From Left to Right: John Friend is executive director, Arizona Connected Care, Tucson; Judy Rich is president and CEO, Tucson Medical Center, Tucson; Jeffrey I. Selwyn, MD, is chairman, Arizona Connected Care, and a partner in New Pueblo Medicine, Tucson (JSelwyn@NewPuebloMedicine.com).
In the eyes of the federal government, Arizona Connected Care is an accountable care organization (ACO). But John Friend, its executive director, prefers not to limit the new entity to that description. "We are a collaborative organization that is in the Medicare Shared Savings Program and is taking on commercial contracts."
Emphasis on "collaborative": The leaders of Arizona Connected Care-which brings together more than 200 physicians, three federally qualified health centers, and Tucson Medical Center-believe that they are creating a model of care that will make them successful in any payment system that rewards improved quality and increased efficiency.
Arizona Connected Care was initiated by Tucson Medical Center, a 600-bed hospital. "We needed an integration strategy for physicians who were still in private practice and not employed," says president and CEO Judy Rich.
The partnership puts physicians in charge of creating a new delivery model. "Physicians are able to take responsibility for the care of their patients and be held accountable for it-and that's the way it should be," says Jeffrey Selwyn, MD, chairman of Arizona Connected Care.
Arizona Connected Care is a hospital-initiated, physician-led organization. What does that mean?
Selwyn: Tucson Medical Center provided the money for start-up costs, but this is truly a physician-led organization, and everyone recognizes that this is key to its success. Physician shareholders outnumber the hospital by approximately a 3-1 ratio.
Rich: To achieve our goals, we believe that physicians have to be the leaders. But we also know that the funding has to come from the hospital because nobody is going to go out and get 200 physicians to underwrite this kind of effort.
Friend: The board of directors that manages the affairs of Arizona Connected Care is indeed physician-led because there are more physicians than any other parties on the board. We knew this would be critical to this initiative since the proactive efforts of physicians are really critical.
Culturally, we need to let physician leaders in the community change the way they practice. If physicians follow a path of transformation, the clinical services will improve, the patient experience will improve, the financial performance of physician practices will improve, and the hospital will see improvement in efficiency, quality, collaboration and, ultimately, its business.
In April 2012, Arizona Connected Care was in the first wave of organizations to enter the Medicare Shared Savings Program. How did you prepare to be at the forefront of new payment models?
Rich: Tucson Medical Center was the first hospital in Arizona to achieve the highest stage (Stage 7) on the HIMSS EHR-adoption scale, which is significant because data sharing will be essential for our success in the Medicare shared savings program. The hospital is also participating in a statewide health information exchange that will launch later this year.
Finally, in 2009, we were selected to participate in the Brookings-Dartmouth ACO Pilot Program, where we received technical support and guidance for putting together the ACO. The next year, the hospital and the physician groups created a management services organization to provide data collection and care coordination tools and resources for the physician practices.
What lessons learned can you share with health system executives who want to partner with independent physicians in new ways?
Friend: The biggest challenge was developing a concise message about what we were proposing while also waiting for Washington D.C. to issue the Affordable Care Act and then the Supreme Court decision. So we had to draw a very clear business plan that showed physicians that they would be at least equal partners in the process. We had to develop a business plan that spelled out the structure of the collaborative partnership, how physicians would participate, the potential benefits, and the work that needed to be done.
It was a breakthrough moment when we came to conclude as a group that we could really improve patient care. Many initially said, "This sounds like something I heard before, and none of this ever works." But we are to the point now where there is a high degree of excitement around how we can use data and information and collaborate to actually improve outcomes for patients.
The Arizona Connected Care partnership puts relatively small physician practices in charge of creating a new healthcare delivery model. What gives you confidence this will work?
Selwyn: Many of us have proven to ourselves and our payers that we can use EHR technology and other things to change our practices and improve the way that we take care of our patients, and we are motivated to share our ideas with each other. In my own practice, for example, we have been in a gainsharing contract with United Healthcare, and we have found a lot of ways to use healthcare IT to be very successful. For example, when EHR data showed that New Pueblo Medicine physicians only had a 43 percent rate for colorectal cancer screenings, new reminders were put in place-and the average now is 85 percent (compared to the U.S. average of 65 percent).
We offer same-day appointments, which help keep people out of the emergency department, and we have created new staff positions, such as nurse care advocates, so we can offer more of a team approach. That improves the way patient care is managed and it allows us to see more patients. We also reorganized so that one of our physicians works full-time as a hospitalist. She helps manage our patients' care in the hospital, which shortens their hospital stays, and helps ensure they get appointments at the office right after they leave the hospital.
Our CEO and COO at New Pueblo have important roles in Arizona Connected Care, and they will help disseminate a lot of best practices to the other physician practices.
How do independent physicians who are competitors work as partners in Arizona Connected Care?
Selwyn: The only way we succeed as an organization is if we all take good care of our patients, so we all have an incentive to share best practices. And the only way physicians can succeed individually is if they perform in a way that makes the organization successful.
All physicians who participate in Arizona Connected Care are held accountable to 33 quality measures-such as the percentage of eligible patients who receive breast cancer screenings and cervical cancer screenings-that we spent a lot of time agreeing on. We will be measured quarterly and anyone who does not meet the benchmarks will not be eligible for the annual shared savings distribution.
Just having the opportunity to discuss things together is an unbelievably positive learning opportunity. For example, those of us in private practice have not had any experience with federally qualified health centers. We never knew what they did. Having three of these health centers in Arizona Connected Care has helped us learn from them. It turns out they have been doing disease management and care coordination for years.
How do hospitals succeed when physicians are in charge of the organization and get most of the shared savings? What does "winning" look like from Tucson Medical Center's perspective?
Rich: We get paid for many of our patients at the DRG rate, which means the more efficient we are and the better we take care of them, the better our bottom line is. So "winning" for us means getting patients out of the hospital quickly and not re-admitted.
Also, we should see more physicians wanting to come to our hospital and be a part of this opportunity. There's a lot of cynicism on the part of physicians in this country who feel they have been asked to work harder and harder for less and less money. They have seen their own incomes drop, and they have a lot of frustration with the healthcare system.
So "winning" for us is when doctors say, "This is a place where I can be a part of something that is going to put us on a different path, and something that is going to help me to succeed as a physician."
Are there opportunities for specialist physicians to partner in Arizona Connected Care?
Rich: A challenge for us is the fact that Arizona Connected Care is primary care-centered, and most of the physicians who come to the hospital every day are specialists.
Friend: There are some specialists who will collaborate with us, but they may not be members with distributive rights. In other words, they will not be sharing their data for quality purposes to earn a shared savings distribution, but they will be preferred recipients of referrals because their quality and efficiency makes them stand out.
Based on what you see in the Tucson market, do you think there will be any straight fee-for-service contracts in health care a decade from now?
Friend: We entered into a three-year shared savings contract with United Healthcare that started in March 2012, and most of the significant payers in our community are at least engaged in dialogue about alternative payment approaches right now. Participation by a very high percentage of payers is expected in the fairly short term, two to three years at the outside.
Payers are at different levels of engagement, so we are talking about different types of arrangements with different payers. For instance, you might be able to get patient-centered medical home support under one payer, whereas another payer might prefer something else.
What motivated Tucson Medical Center to be on the forefront of new payment models?
Rich: If you continue to think that life is going to be the same, you are probably going to talk yourself out of this kind of risk. I believe that the future is not going to look like the past, and that has been a strong motivator for me to say, "How do we work with physicians differently than we have before? And how do we share in the opportunities and the successes in a different way than we have before?"
Friend: ACOs may have a way of redefining markets and collaborations within marketplaces. I think it's no longer the time to be waiting for the perfect answers about the future to emerge because the answers are going to look very, very different in different communities.
It's time to get engaged in the conversation-at a minimum. A lot of people have been sitting on the sidelines, and there may come a time when they wait too long and certain opportunities may evaporate.
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Ontario Systems: Maximizing Self Pay Collections
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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
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Streamlining the Patient Billing Process
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Wallace Thomson Hospital Automates to Maximize Limited Resources
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7 Steps for Building and Funding Sustainability Projects
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Key Capital Considerations for Mergers and Acquisitions
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Trend Watch: Providers adapt as value-based care moves from hype to reality
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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.
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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.
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5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
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5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
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Providers Focus Too Much On Revenue Cycle Management
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Lucille Packard Children’s Hospital Stanford Case Study
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ZOLL and Emergency Mobile Health Care Case Study
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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
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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.
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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.
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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.
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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).
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Succeeding in Value-Based Care
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Therapy: Benefits at All Levels of Care
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Does Your Budgeting Process Lack Accountability?
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