Structuring Our Network(insert network name and/or location)

Nature of our networkExisting legal relationships among our network partners (contractor/subcontractor, partnership, MOU, … )•Verbal agreement to work together•Letters of support for ACL – MOU

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Nature of our networkNext step(s) to further develop the capability of our network:

•Mapping our service capacity•Advance work before December 6 meeting to show three alternative structures!•Geographic boundaries – member territories

– Legal advice may be needed for that

•Service lines– Packages, contributions of each to package – directly or through

subcontracts

•How money would flow?•Who wins individual contracts? How not to compete with each other?

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Our network as a community assetFeatures that appeal to our customers

• Language/culture• Location – meet them where they

are• Community settings of comfort • Flexibility• Reputation – excellence• Outreach/creating awareness• We listen to consumers• Supporting caregivers• Connectors to comprehensive

services in community

Features that appeal to contracting organizations

• We’re in the home• Experience • Geographic coverage• Multiple interventions• Wraparound and follow-on

services• Know the community &

resources• Language & culture

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Our network as a community assetThe next action(s) we will take to develop the image and influence of our network:•Board members•Joining boards and committees for healthcare orgs•Attending & presenting at healthcare conferences•Menu of services & business case statements•Educating healthcare about messaging to community•Educating community to message to healthcare

– What you said…what they heard

•Common IT•Collateral •Formal agreement and ability to enter into contracts together and separately, where appropriate

Organizational issues we need to address

• Structure – principles for collaboration– Coop-etition– Subcontracting

• Mission statement, goals, etc.• Credentialing standards – RFA• Quality management and uninviting members• Rapid learning, CQI• Consider need for TPA, MSO, fiscal agent – and who• IT, IT, IT

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Our network as a business enterpriseEntities that can bill for services

• All doing list-bills to CMS• AltaMed & Jewish Home bill

Medicare• All can bill case rate• Most do Medi-Cal billing• Private insurance for ADHC

Consider MSO/TPA – negotiate with existing entity for back-office support

Price for value & volumeAssets for capitation & cashflow

Entity/entities that can receive and distribute payment

• Anyone but public entities

Our network as a business enterpriseSpecial requirements we must meet to secure and deliver on a contract•HIPAA compliance plan & business associate agreement•Audit requirements operationalized for contractor’s standards

– Timeliness, turnaround, etc.

•Secure communications•Arrangement for referrals•Definitions•Quality tracking agreement – 2-way data/commitment•Face time to ground the intervention and operate it

Our network as a business enterprise

Action steps(s) we will take to strengthen the business capability of our network:•IT•Survey members for capacity along all of the dimensions above•Operationalize SharePoint - Ami

– Collaborative contact list, shared documents, surveys

•Get Capital! •One-stop-shop infrastructure•Business plan – cost to have a network office & infrastructure

– Dues?

•Branding – developing collateral

InsightsOur biggest insight(s) from Structuring Our Network is/are… •Finding where phase 1 is at and what next step should be

•Best practices are a way of pulling together our strengths•We have to prepare, work the relationships with healthcare•Healthcare partners have to understand their role in success

•A structure is needed to really get started – something official to move us beyond being just a collaborative•We need a service menu with pricing•Bundling /package of services for an array – e.g., fall prevention, safety – a la Waiver

•This is a great outline and very timely for us.•We’re building the plane as we’re flying it!!

Action Steps Next Month• Meeting on December 6 to begin to formalize• Standardization/defining our services– What are we offering?

• Keep reviewing IT systems• Survey members for capacity along all of the

dimensions above• Operationalize SharePoint - Ami– Collaborative contact list, shared documents, surveys

• Branding – developing collateral

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Parking Lot (Issues for later, additional questions for speakers)

• List here

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