Get the E-newsletter
Years ago, contracting primarily was left to the contracting department. Yet since the advent of value-based payment contracts, healthcare organizations increasingly have relied on multidisciplinary teams to help shape the design of these programs, including how quality and financial incentives are aligned.
One reason is that providers are wary of repeating the same mistakes they made in the past. “In the early 1990s, many provider organizations that negotiated capitated agreements with payers failed because they didn’t understand population management agreements,” says S. Patrick Hammond, CEO, Emory Healthcare Network, and chief market services officer, Emory Healthcare, Decatur, Ga. “Although a contract may have sounded reasonable because it was based on averages, the reality is that no population is based on averages.”
To help vet population-based contracts, Emory’s contracting team has expanded to include an outside actuary, who helps leaders understand actuarial trends, how data are risk-adjusted to reflect patient severity, and the financial ramifications of the agreement. Emory’s CMO/chief quality officer also is on the negotiating team. “He can tell us if a metric will be meaningful to the doctors,” Hammond says.
S. Patrick Hammond, CEO, Emory Healthcare Network, and chief market services officer, Emory Healthcare, has added an outside actuary to his negotiating team. (Photo: Emory Healthcare)
Find the right structure. Emory Healthcare Network, which includes 1,800 physicians and six hospitals, moved from contracting via a clinically integrated network (CIN) to a commercial accountable care organization (ACO) model in 2014. “When we looked at how much we were going to earn under a CIN agreement, it really wasn’t sufficient to justify the investments in infrastructure and the dollars that would be moving out of fee-for-service,” Hammond says. “So we jumped in sooner with an ACO to take more upside and downside so we could negotiate to retain a higher percentage of what we saved.”
Today, Emory’s ACO is piloting population health management agreements with Blue Cross and Blue Shield of Georgia to manage 35,000 members. The ACO demonstrated a 25 percent improvement on 37 quality metrics collectively and cut medical costs by 3 percent in CY14. The health system is piloting a similar program with Aetna that includes 17,000 members.
Commercial Shared Savings Payment Model Results
Create a tiered approach to align incentives. To cascade the goals of its population-based contracts down to its physician practices, Emory Healthcare Network has created a tiered incentive plan. Ten percent of the bonus for primary care physicians hinges on overall ACO performance. Approximately 20 percent is based on how the physicians’ local health network performs against quality and cost targets (the ACO is comprised of six local health networks). The remaining 70 percent reflects individual performance based on approximately 25 metrics that are used to calculate an individual score.
Pursue a solution for specialists. “With primary care, you can basically attribute membership back to the primary care physicians, and they have a lot of direct impact on the measures,” Hammond says. “Assigning a patient to specialists is a much bigger challenge because the number of attributed patients they treat is much smaller.” Another issue is that most quality metrics in payer arrangements are claims-based, but metrics for specialties should be based on medical record data because such data offer a deeper level of clinical information, Hammond says. Although the incentives are still somewhat broad for specialists, leaders at Emory Healthcare Network are in discussions with payers regarding how they can structure their metrics more accurately using electronic health record (EHR) data.
Northwell Health (formerly known as North Shore- Long Island Jewish Health System), a 21-hospital, $8 billion health system based in Great Neck, N.Y., currently manages 200,000 lives in value-based contracts with government and commercial payers. The organization also has shared savings arrangements with many managed care companies, including Humana, Aetna, and Empire Blue Cross and Blue Shield.
Rich Miller, senior vice president, payer relations and contract development, and his team have developed an extensive template for evaluating every proposed population health arrangement. When reviewing a contract, some of the questions they consider include:
Involve physician leaders. Once the template is complete, Miller’s team shares it with the health system’s value-based payment model work group, which includes physicians and leaders from finance, care management, managed care, legal, and IT who review value-based arrangements in the contracting phase. “We thought it was imperative to get clinical input up front before any of these value-based contracts were executed,” Miller says, adding that it is not always a nimble process: “It typically takes months to vet a contract, but we feel very strongly that we shouldn’t enter into an arrangement unless we are comfortable that the provisions serve all the parties involved, including patients.” The work group also meets biweekly to review how current value-based programs are performing and to suggest clinical and operational changes that may be needed.
Two years ago, Northwell Health also formed a multidisciplinary pay-for-performance task force at the health system level to provide feedback on quality performance measures included in value-based contracts. Most members are physicians, although some are leaders from finance, IT, and provider network operations. “The physicians are so passionate about this that in some cases, they have asked us to set up conference calls with payers to make the case with the clinical leadership of a health plan regarding how a measure was being used,” Miller says.
Develop a preferred list of measures. Getting convergence on the measures used by different payers in these contracts is a challenge for many organizations. “We’ve accumulated more than 200 different measures, and some are similar measures just calculated differently,” says Joseph Schulman, executive director of Care Solutions, Northwell Health’s new care management organization, which is responsible for the performance, management, and implementation of risk-based contracts and population health management programs. To that end, Northwell’s pay-for-performance task force developed a list of approximately 10 inpatient and 15 outpatient measures that clinicians felt were aligned with the organization’s quality agenda. Whenever possible, the contracting team incorporates the preferred list of measures in the organization’s value-based contracts.
Joseph Schulman (left), executive director, Care Solutions, and Rich Miller, senior vice president, payer relations and contract development, Northwell Health, suggest that providers incorporate a preferred list of metrics in their contracts. (Photo: Northwell Health)
Appeal to providers. To ensure provider engagement, Northwell Health has developed a provider incentive program that recognizes performance on quality metrics as well as care coordination. “These endeavors lend themselves to alignment because exceptional outcomes for patients is the measurement of success in these programs, and that is what is most appealing to our providers,” Schulman says.
The success of population health programs depends on having incentives that reflect organizational goals at every level, says Cathy Jacobson, CPA, president and CEO, Froedtert Health. “You have to make sure that all of your incentives are aligned through your corporate goals, your system goals, and ultimately your contracts.”
Froedtert Health and the Medical College of Wisconsin (MCW), both based in Milwaukee, have created an affiliation in which they set system goals together (Ramos Hegwer, L., “How Healthcare Organizations Can Strengthen an Affiliation Without Merging,” hfm, April 2015). Froedtert Health and MCW also belong to the eight-member Integrated Health Network (IHN) of Wisconsin, an accountable care network that is exploring risk-sharing and population management strategies with employers and payers. The network includes 53 hospitals and more than 8,100 physicians. Each member of IHN develops its own physician compensation model to create incentives that can drive change. At Froedtert Health, 10 percent of community-based physician compensation is at risk for a variety of clinical and financial measures.
Create a value council. As part of their affiliation, Froedtert Health and MCW have formed a joint healthcare value council, which is led by the enterprise CMO and includes physician leaders from the community physician practice and the academic physician practice. The CMO, who also sits on the IHN clinical integration committee, is responsible for making sure that the physician practices’ goals align with IHN’s goals and for offering feedback on contracts. “Through IHN, we’ve had some great conversations with commercial payers on how certain diabetes metrics they are using are being replaced in the medical literature, and we have suggested newer metrics instead,” Jacobson says. “That speaks to the power of a network. They might not have listened to us if it was just Froedtert and MCW.”
Cathy Jacobsen, CPA, president and CEO, Froedtert Health, Milwaukee, says physician leaders should help vet population-based contracts.
Focus on quality performance. IHN is finishing its second year of participation in a shared savings contract covering United Healthcare’s commercial population in the region. Froedtert’s finance team worked with IHN’s finance council to determine how shared savings would be distributed to members after IHN meets its network- wide goals. “The debate centered on how much of the reward should be based on financial performance versus quality,” Jacobson says. “We decided to increase the shared savings that a member would earn back based on quality metrics. Because we are a member of the Wisconsin Collaborative for Healthcare Quality, which publicly reports quality metrics, we thought our focus on quality performance should be increased.”
At Dartmouth-Hitchcock, an academic health system with more than 1,200 physicians based in Lebanon, N.H., the system’s physicians are salaried, although their compensation is still based on relative value units (RVUs) to measure productivity. This approach means clinicians, particularly specialists, may see value-based care as the “flavor of the month,” says Lynn M. Guillette, FHFMA, CPA, vice president of finance, payment innovations. “Right now, some specialists don’t see how these value-based payment models really affect them,” she says. “The challenge is to help them understand that this is not a gatekeeper model, but rather primary care and specialists working together to make sure patients’ needs are met in the most cost-effective manner possible.”
Build on early success. From 2005 to 2010, Dartmouth-Hitchcock was one of 10 providers that participated in the Medicare Physician Group Practice (PGP) Demonstration, which created physician incentives to improve quality and reduce the total cost of care for a set of Medicare patients. The model is considered a forerunner to the ongoing Medicare ACO models. During its participation in the PGP demonstration, Dartmouth-Hitchcock began the difficult but necessary work of reorienting how it delivered primary care to better manage this set of patients. Dartmouth-Hitchcock did not set out to create patient-centered medical homes (PCMHs) through the transition process, as that model had yet to be widely adopted, but the practice transformations resulted in PCMH-type practices nonetheless, Guillette says.
Tammy Benoit (left), contract manager, and Lynn M. Guillette, FHFMA, CPA, vice president of finance, payment innovations, Dartmouth-Hitchcock, are leveraging their health system’s early success with population health pilot programs. (Photo: Dartmouth-Hitchcock)
In 2008, Cigna approached Dartmouth-Hitchcock about piloting a PCMH program for its commercial members. Today, the program has evolved into the Cigna Collaborative Accountable Care program, an upside-only model that involves more than 100 health systems across the country. Dartmouth-Hitchcock in 2010 entered into a two-sided risk contract with Anthem based on quality measures, and inked a similar agreement with Harvard Pilgrim Health Care in 2011. In 2012, Dartmouth-Hitchcock became one of 32 Pioneer ACOs. Today, 65 percent of the health system’s unique primary care patients are attributed to an ACO or risk-based model.
Create a new division. To support these contracts, Dartmouth-Hitchcock has launched a population health management division, headed by a chief population health officer who is also a physician. Dartmouth-Hitchcock’s contracting department works closely with the chief population health officer and the clinical operations, quality, and analytics teams to vet contracts and determine whether the metrics included are realistic. “Typically, these metrics are still not negotiable with payers, so if there is one metric that we don’t collect or buy into, we want to make sure there are enough other measures to offset it,” Guillette says. For example, Dartmouth-Hitchcock is an early adopter of new mammography screening guidelines from the U.S. Preventive Services Task Force that do not recommend yearly mammograms for women ages 40 to 50 without a family or medical history of breast cancer. Most payers have not adopted these guidelines. “We are not always able to get agreement with payers because we may have adopted a different approach based on more current science,” Guillette says. In such cases, the organization will move forward with a contract only if there are other metrics that are actionable.
Back in 2008, Blue Shield of California, San Francisco, laid the foundation for one of the country’s longest- running ACOs, serving members of the California Public Employees’ Retirement System (CalPERS). Blue Shield of California’s partners in the ACO, which is active today, are Dignity Health, the largest hospital provider in the state, and Hill Physicians, a practice with 3,800 providers.
Create a global budget. To create financial alignment across all partners, ACO leaders established a global budget and risk-sharing elements tied to mutually agreed-upon metrics (Markovich, P., “A Global Budget Pilot Project Among Provider Partners and Blue Shield of California,” Health Affairs, September 2012). The three ACO partners provided CalPERS with an immediate premium credit that totaled $15.5 million, and the partners shared both upside and downside risk for total healthcare expenditures. Each partner’s level of risk—that is, the portion that a partner must cover if the ACO misses the savings target—was based on its ability to influence per member per month costs in areas such as ancillary services, pharmacy, and professional services.
Offer and solicit input. “Initially, we took the lead in designing how the financial arrangement would work and how the clinical engagement would work,” says Kristen Miranda, senior vice president, strategic partnerships and innovation, Blue Shield of California. “But since then, we have had considerable input from our ACO partners that has led us to refine our model over time.” At the start, the model was focused on improving care coordination, as well as reducing readmissions and avoidable bed days. The partners since have expanded their focus to include ambulatory programs, such as home care and palliative care.
Blue Shield of California today has 26 ACOs across the state, managing care for more than 325,000 members, each involving a physician practice and most involving at least one hospital or health system. “Because the populations are so different and the systems’ initial levels of performance and sophistication are so different, we’ve had to tailor the programs to meet our partners’ needs,” Miranda says.
Establish a forum for clinical leaders. To help design meaningful incentives, Blue Shield of California has established an ACO quality council comprised of clinical leaders from most of its ACOs. “We’ve let a lot of our provider partners drive the discussion on which metrics matter,” Miranda says. “We recognize that we can’t have ACO leaders across the state managing to a completely different set of metrics for Blue Shield than they are for other insurers.”
The health plan also shares unblinded quality data across all of its ACOs to encourage providers to share best practices.
Aligning incentives is likely to become a more widespread concern as efforts to improve value and achieve the Triple Aim become more prevalent. Healthcare leaders who are on the front line of negotiating value-based contracts and developing population health management programs suggest the following strategies.
Build a better contract. “Value-based care starts with a culture that supports innovation, and it requires collaboration, and contracts can help move people toward that transformation,” says Jeff Micklos, executive director, Health Care Transformation Task Force, Washington, D.C. The task force represents provider, payer, patient, and purchasing organizations dedicated to shifting 75 percent of their business into value-based agreements by 2020.
The task force recently published an action memo on key elements to consider in ACO agreements (available at www.hctff.org). The memo includes some of the financial issues that should be covered in ACO agreements:
Jeff Micklos, executive director, Health Care Transformation Task Force, Washington, D.C., leads a collaborative that aims to create a more uniform set of value-based metrics.
“Whatever the financial structure of a contract is, it should have two options available,” Micklos says. “One model should be based on historical claims, which is more effective for moving high-cost providers into structures that decrease costs. The other model should be based on regional cost trends so providers can continue to become more efficient.” Ideally, an ACO that starts in the first model would shift to the second model over time, he adds.
Work toward a consistent set of measures. One of the task force’s goals is to bring together members so they can whittle down the number of measures that have emerged from private-payer, Medicare, and Medicaid population health management programs.
“We need a more streamlined, consistent set of metrics across all payers and health systems, recognizing that there will need to be some variability depending on the patient population,” Micklos says. He believes the right measures should be based on quality outcomes, rather than process measures, which are less likely to drive improvements in care.
Focus on cost targets. “The initial development of the cost target or benchmark is critical,” Dartmouth-Hitchcock’s Guillette says. “What you think is true about the initial benchmark may not be true if your ACO changes in size or composition.” Dartmouth-Hitchcock left the Pioneer ACO program in 2015, having entered in 2012 and lost more than $3 million in 2013-14. Guillette says the Pioneer ACO model was not flexible enough to accommodate changes in participating providers, including one year in which Dartmouth-Hitchcock doubled the size of its ACO by adding three nonaffiliated health systems. “In essence, we had three different ACOs year after year,” Guillette says.
Charge an executive team with governance over the agreement. “The team can provide clear accountability and a process for escalating issues,” says Miranda of Blue Shield of California. “There will be issues that come up, and you have to have the kind of provider- payer relationship where you can determine what adjustments need to be made when things don’t go as planned,” she says.
Include specific data-sharing terms in the agreement. The agreement should include the frequency and timeliness of data transfer, as well as the content that will be transferred, Northwell Health’s Miller says. “In our contracts, we have started to include the specific field level that should be included in the claims data that are transmitted to us,” Miller says.
Emory Healthcare Network requires that all payers in its shared savings agreements provide a monthly download of claims data on all patients attributed to the network’s primary care physicians. “It may take more than a year into the contract to get consistent, accurate data feeds from payers,” says Hammond of Emory Healthcare Network. “It’s one of the biggest challenges we have as providers.”
Build an IT infrastructure for sustainability. “Sharing performance data only gets you half of the way there,” says Froedtert’s Jacobson. “You need to support practices to help them do the work.” Such support includes hardwiring inpatient protocols that reduce variation in physician practice, as well as building the right IT infrastructure.
Emory Healthcare Network requires physicians to have one of a select list of certified EHRs that can connect to the network’s health information exchange. This cohesion allows providers to connect to Emory’s cloud-based support tools, which include disease registries that help physicians see care gaps in real time during the patient visit.
Create a population health management university. Recognizing that the skills needed to manage populations are different from managing acute episodes, Emory Health Network has created a yearlong program that prepares practices to apply for certification as Level III PCMHs from the National Committee for Quality Assurance. Ten practices are enrolled in the program, including a neuroscience practice that aims to become a medical home for Alzheimer’s patients.
Understand payers’ perspectives. “The biggest challenge for us is engaging with provider partners who understand that our customers are demanding not just a lower trend, but a lower absolute price point— and without sacrificing continuous improvements in clinical quality, patient safety, and service,” says H. Scott Sarran, MD, senior vice president and CMO, government programs, Health Care Service Corporation (HCSC), Chicago.
When choosing partners to carry out population-based contracts, HCSC looks for strong physician leadership at the practice level. Among hospital-based partners, HCSC also values executive leaders who have invested in clinical and programmatic changes to better manage populations. “If they have not started to make changes in how their executives and physicians are compensated—for example, if physicians are still compensated on a pure RVU basis—it is hard to see how they are going to succeed out of the gate.”
Despite the challenges of aligning quality and financial incentives in value-based contracts, Guillette of Dartmouth-Hitchcock believes providers should feel encouraged.
“Although there is no perfect model yet, these models are heading in the right direction,” Guillette says. “If you look at the quality outcomes from these models, you can tell we are making a difference for patients.”
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Interviewed for this article: S. Patrick Hammond, CEO, Emory Healthcare Network, and chief market services officer, Emory Healthcare, Decatur, Ga.
Rich Miller, senior vice president, payer relations and contract development, Northwell Health, Great Neck, N.Y.
Joseph Schulman, executive director, Care Solutions, Northwell Health, Great Neck, N.Y.
Cathy Jacobson, CPA, president and CEO, Froedtert Health, Milwaukee.
Lynn M. Guillette, FHFMA, CPA, vice president of finance, payment innovations, Dartmouth-Hitchcock, Lebanon, N.H.
Kristen Miranda, senior vice president, strategic partnerships and innovation, Blue Shield of California, San Francisco.
Jeff Micklos, executive director, Health Care Transformation Task Force, Washington, D.C.
H. Scott Sarran, MD, senior vice president and CMO, government programs, Health Care Service Corporation, Chicago.
Grant Thornton: Facilitating EAM
Priority Advantage: Helping Organizations Optimize Their Medicare Advantage Plans
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Building a Clinically-Integrated Network
As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs.
Winning in the Post-Acute Marketplace
Read more about factors contributing to the changes in the post-acute marketplace and what it means for manufacturers, physicians, clinicians, patients, and post-acute facilities as they anticipate the transition to the second curve.
Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy?
Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Adding Value to Physician Compensation
Today’s concerns about physician compensation are the result of the changing healthcare environment. The transition to value is slow, but finally becoming a reality. Proactive hospitals want to ensure that provider incentives are properly aligned with ever-increasing value-based demands.
This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
This publication identifies and outlines the necessary characteristics of a fully-functioning clinically integrated network (CIN). What it doesn’t do is detail how hospitals and providers can participate in the value-based care environment during the development process.
One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Therapy: Benefits at All Levels of Care
Nearly half of all Medicare beneficiaries treated in the hospital will need post-acute care services after discharge. For these patients, a stay in an inpatient rehabilitation facility, skilled nursing facility or other post-acute care setting comes between hospital and home.
Does Your Budgeting Process Lack Accountability?
With the proper process, tools, and feedback mechanisms in place, budgeting can be a valuable exercise for organizations while helping hold organizational leaders accountable. Having a proper monthly variance review process is one of the most critical factors in creating a more efficient and accurate budget. Monthly variance reporting puts parameters around what is to be expected during the upcoming budget entry process.
Cost Accounting: the Key to Cost Management and Profitability
Managing the cost of patient care is the top strategic priority of most hospital CFOs today. As healthcare shifts to more data-driven decision making, having clear visibility into key volume, cost and profitability measures across clinical service lines is becoming increasingly important for both long-range and tactical planning activities. In turn, the cost accounting function in healthcare provider organizations is becoming an increasingly important and strategic function. This whitepaper includes five strategies for efficient and accurate cost accounting and service line analytics and keys to overcoming the associated challenges.