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People news: RIT appoints new dean of business school
HENRIETTA, N.Y. — The Rochester Institute of Technology (RIT) today announced it has appointed Jacqueline Mozrall as dean of its Saunders College of Business. She
Schumer calls on Secret Service to help police combat counterfeit money in Syracuse area
CAMILLUS, N.Y. — U.S. Senator Charles Schumer (D–N.Y.) is urging the U.S. Secret Service to “step up” its efforts to combat the “uptick” in counterfeit
Potbelly Sandwich Shop to enter Syracuse market
Potbelly Corp. (NASDAQ: PBPB), parent of the Chicago, Illinois–based restaurant chain Potbelly Sandwich Shop, plans to enter the Syracuse market this year and is currently reviewing franchisee inquiries. The company announced its plan in a March 19 email message to CNYBJ and in a news release dated March 30. Potbelly is targeting Central
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Potbelly Corp. (NASDAQ: PBPB), parent of the Chicago, Illinois–based restaurant chain Potbelly Sandwich Shop, plans to enter the Syracuse market this year and is currently reviewing franchisee inquiries.
The company announced its plan in a March 19 email message to CNYBJ and in a news release dated March 30.
Potbelly is targeting Central New York for expansion because of its mix of attractive residential and “growing” business communities, according to the company release.
The chain, which offers made-to-order sandwiches, salads, soups, chili, and breakfast, is also targeting other upstate markets, such as Rochester, Albany, and Buffalo.
Potbelly Sandwich Shop currently operates more than 15 eateries across the New York City metro area.
Potbelly, founded in 1977, currently owns and operates more than 300 shops across the U.S. and has more than 20 franchise shops domestically and internationally. It generated $327 million in revenue in its 2014 fiscal year, up 9 percent from $300 million in the prior year, according to the company’s Form 10-K filing with the U.S. Securities & Exchange Commission, dated Feb. 25.
Aylwin B. Lewis is the company’s chairman, president, and CEO.
The company started as a “quiet antique store” that turned into a “happening sandwich shop,” according to its website.
The antique store sold potbelly stoves.
In 1996, Bryant Kiel bought the original store on Lincoln Avenue in Chicago. Kiel is now the company’s founding chairman.
Franchising
For its franchise business, Potbelly is looking at smaller to medium-sized markets, says Rick Fossali, senior director of domestic franchising for Potbelly Franchising, LLC, the franchising arm of Potbelly Corp.
“There’s a lot of those types … of cities and towns in upstate New York,” he adds.
Fossali spoke with CNYBJ by phone from Chicago on March 31.
The company also likes the presence of schools like Syracuse University, he says.
“The college towns tend to be areas that really support Pot Belly as the neighborhood sandwich shop, the type of environment that we have, the live music,” says Fossali.
When asked about the size of the local territory for a franchise agreement, he notes the company is still “putting that together.”
Potbelly hopes to find an ownership group that would want to open “multiple units,” he adds.
“That would be the best thing we believe for our business … people that have [an] understanding of operating in this type of environment,” says Fossali.
Potbelly currently has single-unit franchisees and others who operate multiple stores and want more.
Fossali just wants to find the “right” franchisee who understands what it means to be “part of the neighborhood,” he says.
When asked if anyone from Central or upstate New York has inquired about a franchise agreement, Fossali says, “We have received other inquiries, some that
included discussions about Syracuse.”
He declined to disclose the specific number of inquiries Potbelly has had about a local or regional franchise agreement.
Once chosen, the franchisee is responsible for providing Potbelly suggestions on the best sites for opening a location, says Fossali.
A new Potbelly Sandwich Shop location typically creates more than 40 jobs, the company said.
Costs
A Potbelly franchisee can expect to make a total estimated initial investment of between $469,000 and $794,000, according to its website.
The company’s franchise fee is $40,000.
Potbelly also has an ongoing royalty fee, but Fossali declined to share the figure. The franchise agreement continues for 10 years, and a franchisee is able to
renew the agreement, he adds.
When asked about a franchisee’s required net worth, Fossali said, “It varies based upon the individual.”
Potbelly provides a training program for a prospective franchisee or someone that the franchisee designates, says Fossali.
“They can send up to four people through that training program,” he adds.
The company also provides marketing support for franchisees, includes details for a formal opening once the store begins operations.
Contact Reinhardt at ereinhardt@cnybj.com
Retired couple opens pickle deli in Baldwinsville
BALDWINSVILLE — Collar’s B’ville Pickle Deli — a new eatery serving hot sandwiches, homemade soups, and salads — made its grand opening on St. Patrick’s Day. The event included Baldwinsville’s mayor, Richard Clarke. The deli, located at 12 West Genesee St. in the village, first opened to customers the day before. CNYBJ spoke
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BALDWINSVILLE — Collar’s B’ville Pickle Deli — a new eatery serving hot sandwiches, homemade soups, and salads — made its grand opening on St. Patrick’s Day. The event included Baldwinsville’s mayor, Richard Clarke.
The deli, located at 12 West Genesee St. in the village, first opened to customers the day before.
CNYBJ spoke with John Collar, the deli’s owner, on March 26. He says business has been good in the eatery’s early days.
“The response has been tremendous,” Collar says. “We’re getting a lot of repeat customers.” He declined to provide financial information.
Collar and his wife, Cindy, opened the 530-square-foot deli after more than two months of planning. He says it took a lot of work, including buying all of the equipment and hiring local contractors to get everything set up.
“But I like doing that stuff,” he says.
Collar, a retired used-car salesman, grew up in Baldwinsville. He says the neighborhood never had a stand-alone deli.
He saw the need, and he was bored after his retirement. Cindy Collar was also retired after working for the insurance and financial-services firm, Nationwide Insurance, for 37 years, according to her husband.
So, the Collars decided to start planning their new venture in January.
“It’s a hobby we can make money from,” John Collar says. “We’ve been busy.”
While the Collars are currently the fledgling business’s only employees, John Collar says he might hire one additional employee to help out.
Collar posts daily soup specials on the deli’s Facebook page. The page had 575 “likes” as of March 31. It also had 11 public reviews, with nine giving the eatery 5 stars and two reviewers giving it 4 stars.
B’ville Pickle Deli’s menu, posted online, features an assortment of subs, wraps, the soup of the day, salads, and drinks.
The deli is currently open from 10:30 a.m. to 3 p.m., Monday through Saturday. However, the owners are considering extending the deli’s Thursday and Saturday hours to 6 p.m., according to a March 30 Facebook posting.
UTICA — The staffing and recruiting business, a $400 billion industry, is thriving from increased placements and revenue, according to a survey from Bullhorn, an online recruiting-software firm. Fortus Healthcare Resources, headquartered in Utica, leads this industry trend with a 32 percent, annual-compounded growth rate that has put it on the Inc.–5000 list for
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UTICA — The staffing and recruiting business, a $400 billion industry, is thriving from increased placements and revenue, according to a survey from Bullhorn, an online recruiting-software firm.
Fortus Healthcare Resources, headquartered in Utica, leads this industry trend with a 32 percent, annual-compounded growth rate that has put it on the Inc.–5000 list for the past three years. (The 2014 Inc. listing is based on the percentage of revenue growth when comparing 2010 to 2013.) Michael Maurizio, the president, CEO, and founder of Fortus, says the company is poised to double sales in the next few years.
Maurizio is basing his projections on a business plan he began implementing in November 2013. The first step was to rebrand the firm, which had been known by its two operating corporations: The Fortus Group, Inc., a C-Corp. for the direct-placement business, was set up in 1993 to handle staffing for dialysis units; the second corporation, Fortus Group Travel, Inc., an S-corp. for the travel business, was created in 2006 to place traveling nurses and patient-care technicians. Fortus Healthcare Resources is a d/b/a.
“We recognized the importance of diversifying the business and expanded our business model to become a full-service consultant,” says Maurizio. “The new brand — Fortus Healthcare Resources — is an integral part of our growth strategy.”
The second step was to hire a company CFO to help guide the growth. “I hired Dave (David L.) Keenan,” notes Maurizio, “a certified public accountant, whose previous experience included working at PriceWaterhouseCoopers for eight years as a tax manager and most recently more than a dozen years at Oneida Ltd. as the vice president of treasury and tax. He also has experience in the mergers and acquisitions area, which we are looking at to supplement our organic growth.
Dave has already pointed out a number of opportunities to increase our growth and profitability.”
Keenan is certainly bullish on the direction of the company he joined at the end of October 2014. “The direct-placement business continues to be strong and
consistent,” affirms the new CFO. “But Fortus has seen explosive growth in the travel business, which has grown from $2 million to $6 million just in the last few years. Further growth in both divisions has come from the new initiatives in diversifying our reach to clinicians in other areas of the hospital outside of dialysis. While the potential for organic growth is our primary focus, if the right opportunity appeared, we are open to acquiring a health-care-staffing company. To me, however, our most immediate path is to increase revenue and profitability within our defined organic-growth initiatives.”
The third step was to add the required space to accommodate the projected growth. “In September 2014, we moved our office from the old Harza Building in downtown to our new building on the south side of Utica at 2717 Genesee St. We replaced 5,000 square feet with 8,000 square feet and organized each of the operating corporations on its own floor. This not only gives us room to add staff, but also makes for a smoother operation flow,” Mauruzio says. He owns the new office building through a real-estate company he calls Performance Plus, LLC. Oneida County real-property records indicate that the building and land was sold for $475,000 on July 17, 2014. The structure was built in 1980.
Diversification
Fortus has come a long way since its early days of only placing dialysis professionals. “We really are diversified now,” Maurizio stresses. “In addition to dialysis health-care professionals, we provide health-care organizations with RNs and LPNs, social workers, dieticians, surgeons, in-service and educational clinicians, executive-level management, bio-med technicians, nephrologists, and administrators. Our specialty areas include nephrology, travel positions, ambulatory, and perioperative/surgery. Fortus also offers clinical-practice consulting. With more than 20 years of industry experience, we help our clients prevent critical staff gaps, reduce the time-to-hire as well as the cost-to-hire, provide the best clinical talent available, and eliminate staffing hassles. The bottom line is that health-care institutions need to focus on their patients: We help them do that.”
Fortus’s revenue of $120,000 in year one has blossomed into a business that generated $2.6 million in revenue in 2009, $6.2 million in 2012, and more than $10 million last year. The Fortus headquarters currently houses a staff of 40, of whom 30 are recruiters. The company employs another 60 nurses and patient-care technicians who are in the field. In addition to the Utica office, Maurizio set up an office in Hof, Germany in 2008 to make permanent placements, primarily in Europe. “We live in a global economy, and we want to take advantage of opportunities outside our borders,” asserts Maurizio, who is the sole stockholder of the enterprise. Keenan notes that the Hof office currently represents approximately 6 percent of the non-travel-related revenues.
Maurizio and his leadership team, which includes Keenan, Jeremy Enck as vice president of sales, and Kathy Paquette as director of human resources, are focused on outpatient-based services as the primary growth area. “We see areas like oncology, emergency medicine, labor and delivery, and burn centers growing in their demand for our services. But the number-one growth area for us is ambulatory-surgery centers,” Maurizio says. (December 2014 figures from the U.S. Bureau of Labor Statistics indicated that of the 34,000 new jobs created in health care that month, 16,000 were in ambulatory settings.)
“The country has an aging population. Our care facilities need nurses to fill in as needed. They also need executives. This is a very competitive industry, but what’s really interesting is that most of our competition comes from national and international recruiting companies,” he adds.
Maurizio muses on how high-tech the business has become. “I started this business with a rotary telephone and a Rolodex,” he quips. “Today, we supplement the phone with emails and a variety of social media, and the Rolodex has been replaced by sophisticated databases that monitor our various expenses for the traveling nurses such as housing, car rentals, and per-diems, while also helping us to offer 24-hour concierge service.” Dan Hartman, the communications executive with the company, adds that Fortus utilizes Facebook, Twitter, and LinkedIn as channels for communicating with its clients, candidates, and media contacts. “I estimate that I spend a couple of hours each day communicating via social media,” he observes. “We use Facebook and Twitter a lot to reach out to our nurses and to candidates, and the recruiters also leverage LinkedIn … Our blog posts are another way to educate our audience about the industry and the company.”
Maurizio
Maurizio, 57, is a self-described “Southside boy” who attended high school in Utica before matriculating at Paul Smith’s College to major in hospitality. In 1984, he went to work as a salesman for Whitehall Laboratories, a Fortune 100 company. The Southside boy was promoted to division manager before he left to join Baxter International, a global, diversified health-care company that developed, manufactured, and marketed products for chronic and acute conditions, such as kidney disease. In 1988, Maurizio went to work for the Boston office of Carter/MacKay, a company formed in 1970 to place sales, sales-management, and marketing personnel, plus scientific professionals, in the health-care industry. Family reasons brought him back to the Mohawk Valley to start his own firm.
“Placement is a tough business,” declares Maurizio, “because it’s a double sale. First you have to convince doctors, nurses, technicians, and administrators that the companies we represent are the right choice. Then you have to convince your clients that you have the best candidates to fill the open positions. We spent years building our reputation as the number-one nephrology recruiter in the world. Now, we are getting traction with health-care professionals in the ambulatory-surgery specialty. There’s no doubt that we’re on track to see our revenues … [balloon] to the $20 million mark.”
Fortus’s growth has been reflected historically in the numbers posted on the Inc.5000. The company was also recognized last year by BizEventz and The Business Journal as one of the “Best Places to Work” in the 16-county Central New York area. Maurizio was honored recently by The Staffing Industry Review magazine, a publication featuring the 100 most influential people in the staffing industry.
When Maurizio says the company is poised to double its revenues, the only question is: how quickly?
CORE eatery to open April 23 in Clay, at former location of Jolime Fresh Garden Café
CLAY — CORE, a new fast-casual, “active lifestyle” eatery, plans to open April 23 at the former location of Jolime Fresh Garden Café in the town of Clay. The opening of CORE at 7265 Buckley Road, its first location, follows renovation work at the former Jolime, which closed late last year. The eatery’s
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CLAY — CORE, a new fast-casual, “active lifestyle” eatery, plans to open April 23 at the former location of Jolime Fresh Garden Café in the town of Clay.
The opening of CORE at 7265 Buckley Road, its first location, follows renovation work at the former Jolime, which closed late last year.
The eatery’s owners announced the upcoming opening in a news release issued March 30.
The Caveny family joined Larry Wilson and Todd Mansfield in announcing late last year that they would transition the Jolime location to create a “unique active lifestyle” restaurant with plans to add additional locations.
The news release described Wilson as a “successful entrepreneur and restaurateur” and Mansfield as a “medical-industry veteran.”
Wilson, also described as a “long time friend” of the Caveny family, owns more than 25 Moe’s and Hoopla! restaurants throughout New York, Pennsylvania, and Maryland, according to the release.
They created CORE to offer quick meals for lunch and dinner featuring “unprocessed ingredients that enable peak performance.”
“For years, we have demonstrated a commitment to preparing our creations with fresh, local ingredients. We look forward to taking that to the next level with CORE,” John Caveny, co-owner of Jolime Fresh Garden Café, said in the news release. Jolime currently operates eateries in downtown Syracuse and Clay (North Medical).
The Clay location for CORE is the first of many that the ownership group has planned.
“Our goal is to bring great, healthy and clean foods to as many communities that will support our concept,” Wilson said.
The CORE menu features “healthy, hearty simple” meals based on leafy greens, whole grains, and “slow simmered” bone broths.
The customer can choose from seasonal vegetables, crunch toppings, and “sustainably raised” meats in their entrées.
The MOST’s president Leatherman to retire at year’s-end
SYRACUSE — The Milton J. Rubenstein Museum of Science and Technology (MOST) has announced that president Larry Leatherman plans to retire at the end of
EBRI: employer, worker contributions to health-savings accounts are falling
The percentage of employers and workers making contributions to health savings accounts (HSAs) fell in 2014. That’s according to new research from the Washington, D.C.–based Employee Benefit Research Institute (EBRI). The organization posted a news release about the research to its website on March 26. EBRI is a private, nonprofit research institute that
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The percentage of employers and workers making contributions to health savings accounts (HSAs) fell in 2014.
That’s according to new research from the Washington, D.C.–based Employee Benefit Research Institute (EBRI). The organization posted a news release about the research to its website on March 26.
EBRI is a private, nonprofit research institute that focuses on health, savings, retirement, and economic-security issues.
HSAs are an element of so-called “consumer-driven” health plans (CDHPs). CDHPs involve high deductibles and tax-deferred savings or spending accounts that workers and their families can use to pay their out-of-pocket health-care expenses.
EBRI notes that about 15 percent of the population was enrolled in a CDHP in 2014, representing about 26 million individuals with private insurance.
Among the 15 percent of people enrolled in a CDHP, 57 percent (or 9.3 million) had a health-reimbursement account (HRA) or had opened an HSA, while 43 percent were enrolled in an HSA-eligible health plan but had not opened an HSA.
Employer contributions
The new EBRI analysis indicates that two in three workers (67 percent) with an HRA or HSA reported that their employers contributed to the account in 2014, down from 71 percent in 2013.
The percentage of workers with an HRA or HSA-eligible health plan whose employers contributed to the account had steadily increased between 2009 and 2013, according to the EBRI.
Worker contributions
Individuals’ contributions to HSAs had been growing until 2011, but have declined since then, EBRI found.
Between 2006 and 2011, the percentage of individuals with employee-only coverage contributing nothing to an HSA decreased from 28 percent to 11 percent.
At the same time, the percentage contributing $1,500 or more increased from 21 percent in 2006 to 44 percent in 2011.
More recently, between 2011 and 2014, the percentage of individuals reporting that they contributed nothing to their HSA increased from 11 percent to 23 percent, and the percentage reporting that they contributed $1,500 or more fell from 44 percent to 30 percent.
Among those with individual coverage and employer contributions, the percentage with contributions between $200 and $999 decreased, while contributions of $1,000 or more increased in 2014.
Both lower- and higher-income individuals slightly lowered their contributions in 2014, and lower-income individuals were less likely to contribute anything than higher-income individuals, the EBRI analysis found.
EBRI bases the findings on the results of the 2008–2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey and the 2006 and 2007 EBRI/Commonwealth Fund Consumerism in Health Care Survey, the nonprofit said.
Contact Reinhardt at ereinhardt@cnybj.com
New York DFS to insurers: boost your cyber defenses
The New York State Department of Financial Services (DFS) is calling on insurance companies to “strengthen” their cyber-hacking defenses. Benjamin M. Lawsky, superintendent of financial services, in February announced a series of measures to require insurers to take stronger steps to ward off cyber hackers. In the coming weeks and months, DFS will
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The New York State Department of Financial Services (DFS) is calling on insurance companies to “strengthen” their cyber-hacking defenses.
Benjamin M. Lawsky, superintendent of financial services, in February announced a series of measures to require insurers to take stronger steps to ward off cyber hackers.
In the coming weeks and months, DFS will integrate “regular, targeted” assessments of cyber-security preparedness at insurance companies as part of the department’s examination process.
It’ll also put forward enhanced regulations requiring institutions to meet “heightened” standards for cyber security; and examine “stronger” measures related to the representations and warranties that third-party vendors send insurance companies.
“Recent cyber-security breaches should serve as a stern wake-up call for insurers and other financial institutions to strengthen their cyber defenses. Those companies are entrusted with a virtual treasure trove of sensitive customer information that is an inviting target for hackers. Regulators and private-sector companies must both redouble their efforts and move aggressively to help safeguard this consumer data,” Lawsky said in the news release.
DFS conducted a survey with a focus on cyber security involving a “significant cross-section” of its regulated insurance companies.
A total of 43 firms, with combined assets of about $3.2 trillion, completed a survey seeking information about each participant’s cyber-security program, costs, and future plans.
The department’s analysis of the insurers surveyed found that a “wide array” of factors, not just reported assets, affect the “sophistication and comprehensiveness” of the insurers’ cyber-security programs.
The DFS “did not necessarily find” that the largest insurers had the “most robust and sophisticated” cyber defenses, even though that “may be expected,” according to its news release.
Letter to insurers
The DFS has also expanded its information-technology (IT) examination procedures to focus “more attention” on cyber security.
That’s according to a March 26 letter that Lawsky wrote to insurance executives and that the department posted on its website.
DFS will add new questions and topics to its existing IT exam, including the reporting structure for cyber security-related issues; management of cyber-security issues, such as the interaction between information security and core-business functions; and resources devoted to information security and overall risk management, according to the letter.
The letter also listed additional topics.
DFS said it would schedule IT/cyber-security exams after conducting risk assessments of each institutions. To help in the assessment, DFS asked insurers for a report with several pieces of information.
They include the job description of the current chief information security officer, that person’s training, and organization chart for information-security functions.
DFS wants the report to describe how the organization maintains information-security policies that address “confidentiality, integrity, and availability,” the letter said.
The department asks insurers to identify and describe their use of “multi-factor authentication for any networks, systems, programs, or applications,” according to the letter.
Insurers should describe their incident-response program, including how incidents are “reported, escalated, and remediated.”
DFS also wants insurance companies to describe any protection they use to “safeguard” sensitive data that is “sent to, received from, or accessible to” third-party service providers, such as encryption or multi-factor authentication, according to the letter.
In total, Lawsky’s letter listed 16 pieces of information the DFS seeks in the requested report.
CNY Strategic Positioning for Community-Based Health Care and Human-Service Providers
“One of the best aspects of health care reform is it starts to emphasize prevention.” — Anne Wojcicki My recent column described the monumental Medicaid Managed Care Reform Initiative (MMCRI) being implemented by New York state as rapidly as possible. The reform initiative is being implemented under the umbrella of the Delivery System Reform
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“One of the best aspects of health care reform is it starts to emphasize prevention.”
— Anne Wojcicki
My recent column described the monumental Medicaid Managed Care Reform Initiative (MMCRI) being implemented by New York state as rapidly as possible. The reform initiative is being implemented under the umbrella of the Delivery System Reform Incentive Program (DSRIP) with the formation, implementation, and operation of 25 Performing Provider Systems (PPS) throughout the state.
Acronyms, acronyms — when it comes to health care, their use is without limits.
The Central New York Care Collaborative (CNYCC) is the state-authorized PPS for six counties in Central New York. Cayuga, Oneida, Cortland, Onondaga, Madison, and Oswego counties represent the primary counties forming the PPS Region Provider Network. CNYCC health-care providers accounted for less than $1 billion of Medicaid spending in 2013, which represents less than 2 percent of total New York annual Medicaid spending ($55 billion). As one might expect, the vast majority of state Medicaid spending occurs in the greater New York City metro area, where there are 15 separate PPS regional entities.
The focus of this column is on strategic positioning for community-based health care and human-service providers in the CNYCC region. Each of the 25 Performing Provider Systems is led by hospital systems. In the case of CNYCC, sponsors include Auburn Community, Faxton St. Luke’s, St. Joseph’s, and Upstate University hospitals.
The hospitals in the CNYCC region are supported by more than 100 health-care and community-based providers who have committed to be a part of the CNYCC Network that will provide cost-effective, coordinated managed care to Medicaid-eligible individuals in the region (https://cnycares.org).
Each PPS was required to submit project implementation plans to the New York State Department of Health by April 1, 2015. These implementation plans relate directly to the 11 DSRIP reform projects selected by CNYCC, following a comprehensive needs assessment. The CNYCC projects are extensive and affect virtually every one of the more than 100 Medicaid service providers in the region. The projects selected by CNYCC requiring an implementation plan are as follows:
a) reate integrated delivery systems that are focused on evidence-based medicine/population health management
b) mergency-department care triage for at-risk populations
c) mplementing the INTERACT project (inpatient transfer-avoidance program for SNF)
d) ospital home-care collaboration solutions
e) ntegration and co-location of primary-care services and behavioral health services
f) nstitute for Healthcare Improvement — implementation of its “Conversation Ready Model” for palliative-care options
g) trengthen mental health and substance-abuse infrastructure across systems
If the initiatives above sound like monumental efforts at moving mountains, they are. Others may say, “I thought we were doing an effective job in each of these areas already.” Those individuals would be dead wrong. The current Medicaid service delivery system is fragmented as evidenced by the more than 100 providers in the six-county region.
So, from a strategic-positioning perspective, what should a community-based Medicaid service provider do in response to the MMCRI and PPS structure?
The answer to this strategic question is both complicated and complex. This is particularly true since community-based service providers are purported to be an integral component to the primary objectives of MMCRI. Those objectives are a 25 percent reduction in avoidable Medicaid emergency-room visits, hospital admissions, and readmissions within 30 days of discharge, over a five-year DSRIP timeframe.
One of the key strategies for community-based providers to consider has been and continues to be the formation of and membership in one or more Independent Provider Associations (IPA).
1. Independent Provider Association (IPA) defined
An individual group of physicians and/or other health-care providers that are under contract to provide services to members/enrollees of different MCOs, ACOs, and PPSs, as well as other insurance plans, incorporating a fixed-fee per enrollee (capitation) or based on a pay-for-performance model (partial capitation), service care-outs, and/or targeted performance incentives.
ν For example, the primary focus of managed-care organizations (MCOs) since the early 1970s has been on reducing the utilization of emergency room and hospital inpatient admissions.
ν The increased recent emphasis on reducing hospital re-admissions is an area where community-based providers can have direct and significant influence.
ν An IPA serves as the fiscal intermediary between groups of providers, which are members of the IPA and the MCO.
2. Types of IPAs
a. Independent
b. Captive — typically owned/controlled by the MCO or a health system
c. Partnership between MCO and IPA entities
Depending upon facts and circumstances, any one of the three alternatives may be appropriate. Provider control is greatest in the independent model IPA. Depending upon the attitude and relationship between the PPS/MCO and the individual providers, the captive and partnership models may be desirable or, alternately, not feasible.
3. Characteristics of the Independent IPA model
ν Formation of the independent IPA is a grass-roots effort of the providers who are also members of the IPA.
ν Board representation consists only of representatives from participating provider members of the IPA.
ν Decision-making authority rests with the IPA board that is initially appointed by the IPA provider members.
ν Can be formed as either taxable or tax-exempt, depending on membership, structure, and objectives.
ν Contract negotiations with PPSs/MCOs are managed directly by the IPA board, its independent legal counsel, and individuals designated with contract-negotiation authority.
ν Primary advantage for the PPS/MCO is that through a single signature, a regional network of providers can be PPS/MCO network participants without having individual negotiations with each provider.
ν Single-signature contract authority by the IPA Board is powerful from a negotiation and leverage perspective.
ν In order to pass legal requirements and anti-trust regulations, an IPA cannot be formed for the sole purpose of negotiating rates.
ν Rather, in addition to rate negotiation, the IPA must assume some degree of financial risk and/or targeted performance-based incentives as a condition of the contract with the PPS/MCO.
ν In order to effectively function as a joint network entity of multiple providers, there must be some evidence of “clinical and financial integration” (e.g., electronic medical records, billing systems, clinical protocols, etc.) among IPA provider members.
ν Financial risk, coupled with clinical and financial integration, represent “safe harbors” that allow regional provider IPA networks to operate without substantial risk of anti-trust challenges.
Membership in a provider-sponsored IPA is one of many strategic considerations for community-based service providers to evaluate in developing an appropriate strategic position that is responsive to integrated and regional reform initiatives.
Gerald J. Archibald, CPA, is a partner in charge of the management advisory services at The Bonadio Group. Contact him at (585) 381-1000, or via email at garchibald@bonadio.com
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