Preparing for a future in accountable healthcare requires current government-based providers to develop skill sets that they have not previously had. Specifically, strategic and tactical market prowess—including timely responsiveness to market opportunities and threats. They must convey the value-added benefits of services to consumers, payers, and providers. I am a proponent of Philip Kotler's four P’s of strategic market planning, whose formulation contained four elements: product, positioning, promotion, and price. I add a fifth element, politics.
What clinical or ancillary services are currently being offered? What future services will be of high value to consumers, payers, and benefit managers? How will ICD-10 affect how we diagnose, treat, measure and finance existing services? Consider offering high incident, population-based services for depression and anxiety, emergency-room diversion and services to medical groups to assist in consumer adherence to lifestyle and preventive care. Services for co-morbidity in high-risk consumers, such as case management and disease management, as well as medical home core elements, will be in high demand. Should you manage other ancillary services such as occupational therapy, physical therapy, speech and hearing services?
Ensuring the greatest decisionmaking impact for the public interest is critical. Be both a provider and benefits manager if the politics permit. Take a leadership role in behavioral health partnerships or accountable care organizations (ACOs). Offer specialized behavioral health/intellectual disabilities benefits management to health insurance plans or ACOs. Consider creating or partnering with a Federally Qualified Health Center (or a look alike) if in a medically underserved area. Join trade associations focusing on primary care, chronic disease management and healthcare reform.
You must prove your worth and value to all stakeholder groups. Adopt, use and demonstrate a public health proof-of-performance model, focusing on return on investment, tax conservation, and other value propositions such as crisis stabilization, emergency room diversion and avoiding readmissions though assertive care management programs. Prove your worth to commercial stakeholders through reduced episodes of care costs, absenteeism or increased productivity at less cost.
Develop flexible accounting and episode/value pricing. Integrated electronic health records, Meaningful Use qualification, and financial and management systems are essential. Administrative efficiency is paramount, given medical loss ratio caps of 20 percent at the ACO level. Develop public-private outsourcing models for variable volume clinical services and routinely revisit the question of “Do we do this, contract this out, lease, buy or build?”
Extend and raise your political presence in the local and state arena. Track each stage of the evolving regulatory process and develop presence and connections in the emerging health system politics in your communities, statehouses, and at county and city council levels. Approach each day as if the future of your vision of healthcare transition would be tested at least once.
Charles G. Ray has led hospital/community behavioral health organizations in Missouri and Florida and served as CEO of the National Council of Behavioral Healthcare (1988-2003). In his 42-year career spanning clinical and executive stewardship, he has earned a national reputation as a coalition builder and advocate in the areas of resource based managed care design, development, and delivery in both public and commercial sectors with payers, providers, and consumers, emphasizing evidence-based practice and public-private partnership models. His firm designed, developed, and implemented the Kansas Medicaid Behavioral Health Carve Out (2006-08) and the first statewide commercial autism spectrum disorder network in New Jersey (2009-11). He recently served as Interim Executive Director of the City of Norfolk Community Services Board and is the President of CGR and Associates International, LLC, Fairfax, Virginia. He serves on multiple national NPO Boards of Directors and is a frequent contributor to national publications and is often cited as a subject matter expert by media.