Emerging Business Models for Hospital and Physician Integration: Clinical Integration as a Business...

L E A D E R S H I P P R O B L E M SO L V I N G V A L U E C R E A T I O N

Copyright 2010. Alvarez & Marsal. All Rights Reserved.

November 4, 2010

Christopher J. Kalkhof, FACHE

Director, Healthcare Industry Group

Francis LaMorte, M.D.

Director, Healthcare Industry Group

(New York Office)

NAMCP Fall Managed CareForum 2010(Las Vegas, NV)

Emerging Business Models for Hospital andPhysician Integration: Clinical Integration asa Business Strategy for Accelerated Growth

Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved.

Presentation Agenda

I. Overview of Evolving Federal

and State Regulatory

Landscape and Impact on

Provider Revenues

II. Emerging Provider

Business/Financing Models:

Options and Considerations

III. Lessons Learned

IV. Q&A and Program Close

(1)1

Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. 2

I. Overview of Evolving Federal

and State Regulatory

Landscape and Impact on

Provider Revenues

Plan now for ACA impact

Do not put yourself in the

position of having to react in

2013 or 2014

Presentation Agenda

© Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved.

Cost shifting, government reform, and budget deficits are

eroding the traditional payer-provider relationship

Cost shifting from government payers will not lessen and may

increase under the Affordable Care Act.

CMS, State Medicaid programs and the health plan

community (irrespective of product type e.g., commercial,

Medicaid, Medicare, etc.) have begun the process of

fundamentally restructuring payment methodologies.

Private sector health plans have to rethink the fundamental

structure of their provider networks.

Providers and payers… will be expected to do more with

less! How efficient and cost-effective are your ops?

Evolving Federal and State Regulatory Environments

I. Provider and Payer Brave New World – Transitions Under Affordable Care Act

3


What will be the impact of health care reform with respect

to negotiated agreements between providers and payers?

Providers and payers alike will be entering into unchartered

waters.

There will be multiple pricing and payment models emerging

within different regional markets around the country over the

next few years.

There will be different winners and losers on a region-to-

region basis. Some critical success factors?

– Business model and ability to manage patient populations.

– Physician alignment and integration.

– Collaborative vs. adversarial payer relationships

4




A value-driven/outcomes-based system reimbursement

and by extension… pricing environment will:

Hold providers accountable for their performance in terms

of patient quality, safety and outcomes as well as the cost

and setting of care delivery.

Emphasize population and disease care management

across a care continuum.

Creates significant financial incentives for physicians,

hospitals, health insurance plans and other healthcare

providers… to better align and coordinate care delivery.

Will require that providers in many cases… greatly

enhance their decision support capabilities and overall

contracting strategy across all contracts.

5




The ACA offers few specifics at present.

The different legislative components of the ACA which

impact providers and payers the most, go into effect

between 2010 and 2014… some retroactively, but most on

a “to be determined” going forward basis.

– To finance the ACA… a re-basing of our core

healthcare financing mechanisms will be required.

Absent specific regulatory guidelines, many organizations

are struggling to understand the impact of the ACA on their

organizations so that they can plan accordingly.

– The economic and lost opportunity costs or either

going in the wrong direction or waiting too long to

take action… can be very significant.6




What do we think we know about strategic impact?

Reform laws include provisions that pressure…

– Health plan historical pricing and assumptions about

managing provider costs.

– Provider net revenue with the assumption of more risk.

– Provider and health plan margins.

There are general national themes… however

implementation of specific strategies will most likely be

deployed on a regional basis.

There will be notable regional successes and failures.

What about your local market?

7




What if…

Fed/State

deficits grow?

ACA costs:

> $1 trillion?

> $2 trillion?

Access

diminishes?

Hospitals fail?

Payer par

networks

change?

Government and

payers under

pressure from

premium increases

Budget shortfalls in 48 States

States blocking payer rate hikes

Demand for demonstrable value

Double digit billion $$ Medicare deficits

Unresolved Medicare SGR payment-

adjustment for physicians (40%

cumulative cut by 2016)

EHR meaningful issues/penalties

RAC expansion into other payers

New risk-based payment models

Need for clinical integration/physicianalignment and IT/operational support

ICD-9 to ICD-10 conversion in 2013

Continual CMS

threat to reduce

payments

Increased

uncertainty and

revenue risk

Impact of above on your care delivery model?

Converging market forces will impact strategic choices:

8




Continue to operate the same butexpect different resultsMaintain status quo

Consolidation of like operations;economies of scale; shared services; afunctional physician alignmentstrategy and the ability to capture andretain lives

Horizontal Merger

Market Strategy

Develop strengths along continuumof care to manage patientpopulations… requires enhancedquality of care and coordinationacross vertical care continuum;supporting IT and ability tocollaborate across care continuum

Vertical Clinical

Integration

Strategy



9


II. Emerging Provider Business

and Financing Models:

Options and Considerations

Understand clinical integration

models

Understand your cost structure

Know how to “clinically integrate”

at the service line level

Determine how emerging payment

methodologies will evolve and

impact your care delivery model

Presentation Agenda

© Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. 11

Emerging Business/Financing Models: CIO Options

II. Clinical Integration as a Business Strategy for Accelerated Growth

Clinical Integration as defined by regulators

1996 Department of Justice and Federal Trade

Commission Statements of Antitrust Enforcement

Policy in Health Care

– "[A]n active and ongoing program to evaluate

and modify practice patterns by the network's

physician participants and create a high

degree of interdependence and cooperation

among the physicians to control costs and

ensure quality."


Future State – CIO Provider Networks

Integration of facilities-practitioners with a true

interdependence and collaboration.

Disease management and corresponding clinical

protocols.

Integrated IT which allows efficient/effect patient

information exchange… utilization and claims

data collection to manage care and lower costs…

clinical indicators to improve quality and measure

physician protocol compliance and performance.



12


Future State – CIO Provider Network

Specialists and PCP focus on in-network referrals.

A high level of physician financial investment and

commitment of time for training, utilization of the

disease management protocols and compliance

with varied clinical pathways.

Processes for improving performance and care

delivery, with enforceable consequences for non-

compliance.



13


The evolution of a messenger model PHO/IPA to CIO?

The CIO will be a more complex, fully clinically integrated

business model, which will be capable of providing non-

risk/at-risk solutions to external stakeholder purchasers of

healthcare services… will require:

All internal stakeholders to share a common vision

Joint governance (e.g., physician lead and

professionally managed)

The equitable distribution of risks and rewards.

14



Think “Group Model” HMOw/o the Insurance Risk


Full GlobalCapitation

Acct Care Orgs(Physician Model)

Global HospitalCapitation

Episodes of Care &Gainsharing

Deg

reeof

Fina

ncialR

isk

Global HospitalCase Rates

Low

High

Risk Withholds& P-4-P

Hospital PPS (IP/OP)

FFS Charges

Degree of Clinical integration

Medical Homes

High

Low

Care Delivery and Financial Risk Continuum

Non-CompetitiveMarket and

Provider Risk isUncommon

CompetitiveMarket and

Provider Risk IsDominant

15




ProjectPlanning

Clinical IntegrationGap Analysis

Determine C.I.Organization Model

Determine ClinicalInfrastructure

Define and PlanClinical Initiatives

Determine RegulatoryCompliance

Implement InitialC.I. Programs

Measure, Monitor,Report and Educate

Eight Step Clinical Integration and Business Plan

Development Process: Hospital – Physician PHO Model



16


The process of starting a CIO starts with a strategic

clinical integration planning process

Choose high level goals for redesign.

Determine the design of the overall care delivery system,

care management and business processes.

Create a compelling value proposition for physicians to

become actively engaged in the change process, take

leadership roles in ensuring the success of the CIO and

establish a system wide culture that says…

…“this is how we will delivery high quality, safe,

effective and efficient care to our patients.”



Project Planning and Gap Analysis


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Audit clinical integration readiness of the medical staff

Assess physician motivations to develop a collaborative

clinical integration initiative across the health system.

Use interview-based findings and existing management

reports to create a summary profile of independent and

employed physicians.

Identify the “vital few” …the critical mass of physicians who

are willing to adapt/adopt and transition to a new model.

Identify physician needs and incentives relative to C.I.

Gauge physician views on expanding the PHO/IPA to include

additional physicians in primary and secondary service area.

18


II. Clinical Integration as a Business Strategy for Accelerated Growth: Assessment to CIO Business Plan



(19)

Project organizational and internal/external project

team roles; develop, review and finalize the work plan

Prepare internal communications plan for project stakeholders

Evaluate current processes and value stream mapping.

Assess current “level of clinical integration” among

inpatient, outpatient and ambulatory services.

Perform internal/external benchmarking of cost, quality,

efficiency, job skill requirements and calculate cost reduction

and efficiency improvement opportunities

Assess technology tools, enabling capabilities, datawarehouse and operational support needs.

19





Match Organizational Architecture to Organizational Culture

Governance structure:

– A committee hierarchy and governance model that

promotes equitable distribution of rewards, risks, and

control between hospital and physician partners.

Legal structure options.

– Consider need to create a “New Co.” physician enterprise

structure to serve as the integration vehicle.

Plan for transition… not disruption

– Physician alignment preparation for transition to CIO model.

– Payer relationship maintenance and CIO contracting

strategy.


Determine “Best Fit” C.I. Organizational Model



EmployedPhysicians

Aligned w/HospitalService Lines

Aligned w/HospitalService Lines

Compensation tied togoals and productivityCompensation tied togoals and productivity

Higher cost structureHigher cost structure

Advanced IT tools andreporting

Advanced IT tools andreporting

Few RegulatoryBarriers

Few RegulatoryBarriers

Non-EmployedPhysicians

Diffuse collection ofinterests…not aligned

w/hospital service lines

Diffuse collection ofinterests…not aligned

w/hospital service lines

Strategic focus atpractice level

Strategic focus atpractice level

Declining economicsand often unfavorable

payer contracts

Declining economicsand often unfavorable

payer contracts

Limited IT tools, limitedreporting to manage

Limited IT tools, limitedreporting to manage

Many regulatorybarriers to hospital

alignment

Many regulatorybarriers to hospital

alignment

Integrating

independent and

employed

physicians?

One piece of the CIO

puzzle… a selective,

scalable membership

criterion which

focuses on

collaboration and

equitable treatment

among physicians,

patient outcomes

and managing

patient populations.

21



Determine “Best Fit” C.I. Organizational Model

© Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. 22Determine Clinical Infrastructure and Define/Plan C.I. Initiatives


Define and Plan Clinical Integration Initiative Considerations

Build a clinical care model which emphasizes value-driven

care and which can be deployed across disease

management-based service lines in anticipation of future

episodes of care and global capitation reimbursement models.

Identify and validate the key metrics that will be used to define

success and provide meaningful, actionable information.

Provider network refinement/recruitment to allow for strategic

community outreach and inclusion in the “New Co.” clinical

integration organization.

Focus on safety.



Management and clinical integration plan development

should include utilization management strategies to:

Facilitate administration and physician development.

Foster agreement for a hospital-based UM program jointly

developed with, and formally adopted by employed and non-

employed physicians.

Accomplish joint review of the protocols between employed

and non-employed physicians as well as the “New Co” CIO.

Evaluate the role/need for a CIO Medical Director.

Propose Policy and Procedures guideline for the development

of quantifiable definitions and standards to be formally

incorporated into the hospital's UM program.

23



Determine Clinical Infrastructure and Define/Plan C.I. Initiatives



Define and Plan C.I. Initiative Considerations

Develop comparative performance methodology to:

– Identify physician- leaders with styles that are visionary,

mentoring, affiliate, and democratic.

– Avoid confrontational processes that could perceived as

threatening to physicians with non-aligned practice styles.

– Plan for the development and distribution of physician-

specific reports.

Build transformational experiences (small wins) to build trustand demonstrate successes.

Remove barriers that frustrate physicians in delivery of care.

Determine Clinical Infrastructure and Define/Plan C.I. Initiatives


© Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. 25Determine Clinical Infrastructure and Define/Plan C.I. Initiatives


Define and Plan C.I. Initiative Considerations

Develop training and physician leadership roles for varied

C.I. committees.

Assess necessary information technology and operational

support structure necessary to enable and facilitate high

quality physician care… as is clinically appropriate… at the

individual patient level… across disease management

oriented service lines.

Evaluate technology and infrastructure options for data

collection, common patient data registry, disease

management and EBM clinical protocols as well as EHRs.



Clinical data brokertechnologies

Common EMR / AffiliateEMR

Data warehousing

Managed care systems

Single purpose 3rd partyintegration “overlays”

Patient registry systems

Portals

Health data exchangetechnologies

Current StateUnderstanding

Clinical IntegrationObjectives

Supporting Systems Strategy

26Determine Clinical Infrastructure and Define/Plan C.I. Initiatives



Potential IT strategies may include the following:


Determine Regulatory Compliance

Engage qualified legal counsel in early development stages as

well as to determine likely FTC regulatory compliance. FTC

review considerations typically encompass the following:

1. Integration of facilities/practitioners that represents true inter-

dependence in collaboration and productive information sharing.

2. Participation of both specialists and primary care physicians, in a

way that requires in-network referrals.

3. Treatment of a broad spectrum of diseases/disorders accompanied

by a comprehensive array of corresponding clinical protocols.

4. Integrated information technology that allows network providers to

efficiently and effectively exchange information regarding patients

and practice experience.

27

Determine Regulatory Compliance of Change Process





Determine Regulatory Compliance

5. Integrated IT in which utilization and claims information is

collected, analyzed, and distributed with the goals of lowering

costs, reducing utilization rates, and improving the quality of care.

6. Integrated IT that enables the measurement of physician

compliance and performance, in comparison to widely accepted,

peer-reviewed benchmarks and standards.

7. A high level of physician financial investment and commitment

of time for training and utilization of the system, accompanied by

agreement among physicians to comply with the standards,

benchmarks, and protocols of the network.

8. Processes for improving performance and compliance, with

enforceable consequences for non-compliance.

Determine Regulatory Compliance of Change Process



Determine Business Case for Change Process


Scenario Planning for Clinical Integration Initiatives

Define clinical integration strategy… obtain senior

management and physician leadership input… prioritize

strategic alternatives… identify and validate growth

objectives… identify and confirm potential growth

vehicles to achieve clinical integration objectives.

“What if” considerations for extension of the planned

CIO business model to other facilities in the region (e.g.,

for future initiatives such as an ACO or a network PHO

clinical integration model).



Scenario Planning for Clinical Integration Initiatives

Define key barriers and facilitators to future state process

redesign and risk mitigation action plan.

Develop IT Vision (e.g., financial, clinical and E.H.R.).

Estimate one-time and recurring costs for each future state

redesign area.

Define phasing options relative to indentified change priorities

and cost reduction/efficiency gain goal achievement.

Estimate benefits to organization-physician members of

Clinical Integration by major care delivery service line.

Make the business case for each future state CIO design.


30


Determine Business Case for Change Process


Preparing Your Clinical Integration Business Plan (i.e., from

your completed assessment and planning process)

1. Internal and external clinical integration readiness

assessment… current state design.

2. Scenario planning: your future state design options and the

required process changes to achieve them (core/contingent).

3. Governance and committee structure for a clinical integration

organization.

4. Physician and Staff educational needs for creating a clinical

integration business model.

5. Required information system technologies to support a clinical

integration business model.

31



Your Clinical Integration Business Plan




6. Core operational, physician and employee issues associated

with transitioning from a current state to a future state

business model.

7. Estimated cost reduction as well as potential efficiency and

quality gains.

8. Project management and performance improvement tools

needed for clinical integration initiatives.

9. Future state clinical integration organization

redesign/transition work plan for each major clinical service

line area.

Use your C.I. business plan as your development roadmap

and/or as a template for a FTC Staff Advisory Opinion.

Your Clinical Integration Business Plan



II. Clinical Integration as a Business Strategy for Accelerated Growth: Payments

Evolving/new payment value-based payments…

Should allow providers time to transition from current

payment methodologies to more risked and

accountability based payment methodologies.

The degree of provider integration and alignment of

financial incentives across the care continuum… will

determine the ability of providers to accept risk/reward

based payments and remain financially viable.

The two leading contenders for the new “norm” for

payment methodologies... bundled payments and

global capitation.

© Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (34)34

Features of a 2010+ Global Capitation Payment Model?

Capitated payments supply provider organizations with

fixed “medical care” budgets… partial or global services

– Risk adjustments… protection mechanisms for

adverse risk and catastrophic patient cases… formulaic

structural rewards to providers for improving quality and

reducing unnecessary services utilization.

– Performance incentives… based on quality and safety

metrics.

– Shared savings opportunities… reducing underuse,

misuse and overuse within global payment levels.




Utilization Average Gross Deduc. Net

Category Of Service PMPY Cost PMPM or Copay PMPM

HOSPITAL

Inpatient 0.0860 7,664.40$ 54.93$ 0.00 54.93$

Ambulatory Surgery 0.0520 1,057.96 4.59 0.00 4.59

Emergency Room 0.1530 276.90 3.54 50.00 2.91

Outpatient Radiotherapy 0.0433 212.67 0.77 0.00 0.77

Hospital Outpatient 0.1537 595.73 7.64 0.00 7.64

SNF 0.0001 1,953.00 0.02 0.00 0.02

Ambulance 0.0170 612.56 0.87 0.00 0.87

Dialysis/Chemo/Private Nurse 0.0461 374.40 1.44 0.00 1.44

Home Care 0.0035 306.47 0.09 0.00 0.09

Home Care Supplies 0.0340 1,271.90 3.61 0.00 3.61

Surgery/Major 0.0060 2,755.96 1.38 0.00 1.38

Misc. Office Serv. 0.0335 348.41 0.98 0.00 0.98(HMO CoPay/COB adjust.

factors & above changes) 0.0052 400.00 0.18 10.00 0.18

TOTAL HOSPITAL 0.6282 1,527.49$ 80.04$ 0.63$ 79.41$

COMMERCIAL MEDICAL BUDGET -- AVE. COSTS 1-1-XW TO 12-31-XW

Hospital Financial Proposal Review - HMO/Capitation ProposalMedical Budget - IPA/Hospital - Joint Managed Care Product IPA/Hospital Network

10/1/20XY - Small Urban Market

(35)

Example: Global Capitation35

PHYSICIAN SERVICES

Office Visits - PCPs 2.8505 90.76$ 21.56$ 15.00 18.00$

Office Visits -Specialists 2.1010 90.76 15.89 15.00 13.27

Inpatient Visits 0.1660 260.73 3.61 0.00 3.61Laboratory 2.3480 22.77 4.46 0.00 4.46Miscellaneous Office Procedures 0.8310 178.04 12.33 0.00 12.33

Surgery - Major 0.4820 517.39 20.79 0.00 20.79

Surgery- Minor 0.0060 282.58 0.15 0.00 0.15

Anesthesia 0.0520 999.72 4.34 0.00 4.34

Emergency Room 0.1680 228.82 3.21 0.00 3.21OB/Delivery 0.0200 2,679.32 4.47 5.00 4.47Outpatient Mental Health 0.2180 150.40 2.74 25.00 2.29

TOT. PHYSICIAN SRVCs 9.2425 121.40$ 93.55$ 6.63$ 86.92$




OTHER OUTPATIENT

Other Hosp Outpatient 0.0020 151.64$ 0.03$ 0.00 0.03$

Radiotherapy 0.0010 483.87 0.05 5.00 0.05

DME 0.0430 296.48 1.07 0.00 1.07

Pharmacy 7.5300 72.60 45.56 15.00 36.15

Ambulance 0.0010 697.15 0.06 50.00 0.06

Home Visits 0.0010 135.23 0.02 20.00 0.02

Home Health Supplies 0.0110 345.02 0.32 0.00 0.32X-Ray 1.6060 162.78 21.79 0.00 21.79

High Risk Int. Care 0.0010 175.35 0.02 0.00 0.02

Optical Dispensing 0.0130 108.11 0.12 0.00 0.12

Alcohol Abuse 0.0730 142.36 0.87 0.00 0.87

Physical Therapy 0.1560 101.75 1.33 15.00 1.14

TOT. OTHER O/P 9.4380 90.50$ 71.24$ 9.60$ 61.64$

TOTAL MEDICAL COSTS 19.3087 1,739.39$ 244.83$ 16.86$ 227.97$

IPA Desired Medical Mgt. Fee For Physician Services @ 2% of Medical = 1.74$

TOTAL GLOBAL CAPITATION REQUIRED = 229.71$







Bundled Payments...

Payment methodologies referred to as “Episodes of Care”

(EoC) – CMS has already started piloting an EoC payment

methodology called “Acute Care Episodes” with a select

number of hospitals… as CMS goes, will others?

The ACA expands episode of care pilot programs at the

Medicare and State Medicaid levels… expect 1115 waiver

modifications.

Some health plans are presently engaged in these pilot

programs with hospitals or other provider organizations that

have the operational support infrastructure to manage

episode of care reimbursement methodology and risk.

36



© Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. (37)

The key challenge for providers will be their ability to

align and integrate community care standards for a

specific EoC while also being able to provide

clinical/operational support for the entire episode of care.

37

Bundled payments have been around for some time in

the form of specific provider type oriented payments such

as DRGs… would expand to capture all EoC services.

The main difference with EoC payment methodologies

of the future… specific requirement to coordinate and

manage care across a vertical continuum of care…

specific to an episode of care event… tied to a specific

length of time… at a set, fixed price.




III. Lessons Learned

Effective change in a

restructured regulatory and

reimbursement environment

will not be sustainable…

absent… physician

leadership

Presentation Agenda


III. Risk Models and the Assumption of Performance Risk

Transition to a value-driven healthcare system will require a

great deal of re-engineering to support more integrated care

delivery models designed to manage patient populations.

Managing the financial risk associated with bundled and

capitation payment methodologies… the greater the

financial risk for healthcare organizations… the greater the

need for clinical integration and expanded information

technology and operational support.

Healthcare organizations unable to develop the appropriate

operating business model relative to the accepted level of

financial risk will become financially distressed and at

greater risk for bankruptcy.

39

Lessons Learned: Risk and Care Management Models




In the end, its about…

Strategy and Strategy Execution

People

Process

Technology and Capital

Sustainability


The ACA will be a

transformative event… be

prepared… do not wait

until 2013 or 2014 to act!!!

41




IV. Questions and Answers

Presentation Agenda


Christopher Kalkhof,FACHE

Director

Office

(347) 254-2433

Mobile

(716) 912-0309

E-Mail

ckalkhof@

alvarezandmarsal.com

Website

www.alvarezandmarsal.com

Christopher Kalkhof

IV. Contact Information and Speaker Bio

(43)43

▲ Christopher Kalkhof is a Director with Alvarez & Marsal’s Healthcare Industry Group in New York. He has more than25 years of diverse healthcare management experience. He specializes in managed care strategy development andcontract negotiations; contract implementation and integration with revenue cycle/case management processes;provider-payer collaborations; physician alignment and integration; strategic planning and new product development.

▲ Over the last several years, Mr. Kalkhof has spent much of his time assisting clients optimize their net managed carerevenue potential, resulting in net rate increases and revenue improvements of nearly $500 million. Over the span ofhis career he has gained managed care related work experience in over 20 states and has directly negotiatedhundreds of payer agreements for hospital, behavioral health, physician, IPA/PHO, home care, hospice and skillednursing facility clients. He has also reviewed hundreds of additional payer contracts.

▲ Recent or prior relevant experience has included:

– Developing a broad-based managed care strategy and leading a contract rebasing/negotiations process involvingover 50 payer product contracts/20 different payers for a partial physician owned hospital with an estimated netrevenue improvement of $10 million on an 18 month run rate basis.

– Working with a large safety net health system to improve physician charge capture and reduce payer denials aswell as reorganize the managed care department, build a contracts administration unit and develop strategies forimproving market position for a system owned health plan.

– Renegotiated payer contracts for nearly $13 million in net revenue increases (24 month run rate basis). Stoppedan unjustified payer attempt to recoup $1.2 million in alleged overpayments, upgraded contract manager (CM) andincorporated CM application into revenue cycle operations.

– Conducting a risk mitigation/EBIDA improvement opportunity assessment as part of a due diligence “clean team”review of an acquisition candidate hospital, which also included a clinically integrated PHO joint venture.

– Evaluating a hospital’s current contracting strategy, contract content and physician-clinical integration options.

▲ Prior to joining A&M, Mr. Kalkhof was: Director/National Managed Care Lead for a Big 4 firm’s provider consultingpractice; Interim SVP of Managed Care for a nine hospital system; Interim VP Managed Care for a community hospital;consulting Director of Managed Care at community hospital through the bankruptcy and post-bankruptcy ownershipchange to physicians; Partner in a practice management firm; Director of Marketing Administration and ProfessionalRelations for a large health insurer; and Product Development Manager for a HMO.

▲ Mr. Kalkhof received his Master of Health Administration degree from Tulane University and his Bachelor of Science,degree from Allegheny College. He is a Fellow in the American College of Healthcare Executives and a frequentpresenter on managed care revenue improvement and physician alignment topics for the HFMA, ACHE, MGMA, WRGand other professional groups. In 2008, Mr. Kalkhof served as a member of the NYS Office of Medicaid InspectorGeneral’s Medicaid Managed Care Compliance Program Guidance Advisory Committee.


Francis LaMorte,M.D.

Director

Office

(347) 891-0116

E-Mail

flamorte@

alvarezandmarsal.com

Website


Christopher Kalkhof

IV. Contact Information and Speaker Bio

44

Dr. Francis LaMorte is a Director with the Alvarez & Marsal Healthcare Industry Group in New York. He specializesin physician practice management, healthcare business strategy, hospital-based patient throughput, physiciancompensation, and governance

Prior to joining Alvarez & Marsal, Dr. LaMorte advised a financial syndicate on the buy-out of a genericpharmaceutical company, and developed the business plan and start up of a PPO

Since joining A&M his work has included contract assessment of a one-hundred member employed -physicianmedical foundation, a medical staff audit and development of a contract renegotiation strategy for a 252-bedmedical center, a hospital merger assessment, and planned hospital closings for two systems

Previously, Dr. LaMorte served as executive chairman of EMX, L.P., He led a post-demerger restructuring of thefirm’s operations and governance, designing and leading multiple, sustained, transformational initiatives thatenabled EMX to turnaround and become one of the nation’s largest privately-held emergency medicine practicemanagement firms, with more than 400 providers under management at twenty-four emergency departments andhospitalists practices providing care for 1.3% of the nation’s emergency patients

– Achievements included: design and execution of a recapitalization as an alternative exit strategy to a plannedIPO; restructuring of the corporate governance board; implementation of a balanced scorecard andproductivity–driven physician compensation plan; and the business development of subsidiaries for urgent carecenters, hospitalist practices, a consumer retail chain, physician billing company and an IT managementsystem now operating thirty EDs

As company compliance officer, he co-developed the company HIPAA program. He developed risk controlsystems and training programs for billing, coding, EMTALA, and HIPAA obligations

Dr. LaMorte served for twenty years as attending physician in the emergency department of the flagship hospital ofthe St. Barnabas Health Care System. He was chairman of the System’s utilization management committee, andpresident of the thousand-member IPA

Dr. LaMorte earned a bachelor's degree from Princeton University, and received his doctorate in medicine from theRobert Wood Johnson Medical School. He holds a master's degree in business administration from the YaleUniversity School of Management



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A&M is the leading, independent global professional services firm which excels at leadership, problem solving and value creation. A&M’sHealthcare Industry Group practice represents an assembled team of healthcare professionals who bring a significant track record of workingwith management, boards of directors and stakeholders of both investor-owned and non-profit providers, payers and suppliers to improveoperational, financial and clinical performance.

A&M’s managed care consultants and interim management professionals bring deep best practices expertise in the development of managedcare contracting and physician alignment strategies, payer contract negotiations, and the implementation / integration of contracting andphysician alignment strategies into an organization’s overall clinical and business operations.

Our managed care services are aligned with your contract management cycle and can be tailored to meet your specific needs and marketenvironment. We work with your team, serving in advisory or interim management roles, to ensure your success with your overall payercontracting strategy.

Emerging Business Models for Hospital and Physician Integration: Clinical Integration as a Business...

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