Business Plan 

Review

Timothy P. McNeill, RN, MPH
Business Plan Feedback 

Refining Your Sales Strategy 

New Opportunities to Consider 

Questions 

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Business Plan Feedback 

• Business Plans Review 

– Comprehensive 

– Keen Awareness of Market Forces Impacting Healthcare 

– Immediate opportunities for increased revenue sometimes 

overlooked 

– Opportunities to leverage current strengths to meet healthcare 

challenges creates a “Win-Win” situation

• Business Plans are a living document 

– Track your progress and refine your plan 

– Strategy and timeline map a path for success
Business Plan Section: 

MARKETING / SALES 

STRATEGIES 
Alignment with Value-Based Payment Models 

• Medicare FFS beneficiaries have a profound impact on 

physician performance in value-based payment models 

– Quality and Cost measures are directly correlated with the 

number of persons with two or more chronic conditions 

• MACRA 

– Merit Incentive Payment System (MIPS) 

– Alternative Payment Models (APMs) 

• ACOs 

• Bundled Payment 

• Costs 

– Admissions/Readmissions 

– Post-Acute Care Utilization (Rehab, SNF, etc.) 
Provider Merit Incentive Payment System 

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Medicare Beneficiary Data: State/County 

Penetration 

• https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/MCRAdvPartDEnrolData/MA-State-County-Penetration.html 
Provider MIPS Categories applicable to 

CBOs 

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• Quality 

– Diabetes outcomes 

– Depression screening 

– Fall risk 

• Advancing Care Information 

– Referrals to community programs 

– Send a summary of care 

• Improvement Activities 

– Care transitions documentation 

– Engagement of community for health status improvement 

– Evidence-based interventions to promote self-management 

– Chronic care and preventive care management 
Is there a Bundled Payment Program Near You? 
Market Opportunity Analysis 

• Hospitals in your market 

– Readmissions / Admissions 

– ER Utilization 

– Post-Acute Care Provider Network 

• Physician market 

– Hospital-Owned Practices 

– Independent Practices 

– Specialists vs Primary Care 

• Accountable Care Organizations 

• Bundled Payment programs 

• Medicare FFS Beneficiaries in your market 
CMS Medicare Chartbook: 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/Chronic-Conditions/Downloads/2012Chartbook.pdf 
Distribution of Fee-For-Service Medicare 

Beneficiares 
Nearly 70% of FFS Medicare has 2 or more 

chronic conditions 
Per Capita Expenditures increase as the 

conditions increase 
Which Population has the most chronic 

disease? 

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• Most chronic conditions were more prevalent for dual-eligible 

beneficiaries 

– 72% of dual-eligible beneficiaries had two or more conditions 

– Dual eligible beneficiaries were 1.7 times as likely to have 6 or 

more chronic conditions 

• 98% of readmissions, in 2010, were for Medicare beneficiaries 

with two or more chronic conditions 

– CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook – 2012 Edition. Available Online: 

https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronicconditions/downloads/2012chartbook.pdf 
How Many Duals Do We Have? 

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• Nationally, there are approximately 9.6 million dualeligible beneficiaries 

• 3.9 million were under age 65 

• 5.7 million were aged 65 and older 

Data book: Beneficiaries dually eligible for Medicare and Medicaid 

— January 2015 MedPAC 
New Opportunities to Consider 

• Expanding Medicaid Waiver or Medicaid Managed Care 

services for the target population 

• New requirements to screen for malnutrition 

– 2018 CMS Proposed Rule for Inpatient Hospitals 

– Requirement to screen for malnutrition 

– Report screenings and number that have a malnutrition diagnosis 

– Data shows 25% of hospitalized Medicare beneficiaries have 

malnutrition 

– With a diagnosis comes a requirement to develop a plan to 

address the problem 
Questions 

• Tim McNeill, RN, MPH 

– Phone: (202) 344-5465 

– Email: tmcneill@me.com