Emerging Business Models for Hospital and Physician Integration: Clinical Integration as a Business Strategy for Accelerated Growth

NAMCP Fall Managed Care
Forum 2010
(Las Vegas, NV)
L E A D E R S H I P  P R O B L E M SO L V I N G  V A L U E C R E A T I O N November 4, 2010

Emerging Business Models for Hospital and
Physician Integration: Clinical Integration as
a Business Strategy for Accelerated Growth
Christopher J. Kalkhof, FACHE
Director, Healthcare Industry Group
Francis LaMorte, M.D.
Director, Healthcare Industry Group
(New York Office)
Copyright 2010. Alvarez & Marsal. All Rights Reserved.

Presentation Agenda

I. Overview of Evolving Federal
and State Regulatory
Landscape and Impact on
Provider Revenues
II. Emerging Provider
Business/Financing Models:
Options and Considerations
III. Lessons Learned
IV. Q&A and Program Close
Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. 1
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Presentation Agenda

I. Overview of Evolving Federal
and State Regulatory
Landscape and Impact on
Provider Revenues
 Plan now for ACA impact
 Do not put yourself in the
position of having to react in
2013 or 2014


Evolving Federal and State Regulatory Environments
I. Provider and Payer Brave New World – Transitions Under Affordable Care Act

Cost shifting, government reform, and budget deficits are
eroding the traditional payer-provider relationship
 Cost shifting from government payers will not lessen and may
increase under the Affordable Care Act.
 CMS, State Medicaid programs and the health plan
community (irrespective of product type e.g., commercial,
Medicaid, Medicare, etc.) have begun the process of
fundamentally restructuring payment methodologies.
 Private sector health plans have to rethink the fundamental
structure of their provider networks.
 Providers and payers… will be expected to do more with
less! How efficient and cost-effective are your ops?

© Copyright 2010. Alvarez & Marsal Holdings, LLC. All Rights Reserved. 3


What will be the impact of health care reform with respect
to negotiated agreements between providers and payers?
 Providers and payers alike will be entering into unchartered
waters.
 There will be multiple pricing and payment models emerging
within different regional markets around the country over the
next few years.
 There will be different winners and losers on a region-to-
region basis. Some critical success factors?
– Business model and ability to manage patient populations.
– Physician alignment and integration.
– Collaborative vs. adversarial payer relationships


A value-driven/outcomes-based system reimbursement
and by extension… pricing environment will:
 Hold providers accountable for their performance in terms
of patient quality, safety and outcomes as well as the cost
and setting of care delivery.
 Emphasize population and disease care management
across a care continuum.
 Creates significant financial incentives for physicians,
hospitals, health insurance plans and other healthcare
providers… to better align and coordinate care delivery.
 Will require that providers in many cases… greatly
enhance their decision support capabilities and overall
contracting strategy across all contracts.


The ACA offers few specifics at present.
 The different legislative components of the ACA which
impact providers and payers the most, go into effect
between 2010 and 2014… some retroactively, but most on
a “to be determined” going forward basis.
– To finance the ACA… a re-basing of our core
healthcare financing mechanisms will be required.
 Absent specific regulatory guidelines, many organizations
are struggling to understand the impact of the ACA on their
organizations so that they can plan accordingly.
– The economic and lost opportunity costs or either
going in the wrong direction or waiting too long to
take action… can be very significant.


What do we think we know about strategic impact?
 Reform laws include provisions that pressure…
– Health plan historical pricing and assumptions about
managing provider costs.
– Provider net revenue with the assumption of more risk.
– Provider and health plan margins.
 There are general national themes… however
implementation of specific strategies will most likely be
deployed on a regional basis.
 There will be notable regional successes and failures.
What about your local market?


Converging market forces will impact strategic choices:
Government and  Budget shortfalls in 48 States
What if…
payers under
 States blocking payer rate hikes
Fed/State pressure from
premium increases  Demand for demonstrable value
deficits grow?
ACA costs:  Double digit billion $$ Medicare deficits
> $1 trillion? Continual CMS  Unresolved Medicare SGR payment-
threat to reduce adjustment for physicians (40%
> $2 trillion?
payments cumulative cut by 2016)
Access  EHR meaningful issues/penalties
diminishes?
 RAC expansion into other payers
Hospitals fail?  New risk-based payment models
Increased
Payer par  Need for clinical integration/physician
uncertainty and
networks revenue risk alignment and IT/operational support
change?  ICD-9 to ICD-10 conversion in 2013

Impact of above on your care delivery model?


Continue to operate the same but
Maintain status quo expect different results

Consolidation of like operations;
Horizontal Merger economies of scale; shared services; a
functional physician alignment
Market Strategy strategy and the ability to capture and
retain lives

Develop strengths along continuum
Vertical Clinical of care to manage patient
populations… requires enhanced
Integration quality of care and coordination
across vertical care continuum;
Strategy supporting IT and ability to
collaborate across care continuum


Presentation Agenda

II. Emerging Provider Business
and Financing Models:
Options and Considerations
 Understand clinical integration
models
 Understand your cost structure
 Know how to “clinically integrate”
at the service line level
 Determine how emerging payment
methodologies will evolve and
impact your care delivery model

Emerging Business/Financing Models: CIO Options
II. Clinical Integration as a Business Strategy for Accelerated Growth

Clinical Integration as defined by regulators
 1996 Department of Justice and Federal Trade
Commission Statements of Antitrust Enforcement
Policy in Health Care
– "[A]n active and ongoing program to evaluate
and modify practice patterns by the network's
physician participants and create a high
degree of interdependence and cooperation
among the physicians to control costs and
ensure quality."



Future State – CIO Provider Networks
 Integration of facilities-practitioners with a true
interdependence and collaboration.
 Disease management and corresponding clinical
protocols.
 Integrated IT which allows efficient/effect patient
information exchange… utilization and claims
data collection to manage care and lower costs…
clinical indicators to improve quality and measure
physician protocol compliance and performance.


Future State – CIO Provider Network
 Specialists and PCP focus on in-network referrals.
 A high level of physician financial investment and
commitment of time for training, utilization of the
disease management protocols and compliance
with varied clinical pathways.
 Processes for improving performance and care
delivery, with enforceable consequences for non-
compliance.



The evolution of a messenger model PHO/IPA to CIO?
The CIO will be a more complex, fully clinically integrated
business model, which will be capable of providing non-
risk/at-risk solutions to external stakeholder purchasers of
healthcare services… will require:
 All internal stakeholders to share a common vision
 Joint governance (e.g., physician lead and
professionally managed)
 The equitable distribution of risks and rewards.
Think “Group Model” HMO
w/o the Insurance Risk


Care Delivery and Financial Risk Continuum
Full Global High
Capitation
Episodes of Care & Competitive
e re fF a c lR k
D g eo in n ia is

Gainsharing Market and
Global Hospital
Provider Risk Is
Capitation Dominant
Global Hospital
Case Rates
Medical Homes Low High
Acct Care Orgs
(Physician Model) Non-Competitive
Risk Withholds
Market and
& P-4-P Provider Risk is
Uncommon
Hospital PPS (IP/OP)
FFS Charges Low

Degree of Clinical integration


Eight Step Clinical Integration and Business Plan
Development Process: Hospital – Physician PHO Model

Project Clinical Integration Determine C.I.
Planning Gap Analysis Organization Model

Determine Clinical Define and Plan
Infrastructure Clinical Initiatives

Determine Regulatory Implement Initial
Compliance C.I. Programs

Measure, Monitor,
Report and Educate


The process of starting a CIO starts with a strategic
clinical integration planning process
 Choose high level goals for redesign.
 Determine the design of the overall care delivery system,
care management and business processes.
 Create a compelling value proposition for physicians to
become actively engaged in the change process, take
leadership roles in ensuring the success of the CIO and
establish a system wide culture that says…
…“this is how we will delivery high quality, safe,
effective and efficient care to our patients.”
Project Planning and Gap Analysis

II. Clinical Integration as a Business Strategy for Accelerated Growth: Assessment to CIO Business Plan

Audit clinical integration readiness of the medical staff
 Assess physician motivations to develop a collaborative
clinical integration initiative across the health system.
 Use interview-based findings and existing management
reports to create a summary profile of independent and
employed physicians.
 Identify the “vital few” …the critical mass of physicians who
are willing to adapt/adopt and transition to a new model.
 Identify physician needs and incentives relative to C.I.
 Gauge physician views on expanding the PHO/IPA to include
additional physicians in primary and secondary service area.
Project Planning and Gap Analysis (18)


Project organizational and internal/external project
team roles; develop, review and finalize the work plan
 Prepare internal communications plan for project stakeholders
 Evaluate current processes and value stream mapping.
 Assess current “level of clinical integration” among
inpatient, outpatient and ambulatory services.
 Perform internal/external benchmarking of cost, quality,
efficiency, job skill requirements and calculate cost reduction
and efficiency improvement opportunities
 Assess technology tools, enabling capabilities, data
warehouse and operational support needs.
Project Planning and Gap Analysis (19)


Match Organizational Architecture to Organizational Culture
 Governance structure:
– A committee hierarchy and governance model that
promotes equitable distribution of rewards, risks, and
control between hospital and physician partners.
 Legal structure options.
– Consider need to create a “New Co.” physician enterprise
structure to serve as the integration vehicle.
 Plan for transition… not disruption
– Physician alignment preparation for transition to CIO model.
– Payer relationship maintenance and CIO contracting
strategy.
Determine “Best Fit” C.I. Organizational Model


Integrating Employed Non-Employed
Physicians Physicians
independent and
employed Diffuse collection of
Aligned w/Hospital interests…not aligned
physicians? Service Lines w/hospital service lines
One piece of the CIO
puzzle… a selective, Compensation tied to Strategic focus at
goals and productivity practice level
scalable membership
criterion which Declining economics
focuses on Higher cost structure and often unfavorable
collaboration and payer contracts
equitable treatment
Advanced IT tools and Limited IT tools, limited
among physicians, reporting reporting to manage
patient outcomes
and managing Many regulatory
Few Regulatory barriers to hospital
patient populations. Barriers alignment
Determine “Best Fit” C.I. Organizational Model


Define and Plan Clinical Integration Initiative Considerations
 Build a clinical care model which emphasizes value-driven
care and which can be deployed across disease
management-based service lines in anticipation of future
episodes of care and global capitation reimbursement models.
 Identify and validate the key metrics that will be used to define
success and provide meaningful, actionable information.
 Provider network refinement/recruitment to allow for strategic
community outreach and inclusion in the “New Co.” clinical
integration organization.
 Focus on safety.

Determine Clinical Infrastructure and Define/Plan C.I. Initiatives


Management and clinical integration plan development
should include utilization management strategies to:
 Facilitate administration and physician development.
 Foster agreement for a hospital-based UM program jointly
developed with, and formally adopted by employed and non-
employed physicians.
 Accomplish joint review of the protocols between employed
and non-employed physicians as well as the “New Co” CIO.
 Evaluate the role/need for a CIO Medical Director.
 Propose Policy and Procedures guideline for the development
of quantifiable definitions and standards to be formally
incorporated into the hospital's UM program.


Define and Plan C.I. Initiative Considerations
 Develop comparative performance methodology to:
– Identify physician- leaders with styles that are visionary,
mentoring, affiliate, and democratic.
– Avoid confrontational processes that could perceived as
threatening to physicians with non-aligned practice styles.
– Plan for the development and distribution of physician-
specific reports.
 Build transformational experiences (small wins) to build trust
and demonstrate successes.
 Remove barriers that frustrate physicians in delivery of care.



Define and Plan C.I. Initiative Considerations
 Develop training and physician leadership roles for varied
C.I. committees.
 Assess necessary information technology and operational
support structure necessary to enable and facilitate high
quality physician care… as is clinically appropriate… at the
individual patient level… across disease management
oriented service lines.
 Evaluate technology and infrastructure options for data
collection, common patient data registry, disease
management and EBM clinical protocols as well as EHRs.



Current State
Understanding
Supporting Systems Strategy
Clinical Integration
Objectives

Potential IT strategies may include the following:
 Clinical data broker  Single purpose 3rd party
technologies integration “overlays”
 Common EMR / Affiliate  Patient registry systems
EMR  Portals
 Data warehousing  Health data exchange
 Managed care systems technologies



Determine Regulatory Compliance
Engage qualified legal counsel in early development stages as
well as to determine likely FTC regulatory compliance. FTC
review considerations typically encompass the following:
1. Integration of facilities/practitioners that represents true inter-
dependence in collaboration and productive information sharing.
2. Participation of both specialists and primary care physicians, in a
way that requires in-network referrals.
3. Treatment of a broad spectrum of diseases/disorders accompanied
by a comprehensive array of corresponding clinical protocols.
4. Integrated information technology that allows network providers to
efficiently and effectively exchange information regarding patients
and practice experience.
Determine Regulatory Compliance of Change Process


Determine Regulatory Compliance
5. Integrated IT in which utilization and claims information is
collected, analyzed, and distributed with the goals of lowering
costs, reducing utilization rates, and improving the quality of care.
6. Integrated IT that enables the measurement of physician
compliance and performance, in comparison to widely accepted,
peer-reviewed benchmarks and standards.
7. A high level of physician financial investment and commitment
of time for training and utilization of the system, accompanied by
agreement among physicians to comply with the standards,
benchmarks, and protocols of the network.
8. Processes for improving performance and compliance, with
enforceable consequences for non-compliance.
Determine Regulatory Compliance of Change Process


Scenario Planning for Clinical Integration Initiatives
 Define clinical integration strategy… obtain senior
management and physician leadership input… prioritize
strategic alternatives… identify and validate growth
objectives… identify and confirm potential growth
vehicles to achieve clinical integration objectives.
 “What if” considerations for extension of the planned
CIO business model to other facilities in the region (e.g.,
for future initiatives such as an ACO or a network PHO
clinical integration model).

Determine Business Case for Change Process


Scenario Planning for Clinical Integration Initiatives
 Define key barriers and facilitators to future state process
redesign and risk mitigation action plan.
 Develop IT Vision (e.g., financial, clinical and E.H.R.).
 Estimate one-time and recurring costs for each future state
redesign area.
 Define phasing options relative to indentified change priorities
and cost reduction/efficiency gain goal achievement.
 Estimate benefits to organization-physician members of
Clinical Integration by major care delivery service line.
 Make the business case for each future state CIO design.
Determine Business Case for Change Process


Preparing Your Clinical Integration Business Plan (i.e., from
your completed assessment and planning process)
1. Internal and external clinical integration readiness
assessment… current state design.
2. Scenario planning: your future state design options and the
required process changes to achieve them (core/contingent).
3. Governance and committee structure for a clinical integration
organization.
4. Physician and Staff educational needs for creating a clinical
integration business model.
5. Required information system technologies to support a clinical
integration business model.
Your Clinical Integration Business Plan


6. Core operational, physician and employee issues associated
with transitioning from a current state to a future state
business model.
7. Estimated cost reduction as well as potential efficiency and
quality gains.
8. Project management and performance improvement tools
needed for clinical integration initiatives.
9. Future state clinical integration organization
redesign/transition work plan for each major clinical service
line area.

Use your C.I. business plan as your development roadmap
and/or as a template for a FTC Staff Advisory Opinion.
Your Clinical Integration Business Plan

II. Clinical Integration as a Business Strategy for Accelerated Growth: Payments

Evolving/new payment value-based payments…
 Should allow providers time to transition from current
payment methodologies to more risked and
accountability based payment methodologies.
 The degree of provider integration and alignment of
financial incentives across the care continuum… will
determine the ability of providers to accept risk/reward
based payments and remain financially viable.
 The two leading contenders for the new “norm” for
payment methodologies... bundled payments and
global capitation.



Features of a 2010+ Global Capitation Payment Model?
 Capitated payments supply provider organizations with
fixed “medical care” budgets… partial or global services
– Risk adjustments… protection mechanisms for
adverse risk and catastrophic patient cases… formulaic
structural rewards to providers for improving quality and
reducing unnecessary services utilization.
– Performance incentives… based on quality and safety
metrics.
– Shared savings opportunities… reducing underuse,
misuse and overuse within global payment levels.
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Hospital Financial Proposal Review - HMO/Capitation Proposal
Medical Budget - IPA/Hospital - Joint Managed Care Product IPA/Hospital Network
10/1/20XY - Small Urban Market
COMMERCIAL MEDICAL BUDGET -- AVE. COSTS 1-1-XW TO 12-31-XW

Utilization Average Gross Deduc. Net
Category Of Service PMPY Cost PMPM or Copay PMPM
Hospital Financial Proposal Review - HMO/Capitation Proposal Review - HMO/Capitation Proposal
HOSPITAL Hospital Financial Proposal
Medical Budget - IPA/Hospital - Joint Managed Care Product IPA/Hospital Network Managed Care Product IPA/Hospital Network
Medical Budget - IPA/Hospital - Joint
10/1/20XY - Small Urban Market 10/1/20XY - Small Urban Market
Inpatient COMMERCIAL MEDICAL BUDGET -- AVE. COSTS 1-1-XW7,664.40
0.0860 $ COMMERCIAL MEDICAL BUDGET -- AVE. COSTS 1-1-XW TO 12-31-XW
TO 12-31-XW $ 54.93 0.00 $ 54.93
Ambulatory PHYSICIAN SERVICES
Surgery 0.0520 OUTPATIENT 1,057.96
OTHER 4.59 0.00 4.59
Office Visits - PCPs
Emergency Room
Other Hosp Outpatient
2.8505 0.1530 90.76 $
$ 21.56 0.0020
276.90 15.00 $ $ 151.64 $
18.00 3.54 0.05 50.00 $
0.03 0.00 0.03
2.91
Radiotherapy 0.0010 483.87 5.00 0.05
Office Visits -Specialists 2.1010 90.76 15.89 15.00 13.27
0.0430 296.48 1.07 0.00 1.07
0.1660 0.0433260.73
DME
Outpatient Radiotherapy
Inpatient Visits
Pharmacy
212.67
3.61 7.5300 0.00 3.61
72.60
0.77 45.56 0.00 15.00 36.15
0.77
Hospital Outpatient Office Procedures 2.3480 0.1537178.04
Laboratory
Miscellaneous
Ambulance
0.8310 Home Visits
22.77 4.46 0.0010
595.73
12.33 0.0010
0.00
0.00
4.46
697.15
12.33
7.64 0.06 0.00 50.00 0.06 7.64
135.23 0.02 20.00 0.02
SNF Surgery - Major 0.4820 0.0001517.39
Home Health Supplies 1,953.00
20.79 0.0110 0.00 20.79
345.02 0.02 0.32 0.00 0.00 0.32 0.02
Surgery- Minor 0.0060 X-Ray 282.58 0.15 1.6060 0.00 0.15
162.78 21.79 0.00 21.79
Ambulance Anesthesia 0.0520 0.0170999.72
High Risk Int. Care 612.56
4.34 0.0010 0.00 175.35
4.34 0.87 0.02 0.00 0.00 0.02 0.87
Dialysis/Chemo/Private Nurse 0.1680 0.0461228.82
Emergency Room Optical Dispensing 3.21 0.0130
374.40 0.00 108.11
3.21 1.44 0.12 0.00 0.00 0.12
1.44
OB/Delivery 0.0200 Alcohol2,679.32
Abuse
4.47 0.0730 5.00 142.36
4.47 0.87 0.00 0.87
Home CareOutpatient Mental Health 0.2180 0.0035150.40
Physical Therapy 306.47
2.74
0.1560
25.00
101.75
2.29 0.09 1.33 0.00 15.00 1.14 0.09
Home CareTOT. PHYSICIAN SRVCs
Supplies 9.2425 0.0340121.40O/P
TOT. OTHER $
$ 1,271.90 $ $ 86.92 $3.61 71.24 $ 0.00 $
93.55 9.4380
$ 6.63 90.50 9.60 61.64 3.61
Surgery/Major 0.0060MEDICAL COSTS
TOTAL 2,755.9619.3087 $ 1,739.39 1.38244.83 $ 0.00 $
$ 16.86 227.97 1.38
Misc. Office Serv. 0.0335 Medical Mgt. Fee348.41 Services @ 2% of Medical =
IPA Desired For Physician 0.98 0.00 $ 1.74 0.98
(HMO CoPay/COB adjust. TOTAL GLOBAL CAPITATION REQUIRED = $ 229.71
factors & above changes) 0.0052 400.00 0.18 10.00 0.18
TOTAL HOSPITAL 0.6282 $ 1,527.49 $ 80.04 $ 0.63 $ 79.41

Example: Global Capitation
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Bundled Payments...
 Payment methodologies referred to as “Episodes of Care”
(EoC) – CMS has already started piloting an EoC payment
methodology called “Acute Care Episodes” with a select
number of hospitals… as CMS goes, will others?
 The ACA expands episode of care pilot programs at the
Medicare and State Medicaid levels… expect 1115 waiver
modifications.
 Some health plans are presently engaged in these pilot
programs with hospitals or other provider organizations that
have the operational support infrastructure to manage
episode of care reimbursement methodology and risk.


 Bundled payments have been around for some time in
the form of specific provider type oriented payments such
as DRGs… would expand to capture all EoC services.
 The main difference with EoC payment methodologies
of the future… specific requirement to coordinate and
manage care across a vertical continuum of care…
specific to an episode of care event… tied to a specific
length of time… at a set, fixed price.

The key challenge for providers will be their ability to
align and integrate community care standards for a
specific EoC while also being able to provide
clinical/operational support for the entire episode of care.
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Presentation Agenda

III. Lessons Learned

Effective change in a
restructured regulatory and
reimbursement environment
will not be sustainable…
absent… physician
leadership


Lessons Learned: Risk and Care Management Models
III. Risk Models and the Assumption of Performance Risk

 Transition to a value-driven healthcare system will require a
great deal of re-engineering to support more integrated care
delivery models designed to manage patient populations.
 Managing the financial risk associated with bundled and
capitation payment methodologies… the greater the
financial risk for healthcare organizations… the greater the
need for clinical integration and expanded information
technology and operational support.
 Healthcare organizations unable to develop the appropriate
operating business model relative to the accepted level of
financial risk will become financially distressed and at
greater risk for bankruptcy.



In the end, its about…
 Strategy and Strategy Execution
 People
 Process
 Technology and Capital
 Sustainability


The ACA will be a
transformative event… be
prepared… do not wait
until 2013 or 2014 to act!!!


Presentation Agenda

IV. Questions and Answers


Christopher Kalkhof
IV. Contact Information and Speaker Bio
▲ Christopher Kalkhof is a Director with Alvarez & Marsal’s Healthcare Industry Group in New York. He has more than
25 years of diverse healthcare management experience. He specializes in managed care strategy development and
contract negotiations; contract implementation and integration with revenue cycle/case management processes;
provider-payer collaborations; physician alignment and integration; strategic planning and new product development.
▲ Over the last several years, Mr. Kalkhof has spent much of his time assisting clients optimize their net managed care
revenue potential, resulting in net rate increases and revenue improvements of nearly $500 million. Over the span of
his career he has gained managed care related work experience in over 20 states and has directly negotiated
hundreds of payer agreements for hospital, behavioral health, physician, IPA/PHO, home care, hospice and skilled
nursing facility clients. He has also reviewed hundreds of additional payer contracts.
Christopher Kalkhof, ▲ Recent or prior relevant experience has included:
FACHE – Developing a broad-based managed care strategy and leading a contract rebasing/negotiations process involving
over 50 payer product contracts/20 different payers for a partial physician owned hospital with an estimated net
Director revenue improvement of $10 million on an 18 month run rate basis.
– Working with a large safety net health system to improve physician charge capture and reduce payer denials as
Office
well as reorganize the managed care department, build a contracts administration unit and develop strategies for
(347) 254-2433 improving market position for a system owned health plan.
Mobile – Renegotiated payer contracts for nearly $13 million in net revenue increases (24 month run rate basis). Stopped
an unjustified payer attempt to recoup $1.2 million in alleged overpayments, upgraded contract manager (CM) and
(716) 912-0309 incorporated CM application into revenue cycle operations.
E-Mail – Conducting a risk mitigation/EBIDA improvement opportunity assessment as part of a due diligence “clean team”
ckalkhof@ review of an acquisition candidate hospital, which also included a clinically integrated PHO joint venture.
– Evaluating a hospital’s current contracting strategy, contract content and physician-clinical integration options.
alvarezandmarsal.com
▲ Prior to joining A&M, Mr. Kalkhof was: Director/National Managed Care Lead for a Big 4 firm’s provider consulting
Website practice; Interim SVP of Managed Care for a nine hospital system; Interim VP Managed Care for a community hospital;
www.alvarezandmarsal consulting Director of Managed Care at community hospital through the bankruptcy and post-bankruptcy ownership
change to physicians; Partner in a practice management firm; Director of Marketing Administration and Professional
.com
Relations for a large health insurer; and Product Development Manager for a HMO.
▲ Mr. Kalkhof received his Master of Health Administration degree from Tulane University and his Bachelor of Science,
degree from Allegheny College. He is a Fellow in the American College of Healthcare Executives and a frequent
presenter on managed care revenue improvement and physician alignment topics for the HFMA, ACHE, MGMA, WRG
and other professional groups. In 2008, Mr. Kalkhof served as a member of the NYS Office of Medicaid Inspector
General’s Medicaid Managed Care Compliance Program Guidance Advisory Committee.

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Christopher Kalkhof
IV. Contact Information and Speaker Bio

 Dr. Francis LaMorte is a Director with the Alvarez & Marsal Healthcare Industry Group in New York. He specializes
in physician practice management, healthcare business strategy, hospital-based patient throughput, physician
compensation, and governance
 Prior to joining Alvarez & Marsal, Dr. LaMorte advised a financial syndicate on the buy-out of a generic
pharmaceutical company, and developed the business plan and start up of a PPO
 Since joining A&M his work has included contract assessment of a one-hundred member employed -physician
medical foundation, a medical staff audit and development of a contract renegotiation strategy for a 252-bed
medical center, a hospital merger assessment, and planned hospital closings for two systems
Francis LaMorte,
M.D.  Previously, Dr. LaMorte served as executive chairman of EMX, L.P., He led a post-demerger restructuring of the
firm’s operations and governance, designing and leading multiple, sustained, transformational initiatives that
Director enabled EMX to turnaround and become one of the nation’s largest privately-held emergency medicine practice
management firms, with more than 400 providers under management at twenty-four emergency departments and
Office hospitalists practices providing care for 1.3% of the nation’s emergency patients
(347) 891-0116 – Achievements included: design and execution of a recapitalization as an alternative exit strategy to a planned
IPO; restructuring of the corporate governance board; implementation of a balanced scorecard and
productivity–driven physician compensation plan; and the business development of subsidiaries for urgent care
E-Mail centers, hospitalist practices, a consumer retail chain, physician billing company and an IT management
flamorte@ system now operating thirty EDs
alvarezandmarsal.com  As company compliance officer, he co-developed the company HIPAA program. He developed risk control
systems and training programs for billing, coding, EMTALA, and HIPAA obligations
Website
www.alvarezandmarsal  Dr. LaMorte served for twenty years as attending physician in the emergency department of the flagship hospital of
.com the St. Barnabas Health Care System. He was chairman of the System’s utilization management committee, and
president of the thousand-member IPA
 Dr. LaMorte earned a bachelor's degree from Princeton University, and received his doctorate in medicine from the
Robert Wood Johnson Medical School. He holds a master's degree in business administration from the Yale
University School of Management


The Alvarez &Marsal Advantage

 Founded in 1983, Alvarez & Marsal (“A&M”) is a leading independent global professional services firm with more than 1,700 professionals
based in North America, Europe, Asia and Latin America.
 Currently 39 offices globally with headquarters in New York, London, and Hong Kong.
 Offer deep financial, tax, operational and industry expertise.
 Deep bench of talent across industries with the unique ability to transition between financial, operational and advisory roles to meet client’s
changing business needs.

A&M is the leading, independent global professional services firm which excels at leadership, problem solving and value creation. A&M’s
Healthcare Industry Group practice represents an assembled team of healthcare professionals who bring a significant track record of working
with management, boards of directors and stakeholders of both investor-owned and non-profit providers, payers and suppliers to improve
operational, financial and clinical performance.

A&M’s managed care consultants and interim management professionals bring deep best practices expertise in the development of managed
care contracting and physician alignment strategies, payer contract negotiations, and the implementation / integration of contracting and
physician alignment strategies into an organization’s overall clinical and business operations.

Our managed care services are aligned with your contract management cycle and can be tailored to meet your specific needs and market
environment. We work with your team, serving in advisory or interim management roles, to ensure your success with your overall payer
contracting strategy.

www.alvarezandmarsal.com


Emerging Business Models for Hospital and Physician Integration: Clinical Integration as a Business Strategy for Accelerated Growth

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