By Maggie Van Dyke
During most of Thomas McCarrick's 27 years as a primary care physician, he rarely engaged with insurers. When he did, the talk was mostly about fee schedules. Then his Verona, N.J., practice, Vanguard Medical Group, joined a patient-centered medical home program developed by Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) in collaboration with the New Jersey Academy of Family Physicians and physician leaders.
That was the start of a beautiful provider-payer friendship. "Instead of looking so much at what we can get out of each other, we are now focused on what we can do together to improve patient care and reduce costs," says McCarrick.
Horizon provides Vanguard, as well as other medical groups in the program, with extensive operational and financial support, including a paid nurse to coordinate the care of high-risk patients, a care coordination fee, and shared savings payments for reaching outcomes-based benchmarks related to clinical quality, patient experience, and utilization.
Early results indicate that the medical homes are successfully meeting the program's dual quality and cost goals. For instance, in 2011, Horizon medical home members with diabetes had 8 percent better blood sugar rates than those not enrolled in medical homes. Medical home members also had a 10 percent lower cost of care (per member per month) in 2011, compared to non-medical home members, due primarily to 25 percent fewer hospital readmissions and 26 percent fewer emergency department (ED) visits.
For Vanguard's patients, especially those with complex or multiple medical conditions, the group's medical home conversion has transformed their lives. "Practically speaking ... my mom has not fallen," says Helen Kuryllo, caregiver to her parents who are patients at Vanguard Medical Group. "There have been no hospitalizations for either parent. The paramedics in town no longer recognize me on the street. Most important, there is close, consistent care."
See interview with Kuryllo: A Caregiver's View of a Medical Home
All of this began with a new type of working relationship between Horizon BCBSNJ and the participating physician groups. "From day one, what has made this program so unique is the collaboration?and it is absolutely a leading factor in why we've been able to achieve positive results," says Jim Albano, vice president, network management and Horizon Healthcare Innovations at Horizon BCBSNJ, which is the largest insurer in New Jersey.
Before launching its full-fledged medical home program, Horizon piloted the approach in 33 group practices with members who have diabetes. After getting its feet wet, Horizon transformed the diabetes pilot into a comprehensive medical home program that aims to eventually include all Horizon members in New Jersey. Launched in January 2010, the program-called the Horizon BCBSNJ's Patient-Centered Medical Home Program-currently includes more than 500 physicians and 154,000 Horizon members at more than 145 N.J. practice locations.
Like other medical homes, the Horizon model focuses on improving care coordination and encouraging patients to get needed preventive and wellness care. Following a population management approach, a lead physician and a team of caregivers regularly monitor patients' progress, engage patients to obtain needed tests and treatments, and coordinate care with other providers.
Reinvesting in primary care. Vanguard, a three-group practice, participated in Horizon's diabetes pilot and went on to become one of the first eight practices in Horizon's comprehensive medical home program. As part of this work, Vanguard achieved Patient-Centered Medical Home recognition from the National Committee for Quality Assurance (NCQA).
"We were trying to figure out how to do things better for our patients and to find opportunities to get away from the current fee-for-service business model in which we are basically just paid for office visits," says McCarrick. "Rising healthcare costs are causing insurance companies to keep a lid on our payments. This has left many primary care practices struggling to survive, and they can't invest in things that will make their practices better or offer competitive salaries to bring in newly graduated physicians."
New Jersey, in particular, is expected to bear the brunt of the looming physician shortage in coming years. The American Academy of Family Physicians has deemed the state a primary care desert caused in part by low primary care physician salaries and the decision of many New Jersey-trained physician graduates to practice outside the state.
By supporting primary care practices with its medical home program, Horizon hopes to achieve its own business objectives of higher quality, better patient satisfaction, and improved affordability for its members. "One of our core goals is to reinvest and re-energize primary care throughout New Jersey because a strong primary care doctor/patient relationship is key to helping individuals manage their health and avoid serious illnesses and hospitalizations," says Albano.
Developing a playbook. The NCQA has spelled out specifics on what medical homes should look like (e.g., coordinated, integrated care). However, the down-and-dirty how-tos of operationalizing these standards are still a work in progress. As a result, Horizon and the initial eight physician practices that participated in the first phase of the medical home program spent a lot of time inventing-and reinventing-the necessary wheels.
"During our collaborative meetings, we worked together to fully comprehend the challenges that the physicians face as they transform their practices into medical homes," says Albano. "The dialogue has helped Horizon build a medical home program that is more gratifying for physicians and patients alike. While financial support is important, there is even greater value from collaboration. By consulting with physicians, nurses, and other stakeholders, we're better able to develop innovative tools and useful resources that practices can use to improve the quality of patient care."
McCarrick and other physicians from the initial eight practices met weekly with Horizon staff and members of a consulting firm. The participants were divided into six work groups that developed how-to approaches to key issues:
In addition, Horizon hosted monthly meetings between Horizon leadership and the eight lead primary care physicians.
From this collaborative work came the development of a patient-centered medical home playbook, which outlines best practices and offers various solutions on how to succeed as a high-functioning medical home. For example, the playbook covers the core components of establishing a medical home within the first 60 days.
A number of tools and resources were also developed to help the medical homes coordinate care, engage patients, etc. For example, one concern was how to communicate the concept of the medical home model to patients. "Together, we developed communication tools and resources, like letters, scripting, and starter kits, for practices to use in communicating with their patients," says Albano. "This targeted effort increased patients' understanding of the medical home program by 60 percent. This was an important first step to engaging and empowering patients in their health care."
Tackling the hard work. Because of its size and proactive leadership, Vanguard has managed to side step the financial problems facing many other New Jersey practices, says McCarrick. The practice already had an electronic health record (EHR) and a patient portal in place when it joined the Horizon program-essential technologies for a medical home that prides itself on care coordination and patient engagement.
Because of these and other advances, Vanguard was able to earn NCQA medical home recognition in just four months. However, McCarrick says the true transformation into a medical home takes much longer. "It took four months to work through the NCQA process-but that was just the NCQA process. That's different than having to build all the needed medical home processes and technologies from scratch. That's a huge amount of work, and it takes years to accomplish."
Vanguard is still fine-tuning various processes and procedures that are essential to a medical home, such as coordinating discharges with hospitals and improving patient access. "We get bogged down in practical problems that are not really addressed in the literature and often take a lot of time to fix," says McCarrick.
See related sidebar: Vanguard's Approach to Three Practical Medical Home Challenges
While all patients at Vanguard Medical Group receive coordinated care, some patients need a lot more attention than others. For this reason, McCarrick is very grateful for the full-time, fully paid population care coordinator that Horizon provided to his practice.
Currently, the population care coordinators within the Horizon medical home practices are either Horizon employees or employed by the practice and supported by Horizon, says Albano. In addition, Horizon is also supporting a 12-week training program for nurses who will work within the medical home practices. Horizon is expecting to train at least 200 care coordinators within the next two years.
Focusing on the sickest patients. The specially trained population care coordinators focus primarily on Horizon members who are considered the sickest 5 percent in the practice?and account for about 40 percent of costs.
"These are patients with significant comorbidities," says Janet Duni, RN, MPA, Vanguard's population care coordinator. "They are often not using healthcare services in the most strategic way, or they are overwhelmed by the complexities of seeing several specialists and have trouble self-managing their care. In many instances, there are opportunities to improve coordination of services and help patients better understand their diagnoses."
About 5,000, or 30 percent, of Vanguard's patients are Horizon members. Of these 5,000, about 150 are on Duni's "high-risk " list. "I'm in contact with 90 percent of the high-risk list no less than every three months, with a substantial subgroup receiving monthly or even weekly outreach," she says. "These are patients with sometimes complicated health histories, often with family or social problems as well. I try to understand the whole dynamic, which includes developing a relationship with spouses or caregivers. I touch these patient charts as often as I can, and have instituted a work flow to support that process. I try to ensure specialist reports are sent to our office and confirm that, if high-risk patients are not seeing us, they are being actively managed by their specialists."
Fine-tuning risk. Identifying high-risk patients is an issue that many providers and payers are grappling with. Using a combination of science and art, Vanguard is "about 75 percent there in terms of fine-tuning risk," says Duni. She and the physicians in the medical group begin with a list of about 500 high-risk Horizon members at Vanguard, which the insurer develops using a claims-based risk assessment tool. The clinicians then fine-tune this list based on patient assessment, medical history, and use of medical services, among other factors.
"Horizon gives us a risk score on their members so we can actually look at those patients and decide if we agree with that score," says McCarrick. "Many times it turns out that a patient may have been in the hospital for an acute, self-limited problem, and once that problem is solved, the patient turns out not to be high risk. Conversely, we've had patients who have medical problems who are not captured in claims data very well, such as an elderly diabetic patient with cognitive impairment or a patient whose spouse is dying or recently died.
"EHRs are not typically set up to identify high-risk patients, he says. "There's no high-risk field that you can pull into your reports. So we had to develop a workaround. We are taking ICD-9 codes that we created and renaming them 'high-risk,' 'very high-risk,' and 'high-risk status post 30 days hospitalization.' This allows us to generate reports of our high-risk patients."
Vanguard also invested in a disease registry software tool that helps clinicians to identify patients who may need additional treatments, tests, or education. "It helps us better spot, for example, patients with cholesterol above a certain goal or blood pressure that is not controlled," says McCarrick. "It lets us drill down into populations of patients and actually pick out, for example, a subpopulation of diabetics with A1c hemoglobin levels greater than 8."
Maintaining high touch. Once high-risk patients are identified, the next challenge is keeping these patients "in our sight line" to ensure they are getting needed care and coordination, says Duni. To stay on top of patients, she uses a care planning tool, which was developed during Horizon's initial medical home planning meetings. Duni also uses a spreadsheet she developed that supports consistent tracking of appointments and outcomes.
"We are very concerned about having high touch with our highest risk patients. High-risk patients need individualized care plans, which may require weekly, monthly, or quarterly interactions. That can translate into phone contact, office visits, home visits, or assisting with coordination of services from other providers or community agencies."
In creating its medical home model, Horizon recognized the need to help primary care physicians pay for care coordination, which is not typically covered by Medicare or private insurance, says Albano. The care coordination fees are per-member-per-month fees on top of the practice's usual fee-for-service charges, he explains.
"We look at that payment as non-visit-based transformation support. A portion of the care coordination payment is dedicated to support a nurse care coordinator and the remaining support could be used to hire additional staff, improve technology, or develop other capabilities to improve care coordination," says Albano.
Participating practices can also receive an outcomes-based payment if they meet certain performance targets for clinical quality (e.g., percentage of pneumonia vaccines given to older adults), patient satisfaction, and utilization (e.g., percentage of hospital readmissions). Altogether, there are 18 targets that the medical homes are striving to achieve.
"We are moving from fee for service to fee for value," says Albano. "Instead of paying these practices for the volume of tests or treatments they perform, we are paying practices to get and keep their patient populations healthy in a cost-efficient way."
McCarrick believes the tide is starting to take a positive turn for primary care practices in New Jersey. In addition to the Horizon medical home project, the state is benefiting from a national medical home initiative sponsored by the Department of Health and Human Services (HHS). New Jersey was one of seven states selected to participate in the Comprehensive Primary Care Initiative, which will provide practices with monthly care management fees and shared savings.
"For us, the Horizon program has been a huge success, and I think it provides a path for other insurance companies to follow," McCarrick concludes. "I tend to be a glass-half-full guy, but I really do see a light at the end of the tunnel."
Quoted in this article (in order of appearance):
Thomas McCarrick, MD, is a primary care physician, Vanguard Medical Group, Verona, N.J. (email@example.com).
Jim Albano is vice president, network management and Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield of New Jersey, Newark, N.J.
Janet Duni, RN, MPA, is population care coordinator, Vanguard Medical Group, Verona, N.J. (firstname.lastname@example.org).
ROi: Delivering a Complete Provider Driven Supply Chain and GPO Strategy
TriMedx: Unlocking the Full Potential of an Organization's Clinical Assets
Grant Thornton: Providing Robust Due Diligence to Facilitate Successful Health System Mergers and Acquisitions
Xtend Healthcare: Helping Organizations Optimize Their Revenue Cycle
In this business profile, Mike Morris, president of Xtend Healthcare, discusses the value of partnering with a revenue cycle management vendor that has deep experience in delivering strong ROI.
AvaSure: Using Video Monitoring to Improve Patient Safety and Achieve Cost Efficiencies
Professional Credit: ‘The New Deal’ Approach to Healthcare Collections is Data-Driven and Consumer-Focused
Medxcel Facilities Management: Working Smarter to Make Organizations Safer
The Claro Group: Partnering for Performance Improvement
In this Business Profile, Larry Volkmar, a managing director in the performance improvement
practice at The Claro Group, discusses key strategies for improving
clinical and financial performance.
Deloitte: Taking Data Analytics to the Next Level
In this Business Profile, Christine Santos, chief of strategic business analytics for
Providence Health Services and Chris DeBeer, principal at Deloitte
Consulting LLP explain the value of enterprise data analytics.
PatientMatters: A Patient-Centered Financial Experience
In this Business Profile, Sheila Schweitzer, founder and CEO of PatientMatters, offers insights
on ways hospitals and healthcare systems can address rising patient
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.