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Ask people on the street what ground-breaking innovations they hope to see in health care during the next five to 15 years, and they might first think about miraculous medical discoveries like the cure for cancer or a vaccine against Ebola.
The five healthcare leaders interviewed for this article also have high hopes for medical advances—and point to exciting discoveries that are already alleviating pain and suffering. For instance, at Seattle’s Virginia Mason Medical Center, a radiation oncologist is working with surgeons to administer a single dose of intraoperative radiation therapy in the operating room to women with breast cancer who meet certain criteria, eliminating weeks of radiation treatment post-surgery, says Suzanne Anderson, executive vice president, CIO, and CFO.
Virginia Mason Health System executive vice president, CFO, and CIO Suzanne Anderson makes a point during a conversation with Steve Schaefer, vice president of finance. (Photo: Bob Riedlinger)
However, most of the innovations that healthcare leaders say they are excited about have less to do with medical advances and more to do with improving how health care is accessed, provided, and paid for in this country. This makes sense. While medical science has advanced at rapid speed over the last 60-70 years, the cost of health care has spun out of control, the level of quality is inconsistent, and the patient experience is in need of repair. In other words, it’s the way we deliver care that really needs a mammoth dose of innovation.
Here are some of the healthcare delivery trends that progressive leaders from provider and payer organizations expect will become common place in five to 15 years—if not sooner.
New paradigms in healthcare delivery will make care more affordable, more convenient, and more responsive.
Immediate answers.The traditional way of dispensing health care is longitudinal and fragmented, with lots of days between value-producing office visits, says Douglas L. Wood, MD, cardiologist and medical director of Mayo Clinic’s Center for Innovation. What we need instead is a system that provides answers to questions immediately, making it easier for patients to make more informed choices so they can go about their lives with less disruption and anxiety. Wood believes this is the system of the future.
“Say a patient with shortness of breath sees his primary care physician, who recommends consultation with a cardiologist. Typically, that physician will call my office to arrange a visit sometime in the next two days to four weeks—which will require the patient to take additional time off from work. But suppose I am readily available, at the time of that first office visit, to talk with the physician and listen to the patient. I can make a quick decision about whether the problem is likely to be serious or not and even decide on what next steps we should take.”
Mobile care. In this new system, 10-15 years down the road, much more care will be delivered where the patient is—at home, at work or school, even traveling—using onsite and mobile clinics.
“Maybe a company that has a handful of salespeople with potential health risks has a regular regional sales meeting,” Wood speculates. “We could see them all together on the same day by traveling with an optimized care team—a physician, a nurse, maybe a physician assistant—to that location.”
Philip A. Newbold, CEO of Beacon Health System in Indiana, anticipates that home care will be used extensively to manage higher-risk populations, including big users of the emergency department (ED).
Home care is the least expensive site of care, Newbold points out, and the place where people with their own support systems are most comfortable. “We’ll use sensors and early warning systems—this person hasn’t taken her medications, that person is gaining too much weight—to trigger a phone call or a visit to head off a problem. That way, family or neighbors could be educated as well: If this happens, here’s what you do; if that happens, call this number.”
See related sidebar:
Beacon Health System Educates Staff on Innovation
Remote monitoring. New technological applications for engaging, communicating with, and delivering care to patients will be “huge” over the next 15 years, according to Anderson. As a result, providers will be able to serve more patients with existing resources.
“There will be more monitoring of chronic conditions through mobile apps, in which the patient provides information that feeds directly into our EHR system, which will be able to evaluate those data. If, say, a diabetic’s glucose levels are within a predetermined range, the information is just recorded for future reference. If the glucose levels are problematic, both caregiver and patient will get a message saying ‘We need to connect.’ And, if something changes with a patient, we will be able to send her information that’s relevant to the new stage of her disease.”
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How Mobile Health Is Changing Care Delivery
One telemonitoring development already proving its clinical efficacy is the depression automated remote monitoring system (D-ARMS), developed by the Los Angeles County Department of Health Services in partnership with the University of California. This is a phone system that makes multiple simultaneous outbound calls to patients at high risk for depression on both a scheduled and data-triggered basis and collects touchtone or spoken responses to recorded questions.
“By generating provider alerts in real time, it appears to be a viable, high-tech alternative to human monitoring in disease management programs—at 5 percent of the cost,” says Molly Joel Coye, MD, MPH, chief innovation officer at UCLA’s Institute for Innovation in Health, which maintains an
international innovation inventory.
Molly Coye, MD, chief innovation officer of UCLA Health speaking at “Los Angeles Innovates—Meeting New Demands for Access to Healthcare,” at Martin Luther King Jr., Community Hospital. (Photo: Reed Hutchinson/UCLA)
Remote monitoring can also be used to encourage healthcare staff to adopt best practices. One example is a wearable, electronic hand-hygiene prompter, which promises to slash healthcare-acquired infection rates and, with them, hospital length of stay and related costs. The technology tracks clinicians’ hand washing and delivers a sound or vibration to prompt washing between patients, along with data reports that summarize compliance rates by location and department.
Acute care clinics. Coye believes the future will see the mushrooming of a new phenomenon: freestanding emergent and urgent care clinics that treat patients with acute but non-life threatening conditions, including wounds and fractures, which comprise 13 percent to 27 percent of ED cases. With lower overhead, such clinics already are charging a third to a fifth of the cost of equivalent care in an ED—with no facility fees, no appointments necessary, and more diagnostic capabilities.
All the experts concur: By 2030, the care delivery team will look very different than it does today. There are a lot of reasons—among them the shift in focus to population health, to prevention and wellness, to more localized and personalized care, to more affordable approaches to treatment approaches—but they all call for an expansion of players beyond the traditional physician and nurse.
The key, says Newbold, is to develop a system and processes that let all practitioners practice at the top of their licenses, doing things they are uniquely trained to do and that have the greatest value.
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Expanding the Primary Care Team
“Physicians would mainly work with the very sick, the 5 to 10 percent that bounce back into the ER and account for most readmissions and a disproportionate amount of resources, Newbold says. “And then you have a wide range of new players—nutritionists, physical and occupational therapists, exercise physiologists, stop-smoking coaches, social workers, care coordinators, health coaches—doing what they do best to help the healthy stay out of trouble and people with chronic conditions manage their risk factors.”
A good example of a new team member who is trained to support patients in self-management and adherence to prescribed treatments is the
nurse extender clinical aide, a care coordinator concept that Coye is enthusiastic about. Working under the close supervision of a nurse or physician and using tablets to communicate with their supervisors during patient encounters, these aides can be trained in three to four weeks to work with patients with specific diagnoses in clinics, EDs, home visits, and over the phone. Nurse extender clinical aides are currently being used in six sites nationally, including the Heart Health at Home program offered by the University of Virginia Health System.
In the past, says Coye, patients would come in every three or six months if they had a serious chronic disease and see the physician for 15 minutes. “In the future, such a patient will work with a clinical aide and, in many cases, may not need to see the physician more than once every couple of years.
Studies of the effect of a clinical aide program found that 74 percent of non-acute pediatric ED visits and 62 percent of walk-in pediatric cases were resolved without seeing a physician. In one pilot for post-discharge management of heart failure patients, there was a drop of 58 percent in 30-day all-cause readmissions and 77 percent in heart failure-related readmissions, according to a
Another development that promises to affect health care is the tremendous growth in the amount of usable data being generated in health care today.
Data analytics. Sorting through large amounts of historical clinical data to identify past patterns (e.g., at-risk populations, early symptoms of disease, utilization) opens windows to the future—and makes it possible to improve outcomes by homing in on best practices. The same is true with financial data, population health data, supply chain data, facility design data, and so on.
For this reason, says Anderson, data analytics—predictive analytics, in particular—will explode in the next 15 years. “I think this capability is in its infancy in terms of technology, but as it grows to adulthood, we’ll see amazing changes in care. For example, if we can identify biomarkers for sepsis, we might be able to predict which patients are especially vulnerable even before they come into the hospital, so we can monitor them very closely.”
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Predictive Analytics: Pinpointing How to Best Allocate Patient Resources
Data infrastructure.One key to making this happen is technological readiness, says Joseph M. Zubretsky, senior executive vice president of National Business at Aetna. “Historically, the industry has done an “abysmal job of being able to integrate and synthesize clinical and claim information. Now we are creating tools and capabilities that allow both kinds of information to be combined, read, interpreted, and acted on. But organizations must have the basic infrastructure—what we call the pipes—to keep data flowing in multiple directions with higher veracity and velocity.”
Another necessity, says Zubretsky, is a clinical decision support platform that uses algorithms to glean facts from data sets and get them to providers in real time. Finally, we need to determine how to best share relevant data and information, such as evidenced-based treatment protocols and costs of care, with patients and their families, empowering them to participate in clinical decision making.
“Given the range of generations that interact with the healthcare system, from infants to people in their 90s, this will require using many different modalities to communicate in the way patients prefer—paper, mobile, phone, email.”
In the coming years, Zubretsky believes, technological developments in all three areas (technological infrastructure, decision support platforms, and mobile communication devices) will allow providers and payers to thwart disease progression and curb unnecessary hospital admissions and ED visits—all the things necessary for the ultimate goal: true population health management.
One of the greatest difficulties facing hospitals and healthcare systems today comes from trying to serve two masters at once: the value-based reimbursement of the future and the volume-based reimbursement so deeply embedded throughout the industry. Innovations are needed to help us make the transition.
Pay for meeting personal goals. Some of the most radical changes in the next decade or so will be shifts in payment systems to accommodate the changes in goals and delivery systems.
“Right now, there’s a lot of time spent arguing over who’s getting how many dollars,” says Anderson. “As we get into more accountable care (with a small ‘a’), providers will be forced to either develop straightforward calculations for bundled payments, or really start thinking as a single, integrated system.”
Once they do, Wood says, providers will no longer be paid for providing services to people but for keeping people healthy. “Patients will determine the status of their total functioning—physical, behavioral, mental—based on highly personal goals and insurers will pay me a certain amount of money annually to care for a person’s heart disease in a way that meets those goals.
Douglas L. Wood, MD, medical director for Mayo’s Center for Innovation (in foreground) talks with his team. (Photo: Mayo Clinic)
“They might actually pay me a bonus if I’m able to improve a patient’s level of functioning. We might set up a risk contract, so that if the patient encounters a lot of problems, I might potentially have to pay a financial penalty.”
According to Wood, one result of this arrangement will be an end to the administrative nightmare we’ve created with our obsession with documentation, which stems from the need to precisely measure the input labor and supply costs of every service and then allocate those back across physician groups.
“When we’re being paid for our results, we can largely ditch all this structure.”
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Partnering Around Value-Based Payment
Guaranteed quality. The idea of a guarantee of quality is definitely coming, says Anderson. In fact, Virginia Mason introduced a new warranty program for total hip and knee replacement patients in September 2014. The concept is simple: an organization that agrees to assume the costs of avoidable, surgery-related complications is an organization that has a major incentive to deliver high quality care.
Anderson explains: “Say a person comes into a hospital for a knee replacement and develops an infection. She becomes delirious and tries to get up on her own to go to the bathroom, falls and breaks a hip, gets the hip replaced, finally goes home—only to develop an embolism and be readmitted immediately.”
Currently, under the fee-for-service payment system, most hospitals get paid for taking care of the knee, the infection, the hip, and the embolism. The hospital of the future will get paid for the knee, period.
“So unless they want to go out of business, they will get pretty darn good at what they do,” says Anderson.
This appears to have been the case at Geisinger Health System, which implemented a warranty for coronary artery bypass eight years ago and has since improved adherence to a 40-metric list of bypass best practices from 56 percent to almost 100 percent.
The insurance marketplace. According to Zubretsky, population health, which is fast becoming the holy grail of the healthcare system, is about bringing providers, patients, and payers into a “digitized community” with completely revamped business and clinical processes to improve quality and drive down costs. Over time, he says, the structural lines between providers and payers will blur, if not disappear.
“Providers know that to have a sustainable business model in the future, they will need to participate in the insurance marketplace, says Zubretsky. “There are three ways this can be achieved: a provider-owned health plan that is powered by an insurance company, a 50/50 joint venture, or an arrangement in which the insurance company is the legal entity that conducts the business while the provider participates in the underwriting cash flow.”
The big learning curve for everyone in the healthcare industry over the next five to 15 years, says Newbold, is moving from just making the medical model more efficient to implementing the health model.
This, he says, encompasses three new competencies:
This offers plenty of scope for innovation. And, according to industry leaders, there is plenty of radical innovation on the horizon.
See related sidebar:
UCLA Health Puts Innovation to the Test
Lauren Phillips is the president of Phillips Medical Writers, Ltd., in Bellingham, Wash.
Quoted in this article:
Suzanne Anderson is executive vice president, CIO, CFO, Virginia Mason Medical Center, Seattle.
Molly Joel Coye, MD, MPH, is chief innovation officer, Institute for Innovation in Health, UCLA Health, Los Angeles.
Philip A. Newbold is CEO, Beacon Health System, South Bend, Ind.
Douglas L. Wood, MD, is medical director, Center for Innovation, Mayo Clinic, Rochester, Minn.
Joseph M. Zubretsky is senior vice president, national business, Aetna, Hartford, Conn.
Change Healthcare: Accelerating Revenue Cycle Transformation
Jason Williams, vice president for strategy and business analytics, Change Healthcare, discusses the importance of technology and technology-enabled services in reinventing the revenue cycle.
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Grant Thornton: Facilitating EAM
Priority Advantage: Helping Organizations Optimize Their Medicare Advantage Plans
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.
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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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Providers Focus Too Much On Revenue Cycle Management
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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.
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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.
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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.
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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.
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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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Effective Revenue Cycle Management in Your Network
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