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In this Business Profile, Jim Bohnsack, vice president, solution & corporate ?development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement ?for all payment arrangements.

Jim BohnsackTell me a little bit about your organization.

Conifer Health Solutions focuses on strengthening healthcare organizations' financial and clinical health as well as the personal well-being of their patients, communities, and employees. Serving integrated delivery networks, hospitals and physician groups, provider-sponsored health plans, and employers, Conifer Health helps healthcare organizations get paid appropriately for the care provided under volume-based reimbursement, as well as helps provider organizations succeed under risk-based models. Conifer Health also works directly with consumers to guide them to the appropriate care setting and consults with them on adhering to care management programs.

Conifer Health's value is helping organizations address every aspect of the Institute for Healthcare Improvement's Triple Aim: elevating the patient experience, driving improved outcomes, and achieving cost reduction. The breadth of its client base across the healthcare landscape, coupled with 30-plus years of experience, allows Conifer Health to draw on lessons learned and offer tailored services and technology for each client. We work with our clients to identify the right solutions to drive value for an organization based on its strategic goals. For example, an integrated delivery network might be growing via acquisition or perhaps an employer group wants to reduce its healthcare expenditures and provide care management to its employees. Conifer Health's goal is to provide the foundation for these efforts and help our clients tackle the challenging clinical, financial, and quality initiatives they need to grow in their local markets.

What are some of the biggest challenges you see affecting healthcare organizations?

Payers and providers must control the cost of care while ensuring quality and elevating the consumer experience. The changes in health care are driving the need for innovation and the development of "big data" capabilities. For instance, financial information (e.g., claims data) is the most readily available data source and can provide valuable insights across the entire continuum of patient care. Data related to orders, results, and clinical documentation constitutes a deeper but narrower data set, and can also provide important information. Those organizations that have a comprehensive data strategy and can operationalize their data insights will have the ability to achieve quality outcomes and satisfied consumers, both critical to succeeding under value-based purchasing models. Those that do not will be "flying blind."

How does your product or service offering(s) help address these needs?

Conifer Health provides data-driven performance improvement and health management solutions to healthcare organizations. Harnessing the power of data to drive the design and refinement of our solutions has yielded tremendous benefits for our clients. Lowering the cost of delivering services without the right focus has the potential to adversely affect patients. However, using analytics to pinpoint the areas of opportunity to reduce waste can not only lower cost, but also improve the overall efficiency of the process. Our approach to claim submission and follow-up illustrates this in practice. As payers constantly implement new rules for processing claims, significant variations can occur on the provider side of the equation. Many organizations submit claims and follow-up if payment is not received within 30 days. Using our data and analytics capabilities, Conifer Health can segment accounts based on individual payer logic at the claim element level, allowing us to pinpoint necessary changes in workflows. For example, a specific diagnosis to procedure combination may always get pended for utilization review by the payer, adding six days to the standard payment cycle. Conifer Health has the ability to recognize that logic and adjust our workflow to ensure those claims are not touched within the six-day window because we know that is the new standard for that payer.

What are some key considerations for healthcare leaders when choosing this type of product or service?

A potential partner should have a proven service that is applicable to a healthcare organization's current situation and goals. Moreover, the company should have credible experts who can provide guidance and problem solve in areas of ambiguity. Before committing to a service provider, organizations should verify that the company has a lengthy history of success with similar clients. Peer references should be able to corroborate the potential partner's experience. In addition to having a track record, vendors must be able to clearly articulate and contextualize the roadblocks an organization may face when trying to address a given problem. Conifer Health, for example, has 30-plus years of success in health care and leverages that experience to help organizations fully appreciate the nuances of various challenges and the pros and cons of different solutions.

As healthcare organizations implement use of your product or service into their day-to-day operations, what advice would you offer so they can best set themselves up for success?

Before a healthcare organization can solve a multifaceted business challenge, it must be able to clearly articulate its goals. Some questions to ask might include: What issues are we trying to solve as our organization evolves? Do we have a particular competency in a given service line and want to attract patients to it? Or, do we see a need in an underserved market and want to address it so we can cultivate and retain new business? When an organization clearly defines its goals, it becomes easier for a vendor partner to meet the entity's objectives, selecting just the right services, technology, and other solutions to yield the best outcomes.

Are there any educational materials you would like to share to help healthcare providers in these efforts?

Our website is a resource for providers looking for practical insights to help prioritize their approach to value-based care. Visit the site for a collection of articles, briefings, and related content, covering everything from provider-sponsored health plans and assuming risk to optimizing the revenue cycle.


HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. Business Profiles are funded through advertising with leading solution providers. Learn more.

ConiferHealthContent for this Business Profile is supplied by Conifer Health Solutions. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.