Posts Tagged ‘PCMH’

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5 Features of the Patient-Centered Medical Home

October 23rd, 2014 by Cheryl Miller

Patient-centered medical homes (PCMHs) are not about pigeon-holing certain diseases or illnesses, says Terry McGeeney, MD, MBA, director at BDC Advisors, but about delivering acute and chronic care prevention and wellness. Dr. McGeeney reiterated the five essential features of the medical home as the groundwork for a medical neighborhood.

Given many of the initiatives of the Centers for Medicare and Medicaid Services (CMS), coupled with the Triple Aim, many have gotten bogged down and probably overly focused on the name: patient-centered medical home (PCMH). What’s important are the features or attributes of the PCMH: first, its patient-centeredness, a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients and ensures patients have the education and support they need.

Secondly, in a PCMH, the care needs to be comprehensive. It’s a team of care providers who are wholly accountable for a patient’s physical and mental healthcare needs, including prevention and wellness, acute care, and chronic care.

Third, you will hear discussions about the PCMH being about a certain disease or illness. Please note that it’s acute and chronic care prevention and wellness. Pigeon-holing conditions, while important, is more of a chronic quality improvement initiative and not PCMH.

Fourth, under the PCMH, care needs to be coordinated. Care is organized across all elements of the broader healthcare system, including specialists, hospital, home healthcare, community service and support. There’s a lot of debate now about what we call ‘post-acute care’ or ‘transitions in care.’ Jonathan Blum, principal deputy administrator of CMS, recently spoke on the importance of post-acute care. This is what coordinated care particularly is all about.

Care has to be accessible. Patients are able to access services with shorter waiting times, after-hours care with access to EHRs, etc., and there has to be a commitment to quality and safety. Clinicians and staff need to enhance quality improvement with the use of health IT and other tools that are available to them.

We also need to be very careful that quality care is not equated with lower cost of care. Sometimes those two have a tendency to get muddled.

Source: Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs

http://hin.3dcartstores.com/Blueprint-for-a-Medical-Neighborhood-Building-Care-Coordination-Between-Specialists-and-PCPs_p_4967.html

Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs provides a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model. Pictured here is Terry McGeeney, MD, MBA, director of BDC Advisors, who navigates the landscape of the medical neighborhood, from the value-based payment realities of healthcare today to identifying and engaging specialists in a medical home neighborhood.

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Posted in Cardiac Care, Care Coordination, Care Transitions, Disease Management, Medical Neighborhood, Medication Management, Patient-Centered Medical Home | Comments Off on 5 Features of the Patient-Centered Medical Home

4 Goals for Furthering Care Coordination in the Medical Neighborhood

August 28th, 2014 by Cheryl Miller

With the advent of the medical neighborhood, care coordination is no longer the sole domain of the primary care practice (PCP), but a responsibility shared among all providers that touch the patient. But how to formalize co-management of patients by PCPs and specialists — in a way that both assures efficient delivery of high-quality healthcare and addresses the ‘pain points’ of each provider group? Here, Robert Krebbs, director of payment innovation at WellPoint, Inc., discusses the four goals for furthering care coordination in the medical neighborhood.

The care compact isn’t intended to solve all the world’s problems. We know it’s not going to make care coordination perfect, but it’s a starting point. Just like the PCMH provides a foundation for the medical neighborhood, the care compacts provide a foundation for care coordination between practices. It’s an essential starting point to further care coordination expectations across the medical neighborhood.

First, with the care compact, we’re helping the pilot practices by identifying the PCPs they can collaborate with to put care compacts in place. We’re playing connector for these two practices.

Second, we’re assessing the current care coordination capabilities of the specialist practices in the pilot and looking at where they’re starting from in terms of care coordination.

Third, we’re watching them customize the care compact and monitoring how they adapt it to their practice needs so we can come up with a stronger template at the end of this pilot than we started with that guides this last point.

Finally, we’re going to disseminate best practices throughout the process to all participants in the pilot. Everyone will benefit from the hard work of each participating practice.

Excerpted from Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination.

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8 Challenges to Medical Home Success

August 21st, 2014 by Cheryl Miller

“The reality of today is that the healthcare world as we know it is changing more than any time since the advent of Medicare,” says Dr. Terry McGeeney, director of BDC Advisors. System coordination, patient-centeredness and patient engagement are some of the new industry goals, he says, which bring new challenges, chief among them being physician reluctance to change.

  • First, there are some real challenges to making the changes to patient-centered medical homes (PCMHs). A lot of physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc.
  • Second, physician leadership and physician champions are critical, and again, sometimes this has to be trained and taught.
  • Third, there’s a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation.
  • Fourth, some providers are not able to function effectively in a team environment and this needs to be supported and transformed with the appropriate training provided.
  • Fifth, communication is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that’s delivered, data, quality metrics, lab data, etc.
  • Sixth, there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical, and again, that hasn’t always existed.
  • Seventh, we need to make sure there are aligned incentives; you can’t ask people to do more work for the same compensation. You can’t ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called ‘value-proposition’ or ‘pay-for-value,’ or to where there is an expectation to improve quality and lower cost.
  • And finally, there needs to be full recognition that PCMH transformation is not easy. It’s very difficult, it’s time consuming, but at the end it’s highly rewarding.

value-based reimbursement
Terry McGeeney, MD, MBA, is a director at BDC Advisors. He was recently appointed a visiting scholar in Economic Studies for the Brookings Institute in Washington, D.C.

Source: Driving Value-Based Reimbursement with Integrated Care Models

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2014 Value-Based Priorities: Population Health, Care Coordination, Integrated Care

July 3rd, 2014 by Cheryl Miller

From an early surge in Medicare accountable care collaborations (ACOs) to the problematic rollout of the nation’s historic health insurance exchanges during a 16-day government shutdown, healthcare in 2013 was nothing short of unpredictable. Respondents to HIN’s tenth annual Healthcare Trends and Forecasts survey identified a trifecta of value-based priorities for 2014, deeming population health management (56 percent), care coordination (51 percent) and integrated care delivery (42 percent) initiatives most worthy of their attention in 2014.

In tandem with these Triple Aim priorities, respondents also selected the accountable care organization (ACO) as the care delivery model most likely to transform healthcare, from both cost and care delivery perspectives. The patient-centered medical home has held this distinction for the last two years.

Some key findings from the survey include the following:

  1. The top business areas affected by the 2013 economy were growth (65 percent, still the top area but down from 72 percent in 2012); hiring and recruitment (65 percent); capital improvement (48 percent); and service expansion (43 percent).
  2. The top five factors impacting healthcare business in 2013 were not limited to purely financial issues as they have been in recent years: budget constraints (42 percent), the Affordable Care Act, or ACA (30 percent), reimbursement (28 percent), care transitions (27 percent), and the economy (25 percent).
  3. Beyond the ACO and the patient-centered medical home (PCMH), the care delivery systems with the most transformational potential were comprehensive primary care (19 percent) and bundled payments (11 percent).
  4. Beyond population health management, care coordination and integrated care delivery, the areas of healthcare most ripe for development are e-health and telehealth (39 percent), access to healthcare (33 percent), health and wellness (26 percent) and dual eligibles (25 percent).
  5. Impacts from continued rollout of ACA initiatives in 2014 include (in respondents’ own words): expansion of customer base from implementation of physician ACO and bundled payment programs; reduced reimbursement, requiring more efficiency and cost reductions; the challenge of delivering primary care services with improved outcomes and transparency in reporting; and revenue streams created by exchanges, along with a need to add primary care practitioners.

Excerpted from Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry.

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Posted in Accountable Care Organizations, Affordable Care Act, Avoidable ER Use, Bundled Payments, Care Coordination, Health Information, Healthcare Costs, Healthcare Quality Ratings, Healthcare Reform | Comments Off on 2014 Value-Based Priorities: Population Health, Care Coordination, Integrated Care

HINfographic: 10 Things to Know About Patient-Centered Medical Homes in 2014

June 23rd, 2014 by Jackie Lyons

Having established a firm foundation over two decades of patient-centered care, the patient-centered medical home (PCMH) model is poised for renovation, expanding into medical neighborhoods and opening the door to specialists’ enhanced role in care coordination, according to a new infographic from the Healthcare Intelligence Network.

This HINfographic presents 10 metrics documented by HIN’s seventh PCMH survey in March 2014, including the rise in medical homes, involvement of remote care management and case management, biggest challenges, future outlooks and more.

Want to know more about patient-centered medical homes? 2014 Healthcare Benchmarks: The Patient-Centered Medical Home, a 40-page report now in its seventh year, is designed to meet business and planning needs of physician practices, clinics, health plans, managed care organizations, hospitals and others by providing critical benchmarks in medical home implementation and results.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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Care Coordination Compacts: Establishing Accountability, Clarity between Physicians and Specialists

May 22nd, 2014 by Cheryl Miller


It’s a scenario that occurs time and time again, and is a deep source of frustration for all involved: a physician refers a patient to a specialist, but hears nothing back from that specialist. In fact, they learn that the visit happened only when the patient returns for his primary care visit, but without any necessary information.

Or, a specialist receives a patient who has none of the pre-work or test results necessary for an effective visit, which ends up delaying care for the patient. Or, on the flip side, the specialist receives patients that had numerous unneeded and avoidable tests done prior to the referral.

The culprit? Lack of accountability and clarity, the foundations of the Care Compact, an agreement between two practices that outlines the roles and responsibilities of each in order to promote patient-centered care, says Robert Krebbs, director of payment innovation at WellPoint, Inc., during Care Compacts: Forming the Foundation of Care Teams with PCPs and Specialists, a May 2014 webinar now available for replay from the Healthcare Intelligence Network.

The Care Compacts (also known as Care Coordination Agreements and/or Referral Agreements) are key to WellPoint’s patient-centered medical home neighborhood (PCMH-N) pilot, Patient-Centered Specialty Care (PCSC). The program was launched in January 2014 with a select number of pilot practices, ranging in size from solo practices to large group practices in markets where there is a strong patient-centered medical home (PCMH) foothold, says Krebbs.

PCSC is a value-based reimbursement program developed for three types of specialties with clear care coordination alignment opportunities with PCMHs: cardiology, endocrinology, and OB/GYN. These specialists work with existing patient-centered medical home partners to improve quality and coordinate care guided by cost and efficiency measures, Krebbs continued, ensuring the following:

  • Effective two-way communication between primary and secondary providers;
  • Appropriate and timely referrals and consultations with prompt feedback of findings / recommendations;
  • Effective co-management of patients when necessary; and
  • Commitment to practice in a patient-centered fashion across all physicians delivering care to a patient.

The reason these care agreements work is because they provide a standard set of processes for roles in care coordination, truly defining what care coordination is between two practices. While many practices across the country agree they need care coordination, they don’t always agree on what the concept of care coordination is, Krebbs continues.

At their simplest, they help to clearly outline who’s going to do what in a referral or consult situation. By cutting out inappropriate duties and maintaining appropriate ones, they help to curb healthcare spend and improve patient care, Krebbs says.

“The care compact isn’t intended to solve all the world’s problems. It’s not going to make care coordination perfect, but it’s a starting point. Just like the patient-centered medical home (PCMH) provides a foundation for the medical neighborhood, the care compacts provide a foundation for care coordination between practices. It’s an essential starting point to further care coordination expectations across that medical neighborhood,” says Krebbs.

Listen to an interview with Robert Krebbs.

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8 Challenges to Medical Home Success

March 12th, 2014 by Jessica Fornarotto

“What’s important about patient-centered medical homes (PCMHs) is that they’re patient-centered. PCMHs are a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients. And patients have the education and support they need,” explains Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney lists below the eight challenges in successfully changing to a PCMH.

The first challenge to PCMH success is that many physicians are reluctant to change. Physicians have been trained to be change-averse and variable-averse to avoid making mistakes at two o’clock in the morning, etc. Second, physician leadership and physician champions are critical. Sometimes this has to be trained and taught.

Next, there’s a culture that is very traditional in healthcare; we need to think and talk about that. There is also a culture within individual practices and health systems that creates barriers to successful transformation. Another challenge is that some providers are not able to function effectively in a team environment. This needs to be supported and transformed with the appropriate training provided.

The next challenge is communication, which is critical at multiple levels. Successful medical neighborhoods and clinically integrated neighborhoods (CINs) are built around communication, care plans, care that’s delivered, data, quality metrics, lab data, etc. The sixth challenge is that there has to be trust between all of the entities as systems are transforming and payor data becomes more critical. Partnerships with payors around shared savings or shared risk are becoming more common. Trust is critical and that hasn’t always existed.

Next, we need to make sure there are aligned incentives; you can’t ask people to do more work for the same compensation. You can’t ask them to assume more risk for the same compensation. Incentives need to be aligned around what is now called ‘value-proposition’ or ‘pay-for-value,’ or to where there is an expectation to improve quality and lower cost.

The final challenge is there needs to be full recognition that PCMH transformation is not easy. It’s very difficult and time consuming, but in the end it’s highly rewarding.

Excerpted from: Driving Value-Based Reimbursement with Integrated Care Models

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4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

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3 2014 Trends for Health Plans

January 21st, 2014 by Jessica Fornarotto

Influencing primary care, aggregating and mining data, and embracing bundled or episode-based payments are three trends that will influence health plans in 2014, predicts Catherine Sreckovich, managing director in the healthcare practice at Navigant Consulting.

HIN interviewed Sreckovich on these trends prior to her presentation during HIN’s tenth annual webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: Where will data analytics take health plans in the coming year, and how will this shape population health management offerings?

(Catherine Sreckovich): We’re certainly hearing a lot about big data, and it will be an integral approach to merging this practice’s or population’s health, the ability to aggregate and mine data is going to be an essential capability for health plans for their predictive models. And the outputs of these models are going to enable the health plans to identify and stratify their members or population health. Member and patient demographics can also inform consumer engagement strategies to support population health. And the analytics are going to inform the effectiveness of different care management interventions and consumer engagement strategies.

HIN: Health plan case managers embedded alongside providers has become almost a de facto model. How will payors influence primary care delivery in the year to come?

(Catherine Sreckovich): There is a number of approaches evolving right now and that will continue to evolve as payors attempt to influence primary care delivery. One is the use of patient-centered medical homes (PCMHs) and other integrated models to expand the payor’s role as the primary care case manager.

In addition to paying primary care providers to hire case managers and care coordinators, payors are pushing for shared savings arrangements with these primary care providers, such as within an accountable care organization (ACO), and to push them to manage the care for those with chronic conditions.

We’re also seeing payors paying for primary care physicians to become certified PCMHs and to implement electronic health records (EHRs), either by paying directly for the certification of the technology or by adding bonus payments to their FFS rates.

Payors are also paying for incentives for primary care physicians to offer wellness programs such as smoking cessation or weight loss programs and are trying very hard to influence where and to whom primary care physicians refer their patients by giving them information about the cost and quality of other provider types, such as specialists and hospitals.

And we will continue to see that payors will target the larger primary care physician practices with whom they have a critical mass of members to achieve enough savings to offset the added costs of incentives, bonuses and shared savings arrangements. As a result, we expect that some of the smaller primary care practices will likely not receive the same level of support and push from payors.

In another example, we see payors increasingly partnering with non-traditional providers, such as retail-based clinics and community health centers to offer easily accessible primary care at lower costs. And this will certainly be an opportunity to address some of the physician supply shortages that we anticipate seeing in the next year or so as more and more people have access to healthcare insurance and coverage.

Finally, another approach payors are using is to offer members access to virtual doctor visits via webcam, for example, and other telemedicine approaches that are giving individuals access to these primary care providers to increase access to convenient and low cost primary care for their patients.

HIN: CMS and top-performing Pioneer ACOs are heavily invested in bundled or episode-based payments. Will more private payors embrace this reimbursement method as well?

(Catherine Sreckovich): Definitely. The bundled or episodic-based payment approaches are here to stay. We’re starting to see this take off in a number of states. For example, there are state innovation grants that CMS has provided to states like Arkansas, Ohio, Delaware and others looking for opportunities to implement multi-payor bundled payment initiatives. Although these are not necessarily the traditional ACO model, they built off of that ACO model.

We also see that the large health plans in various states are starting to build and develop ACOs. Key to these are the shared savings arrangements that they’re implementing with these payment approaches. So whether they’re bundled or episodic-based payments or whether they look more like a traditional ACO, if there is such a thing, we’re starting to see takeoffs on those kinds of models as payors and health plans become more creative in the development of their alternatives.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

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5 Attributes of Medical Home Neighborhoods, Where Practitioners Unite for Patient Care

December 5th, 2013 by Cheryl Miller


“The healthcare world is changing in ways that many of us have never seen in our lifetime with the possible exception of Medicare,” says Dr. Terry McGeeney, director of BDC Advisors, a veteran of the healthcare system for 30 years.

It has moved away from system fragmentation, patient disenfranchisement, technophobia and fee-for-service (FFS) to system coordination, patient-centeredness, tech savviness and fee-for-value reimbursement, where bundled payments and accountable care are the reality, Dr. McGeeney says.

Ultimately, the patient-centered medical neighborhood (PCMN), or network of physicians collaborating and coordinating care per the patient-centered medical home (PCMH) model, will be a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients, says Dr. McGeeney during Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care, a November 20th webinar now available for replay. Dr. McGeeney examined the trend toward medical neighborhoods and effective strategies for building out the neighborhood.

Bridging the gap between physician and provider-speak and hospital-speak, and identifying and engaging specialists in the medical neighborhood are key, Dr. McGeeney continues. Transitioning a clinically integrated entity to a high-functioning medical neighborhood is a real opportunity and challenge.

What are the key attributes of a highly functioning medical neighborhood?

  • A clear agreement on a delineation of roles of the neighbors in the system. Many successful neighborhoods are establishing letters of agreement or understanding on who is going to do what.
  • Sharing clinical information needed for effective decision-making, reducing duplication and waste in the system, as supported by appropriate health information technology (IT).
  • Continuity of medical care when patients transition between settings, particularly important in the post-acute space, and the move toward risk and episodic bundled payments. The transition from clinic to the emergency room (ER) is also critical.
  • Focusing on patients’ preferences, whether it’s to the primary care clinic or through a dedicated care coordinator, with the PCMH playing a key role. Strong community linkages, including both clinical and non-clinical services, including pharmacy, behavioral health, etc.

The top ways for practices to build capacity, Dr. McGeeney says, is to do a workflow analysis, and add capacity when appropriate, ensuring all are empowered.

As with all new healthcare models, there will be challenges, says Dr. McGeeney, among them PCP buy-in, leadership; communication at multiple levels; unaligned incentives, technology updates, and a difficult transformation.

And perhaps the biggest risk to the PCMH and PCMN model is the lack of patient engagement needed to leverage patient choice, Dr. McGeeney adds.

Choosing the ideal specialists is a good way to start — specialists that possess good communication skills, strong reputations and high value.

But as with any neighborhood, the whole is often greater than the sum of its parts, and assuring specialists that this new model will result in improved quality, cost reductions, the reduction of duplicated, unnecessary work and a better life/work balance is key.

And not everyone will be invited into the neighborhood, Dr. McGeeney cautions: there will be winners and losers. “The reality is there’s a number of hospital beds in this country to contract. Some providers may be left out of networks and thereby left out of the potential to share in savings. Proper positioning in this new environment is critical.”

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