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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
Until now, healthcare organizations have structured care delivery and business processes around the needs and requirements of providers and payers, which has resulted in a healthcare environment in which the patient is not the primary customer. It has also led to elevated costs, inefficiencies, and, in some instances, poor quality.
This mindset must change if organizations are to provide greater value. Realistically, shifting care and operations to be more patient-centered is the only way to achieve and sustain value long term.
For many patients, the healthcare experience is fragmented. Different providers and organizations offer care in a vacuum, without coordinating that care with other providers. This siloed approach increases costs and lessens quality—and it frustrates patients, particularly when patients are forced to act as a go-between among providers in addressing complex health issues.
To deliver the level of value needed to maintain long-term financial viability, healthcare organizations must eschew the siloed approach and embrace one that instead supports collaboration and information exchange across the continuum.
New and emerging care models, such as accountable care organizations (ACOs), are slowly pushing healthcare organizations toward greater collaboration. Whether collaborative entities function under one leadership structure or as a group of independent, clinically-integrated organizations, a cooperative care approach can ensure that a patient has easy access to all the resources he or she needs for care. The patient also must be confident that these resources are communicating with one another and keeping the patient’s best interests in mind.
Two recent ACO success stories are Banner Health Network and Monarch HealthCare ACO. Both organizations demonstrate improved care and lower costs, although their approaches to achieving success differ. Banner dispatches hospital-trained nurses to patients’ homes to address key patient needs, while Monarch provides a care-coordination service for beneficiaries with multiple diagnoses who need assistance with managing their numerous medications and care visits (“Pioneer Accountable Care Organizations Succeed in Improving Care, Lowering Costs,” Centers for Medicare & Medicaid Services. July 16, 2013).
Even if a healthcare organization does not pursue a formalized ACO model, future financial stability will be found only through partnerships with other organizations in the community to coordinate care and share information. For instance, by embedding care managers in a hospital, a provider can ensure that once a patient is discharged, the patient's primary care physician is aware of the discharge and can seamlessly pick up where the hospital left off, offering continuing services that limit the likelihood of readmission and sustain the patient’s health long term. These care managers also can act as communication conduits, making sure the hospital and physician practice share data about the patient and the next steps for care, thus reducing costly duplicative services.
For example, Crystal Run Healthcare—a multispecialty group practice located in New York—embedded care managers at a local hospital. The program decreased the 30-day all-cause readmission rate for Crystal Run patients treated at the hospital by 8 percent, benefiting all parties involved (Spencer, G., “Making the Move to an ACO,” hfm, February 2014).
Fundamentally, patient-focused care is based on collaboration. Those organizations that continually strive to look outside their four walls and pursue cooperative relationships with other healthcare providers will position themselves to take a large and financially lucrative step toward value.
Keegan Bailey is vice president, collaborative care strategy, NextGen Healthcare, Horsham, Pa. Follow him on Twitter.
Publication Date: Thursday, July 24, 2014
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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