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integrated healthcare organizations position themselves for value-based care, some
of the scarcest resources are leaders who understand both clinical and
financial operations. Increasingly, integrated organizations—those with both
provider and health plan operations—are exploring ways to develop and share
expertise across the payer and provider sides of their business, as well as to
hire nontraditional talent.
leaders who have worked for health plans particularly are in high demand
because of the mindset they bring. “I have never really thought of a leader
being on the hospital side or the health plan side, from my background,” says Amy
Compton-Phillips, MD (pictured at right), formerly
chief quality officer at the Permanente Foundation and now
executive vice president and chief clinical officer of Providence St. Joseph
Health, Renton, Wash.
says leaders need to think about the healthcare industry beyond their
traditional sphere of influence. “It doesn’t matter whether your paycheck or
direct-line reporting goes up to the health plan, the hospitals, or the medical
group,” she says. “We have to have people who can produce high-value
care—better outcomes at a lower cost—in a way that delivers effective service
for our patients and our communities.”
Exhibit: Providence St. Joseph Health's Population Health Division
health systems do not have adequate internal talent to fill their most
strategic positions, especially those in areas that are still evolving, such as
population health and disruptive innovation, says Courtney Lada, managing
partner of Quick Leonard Kieffer, a healthcare executive search firm in
Chicago. To remain nimble in today’s ever-changing healthcare environment,
provider organizations are recruiting senior team members with experience in
business diversification and merger-and-acquisition strategies, as well as
expertise in public health, data analytics, and management of risk-based
plans are also hiring for cross-functional expertise. “They want clinical
leaders who are business-savvy and operationally astute, with well-honed
interpersonal skills,” Lada says. “With so much riding on outcomes and patient
experience, it is imperative for health plans to have senior leaders who can
successfully foster relationships with providers and patients alike so that
their performance improvement and clinical integration efforts are effective.”
addition, a desire to be more consumer-driven and competitive has spurred some healthcare
organizations to hire talent from industries that are highly regulated and
safety-driven like health care but have more experience with consumerism, such
as airlines, banking, and tech. For example, Providence St. Joseph Health’s new
CFO, Venkat Bhamidipati, was previously CFO of operations and technology at
Microsoft. “Many organizations are taking cues from tech-based companies and
startups to determine how their strategies [to become more consumer-oriented] can
be applied to the healthcare industry,” Lada says.
course, the reverse is also true as startups see an opportunity to disrupt the
healthcare sector. Integrated healthcare organizations must vie for candidates
against other provider organizations, health plans, pharmacy benefit managers,
and now tech companies like Google and Amazon, says Rhonda Medows, MD (pictured at right),
executive vice president of population health at Providence St. Joseph Health.
Providence St. Joseph Health has grown into one of the largest integrated
healthcare organizations in the country, leaders have implemented several talent
development strategies, including a cross-functional mentorship program in the population
Medows, who has worked in health
plans and public health and previously was executive vice president and chief
medical officer of UnitedHealth Group, borrowed the idea from one of her first
employers, Florida Blue. As
a medical director in charge of clinical quality, she rotated through
marketing, actuarial sciences, e-health, and fraud and abuse for a year. Now at
Providence St. Joseph Health, Medows has four mentees: a health plan executive,
a nurse, an information services leader, and a communications expert. Her six
direct reports also have mentees and use the program to groom new talent with
Medows’ team also works alongside quality, finance, and
health plan leaders to identify rising stars to lead multidisciplinary
collaboratives on topics such as Medicare Access and CHIP Reauthorization Act
(MACRA) readiness and lowering the cost of care.
also work with other groups to identify candidates for open positions across
the enterprise. For example, they might discuss whether a leader in quality or
clinical operations could move into medical management in one of the organization’s
three health plans. “When we are looking at talent that we need to bring in or
develop, we look across our entire health system—not just hospitals or health
plans, but also ambulatory, virtual, and long-term care,” Medows says.
health plans evolve into broader health services companies, their staffing
needs are changing as well, says Brigitte Nettesheim (pictured at right), president of
transformative markets for Aetna, Hartford, Conn. Leaders with experience on
both the payer and provider sides are always in demand, as are those with
consumer expertise, Nettesheim says.
her role, Nettesheim hires the agile and diverse leadership teams that manage each
of Aetna’s joint-venture partnerships with providers. She is interested in
“cross-pollination” of experts with different backgrounds. “We look for
experience leading and driving change in an organization—it doesn’t necessarily
need to be a health insurance plan,” she says. Nettesheim also looks for
previous experience with startups and joint ventures in any industry because such
experience helps leaders hone their diplomacy skills. Less important are
technical skills, such as deep knowledge of Medicare Advantage or actuarial
science, she says.
with driving clinical innovations also is becoming more important to health
plans as they get more engaged in care delivery. As an example, Nettesheim
points to Robert Groves, MD, chief medical officer of the Banner|Aetna
insurance company in Arizona. Before joining Banner|Aetna, his experience was
primarily on the provider side, most recently as vice president of health
management at Banner Health and chief medical officer of Banner Health Network,
the health system’s accountable care organization.
believes that Aetna has an opportunity to create a more entrepreneurial culture
inside these joint ventures. For this reason, the company worked with Accenture
to develop a new executive onboarding process, including tools to help leaders
understand how they can drive value in their business. One tool is a
questionnaire that new leaders complete within their first week to map out how
they will meet their strategic objectives. Sample questions include:
offer the following advice to leaders who are interested in serving on today’s evolving
Assess your skills. Medows suggests doing this at
least once a year and determining how to resolve any skill gaps in the coming
year. Solutions might include taking an evening class in financial management
or volunteering for an informatics project.
Engage in cross-functional
Providence St. Joseph Health has a group vice president for care management on
the delivery side who works with a care management leader on the health plan
side. Together, they use common databases to identify and manage complex,
high-risk patients, with the goals of improving clinical outcomes and reducing
costs from avoidable emergency department visits and readmissions. By working
collaboratively, leaders learn from each other and improve their own skills,
Take advantage of internal leadership
academies. This is
especially important for physicians and other clinicians whose professional
aspirations go beyond the traditional paths of medical affairs or nursing
leadership. “The most successful clinical executives that we see are developed
from within and then gain exposure through a variety of domains,” Lada says.
Pursue Lean or Six Sigma
organizations seek to make the most of their integrations and improve value by
standardizing care, reducing costs, and eliminating waste, operational leaders
with process improvement experience are highly valued, Lada says.
Be willing to take risks. This means taking a challenging
position even if it is outside of a personal comfort zone. “Don’t take the safe
route—there is no safe route if you want to be successful and marketable in a
dynamic environment,” Nettesheim says.
Compton-Phillips believes leaders who focus only on their own silo or specific business line of
revenue will be at a disadvantage as more healthcare entities use targets and
incentives to make executives accountable for the performance of their
colleagues across the organization.
achieving this mindset shift can be difficult for clinical leaders. Recently,
Providence St. Joseph Health launched a new initiative called Clinical
Leadership 2.0 to give physicians, nurses, and pharmacists the skills they need
to manage across the continuum. The new executive training includes a clinical
value improvement course, which was developed with the Institute for Healthcare
Improvement (IHI). One example of a project that trainees took on as
part of the course was improving flow in the ED. “By gathering a team,
understanding the entire process, and focusing on small tests of change to make
cumulative, incremental improvements in flow efficiency, our clinical value
improvement program executives shortened stays for patients in the ED, making
care better at lower costs,” Compton-Phillips says. She
also expects the initiative to help the organization cultivate more staff with
skills that are needed for the future.
you were hired as a CMO [chief medical officer] in the past, you were hired for
your ability to deal with cranky docs—you weren’t hired for your ability to
create change,” Compton-Phillips says. But expectations have shifted. As she
says, “We really need to invest in our leaders in a different way than we have
in the past.”
Laura Ramos Hegwer is a freelance
writer and editor based in Lake Bluff, Ill.
for this article: Amy Compton-Phillips, MD,
executive vice president and chief clinical officer, Providence St. Joseph
Health, Renton, Wash.; Courtney Lada, managing partner, Quick
Leonard Kieffer, Chicago; Rhonda
Medows, MD, executive vice president of population health, Providence St.
Joseph Health; Brigitte Nettesheim,
president of transformative markets, Aetna, Hartford, Conn.
Cedar: Reimagining the Patient Financial Experience
Cedar’s CEO and co-founder tackles the topic of patient payment and the importance of having an innovative patient financial management system.
TRIMEDX: Moving Healthcare Providers Toward Mature Clinical Asset Management
This article includes a discussion by TRIMEDX leaders about the best ways to mature a clinical asset management program.
HealthTrust: Optimizing Purchased Services
Andrew Motz, assistant vice president, supply chain consulting at HealthTrust, discusses the value of a data-driven approach when procuring purchased services.
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.
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.