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an effort to bend the cost curve and improve population health, health plans and
providers are actively seeking better strategies to care for underserved patients,
such as those who live in rural areas, are homeless, or are addicted to opioids.
a large degree, improving health equity for these groups means rethinking the
delivery of health care so that patient needs are addressed further upstream,
says Anne Weiss, managing director at the Robert Wood Johnson
Foundation in Princeton, N.J. It also requires different financial models and
an emphasis on collaborative partnerships with social services, public health
agencies, and other groups.
are some innovations designed to improve health equity across the country.
Mississippi has the fewest number of
active physicians per 100,000 residents in the country, according to the U.S.
Census Bureau and the Association of American Medical Colleges. It also has an
especially high prevalence of diabetes, with 13.6 percent of adults affected by
the chronic condition, according to the Centers for Disease Control and
To monitor and manage patients with
chronic diabetes in Mississippi’s poor, rural, and underserved areas, leaders
at the Jackson, Miss.-based University of Mississippi Medical Center (UMMC) are
using remote monitoring via telehealth. “One of the primary reasons we drive
telehealth as a solution is that we can deliver care a lot closer to home,” says
Michael Adcock, FACHE (pictured at right), executive director of UMMC’s Center for Telehealth,
which has been designated a Telehealth Center of Excellence by the Health
Resources and Services Administration.
monitoring helps UMMC providers educate patients with diabetes on healthier
behaviors when the intervention is most likely to be effective—in real time.
Patients whose glucose numbers jump significantly from one day to the next are
flagged by nurses for intervention that day. One UMMC pilot study of 100 adult
diabetic patients found that remote monitoring improved patients’ HbA1c
measures by 1.7 percent while eliminating hospitalizations and emergency
department (ED) visits during a six-month period.
Preliminary Results on the Mississippi Diabetes Telehealth Network
Payment for telehealth varies
significantly by state, and Mississippi is one of the few states that provides
true reimbursement for chronic disease management in the home via remote
monitoring. Adcock believes
that remote patient monitoring could result in significant cost savings across
the country. UMMC’s pilot program of 100 adult diabetes patients saved $330,000
in six months due to decreased ED visits and readmissions. If 20 percent of
Medicaid patients with diabetes were enrolled in the program, the state could
save $189 million annually, he says.
remote-monitoring programs are underway at UMMC for patients with hypertension,
heart failure, asthma, and high-risk pregnancies. Some programs, like one
designed to educate adult kidney transplant patients, are not reimbursed but do
cut costs from the system by reducing unnecessary readmissions and ED visits,
To address the lack of affordable housing
in Portland, Ore., forward-thinking health system and health plan leaders are
collaborating on the Housing Is Health initiative. One of those leaders is Eric
Hunter (pictured at right), CEO of CareOregon, a health organization serving 275,000 Medicaid
members. CareOregon and five major health systems—Adventist Health Portland,
Kaiser Permanente Northwest, Legacy Health, Oregon Health & Science
University, and Providence Health & Services-Oregon—are donating $21.5
million to build three separate housing complexes for the homeless.
The complexes will include nearly
400 housing units, as well as on-site primary care, urgent care, behavioral
health, substance-use disorder treatment, palliative care, and pharmacy
services. Residents also will have access to peer support and case management services
to help them navigate through the healthcare system. Many of the residents will
be recently discharged inpatients who will be offered temporary housing in 175
units that are available for transitional housing, so they have somewhere to recuperate.
“We want to make sure they have a roof over their heads and have help with
their nutrition and needs so they can actually heal,” Hunter says. Two
complexes are slated to open later this summer and the third next summer.
Hunter thinks housing the homeless may
have financial benefits that will accrue over time. A 2016 study
by the Portland-based Center for Outcomes Research and Education (CORE) found
that providing supportive housing to 1,635 individuals reduced annual Medicaid
expenditures for the group by 12 percent, resulting in $936,000 in savings in
the first year. Hunter attributes the savings to an 18 percent reduction in ED
visits—even as primary care use increased by 20 percent.
Hospitals and primary care
physicians also stand to benefit from the housing initiative by having a more
stable population on which to be judged in value-based contracts, Hunter says. Still,
he concedes that it may take years for CareOregon to realize any significant
changes to its balance sheet as a result of the program.
opioid epidemic has been particularly hard on Maine, which had the highest prescribing
rate of long-acting opioids in the country in 2012 (21.8 prescriptions per 100
people), according to IMS National Prescription Audit data. But that rate has
been cut by nearly half as of 2017 thanks in part to provider education led by Portland,
Maine-based Maine Behavioral Healthcare, a member of MaineHealth. More importantly, leaders at Maine
Behavioral Healthcare are rethinking how they approach treatment for
substance-use disorder in primary care.
“The majority of our success as an
organization in serving our communities has been through our efforts to
integrate behavioral health and addiction-related treatments into primary care
settings,” says Stephen Merz, FACHE (pictured at right), Maine Behavioral Healthcare’s president
One of Maine Behavioral Healthcare’s
strategies is offering integrated medication-assisted treatment—an
evidence-based therapy for substance-use disorder, employing one of three drugs—in
its patient-centered medical homes. Leaders apply this strategy using a
hub-and-spoke model that “operates under the premise that the majority of
people should receive behavioral health services in an integrated way as part
of an integrated delivery system, rather than as part of a segmented behavioral
health system that is further separated from care for individuals with chemical
dependency,” Merz says.
As part of this approach, MaineHealth
has embedded 60 licensed clinical social workers in its medical homes to help
identify and care for patients with opioid-use disorder. For the one-third of Maine
Behavioral Healthcare patients with opioid-use disorder who require more-intensive
treatment, specialized behavioral health centers called “hubs” are available.
Each is staffed by a psychiatrist with specialized training in addiction
medicine, licensed behavioral health clinicians and clinicians trained in treating
patients with substance-use disorders, and recovery coaches/peers.
the deadline for this article, MaineHealth had approximately 600 active
patients with opioid-use disorder in its hub-and-spoke system. More than 800
have been served since Oct. 1, 2017. Leaders expect they will treat 900 altogether
in 2018. One of the ongoing challenges for MaineHealth, which serves approximately
75 percent of the state’s residents, is the uninsured population. The state
opted out of Medicaid expansion, and as many as 30 to 40 percent of
MaineHealth’s patients are uninsured, Merz says. The state is piloting a new
opioid health home model that includes a per-member, per-month payment for case
management and other “wrap-around” treatment services for substance-use
disorder that are not traditionally reimbursed under fee-for-service payment.
The model has had a slow start—just 100 or so patients
enrolled in the first year—and some providers find the state’s staffing
requirements restrictive. MaineHealth has expressed interest in the program, however,
and Merz hopes the state will adjust the model and regulations based on
provider feedback to encourage greater participation.
offer the following advice to leaders who want to reduce health disparities in
Use the community health needs
are required to complete the assessment every three years and can use the
process to identify which health inequities to target, Weiss says. MaineHealth
identified substance-use disorder as a priority after reviewing its own
assessment. Leaders may want to conduct this assessment jointly with other providers
in their community.
for help. Health system and health plans may
want to reach out to community stakeholders like criminal justice,
transportation, and business organizations to talk about potential solutions. For
example, leaders at Maine Behavioral Healthcare work with law enforcement to
train officers on how to identify individuals with mental health needs,
including substance-use disorder, Merz says.
about the next generation. In addition to helping adults by
funding stable housing, CareOregon aims to change the trajectory for children
affected by homelessness. Hunter says that homeless children often have higher scores
in Adverse Childhood Experiences testing, which raises their future health
risks. “Housing is a big piece of a family’s economic security and helps to
change the long-term dynamic,” he says.
Be a catalyst for collaboration in
your own organization.
In many provider organizations, internal leaders in finance, population health,
and community benefits may not have had opportunities to interact. But a health
equity project can be a good place to start. “What financial leadership can
help do is bring some of those conversations together,” Weiss says.
Focus on the problem and then think about incorporating
Providers need to consider their clinical needs before they purchase technology
platforms to address health disparities, UMMC’s Adcock says. In addition, they should
realize that one product will not address every issue.
every investment in improving health equity will generate cost savings in the
short term. At the same time, those investing in change may not always be the
stakeholders who reap the most rewards. But focusing just on the money misses
an opportunity to drive significant change and improve the health of the
community, Weiss (pictured at right) says.
think most of us have just always assumed that if we get at social problems
upstream, we should be able to see better health outcomes and reduce spending,
but we have to think about those two things differently,” she says. “It
is an important goal to improve health outcomes, even if the savings take a
long time to materialize or don’t always affect our own bottom line.”
Laura Ramos Hegwer is a freelance
writer and editor based in Lake Bluff, Ill.
for this article: Michael
Adcock, FACHE, executive director, Center for Telehealth, University of
Mississippi Medical Center, Jackson, Miss.; Eric Hunter, CEO, CareOregon,
Portland, Ore.; Stephen
Merz, FACHE, president and CEO, Maine Behavioral Healthcare, Portland,
Maine; Anne Weiss, managing director,
Robert Wood Johnson Foundation, Princeton, N.J.
VitalWare: Creating a Transparency Strategy: Meeting the Mandate to Post Standard Hospital Pricing
A senior leader of VitalWare talks about the need to create a comprehensive pricing strategy for consumers and how to get started.
HealthTrust: Solving Workforce Management Challenges
Two of HealthTrust’s senior leaders talk about strategies for optimizing the hospital workforce to improve productivity and reduce waste.
Grant Thornton: Optimizing the Ambulatory Workforce
One of Grant Thornton’s senior healthcare consultants addresses the topic of workforce management and the importance of a data-driven approach.
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.
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.