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Healthcare Financial Network

Orange County

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Hardesty, LLC

We are a national executive services firm offering flexible financial management solutions primarily focused on the Office

of the CFO.

Headquartered in Orange County, CA / www.hardestyllc.com

• Offices in Los Angeles, Atlanta, Houston, New York, Miami, Chicago and Irvine

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Hardesty, LLC

Private & Confidential

3 • CFO • VP of Finance • Controller Interim Management • Audit Prep • IPO Readiness • M&A Assistance Special Projects • C-Suite Positions

• Senior Financial Management

Permanent Search

• Director of Internal Audit

• Director of Financial Planning & Analysis • Director of SEC Reporting

• Infrastructure Development • SEC Reporting

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OCHFN

Private & Confidential

4

Monthly Networking Luncheons Showcasing…

Innovation

Integration

Healthcare

Trends

Best

Practices

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OCHFN – Target Audience

Private & Confidential

5

Hospital Skilled Nursing Senior Housing Medical Group Specialty Hospital Outpatient Services Medical Device Payer Pharmaceutical

Biotech Medical Software Laboratory Life Sciences Behavioral Health Insurance

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Changes in the Healthcare Marketplace from

Reform

Many know of the political or Health Insurance Changes caused by Healthcare reform but few are aware of the dramatic changes that are occurring in the healthcare delivery marketplace. Healthcare represents 18% of GDP and healthcare providers are often some of the largest employers in many communities. Healthcare reform not only is causing drops in overall healthcare costs resulting in reduced costs to the medicare trust fund but savings to health

plans that have slowed premium increases and should result in lower costs and better access to care.

These changes have resulted in reductions in revenue for some hospitals and specialists.

These reductions are painful but necessary. Anyone relating to this market needs to understand these changes and how they will affect healthcare markets regionally and nationally. Clinical Integration and Population management will change the way healthcare is delivered resulting in revenue reductions for some and opportunities for others. This presentation will educate you about these changes and how to position your organization to relate to healthcare in the future.

Private & Confidential

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Private & Confidential

7

Walter C. Kopp

Medical Management Services

Walter Kopp is President of Medical Management Services a healthcare executive management and advisory group specializing in the development of clinically integrated communities. This group has assisted with medical group practice management, medical group and hospital integration, physician succession planning, managed care analysis and

contracting, and healthcare technology implementation in Health Systems.

Walter was previously Chief Operating Officer of the Sutter Pacific Medical Foundation, formerly Physicians Foundation at California Pacific Medical Center. SPMF is a multispecialty medical group of over 220 physicians operating in over 50 locations throughout Northern California and Nevada. Walter helped this group through a challenging period of growth and change as the group has expanded and built a strong infrastructure while improving its operations and profitability.

Previously, Walter was Chief Operating Officer of Menlo Clinic at Stanford University Medical Center. Walter was also Executive Director of BayCare Medical Group and Assistant VP and Director at St. Luke’s Hospital in San Francisco. In addition, he worked for large accounting firms, Alta Bates Hospital, University of Colorado Hospital, UC San Francisco, and the Ross Valley Medical Group.

Walter has served on various boards of Directors, including; Operation Access, National IPA Coalition, Marin Community Clinic, and the Bay Pacific Health Plan. Walter is founder and advisor to the California eHealth Collaborative. He earned his BA degree from the University of California, Berkeley and his Masters in Health Administration from the University of

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Market Changes from Healthcare

Reform

Walter Kopp

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Walter’s Brief Background

 BA, UC Berkeley; MHA, University of Colorado

CAREER HISTORY

 Worked for large accounting firms

 Hospitals: Alta Bates, U of Colorado; in San Francisco: UCSF, St. Luke’s  Med Groups: Ross Valley , Bay Care

 Executive Director, Menlo Clinic at Stanford University Medical Center  COO, Sutter Pacific Medical Foundation

CURRENTLY

 President, Medical Management Services

 Helping Health Systems to develop Integrated Medical Groups to manage

population health

 Transition of San Leandro Hospital and Alameda Hospital to Alameda Health

System, Lodi Health, Psyche Analytics, MOB Development

 Helping Coalitions to help FQHC’s with Clinical Integration

 Developed Integrated Medical Groups with Marin General, Lodi, Salinas

Valley, Torrance Memorial, City of Hope Medical Group others

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Presentation Outline

Market Drivers in California

Evolution of Clinical Integration

Market Changes by Region

Demand Destruction and Price Drops

Other Trends and Disruptive Technologies

How Groups Transition

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Market Drivers in

California

Aging Medical Staffs

Physicians leaving for employment options

Evolution to integrated multispecialty group

practice

Profits from ancillaries used for cross subsidy

of PCPs

IPAs are aging and must reposition...but are

not

Healthcare reform requires clinical integration

Musical chairs for specialists

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Evolution of Clinical Integration

FFS

PPO

Shared Risk/ ACO

Capitation

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Market Changes in Northern

California by Region

South Bay

 Stanford University Health Alliance…Affinity Med Group  PAMF Expansion

 El Camino ?

 Daughters of Charity… sold to Prime…Foundation?  Good Samaritan… no physician affiliated group  Kaiser expansion

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Market Changes in Northern

California by Region

 East Bay

 Stanford University Health Alliance  PAMF Expansion

 Sutter East Bay Medical Group  Brown and Toland …?

 Hill Physicians..Anthem and Blue Shield  Valley Care Medical Center…Stanford  Washington Hospital…?

 St Rose…Prime

 San Leandro and Alameda Hospitals… AHS  Doctors San Pablo (bailed out, again)

 Alta Bates Summit… new facility

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Market Changes in Northern

California by Region

West Bay

 Stanford University Health Alliance  PAMF Expansion

 Mills Peninsula…PAMF

 Sequoia Hospital..Dignity Medical Foundation  Seton/DOC… sold to Prime.. Foundation?

 San Mateo Medical Center and Clinics  Brown & Toland..?

 Sutter Pacific Medical Foundation, Cathedral Hill  Dignity Medical Foundation

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Market Changes in Northern

California by Region

North Bay

Marin General – Meritage IPA/ Prima Medical

Group, Sonoma and Palm Drive Hospitals

Sutter Hospital, Santa Rosa, Novato, SP Medical

Foundation

St Joseph…Santa Rosa Memorial, Queen of the

Valley…Petaluma Valley – Annadel Medical Group/

Meritage IPA

Healdsburg…?

St Helena… Adventist

Palm Drive…Bankruptcy, again

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Southern California

Foundations

 Cedars Sinai Medical Group  CHW Medical Foundation  City of Hope Medical

Foundation

 St Joseph Heritage Medical

Group

 Memorial Care Medical

Group

 Foundation

 Sharp Rees-Stealy Medical

Group

 Permanente Medical Group

 Bright Health Physicians  Adventist Health

 Loma Linda Medical

Group-Murrietta

 Providence Health Services  Scripps Clinic

 Huntington Medical  Torrance

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Evolution of Medical Groups

HealthCare Partners

Heritage Medical Network

Monarch

Memorial Care

St Joseph Medical Network

UCLA

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Entrepreneurial IPA’s

Many small IPA’s that are

geographically or ethnically defined

Capitation

Aging medical staffs

Fiercely independent

SynerMed

(20)

SoCal Changes

Vivity

Fallbrook closure

UCLA… clinics

USC

Prime purchase of DOCHS

Bear Valley RFP

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Clinical Integration brings

Demand Destruction

Shared Risk contracts are cutting

hospital and specialty revenue

Medical groups are managing chronic

disease better and reducing demand

Hospital affiliated clinics are cutting the

profits that support them

Incentive payments to Medical Groups

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Price Drops, too

Newly insured…will they pay

premium/deductible… only the sick

Increased Medi-Cal…better than

nothing, but below costs

Medicare…decreased demand, revenue,

readmissions, bundled payments, MA

Commercial…decreased HMO payments,

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Other trends

Over built hospitals…white elephants. Debt

Affordability….Price master…pubic perception

Provider sponsored Health Plans

Reductions from Unnecessary care and

management of Hot Spotters

Outcomes data drive referrals…Zombie

Specialists

National Health Systems…Kaiser, DaVita

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Who pays… who benefits

Hospitals investing in clinics that

increase market share but drop revenue

PCMH shifting resources to coordinate

care

Quality Metrics can drive change

How long can hospitals fund systems

that work to cut their revenue….market

share

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Disruptive Technologies

EMR’s gaining value

Big Data used to identify opportunities

(Thrasys)

Clinical Metrics are establishing

standards of care

Engaging all care givers (family)

Tele homecare (CVHCare)

Psychological Screening

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Insurance product evolution

Shared risk contracts…ACO’s for PPO’s

Blue Groove…patient responsibility

PCMH and Ambulatory ICU’s

CalPERS, Blue Shield, Hill, Dignity

Monarch, HCP, Anthem contracts

United Purchase of Monarch and

Memorial

Employer Self-funded growth and

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How Groups Transition

Earn Shared Risk from capitated contracts

Take advantage of shared services from

billing and EHR development

Clinically integrate and manage a population

Affiliate with Hospital Partner

Contracting for Shared Risk with ACOs and

others

Invest in PCP Chronic disease management

Population management, market expansion

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Ways to Grow Virtually

Integrated Communities

Online Billing

Contracting

Capitated Contract Management

Specialty support of PCP’s

Medical Foundation Development

Shared services

EMR development

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Concluding Ideas for Physicians … and

everyone else impacted by Health Reform

 Transition your independent physicians to an integrated group

to provide stability for your physicians and position your group for healthcare reform

 Develop a Clinically Integrated Community that works with your

local hospitals to the long term benefit of the community

 Grow your market share by positioning your organization for

Clinical Integration and telemedicine

 Position for:

 National or Regional chains

 Payment incentives and utilization management will reduce

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More Concluding Ideas

 Develop a Clinically integrated community that works with other

local hospitals, and can bring long term benefits to the community.

 Transition your independent physicians to an integrated group

to provide stability for your physicians and position your group for healthcare reform.

 Providers can benefit from health reform, if they Clinically

Integrate. Healthcare reform will continue no matter what happens with ACA.

 Implementation will unfold over a long timeline, with important

roles for state government and the private sector

 Payment incentives and Utilization Management will change the

(32)

Thanks for listening

Walter Kopp

Medical Management Services

walter@walterkopp.com

References

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