Pendulum Health provides management services for startup and expanding ventures owned by physicians, hospitals and employers.
Contractual Arrangements for Management Services
These can be long term contracts or short term, transitional management agreements. These agreements are constructed like an employee leasing agreement with salaries and benefits set by the client but paid through a management fee to Pendulum Health. In cases where a startup company is cash poor but needs excellent management talent to get started, a commitment to Pendulum Health can be made to ease cash flow pressure but still give the client access to top notch experts in managing joint ventures, physician networks and community based health plans owned by physicians and employers.
Shel Gulinson Sr. Vice President
Joining Pendulum Health in 2001 Shel brings a unique background of working with large and small hospitals systems as well as working in building regional and statewide healthcare trade associations in Illinois and California. He has been instrumental in assisting clients in areas of hospital physician alignment , physician network development and providing technical assistance to ACOs and their governing Boards.
Forney Fleming MD MBA
Dr Fleming is an experienced orthopedic surgeon who worked with Mr. DeMarco in the formation Of MDS, a 300 physician Network in Wichita Kansas . Moving to Texas in 1998 Dr fleming organized a medical staff IPA and eventually led the development of the PHO while finishing his MBA at University of Texas. Dr Fleming assists in areas of physician network development, clinical integration design and implementation ,training of medical management staff, building clinical decision support guidelines and providing advanced education programs for startup committees and executive leadership.
Martin Blum DO MBA
Dr Blum has created and managed a variety large and small primary care group practices including networks, groups without walls and physician hospital joint ventures. Dr Blum works with Pendulum clients in formulating primary care strategies for patient engagement, physician compensation incentives and building practice level efficiencies to improve revenue using CCM billing, coding and reporting. Dr Blum holds several business certifications and holds an MBA in Finance and operations.
Managing referrals between primary care, specialty care and the hospital are essential to the new era of coordinated care. When fulfilling our management responsibilities in starting or expanding new ventures our staffing resources prepare a multidisciplinary plan addressing these essential components of care management. Our goal is to integrate the clinical and financial planning process along with project management discipline to make full use of clients resources blended with our management services.
Assistance with Capitalization
In some cases, Pendulum Health has assisted the client organization in obtaining capital to grow an existing company. In a startup, Pendulum Health assisted the client in constructing the business plan that is then turned into an investment agreement for individual physicians to create a startup pool of dollars that is eventually matched by commercial sources of capital including investment houses, venture capital and commercial banks.
What Pendulum Health Brings
In addition to management talent and capital, Pendulum Health brings infrastructure in the form of superior medical management strength that is clinically based and directly managed by the client's medical directors.
Pendulum Health’s system is a proprietary system that focuses its key objectives on successful outcomes. The old fashioned approach of measuring cost of units and volume of units of care does not document individual severity levels of patients and complexity of diagnosis when more than one illness is present. Pendulum Health's information systems capture both inpatient and outpatient data along with ancillary and pharmacy data and compares it to datasets in a given area to compare performance.
In today’s world of Pay for Performance having access to good clinical data that is severity adjusted and presented in the context of outcomes oriented research gives the physicians and the hospital a strong argument against mass discounts and denials of care in the name of cost containment.
TYPICAL MANAGEMENT SERVICES AGREEMENTS
Independent Practice Associations that are moving toward an integrated network to leverage better pay and share expenses like malpractice and overhead expenses can benefit from Pendulum Health’s management talent, capital and contracted infrastructure. Pendulum Health focuses on medical management so local claims payers and health plans often are willing to work with us to better their satisfaction with employer clients. In many cases, employers would like to contract directly for multi-specialty and/or single specialty health services; Pendulum Health makes an excellent partner.
Physician Hospital Joint Ventures
Many early joint ventures failed due to lack of money and/or lack of focus on improving outcomes. There is even some residual suspicion today that prevents hospitals from working well with physicians on such things as imaging centers, cardiac labs, orthopedic hospitals and surgery centers. Pendulum Health can offer a buffer and allow combined billing charges to be made on a global basis using ETG’s that represent severity-adjusted episodes tied to diagnosis. This makes more dollars available, as the patient may be more complicated in their diagnosis. It also takes away all medical necessity challenges as the diagnosis fixes a package of services at a predetermined price, again tied to patient need, not the insurance company slide rule.
Accountable Care Organizations
For many physician networks and physician hospital joint ventures the ACO challenge has presented an opportunity to build a competitive strategy to align comprehensive health care services that extend beyond the traditional physician office and institutional setting to include home health, long term care, ancillary care and subspecialties that are used frequently by seniors. The MMSP program now offers several varying degrees of risk sharing including track one and track two of the MSSP program plus three new tracks under the New Generation designation. Some clients are signing for all three, some for a single type of ACO configuration, but in all cases physician alignment is key and Pendulum Health has helped clients in building the educational programs to support the rationale for change.
As ACOs have grown some are now considering the move to a commercial ACO agreement with private payers. Many employers and TPAs are looking for networks that can share some risk and produce better outcomes than the traditional broad panel IPA. For many areas of the country where the benchmark is low and the ACO shared savings model does not prove feasible for the Medicare population, the Commercial ACO may be the best starting point to develop a relationship with payers on a direct basis while using the similar metrics of ACO and select HMOs to prove your results of a superior delivery system.
Rural Accountable Care Organizations, A Collaborative Approach
For many existing smaller ACOs as well as potential startup ACOs the ongoing costs can be forbidding. A smaller group of 5000 to 10,000 may look at startup costs in the $2 to $3 million range with ongoing administrative costs in the $750,000 to $1 million annual cost range. This cost is usually driven by three expense areas – Information Technology, Staffing and Salaries, and Preventable and Avoidable Costs (PACs).These medical expenses need to be monitored in such a way to get at both large and smaller costs that will vary from ACO to ACO; however, the tools in terms of IT and select staff could be shared expenses between two or three ACOs thereby lowering startup costs and reducing ongoing management costs. Pendulum Health has the capacity and capability to assist ACOs in spreading administrative costs across several ACOs in a region while l keeping proprietary data and compliance reporting separate for each ACO and Community Based Health Plans
A reemergence in the local health plan has come as a result of strong downward pressure on fees and inflation of medical practice expenses. This, combined with larger hospital and health plan consolidation, has created an opening for a local branded health plan offered by and owned by local physicians. For both the hospital and physicians these provider based health plans offer a great local alternative to accrue patients and have input into reimbursement. The missing elements have been a technology solution to reward quality and a management solution to get and keep experienced health plan talent.
We know employers are rapidly moving away from the discount mentality and toward the need to assure themselves they are purchasing value based quality care. This new definition for the hybrid Community Health Plan can offer physicians and hospitals another chance to strongly influence the market, both in terms of Pay for Performance as well as generating a true return on investment for each successful step towards integrating the delivery of care.
The flexibility to outsource some aspects of building and operating your health care venture has always existed. What Pendulum Health offers is a package of services that generates income (incremental market share development) and also strengthens the physician's and or hospital's bottom line by being able to avoid large expenditures of cash for technology. Employers have been interested in direct contracting for years. As the market moves away from cost and discount agreements toward agreements for value and quality, these employers will influence health plans and, if they cannot, they will come directly to local hospitals and physicians IF the hospitals and physicians can prove they have a better product.
The Centers for Medicare and Medicaid (CMS) have already stated that by 2018 80% of all Medicare payments will come to providers in the form of bundled payment, fixed capitation or a similar Alternative Payment Arrangement. Those physicians who participate in an ACO or Medicare Advantage plan will have options of additional bonuses offered beyond Medicare Fee for Service. Physician who decline to participate will have their Medicare fees frozen at minimum pay levels.
For these reasons and others it makes sense to start looking at how your market is changing and whether it is time to at least test the feasibility of moving towards private or public funded ACOs and/or Health Plans.
Using Pendulum Health’s long or short term transitional management services is truly an advantage in enabling your organization to move forward rapidly in a competitive market.