Get the E-newsletter
When patients seek treatment for any condition at a primary care clinic in the Intermountain Healthcare system in Utah, they get care for whichever condition brought them to the clinic. But they also get a bonus: screening and, if needed, treatment for behavioral health concerns.
"When we were improving our care processes for diabetes and asthma 15 years ago, we said to the CEO that it's great we're improving care for these diseases, but what are we going to do about the behavioral issues we are seeing?" says Brenda Reiss-Brennan, PhD, APRN, the mental health integration director at Intermountain Healthcare. "So we decided to pilot a program that integrates behavioral health care into the primary care system, and that is now fully operationalized."
Brenda Reiss-Brennan, PhD, APRN, Intermountain Healthcare
The system Reiss-Brennan and her colleagues developed has succeeded: Not only have patients reported improved overall health, but an internal study conducted 10 years into the program showed that the rate of cost increase for patients who had depression and were involved in the program was 27 percentage points less than for those who had depression and were not in the program.
"This is consistent with the intended impact of the … intervention, whereby those patients with timely diagnosis and collaborative primary care require less intensive, higher-order treatment (i.e., inpatient admission/use of the ED [emergency department])," notes the study, which was published in the March/April 2010 issue of the Journal of Healthcare Management.
Intermountain's experience provides evidence that integrating behavioral health care into the overall healthcare system improves patient results and reduces costs. As health care moves closer to a population care model, understanding the value of this integration becomes increasingly important. With the National Institute of Mental Health conservatively estimating the annual healthcare costs of treating serious mental illness at $100 billion, plenty is at stake financially as well as for patients and entire communities.
Traditionally, behavioral health issues have been treated separately from physical health issues. The distinction, in both how such conditions were treated and how society viewed them, was clear—and it lingers in many segments of health care.
"The issues that come up over and over again for patients and their families that stand in the way of integrated care are that we don't pay for care in the same way for behavioral health and for physical health, and that there is stigmatization of behavioral health issues," says Marci Nielsen, PhD, MPH, CEO of the Patient-Centered Primary Care Collaborative, a not-for-profit membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home.
"We think of the mental health system for depression and substance abuse and anxiety, but so often people with chronic illnesses have behavioral issues that also need to be addressed. When we integrate the two, we can treat all of those conditions."
Marci Nielsen, PhD, MPH, Patient-Centered Primary Care Collaborative
Despite the lingering societal disconnect between behavioral care and physical care, the connection between mind and body is not in doubt among healthcare professionals. Physical illnesses affect behavioral health, and behavioral disorders affect physical health.
"When you look at the top five chronic health conditions driving healthcare costs—depression, obesity, anxiety, back and neck pain, and arthritis—you see that all five have a behavioral health component," Nielsen notes.
When care for both sides of the mind-body connection is integrated, as is done at Intermountain Healthcare, patient outcomes improve. Data back up this assertion: A meta-study published in the Aug. 10, 2015, issue of JAMA Pediatrics examines the results of 31 studies and finds significant benefits of integrated behavioral care. The abstract of the study reads, in part: "The probability was 66% that a randomly selected youth would have a better outcome after receiving integrated medical-behavioral treatment than a randomly selected youth after receiving usual care. … Our results, demonstrating the benefits of integrated medical-behavioral primary care for improving youth behavioral health outcomes, enhance confidence that the increased incentives for integrated health and behavioral health care in the U.S. health care system will yield improvements in the health of children and adolescents."
Healthcare systems that integrate behavioral health into standard care are experimenting with different models. Common factors include some level of involvement with the patient's primary care physician (PCP) and actual or anticipated cost savings.
Intermountain Healthcare. The Salt Lake City-based health system's model of integrating behavioral care is centered on three levels of need. When a patient at any Intermountain Healthcare clinic or primary care office shows signs of a behavioral health problem—such as social withdrawal or sudden change in appetite—the patient is given a mental health integration screening packet that includes an assessment of behavioral health and chronic disease risk factors. Using the information from the screening, the caregiver decides whether the patient needs routine behavioral health care, collaborative care, or specialty care.
Routine care is provided by a PCP and support staff when a patient screens for mild depression. A patient who shows signs of moderate depression or has comorbid conditions may be placed in the collaborative care environment, which includes treatment by a mental health specialist and a case manager. Patients with more severe behavioral health issues—those deemed to be in danger or who have serious comorbid complexities—are referred to specialty care. In each case, the PCP remains involved, and the PCP support staff can guide patients and families through the designated care regimen.
"In our view of health, behavioral health issues and physical health issues are all interrelated," Reiss-Brennan says. "So if someone comes in for diabetes, they are automatically screened for depression. Thirty-two percent of diabetes patients will have depression, and we know the red flags to look for. If a diabetic patient's mood is getting out of control, they can call the care manager, and the care manager may say, 'Let's not worry about diet right now, let's take care of the depression.'"
The integrated collaboration among the PCP, support staff, and mental health professionals is key to the Intermountain Healthcare program.
"The whole team works together, meets regularly to discuss patients, and keeps everyone in the medical home fold," Reiss-Brennan says. "We have great data showing that if you are treated in a clinic with team-based care, quality indicators improve, people go to the ED less, and overall costs go down."
The reduction in costs is an important result of the program. Intermountain Healthcare, a not-for-profit system that includes 22 hospitals and 185 physician clinics, operates an insurance plan and thus carries risk with some of its patients. That risk will increase as the system ventures further into population health.
"We feel that as we move to population health, managing high-cost patients with team-based care, and identifying and managing behavioral health issues before they get costly, is the right way to go," Reiss-Brennan says.
Carolinas HealthCare System. A South Carolina-based network of 39 hospitals and more than 900 additional care locations, Carolinas HealthCare System operates a slightly different model of integrated behavioral care.
For the past 20 years the system has operated a behavioral health call center that receives 250,000 calls per year. The call center serves as a community behavioral health crisis hotline and is staffed by licensed counselors 24 hours a day. The call center also serves as a referral hub for patients and providers seeking services.
In addition, psychiatrists at Carolinas HealthCare System began providing telepsychiatry services in acute care EDs about 15 years ago. In 2013, building on this experience in virtual care delivery, CHS focused on integrating behavioral health services across the entire continuum of care.
The existing ED telepsychiatry model expanded to encompass the patient experience from arrival to the time the patient is discharged or transported for inpatient care. Patients entering the system through the ED are administered a suicide risk screening, and those who screen positive are scheduled for a telepsychiatry session, where a full risk assessment is completed.
"After the telehealth evaluation, our psychiatrist enters treatment and medication orders directly into the patient's electronic medical record [EMR], allowing treatment to begin immediately," explains Martha Whitecotton, senior vice president of behavioral health services for Carolinas HealthCare System. "If the patient needs to be placed in a higher level of behavioral care, the centralized behavioral health patient-placement team is notified to find bed placement, and a dedicated behavioral health transport system moves the patient safely to the next site of care."
Martha Whitecotton, Carolinas HealthCare System
The integration program at the health system is expanding into the primary care setting, driving early detection of illness, Whitecotton says.
"Our hope is to decrease the need for crisis intervention and impact the trajectory of illness," she says. "Through the use of a standardized screen, embedded into the EMR, primary care providers are able to identify patients in their practice who require further intervention. Depending on the result, the practice has the option to get a licensed behavioral health clinician on the video screen and do an immediate intervention or make a referral to the behavioral health integration team. The telehealth consultation is conducted through a laptop computer or iPad, real-time in the same visit. Long-term, every new patient will be screened, and every existing patient will be screened annually."
The behavioral health integration team at Carolinas HealthCare System consists of a psychiatrist, a pharmacist, licensed counselors, and health coaches. The team makes recommendations to the patient's PCP, helping the physician manage the overall health of the patient.
The team's involvement does not end after the initial consult and treatment. All patients are assigned to a behavioral health coach for telephonic follow-up to make sure they are taking their medications and understand the side effects, and to offer them the opportunity to receive behavioral therapy online, if appropriate. Coaching engagements last an average of 14 weeks and include ongoing assessment of response to treatment. All of this activity is recorded in the EMR.
"Very few of the patients need a face-to-face meeting with a psychiatrist," Whitecotton says. "It's very important to optimize the psychiatrist's time due to the manpower shortage in psychiatry. We can spread the model quickly, as our team can support multiple practices at one time, driving down the expense of providing the service."
Because the program has been fully operational only for about a year, Whitecotton says it's too early to fully calculate the ROI and overall impact on health services utilization. She says some health plans pay for virtual behavioral health care, but only when the care is delivered by a psychiatrist.
"But the whole point is that if we can get people into recovery, their health will improve, and that's the measure of effectiveness," she says. "We do know, based on follow-up PHQ-9 screening, that 89 percent of enrolled patients demonstrate decrease of at least one full severity class after health coaching."
Given that Carolinas HealthCare System is at risk for some patients in its own health plans, improving the long-term health of those patients definitely pays off. "And all hospitals are on the hook for readmissions and avoidable care, so if we can impact those measures, it's a win for the system financially," Whitecotton says.
Advocate Health Care. Based in Downers Grove, Ill., Advocate operates a third model of integrated behavioral health care. Called a "hub-and-spoke" model, the health system uses a team of behavioral caregivers based at Advocate Christ Medical Center in Oak Lawn, Ill., the largest hospital in the 12-hospital system. The team forms the hub and serves patients at several of the smaller hospitals in the system.
Advocate's program, which began in October 2014, focuses on patients 65 and older and on others as clinical judgment indicates. Anyone meeting these criteria who presents at an ED or a general medical floor is screened for depression and anxiety disorders.
"We know that chronic medical problems become more common as people age," says David Kemp, MD, co-medical director for the behavioral health service line at Advocate. "We believe it's important to screen for these behavioral disorders before they worsen. We don't have the manpower to implement this program across the board, so we're focusing on those at highest risk."
David Kemp, MD, Advocate Health Care
At one site, Advocate BroMenn Medical Center in Normal, Ill., screening is more comprehensive and includes all patients with chronic medical conditions.
Patients in the health system who are part of the program receive screening via the PHQ-9 questionnaire or the Generalized Anxiety Disorder seven-question tool. The results are sent to the hub, where the behavioral health team—which is composed of three psychiatrists, three psychologists, an advanced nurse practitioner, and a behavioral health technician—evaluates them. Mild results are reported, with the patient's consent, to the patient's PCP. More severe results are discussed with the physician in the ED; in many of those cases the behavioral health team visits the patient in person or virtually.
"The telehealth machines are on carts, so they can easily move from the ED to the medical floors and back," Kemp says. "The machine is a fairly simple design, akin to Skype, with a large monitor and a camera attached to it. So we can see the patients and talk to them in real time."
As with the programs at Intermountain Healthcare and Carolinas HealthCare System, in some cases the Advocate program has identified behavioral issues underlying physical problems. "Many times patients came in complaining of somatic problems, but behind that was a behavioral issue," Kemp says. "By addressing those we were able to prevent some admissions."
A side benefit of the program has been a reduction in the need for inpatient psychiatric care, Kemp says.
"When a behavioral health issue is present, the emergency department doctor may deem the need for inpatient psychiatric care," Kemp says. "But after evaluation, we are often able to set up in-community care instead of hospitalization."
Kemp is confident that the program will be financially worthwhile. "It's still fairly early for us to be able to analyze the financial data," he notes. "But when we looked at the sites where the model is operating compared to those without, we found a 7.5 percent lower cost per adjusted discharge for individuals with a comorbidity. Moreover, the emergency department length of stay was 11 percent lower for all sites managed by the hub-and-spoke model. Can we say it's directly attributable to the program? No, but that is one very meaningful initiative we have employed, and we feel confident it has had a significant impact given how our data set is defined."
As with the programs at Carolinas HealthCare System and Intermountain Healthcare, payment for the behavioral care Advocate is providing in this program has been inconsistent. However, Advocate has risk for behavioral health in a few of its payer arrangements, so it benefits through reduced costs for those patients.
"The data haven't been fully analyzed yet, but the response has been tremendously positive from patients and providers, and we are anticipating cost savings," Kemp says.
These three examples of integrated behavioral health are likely signs of things to come. Several provisions of the ACA should inspire more health systems to undertake such integration.
For example, the overall expansion of healthcare coverage has made more money available for behavioral care. In particular, parity rules removed the separate annual and lifetime caps on payment for mental health care.
The ACA's promotion of the medical home concept also encourages expanded integration of behavioral care with primary care.
"When it comes to the patient-centered medical home, what we have learned is that a lot of behavioral health care is being offered in the primary care setting," Nielsen, of the Patient-Centered Primary Care Collaborative, says. "Primary care providers are already serving as the de facto provider of behavioral health care, especially to those with minor mental health issues."
However, Nielsen notes, there is still a long way to go in this regard. "We have discovered that behavioral health needs to be integrated into primary care, but many struggle with the best way to do that," she says.
The accountable care organization (ACO) concept also promises to bring about greater integration of behavioral care with primary care. Because organizations involved in ACOs take on risk for the lives they cover, cost savings—such as those demonstrated when behavioral health issues are caught early and treated collaboratively—go directly to the bottom line.
Integration of behavioral health into healthcare systems thus is a trend that likely will grow in coming years, especially as leaders begin to understand the potential cost savings, increase in patient satisfaction, and improvement in overall population health. As the mind-body connection becomes better understood, its implications for health systems will increase.
Ed Avis is a freelance writer.
Interviewed for this article:
Brenda Reiss-Brennan, PhD, APRN, mental health integration director, Intermountain Healthcare, Salt Lake City.
Marci Nielsen, PHD, MPH, CEO of the Patient-Centered Primary Care Collaborative, Washington, D.C.
Martha Whitecotton, senior vice president, behavorial health services, Carolinas HealthCare System, Matthews, N.C.
David Kemp, co-medical director, behavioral health service line, Advocate Health Care.
Grant Thornton: Helping Organizations Embrace Robotic Process Automation
Two senior leaders at Grant Thornton talk about the advantages of robotic process automation to improve office efficiency, reduce costs, and mitigate risk.
VitalWare: Creating a Transparency Strategy: Meeting the Mandate to Post Standard Hospital Pricing
A senior leader of VitalWare talks about the need to create a comprehensive pricing strategy for consumers and how to get started.
HealthTrust: Solving Workforce Management Challenges
Two of HealthTrust’s senior leaders talk about strategies for optimizing the hospital workforce to improve productivity and reduce waste.
Grant Thornton: Optimizing the Ambulatory Workforce
One of Grant Thornton’s senior healthcare consultants addresses the topic of workforce management and the importance of a data-driven approach.
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.