Leading the Change Maximizing Payment Models Melinda S. Hancock, FHFMA, CPA Partner DHG Healthcare 2014-15 Chair Elect, HFMA HFMA Lead #LikeAGirl November 14, 2014

"If your actions inspire others to dream more, learn more, do more, and become more, you are a leader.” – John Quincy Adams

ACA Gains through 2019 Amounts in Billions Source:CBO and Joint Committee on Taxation, 2010 Projection

Industry Tipping Point Revenue Time How do local market conditions impact timing considerations? Can market-changing events create an urgent paradigm shift? What is my step-change business model risk? Do I have the financial tools to adequately analyze relevant states?

Hierarchy of Risk and Payment Models Payment Model & Increasing Risk Acceptance 5

Alignment of Strategy and Metrics Questions to Ask How many metrics am I tracking? How many metrics are duplicated? Do they have the same numerator and denominator? Source? Are they aligned with our results and strategic goals? What contracts are coming up for renewal that should have new metrics or should be at risk (mgd care, medical directorships, PMAs, etc.) What are we focused on?

Reform Timeline

Value Based Purchasing

VBP Shifting of Domain Weights FY 2013 FY 2014 FY 2015 FY 2016 Core Measures Outcomes Patient Experience Efficiency (MSPB)

New NQS Based Domains for FY 2017 Clinical Care - Process = 5% HCAHPS = 25% Clinical Care - Outcomes = 25% Safety = 20% MSPB = 25%

VBP – FY13 Domain Weights Performance Period: July 1, 2011 – March 31, 2012 Reimbursement Period: October 1, 2012 – September 30, 2013 Core Measures = 70%

VBP – FY14 Domain Weights Performance Period: April 1, 2012 – December 31, 2012 Reimbursement Period: October 1, 2013 – September 30, 2014 Outcomes = 25% Core Measures = 45%

VBP – FY15 Domain Weights Performance Period: January 1, 2013 – December 31, 2013 Reimbursement Period: October 1, 2014 – September 30, 2015 HCAHPS = 30% Core Measures = 20% Outcomes = 30% MSPB = 20% One Measure!!

VBP – FY16 Domain Weights Performance Period: January 1, 2014 – December 31, 2014 Reimbursement Period: October 1, 2015 – September 30, 2016 Core Measures = 10% HCAHPS = 25% MSPB = 25% Outcomes = 40%

VBP – FY16 Domain Weights Performance Period: January 1, 2014 – December 31, 2014 Reimbursement Period: October 1, 2015 – September 30, 2016 Clinical Care - Process = 5% HCAHPS = 25% Clinical Care - Outcomes = 25% Safety = 20% MSPB = 25%

Value Based Purchasing Outcomes = Income Mandatory Pay for Performance Program 3,500 hospitals are included in this program across the country Reimbursement Determine Two Ways: Achievement How we compare to National Top Decile (350 Hospitals) Improvement How we measure against ourselves Did we do better than a previously measured baseline period

Value Based Purchasing Percent of Medicare Reimbursement at Risk FY 2013 – 1.00% FY 2014 – 1.25% FY 2015 – 1.50% FY 2016 – 1.75% FY 2017 – 2.00% FY 2018 – 2.00% FY 2019 – 2.00% FY 20xx – refers to the Federal Fiscal Year (Oct. 1 – Sep. 30) when DRG payments will be affected

VBP FY 2016 – New Measures Patient Experience No Change – Same HCAHPS Measures Core Measures 5 Dropped; 1 New Outcomes 3 New Measures Efficiency No Change

VBP – FY 2016 – Patient Experience HCAHPS Hospital Consumer Assessment of Healthcare Providers Survey An engagement survey CMS has mandated each hospital give to every discharged inpatient Consists of 27 questions that lead to the 8 categories assessed for VBP Patients score each question on scale of 4 For answers to count, patients must give hospitals a score of 4 or “Always”

VBP FY 2016 – Patient Experience Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff Pain Management Communication about Medicines Cleanliness and Quietness of Hospital Discharge Information Overall Rating of Hospital

VBP FY 2015 – Core Measures SCIP-Inf-2 AMI-7a SCIP-Inf-3 AMI-8a SCIP-Card-2 SCIP-VTE-2 AMI-7a AMI-8a HF-1 PN-3b PN-6 SCIP-Inf-1

VBP FY 2016 – Core Measures AMI-7a SCIP-Inf-9 PN-6 SCIP-Card-2 SCIP-VTE-2 IMM-2 Note: IMM-2 Performance Period is only 6 MONTHS (Two 3 Month Periods)January 1, 2014 – March 31, 2014 AND October 1, 2014 – December 31, 2014

VBP FY 2016 – Core Measures Measure ID Benchmark AMI-7a 100% IMM-2 98.875% PN-6 SCIP-Inf-2 SCIP-Inf-3 SCIP-Inf-9 SCIP-Card-2 SCIP-VTE-2

VBP FY 2016 – Core Measures AMI-7a PN-6 SCIP-Inf-2 SCIP-Inf-3 SCIP-Card-2 SCIP-VTE-2 IMM-2 AMI-7a PN-6 SCIP-Inf-2 SCIP-Inf-3

VBP FY 2017 – Clinical Care: Process AMI-7a IMM-2 PC-01 PC-01 = Elective Delivery Prior to 39 Completed Weeks Gestation

VBP FY 2015 – Outcomes 30 Day Mortality – AMI 30 Day Mortality – HF 30 Day Mortality – PN AHRQ – PSI-90 CLABSI

VBP FY 2016 – Outcomes 30 Day Mortality – AMI 30 Day Mortality – HF 30 Day Mortality – PN AHRQ – PSI-90 CLABSI CAUTI SSI – Colon SSI – Abdominal Hysterectomy

VBP FY 2016 – Outcomes Measure ID Benchmark CAUTI 0.000 CLABSI Surgical Site Infection Colon Abdominal Hysterectomy

VBP FY 2016 – Outcomes Outcomes 30 Day Mortality – AMI 30 Day Mortality – HF 30 Day Mortality – PN AHRQ – PSI-90 CLABSI CAUTI SSI-Colon SSI-Abdominal Hyster.

VBP FY 2017 – Clinical Care and Safety MRSA C. Diff Clinical Care- Outcomes 30 Day Mortality – AMI 30 Day Mortality – HF 30 Day Mortality – PN AHRQ – PSI-90 CLABSI CAUTI SSI-Colon SSI-Abdominal Hyster.

Reform Timeline

Outcomes – 30 Day Mortality Currently in 3 Performance Periods FY 2016 ended June 30, 2014 FY 2019 began July 1, 2014 30 Day Mortality Measures Assess deaths: AMI, HF, and PN that occur within 30 days after admission; which, depending on the length of stay, may occur post- discharge….

CMS 30 Day Risk-Standardized Mortality Rate Calculation = Measure (AMI, HF, PN) National Crude Rate Facility Predicted Deaths X Facility Expected Deaths

VBP FY 2016 - Efficiency Medicare Spend Per Beneficiary (MSPB) Captures total Medicare Spending Per Beneficiary relative to a hospital stay, bundling hospital sources (Part A) with post acute care (Part B) Bundles the cost of care delivered to a beneficiary for an episode across the continuum of care: 3 Days Prior Hospital Inpatient Stay 30 Days post Discharge

VBP: MSPB Sample US

VBP: MSPB

PROPOSED MSPB Measures Additional Efficiency Measures proposed to be added Risk Adjusted similarly to MSPB Proposed to facilitate alignment with the Physician Value Based Payment Modifier program Includes Part A and B and 3 days prior to admission and 30 days post discharge Medical Surgical Kidney/Urinary Tract Infection Hip replacement/revision Cellulitis Knee replacement/revision Gastrointestinal hemorrhage Lumbar spine fusion/refusion SOURCE: May 1, 2014 Federal Register

System was penalized $376,003 in FY’15 VBP Program Must acknowledge the amount UNEARNED Of the programs dollars made available: System did not capitalize on $6,187,541

Drilldown on Outcomes… Variation within the Domain: Maxed out on AMI Mortality and then got a 0 on CLABSI

Opportunities – VBP: Outcomes Top 50th = Δ1 Patient Top 50th = Δ1 Patient Top 50th = Δ8 Patients Top 10th = Δ3 Patient Top 10th = Δ3 Patient Top 10th = Δ11 Patients

VBP – CMS Proposed Future Measures FY 2018 Program (Performance Period: CY 2016) Patient Experience: Care Transition FY 2019 Program (Performance Period: CY 2017) Surgical Complication: Total Hip and Total Knee Arthroplasty

FY 19 New Measure Added THA/TKA for 30 month performance period. January 1, 2015-June 30, 2017 Baseline of July 1, 2010-June 30, 2013 Risk standardized measure for complications after Total Hips and Knees surgeries for up to 90 days post surgery One of eight complications: AMI, pneumonia, sepsis, SSI, PE, death, mechanical complication or periprosthetic joint infection/wound infection. Each has a defined time frame Each is a ‘Yes’ or ‘No Risk adjusted for patient age, sex and comorbidities SOURCE: August 2014 Proposed Rules Federal Register

Readmission Reduction Program

Reform Timeline

Readmission Reduction Program 9% of Current and Future Medicare Reimbursement at Risk 3% penalty of Medicare Reimbursement at risk each program year Measured Populations 30 days from DISCHARGE AMI, HF, PN, COPD, THA & TKA August 2014: CABG Added to FY 2017 Performance Periods: 3 Year Rolling Program FY’15: July 1, 2010 – June 30, 2013 – 3% FY’16: July 1, 2011 – June 30, 2014 – 3% FY’17: July 1, 2012 – June 30, 2015 – 3% FY’18: July 1, 2013 – June 30, 2016 – 3% FY’19: July 1, 2014 – June 30, 2017 – 3% Currently participating in 3 performance periods simultaneously

How are Readmissions Measured? Scoring Index based at 1.0 Calculate Excess Readmission Ratio Excess Readmission Ratio > 1 = BAD Excess Readmission Ratio < 1 = GOOD Facility Predicted Value Facility Expected Value

Wisconsin RRP By Facility: FY 13- FY 15

Hospital Acquired Conditions

Reform Timeline

Hospital Acquired Conditions (1% at Risk*) 12 Hospital Acquired Conditions Identified Divided in to 2 Domains If a hospital is in the BOTTOM QUARTILE (worst performing 25% in the country), it will be penalized a FULL 1% of Medicare Reimbursement Penalties will begin FY’15 (beginning October 1, 2014) *1% After DSH, Uncompensated Care, and IME

Penalties & Your DRG Payment

Hospital Acquired Conditions: FY’15 First Domain: PSIs Performance Period: 7/1/11-6/30/13 Second Domain: CDC Performance Period: CY 2012 & 2013 Pressure Ulcer Rate CLABSI Foreign Object Left in Body CAUTI Iatrogenic Pneumothorax Rate Postoperative Physiologic and Metabolic Derangement Rate Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate Accidental Puncture and Laceration Rate

HAC Domain Weightings: FY’15 Pressure Ulcer Rate: 8.33% CLABSI: 32.5% Foreign Object Left In Body: 8.33% CAUTI: 32.5%

Hospital Acquired Conditions: FY 2016 First Domain: PSIs 25% Second Domain: CDC 75% Pressure Ulcer Rate CLABSI Foreign Object Left in Body CAUTI Iatrogenic Pneumothorax Rate SSI Following Colon Surgery (FY 2016) Postoperative Physiologic and Metabolic Derangement Rate SSI Following Abdominal Hysterectomy (FY 2016) Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate Accidental Puncture and Laceration Rate

HAC Domain Weightings: FY’16 Pressure Ulcer Rate: 5.83% CLABSI: 32.5% SSI: 32.5% CAUTI: 32.5%

Hospital Acquired Conditions: FY 2017 First Domain: PSIs Second Domain: CDC Pressure Ulcer Rate CLABSI Foreign Object Left in Body CAUTI Iatrogenic Pneumothorax Rate SSI Following Colon Surgery (FY 2016) Postoperative Physiologic and Metabolic Derangement Rate SSI Following Abdominal Hysterectomy (FY 2016) Postoperative Pulmonary Embolism and Deep Vein Thrombosis Rate Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteremia (FY 2017) Accidental Puncture and Laceration Rate Clostridium Difficile (FY 2017)

Dollars At Risk

VBP FY 2016 – Sample Current $$ at Risk

VBP – Sample Total Current $$ at Risk

All Reform – Sample Total Current $$ at Risk

VBP – CMS Proposed Future Measures FY 2018 Program (Performance Period: CY 2016) Patient Experience: Care Transition FY 2019 Program (Performance Period: CY 2017) Surgical Complication: Total Hip and Total Knee Arthroplasty

FY 19 New Measure SOURCE: August 2014 Proposed Rules Federal Register Added THA/TKA for 30 month performance period. January 1, 2015-June 30, 2017 Baseline of July 1, 2010-June 30, 2013 Risk standardized measure for complications after Total Hips and Knees surgeries for up to 90 days post surgery One of eight complications: AMI, pneumonia, sepsis, SSI, PE, death, mechanical complication or periprosthetic joint infection/wound infection. Each has a defined time frame Each is a ‘Yes’ or ‘No Risk adjusted for patient age, sex and comorbidities SOURCE: August 2014 Proposed Rules Federal Register

Bundled Payments

Description of Models 1 - 4 Models 2 and 3 are the most popular by far- retrospective vs prospective models that include the post acute care components

Bundled Payments Model 1 and 4 Model 1 is Retrospective and is all DRGs Model 4 is Prospective Acute LTACH/SNF/ IRF HH Home Readmission 67

Bundled Payments Model 2 Model 2 is Retrospective For 30-60-90 days Acute LTACH/SNF/ IRF HH Home Readmission Model 2 Model 2 is Retrospective For 30-60-90 days 68

Bundled Payments Model 3 Model 3 is Retrospective For 30-60-90 days Acute LTACH/SNF/ IRF HH Home Readmission Model 3 Model 3 is Retrospective For 30-60-90 days 69

Oncology / Hematology (1) General Medicine / Internal Medicine (10) The Episodes CMS created 48 Episodes, each with up to 15 individual MS-DRG codes We categorized Episodes into 9 Service Lines; illustrative purposes only Model 2, 3, or 4 applicants may select 1-48 Episodes for testing   Spine (5) Cardiac Services (12) Vascular Services (3) Orthopedics (10) Neurology (2) Oncology / Hematology (1) Pulmonology (3) General Surgery (2) General Medicine / Internal Medicine (10) http://innovation.cms.gov/initiatives/bundled-payments/ 70

Advantages of Participation Improved quality of care for patients Reduced complications, readmissions, and cost Improved ability to work with hospitals, physicians, nursing homes, home health, rehab centers, and other providers to improve overall care quality and service Potential competitive advantage within market with physicians and post-acute care Opportunity to receive payment aligned with these goals and based on outcomes

Where are the Bundled Payments? MEDICARE: Cohort 1 COMMERCIAL as of July 2014   http://innovation.cms.gov/initiatives/bundled-payments/ 72

Early Results of BPCI Cohort 2 Tremendous increase in the number of applications in the most recent open enrollment in April 2014: Nearly Triple! Models 2,3,4 were open for enrollment Currently in the Phase 1 period which is the non risk, decision making period. Phase 2 is when the Episode Initiator starts to accept risk

Changes In the Cohort 2 Timeline: 7/31/14 Event Original Date Revised Date* Historical Claims & Target Pricing Late Summer 2014 November 2014 Go/No Go Decision to Participate November 1, 2014 January 11, 2015 Go Live with Risk January 1, 2015 April 1, 2015 Other significant changes: ADDITION OF EPISODES: You can now add episodes in July 2015 and October 2015: only 1 episode is required for April 1, 2015. Phase 1 ends in October 2015 B-CARE: B-CARE quality data wont be collected until Spring 2015 Option for Delayed Reconciliation: Will offer a 4 quarter timeline for reconciliation. * Revised again in October 2014

Readiness: Risk Capability What are your data analytics and capabilities and ability to operationalize your quality data What is the maturity of your physician network and post acute care network? What do you know about each? What don’t you know? How are you doing on the VBP and RRP that are building blocks for this? How are you going to manage the gain sharing What quality metrics are you tracking and need to improve that can be built into this program What internal cost sharing could you roll out with this?   75

Strategic Planning: How does it all tie in? System/Facility Strategic Plan Clinically Integrated Networks/Post Acute Care Networks Payment Models MSSP/BPCI/VBP/RRP/HAC Managed Care/Direct to Employer Opportunities

DRG Inpatient and PACS Fee for Service Model Bundled Episodic Model DRG 470 Total Joint Replacement w/out CC Model 2 DRG Inpatient and PACS Fee for Service Model + + + $3,207 $10,129 $8,965 $616 = $22,927 x 98% Home Home Health SNF IRF Outpt. Rehab MD $22,468 Readmission Episodic period for model 2: 3 days prior to admission to 90 days post discharge from hospital $22,468 Bundled Episodic Model Note: any CMI aggregate charges lower than $22,468 can be shared with providers via gain sharing model

Gain Sharing Model Physician Setting ($$) Shared Reward Surgeon Anesthesiologist Hospitalist Outpatient Physician Setting Hospital SNF Home Health

Bundled Payment Episode Pricing and Gain Sharing 2008-2009 2013 Historical Cost Per Episode $12,500 Target Price $13,647 Physicians (35%) $86 Update factor Quality Metrics For illustration: 3% inflation/yr Discount = 3% Settlement (Per Case) $247 Environment of Care - Hospital (40%) $99 Quality Metrics Procedure – nursing, rehab, cost categories. What % of revenue can the cost be to break-even. Implants – 29 to 31%. Reduce the total cost to meet those break-even number. If the doctors don’t hit this number, their group will not qualify – break even analysis on what they are doing. BPLN Episode Definitions Risk Adjustment Actual FFS Cost during Performance Period $13,400 Environment of Care - Post-acute (25%) $62 Quality Metrics

BPCI Multiple Bonus Payments: Physicians 2 opportunities for Physicians to be awarded Bonuses Internal Cost Savings Pool Bundled Payment Savings Pool Both have required Quality Metrics and Cost Savings to be met Cost Savings MUST be directly attributed to Quality Improvement and Care Redesign 80

Outpatient Bundling…coming soon? In February 2014, CMMI issued a Request for Information on a new bundled payment program to expand to outpatient. Focus is Specialty Physicians and on Procedures and (2) complex chronic care Highlighted colonoscopy, cataract surgery, & radiation therapy for procedural options. Regarding the chronic care, “CMS is considering development of a model that would incentivize specialists to more efficiently manage the care provided to beneficiaries with complex or chronic medical conditions over the period of time that corresponds to the specialty practitioner’s long term involvement with managing the beneficiary’s care.” Was seeking responses until March 13

Outpatient Bundling Referred to by CMS as: “Comprehensive Ambulatory Payment Classification (APC)” Finalized in the CY 2014 OPPS/ASC Final Rule Affect payments to 4,000 hospitals and 5,300 ASC’s Delayed implementation to January 1, 2015 instead of the traditional outpatient October 1 implementation date Extra time allowed the Agency, hospitals, and physicians more time to evaluate and comment on the policy

Outpatient Bundling – Comprehensive APC’s Single Medicare payment rather than individual APC payments throughout the episode 25 Bundled Outpatient Procedures Proposed Payment could include all hospital services reported on the claim covered under Medicare Part B for up to a proposed 6 Month Period Few exceptions resulting in a single beneficiary copayment per claim

Outpatient Bundling – Proposed Procedures

Thank you! Contact Information: Melinda Hancock Melinda.Hancock@dhgllp.com (804) 474-1249

Affinity Groups Current Large System CFO Council Large System Revenue Cycle Council Strategic CFO Council Being Formed CMMI Bundled for Care Improvement Council Payer Focused Affinity Group Newly Formed and Actively Meeting Health Care Economics Professional Council Physician Group Practice Executive Council Strategy Executive Council Academic Medical Center CFO Council

Master Level Seminars Chicago, IL | Dec. 8-10, 2014 Beyond Big Data: Developing a Business Intelligence and Analytics Practice Population Health Management and the Next Generation of Clinical Integration Washington, DC | Feb. 18-20, 2015 Transparency, Metrics, and Communication: Proven Practices for Revenue Cycle Strategies Seattle, WA | March 25-27, 2015

Improve the Billing and Payment Experience for Patients hfma.org/dollars 88

Price Transparency Task Force

Enhance Price Transparency Clarifies basic definitions that are often misused Sets forth guiding principles Establishes roles for payers, providers, others Reflects consensus of key stakeholders hfma.org/dollars

Demystify Price Information for Consumers Describes how to request price estimates, step by step Clarifies what estimates may or may not include Explains in-network and out-of-network care Defines key terms Available for posting on your website at no charge Hardcopies available for purchase in bulk at a nominal price through AHA’s online store hfma.org/transparency ahaonlinestore.org

Best Practices Address Key Issues Provision of Care Registration and Insurance Verification Financial Counseling Patient Share Prior Balances (if applicable) Balance Resolution

Achieve Recognition as an Adopter of Best Practices Recognition demonstrates commitment to best practices in patient financial communications Based on HFMA review of an application and supporting documentation All provider organizations may apply Recognition valid for two years Adopters may use the phrase “Supporter of the Patient Financial Communications Best Practices” in their marketing materials .

Leading the Change from Volume to Value Defining and delivering value Key organizational capabilities for building value Organizational road maps hfma.org/valueproject HFMA's Value Project helps healthcare organizations create value for the multiple purchasers of health care. The transformation toward a value-based healthcare system is reshaping the delivery of care, patient expectations, and payment structures. In the resources HFMA has produced for the Value Project since its inception in 2010, healthcare finance leaders and clinical partners come together to: Define the practices of providers who are leading the way toward a value-based healthcare system Describe the primary capabilities that healthcare organizations will need to develop in the areas of people and culture, business intelligence, performance improvement, and contract and risk management to improve the value of care provided Provide specific strategies, tactics, and tools that healthcare organizations can use to build, enhance, and communicate their value capabilities Identify the trends today that are defining the future state of value in health care and describe new care delivery models that could help healthcare organizations create value The various reports produced as part of this project are pictured on the next slide.

New Report Extends Value Resources to Reflect Industry Realignment Acquisition and Affiliation Strategies Acquisition and Affiliation Strategies Current State & Future Directions of Value Value In Health Care HMFA’s Value Project Four Key Capabilities for Value Building Value-Driving Capabilities Defining & Delivering Value Defining and Organizational Road Maps for Value-Driven Health Care The Value Journey: Organizational Road Maps for Value Driven Health Care hfma.org/valueproject

Career Strategies HFMA Resources “Choose a job you love, and you will never have to work a day in your life.” Confucius 96

Take Advantage of HFMA Resources

Your personal plan…what does it really mean? Leadership… Your personal plan…what does it really mean? “Leadership has nothing to do with titles; it has everything to do with, “Do you inspire other people? Do they want to follow you? Do they want to be with you?” -Tom Atchison, author of Followership: A Practical Guide to Aligning Leaders and Followers In closing, I would like to thank each of you for being a leader in our industry. As you see by the quote from Leadership expert Tom Atchison on this slide, “you don’t need formal authority in the form of titles to lead change. You just need to be able to inspire others to join you in the change leadership process.” 98

Be an Exceptional Leader Well cultivated self awareness Compelling vision A real way with people Masterful execution Well cultivated self awareness: Leading with conviction – identify your values and beliefs and let them guide decision making, even if it leads to unpopular decisions Using emotional intelligence – recognize your strengths and weaknesses and manage your emotions. Earning trust ant loyalty – be willing to admit mistakes, do what you'll say you‘ll do and pay attention to the concerns of others. Energize staff- encourage strong work ethic and enthusiasm by modeling it personally. Compelling vision: Develop vision anticipates changes and includes strategies to adapt them. Communicating vision – help others to understand the future state and communicate their role in reaching that state. A real way with people: Listen like you mean it – be approachable and open-minded Give feedback, set clear expectations and provide appropriate criticism and praise when appropriate. Mentoring direct reports – invest time in others Develop a high performance team Masterful execution: Understand the informal sources of power in your org and work to influence them Building true consensus Use mindful decision making-facts, goals, ethics, alternatives, and judgment Driving results Sustaining creativity-be open to new ideas Cultivate adaptability – bring clarity

Be “Great by Choice” Fire bullets instead of cannonballs. 10ers are extremely disciplined They use empirical data and continually plan for the “what if” The take the 20 Mile March Performance markers and self imposed constraints Fire bullets instead of cannonballs. Only shoot cannon balls after testing. Show great financial constraint Zoom out – then zoom in. The best leaders were more disciplined, more empirical, and more paranoid. It is more important to scale innovation; blend with creativity with discipline. Fast decision and fast actions are a good way to get killed. Great companies changed less in reaction to a radically changed world than comparison companies.

Develop Your Leaders… “You cannot lead without knowing the needs of your people—what drives them, what makes them do what they do; then you can give them opportunities to succeed based on their own psychology of success.” Develop your leaders…. Kerry Gillespie, FHFMA, vice president, operations, Community Health System, Inc., Brentwood, TN, and a member of HFMA’s Tennessee Chapter 101 101

Everyone Is a Leader…. Everyone in this room is a leader. I’m asking each of you to renew your commitment to leading our industry forward, to ensuring its long term viability and quality. Together, we CAN improve health care. Together, we can and we must • Mentor young professionals as we have been mentored, • Rise above the uncertainty and frustration of today, and • Work in partnership with our colleagues throughout the industry to lead the change. Kari Cornicelli HFMA National Chair 2014/2015

New Skills for A Leader Convening collaborative efforts Making decisions on behalf of your organization Commitment to move the alliance forward Confidence that the alliance will "get to its destination"

Trend Toward Collaboration Across Traditional Boundaries 8 Key Elements Required for Successful Collaboration A common pain (a shared problem) A convener of stature (an influential leader) Representatives of substance with authority to make decisions Leaders committed to move the alliance forward A clearly defined purpose Established rules Confidence that the alliance will "get to its destination" A shared pool of reliable information Source: 2013. Mike Leavitt and Rich McKeown. Finding Allies, Building Alliances: 8 Elements That Bring…and Keep People Together

Leading Change- Summary