Co-ManagementCollaborating to enhance patient care
Cultivating an environment of shared responsibility, authority & accountability
For both physicians and hospitals, identifying opportunities for collaboration can be a very effective method for long term growth. Dynafios has helped hospitals create a high performing, differentiated service which brings additional value to each party. With our expertise in physician-hospital alignment, we understand what it takes and provide effective and efficient execution.
We have established co-management agreements for key services lines such as cardiovascular, oncology, orthopedics and surgical services. Our process begins with setting expectations and developing a shared vision among physicians and hospitals. While there are many details to work through, the overall structure of a co-management arrangement is straightforward:
We work with executive teams to identify potential co-management participants and develop a project timeline. The design phase includes collecting and analyzing data to first identify appropriate areas of co-management focus. We then further analyze data to design indicators and set performance targets.
Some of the key milestones that will be addressed during the contract phase include: finalizing indicators, determining the compensation structure, identifying the teams, and executing the contract.
Our experienced team of analysts and consultants help establish a new culture of shared accountability, transparency and results. Dynafios brings in best practices and experiences to drive work plans for successful performance improvement. These experiences, coupled with robust analytics, help the co-management team achieve the P4P results.
Dynafios Co-Management Methodology
The initial step in establishing a co-management agreement is to evaluate opportunities for both quality and operational improvements.
The next step is to appropriately identify those physicians that are critical to the program and will be key participants in improving performance through the co-management process.
Determining the scope of the management duties is critical to the process of identifying the compensation for payment to the physicians.
Important to any physician compensation for services is establishing the FMV for the level of work and the scope of the management duties.
Dynafios utilizes an initial kickoff meeting to not only educate key stakeholders on co-management, but to also initiate the process of designing the contract and indicators critical to the success of the agreement.
From the initial meeting to the second, this is the time the Dynafios team works with local counsel and each of the physician managers to appropriately negotiate the terms of the agreement.
A proposed list of indicators spanning 2-3 years is presented to the physicians and hospital executives. The indicator specifics including population criteria, numerator and denominator definition, baseline data and anticipated goals are discussed, modified and agreed upon. The measurement period reveals the timing of “on the clock” results compared to the goals for the bonus compensation.
Dynafios works with all parties to successfully finalize the terms to execute an agreement. Just 90 days from start to kick-off.
Dynafios works with the executive team of the hospital to clearly identify the objective and the longitudinal focus (e.g. build new program, enhance clinical outcomes). A detailed analysis of clinical variation, trended financial results and operational efficiency follows. Operations are compared to national benchmarks and clinical practice is analyzed against evidence-based practice standards. Opportunities are quantified, and anticipated results are discussed along with an initial set of indicators.
Dynafios works with hospital legal counsel to modify a standard co-management agreement to the needs of the client. Management duties, implementation structure, compensation, and indicators are key factors which are developed in conjunction with the physician participants and the hospital.
Fair market value opinion letter defines the total compensation as well as the split between fixed amounts for administrative work and the pay for performance bonus.
Assisting hospitals and physicians with implementation and ongoing compliance monitoring is a key element of the methodology. Providing indicator action plans through ongoing review of the compliance with contract terms and FMV, Dynafios Sr. Consultants are instrumental in the ongoing management of the contract activities and results.
Following completion of the year, Dynafios provides a third-party review of the results, compliance with contract terms, physician engagement and calculates the bonus to be paid. The adjudication report is approved by hospital legal counsel and then is sent to the hospital CEO for payment to the physicians.