Henry Ford Health System is focusing specifically on preventing unnecessary hospitalizations among congestive heart failure (CHF) patients. Using a predictive model developed by a private company, Henry Ford ambulatory case managers can identify CHF patients who are most at risk for either a first admission or a readmission within 30 days hospitalization. Because of Henry Ford’s integrated electronic health record (EHR), the predictive model can pinpoint high-risk patients and target the information for inpatient and outpatient use.
High-risk CHF outpatients are being paired with nurse case managers who are part of the care team at Henry Ford’s medical homes. The case managers coach the patients on how to manage their CHF. Patients who consent are also hooked up with telemonitoring capabilities through Henry Ford’s home health agency.
“The technology gives the case managers direct feedback on a patient’s blood pressure, pulse, weight, and even their pulse oximetry,” says Cara Seguin, RN, MSN, director, Center of Clinical Care Design. “We combine these data with the subjective information we get from our patients, such as whether they’ve been more short of breath than usual. All of these insights help the case manager know when to reach out to the patient and prevent their disease from getting unmanageable.”
“We have algorithms that the case managers use when patients gain extra weight or develop other problems,” says Henry Ford’s Richard Dryer, MD, chief medical officer, primary care. “For instance, the algorithm for weight gain tells the case managers to have the patient take more diuretic.”
The case managers even have algorithms that help them determine when a patient is stable enough to graduate from the intensive monitoring program. “We learned this from our first case management experience,” says Dryer. “We didn’t have a way of discharging the patients from the program. They got in and stayed and that didn’t help the patients who needed to be coming into the program.”
In place for the last six years, Henry Ford’s medical homes got a major funding boost from the Michigan Primary Care Transformation Project, which is part of a Centers for Medicare & Medicaid Services (CMS) demonstration project. “The key thing about this particular CMS demo was the upfront money that allowed us to hire additional case managers who would be paid for by the pilot,” says Dryer.
During the first part of 2012, the health system hired an additional 14 outpatient case managers, for a total of 23. However, even the additional staff would not be enough to monitor all Henry Ford patients with chronic conditions. That’s why the health system has adopted a targeted approach to disease management that focuses on transitions of care for the sickest of the sick.
“There are a lot of sick patients in a chronic disease population,” says Seguin. “So you have to sort out who needs what when there are limited resources.”
This is different than Henry Ford’s past approach, says Dryer. “Physicians used to refer patients with chronic diseases to case managers,” says Dryer. “For instance, they asked the case manager to help a diabetes patient lose a little weight. Now, the focus is switched to keep people out of the hospital. So our case managers identify the sick patients and then confer with the physician on whether a patient would be right for the case management program.”
Henry Ford already knows that home telemonitoring can reduce hospitalizations. “The 30-day readmission rate for these patients is about 5 percent in our system’s e-Home Care program,” says Seguin, compared to an average all-cause readmission rate of 13.5 percent across Henry Ford.
Now with its predictive modeling and enhanced case management capabilities, Henry Ford can pinpoint the patients who would most benefit from this telemonitoring. Seguin is currently tracking program costs, including staffing and telemonitoring. “In 2013, we hope to show the costs of our program versus the cost of a hospital admission and identify a true cost savings in reduced, avoidable, primary-care-sensitive ED visits and re-hospitalizations,” she says.
Interviewed for this case study (in order of appearance): Cara Seguin, RN, MSN, director, Center of Clinical Care Design, Henry Ford Health System, Detroit (email@example.com). Richard Dryer, MD, chief medical officer, primary care, Henry Ford Health System (firstname.lastname@example.org).
Access related feature: Predictive Analytics: Pinpointing How to Best Allocate Patient Resources
McKesson: Leveraging Predictive Analytics to Rein in Operating Costs
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Accretive Health: Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Conifer Health Solutions: Helping Providers and Employers Build a Foundation for Better Health
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.
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.
Ontario Systems: Optimizing Accounts Receivable in a Rapidly Changing Environment
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
Optum: Enabling Transformative Change
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia: Bending the Healthcare Cost Curve Toward Improved Anesthesia Value
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
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.
PMMC: Navigating Revenue Cycle Management Challenges as Value Based Purchasing Emerges
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
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.
Burgess: Simplify the Business of Healthcare
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.