Strategic Planning NMGMA January 2019 Meeting

1. Strategic PlanningNMGMA January 2019 Meeting • Ann Layman Wires • Facilities Chair, NMGMA • Vice President, Business Development and Member Relations, Life Credit Union • Jimmie Holland • President, NMGMA • PSG Performance Improvement Manager, HCA Performance Improvement • You • Feel free to add questions as we proceed

2. Thank You to Nick Fabrizio • This presentation is used with the permission of Nick Fabrizio. Minor adjustments included for Nashville audience. • Nick A. Fabrizio, PhD, FACMPE, FACHE, is a principal with MGMA Consulting with over 25 years of medical group and hospital experience in single and multispecialty group practices, for-profit and nonprofit hospitals and health systems, academic medical centers, and ambulatory care networks. He has significant expertise in governance and board development, integration, operations, and mergers and acquisitions. He specializes in strategic and operational matters focused on turnaround, crisis and specialized advisory, and operational due-diligence services for both distressed and growth-oriented organizations.

3. Polling • We are going to attempt to use polling today • To participate text NMGMA to 22333 • Texting rates may apply • Specific answers for Regular and Affiliate Members • Guests respond with which ever membership is most appropriate

4. Chaos toClarity: Developing a Strategic Plan forYour Group Nick Fabrizio, PhD, FACMPE, FACHE MGMAHealth Care Consulting Group Nick Fabrizio does not have a financial conflict to report at thistime.

5. Where isNorth?

6. Why Is PlanningNeeded? Healthcare is changing everyday. Nooneisinchargeoreveryoneis. Physicians tend to avoidconflict. Job security andsatisfaction. Ifyoudon’tplansomeoneelsewilldo it foryou.

7. What Is StrategicPlanning? Strategic planning is a process of developing an integrated, coordinated and consistentlong-rangeplanofactionforthe organization. Strategic planning is the processof: 1.Deciding where you want togo, and 2.How you will getthere… 3.As agroup.

9. Elements of StrategicPlanning Why do we exist/ where are wegoing? What arethe keyissues? What do wewant todo? How will weget itdone? Mission/VisionStatements EnvironmentalAnalysis InternalAssessment Objectives and Goals Strategies/ActionPlans

10. Stages In The PlanningProcess Stages GettingReady Making thePlan Steps PreplanningActivities Set-up MeetingProcess Collectdata Strengths/Weaknesses Opportunities/Threats Mission -Vision Resolve KeyIssues, SetObjectives Summarizing theResults Follow-up ActionPlans Monitoring

11. Stage: GettingReady

12. GettingReady PreplanningActivities • Identifyparticipants • Agree ontiming • Determine whowill be the “meeting manager” • Getadministratorandleadphysicianonsamepage • Agreeonandgatheranyneededdata • Survey/interview physicians andstaff • Gather financial, demographic and otherdata

13. GettingReady PreplanningActivities Questions for Participants: (this varies depending onthe group, issues, etc.) Whatdoyouseeasthemajorstrengthsand weaknesses of thegroup? Whatdoyouseeasthemajoropportunities and threats that the groupfaces? 3. Whatissuesneedtobeaddressedatthe retreat?

14. GettingReady Set-up MeetingProcess Identify Key StrategicIssues Distribute Survey inAdvance Using the SWOTto Identify Key StrategicIssues Strengths…………………Leverage Weaknesses………..…….………Fix Opportunities………..….Pursue Threats……………………..…Avoid

15. GettingReady Set-up MeetingProcess Key StrategicIssues • External • Market needs – specialtycoverage • Geographic • Recruitment • Newservices • Relationshipswith others • Internal • Governance • Compensation • Workload/Call • Retirement • Facilities

16. GettingReady Set-up MeetingProcess • RetreatAgenda • Dedicated Block of Time • Meeting Goals and GroundRules • Decision-Making • Interview & SurveyFeedback: • Internal Analysis - Strengths andWeaknesses • Environmental Analysis - Opportunities andThreats • Market data and practicedata • Mission and VisionStatement • Discuss Key StrategicIssues • Next Steps in Strategic PlanningProcess • Summary

17. GettingReady Set-up MeetingProcess • Identify Key StrategicIssues. • PrepareAgenda. • Make DetailedArrangements. • Off-sitelocation. • Length: • Retreat - 1day • Evening 3-4 hours sessionfor yearly updates • Flipcharts, handouts,etc.

18. Stage: Making ThePlan

20. Making ThePlan Getting Started: Set GroundRules • Onepersonspeaksatatimeandeveryoneelse listens. • Arrive ontime. • Stay ontopic. • Activelyparticipate. • Nosidebars–oralortexting. • If youmust take a call, leave the room. • Confidentiality.

21. Making ThePlan Getting Started:Decisions • How will the groupmakedecisions? • Unanimity, consensus,vote? • Whatisexpectedofeachphysicianoncea decision ismade? • What youwant to hear is “support it,” “do it,” “not sabotage it,”etc. • Whatareaphysician’soptionsifheorshe doesn’t like thedecision? • Doitanyway–that’sgrouppractice • Try to get it changed, in the appropriateforum. • Self-select yourself out of thegroup.

24. Making ThePlan Using theSWOT Opportunities…………….Pursue Threats……………………Avoid Weaknesses………….………Fix Strengths…………………Leverage Analysis of external environmentand internalsituation. Goals: Get everyone onthe same page. Assure all issues areidentified.

25. MakingThe Plan |SWOT: Opportunities and Threats • EnvironmentalAnalysisistheprocessofreviewingallforcesoutsideof the organization that can affect the organization’sfunctioning. • Purpose is toidentify: • Opportunities:anyfavorablesituationintheenvironmentthat supports demand for a product or service, or permits the organization to enhance itssituation. • Threats:anychallengeposedbyanunfavorabletrendoreventthat, in the absence of purposeful action, would lead to the stagnation, declineordemiseofthegrouporoneofitsproductsorservices. • Lookingfor: • Need, event ortrend • Howitwillimpactyourorganization:opportunityorthreat • Response that might berequired

28. Making thePlan Set Mission andVision

29. Making thePlan Set Mission andVision MissionStatement: Who does the group wish to serve (consider geographic area,typesofpatients,typesofreferringphysicians,etc.)? What“customer”needsdoesthegroupwishtosatisfy? “Customers” may include patients, referring physiciansand others. Whatphysicianandstaffneedsdoesthegroupwishto satisfy? Whatarethecorevaluesandrequirementsforbeinga member of thegroup? Whatprinciplesorpoliciesguidethegroup?

30. Making thePlan Set Mission andVision VisionStatement: Whatservicesandspecialtiesdoyouplantooffer? Whatgeographicregiondoyouintendtoserve? Howmanylocationsareyoulikelytohave? How big will the group become? Will you growto fill the serviceneedsofthemarket,orwillyousetanupperend limitonthenumberofphysiciansinthegroup? What type of relations will you have with others? Willyou Whatbenefitsdoyouhopetoprovidefortheownersand remain an independentgroup? employees?

31. The only difference between a visionand a hallucinationis thenumber of people who seeit.

32. Making thePlan Set Mission andVision • Mission/Vision –Why? • You can’t pursue 15Visions. • Identify gaps/neededcompromise. • Basis to ask forsacrifice.

33. Making thePlan Set Mission andVision • FacilitationTips: • Don’tmakethistheonlythingyoudo. • Youdon’tneedtobeanexpertinyourspecialty. • Split intosub-groups. • Make themstruggle. • Don’t“word-smith.” • Keeptheendinmind–Youneedaplan!

35. Strategic Planning (Four KeyQuestions) • What's Happening In OurArea? • EnvironmentalAssessment • Who AreWe? • InternalAssessment • Values • Expectations • S.W.O.T.Analysis • - Mission • What's Ahead For Us? • Vision • Opportunities • Goals • How Will We GetThere? • ActionPlan

36. Making thePlan Issues/Objectives/Strategies • IssueIdentification • Mostly identified in pre-retreatwork. • Maybemodifiedbasedondiscussionatretreat. • TypicalIssues • Different for everygroup. • Need to consider external andinternal.

37. Making thePlan Issues/Objectives/Strategies Objective: a description of some situation in the future that you would like to see come about, which you can reasonably expect to accomplish, andwhichisinlinewithyourgroup’smissionand vision. Strategies: are the major decisions, policiesand/or action programs employed by the organization to meet itsobjectives.

40. Making thePlan Issues/Objectives/Strategies • “SMART”Objectives • Specific • Measurable • Achievable • Relevant • TimeBound

41. Examples:Strategies • A multi-specialty group of 100 providers in thesouth • Develop surgical subspecialty services in next 5years • Identify potential list of subspecialties to add through market research and identify recruitment challenges for those specialties in the nextyear • Reduce overall expenses by $100,000 through administrative and support service economies (new practice managementsystem) • Group of 3 internal medicine physicians in thewest • Discuss the issue of a hospitalist service with thelocal hospital. Makea decision whether we will participate or not within the next fourmonths • Recruit an additional provider in the next year (depending onparticipation with hospitalistprogram) • Begin discussions with competing group on possiblemerger • After first two issues are resolved-

42. Nominal GroupTechnique

43. Making the Plan |Issues/Objectives/Strategies LowRisk/Cost HighRisk/Cost HighReward LowReward

45. Making thePlan Summarizing theResults • Strategic PlanReport: • Mission/VisionStatements • Objectives • Strategies • MajorDecisions • Policies • Action Plans todevelop • SupportingDocuments

46. ActionPlans • What will bedone? • Who will doit? • What will the costsbe? • What will the benefitsbe? • When will it becompleted? • Guidelines • Establishthespecificgoaloftheplan-whyisitbeingdone? • Identifywhohasoverallresponsibilityfortheplan. • Listthestepstobeperformedtocompletetheplan. • Indicatethedateeachstepshouldbecompleted. • Developandincludealladdedmanpowerandexpensestheplanwill require. • Developandincludedresultsexpectedfromtheplan--quantitative andqualitative. Making thePlan ActionPlans

47. DO: LessonsLearned Attack the most critical issues – Groups tend to focus on the external environment because it issafer! DON’T: Bring in an outside person without knowledge of theindustry Try to do everything in oneday

48. How do we address our strategies in the next three years?

49. NickFabrizio MGMAHealth Care Consulting Group nfabrizio@mgma.com