li> <li>Engagement across employees, medical staff, board, and community</li> <li>Strategic planning facilitation with organization and executive team</li> <li>Long-term positioning and planning</li> <li>Provision of comprehensive solution at lower cost</li> </ul> </li> <li>Permanent CEO Recruitment <ul> <li>Identification of CEO candidates nationwide</li> <li>Facilitation of recruitment with hospital-based search committee</li> <li>Interim CEO support via: <ul> <li>Insider’s perspective of the role</li> <li>Communication of organization’s needs</li> <li>Feedback to search committee on candidates’ suitability</li> </ul> </li> <li>Collaborative determination of best candidates for permanent position</li> </ul> </li> <li>Post-Transition Strategic Planning <ul> <li>Facilitation of transition for permanent CEO</li> <li>Interim CEO strategic planning prior to new CEO start date</li> <li>Development of framework that facilitates: <ul> <li>Understanding of new or existing organizational matters and needs</li> <li>Evaluation of the effectiveness of the new CEO during the initial 18-24 months</li> </ul> </li> </ul> </li> </ul> </p> </div> </div> </div> </div> </div> </section> <section class="single-service__bottom-materials"> <div class="container-fluid"> <div class="row justify-content-center"> <div class="col "> <div class="list-item"> <div class="content "> <h4> Service Line Leadership </h4> <ul class="external-link icon_check_circle"> <li id=""> <a href='/people/anthony-long/' class="link" >Anthony Long</a> </li> <li id=""> <a href='/people/r-kyle-kramer/' class="link" >R. Kyle Kramer</a> </li> <li id=""> <a href='/people/jim-yanci/' class="link" >Jim Yanci</a> </li> <li id=""> <a href='/people/kelly-conroy/' class="link" >Kelly Conroy</a> </li> </ul> </div> </div> <div class="list-item"> <div class="content "> <h4> Resources & Reference Materials </h4> <ul class="external-link icon_out_resources"> <li id=""> <a href='http://askphc.com/wp-content/uploads/2024/09/ACO-Intervention.pdf' class="link" target="_blank" >ACO Intervention</a> </li> <li id=""> <a href='/wp-content/uploads/2024/08/Strategy-Value-Based-Care-Cost-Reduction.pdf' class="link" target="_blank" >Strategy, Value-Based Care & Cost Reduction</a> </li> <li id=""> <a href='/wp-content/uploads/2024/08/Five-Essential-Strategies-for-ACOs.pdf' class="link" target="_blank" >Five Essential Strategies for ACOs</a> </li> <li id=""> <a href='/wp-content/uploads/2024/08/Value-Based-Care-Approach.pdf' class="link" target="_blank" >Value-Based Care Approach</a> </li> <li id=""> <a href='/wp-content/uploads/2024/08/Medical-Practice-Advisory-Services.pdf' class="link" target="_blank" >Medical Practice Advisory Services</a> </li> <li id=""> <a href='http://askphc.com/wp-content/uploads/2024/09/Pinnacle-Supply-Chain-Services.pdf' class="link" target="_blank" >Pinnacle Supply Chain Services</a> </li> </ul> </div> </div>  <div class="list-item"> <div class="content"> <h4> Industry Insights </h4> </div> <ul class="external-link icon_check_circle insights-post-last"> <li id="service-list-9897"> <a href="https://askphc.com/smart-pricing-of-lumbar-stand-alone-devices/" class="link"> Smart Pricing of Lumbar Stand-Alone Devices </a> </li> <li id="service-list-9893"> <a href="https://askphc.com/smart-pricing-of-cervical-stand-alone-devices/" class="link"> Smart Pricing of Cervical Stand-Alone Devices </a> </li> <li id="service-list-9798"> <a href="https://askphc.com/using-implant-data-to-facilitate-surgeon-engagement/" class="link"> Using Implant Data to Facilitate Surgeon Engagement </a> </li> </ul> <div class="more-articles-wrap"> <a href="https://askphc.com/category/strategy-cost-reduction"> Read More Articles </a> </div>  </div> </div> </div> </div> </section> </main> <footer class="footer" style="background-image: url(https://askphc.com/wp-content/uploads/2024/06/Mask-Group-72.png)"> <div class="container-fluid container-pad"> <div class="row justify-content-lg-between justify-content-center"> <div class="col-lg-2 col-md-12 footer__first-menu"> <div class="first-menu"> <div class="footer-title"> Menu </div> <ul id="menu-menu" class="menu"><li id="menu-item-137" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-137"><a href="https://askphc.com/about-us/">About</a></li> <li id="menu-item-144" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-144"><a href="https://askphc.com/our-people/">Our People</a></li> <li id="menu-item-146" class="menu-item menu-item-type-post_type menu-item-object-page 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