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When the Centers for Medicaid & Medicare Services
(CMS) introduced the Hospital Readmissions Reduction
Program in 2012, healthcare organizations across the United States faced a
considerable challenge. How would we improve health outcomes for high-risk
patients and, in turn, decrease the number of hospital readmissions?
We knew that social determinants are often the root cause
of illness and are key to understanding and addressing health disparities. And
it was clear that the industry needed to evolve from diagnosis-specific
interventions that react to a medical problem to an all-inclusive, proactive
approach that focuses on the comprehensive needs—both medical and social—of
each patient. But the cost associated with multiplying the number of case
workers and nurse navigators as required to tackle social barriers presented its
At Lankenau Medical Center, part of Main Line Health in southeastern
Pennsylvania, we serve patients who have abundant resources as well as those
with limited access to care and wellness options. Our hospital is situated
between two contrasting neighborhoods: Montgomery County, generally ranked as the
third-healthiest county in the state, and Philadelphia County, which almost
always comes in last, at 67th. We needed a plan to alleviate the nonmedical
barriers of the patients we considered underserved.
In collaboration with our neighbor, Philadelphia College
of Osteopathic Medicine (PCOM), we identified a solution that both addressed
the immediate concern of preventing hospital readmissions and offered
significant added value across numerous aspects of healthcare delivery and
medical student education. We launched the Medical Student Advocate (MSA)
Program in 2013.
In the MSA Program, second-year medical students at PCOM
can choose to volunteer a minimum of five hours each week with Lankenau Medical
Associates, a primary care practice with a large population of high-risk
patients. The students serve as patient advocates, working closely with the
practice’s patient-centered medical home team to recognize and address
nonmedical needs and barriers to care. Known as MSAs, these students leverage
existing community resources to find solutions for issues such as access to care,
health insurance, prescription coverage, transportation, utility assistance,
health education, food assistance, child care, housing, personal care, and
social support needs.
Each MSA works one-on-one with 15 to 25 patients over the
course of the year under the guidance of a practice administrator and licensed
social worker. This format allows each cadre of students—including 23 this
year—to help hundreds of patients annually. In the first four years of the
program, MSAs have served more than 900 high-risk patients and addressed more
than 2,600 social needs.
The impact of the program is meticulously tracked using
various metrics, including the level of patient satisfaction and how identified
food sources influence a patient’s body mass index or blood sugar levels. In
terms of the program’s original objective, we have seen a measurable decline in
the rate of hospital readmissions and unnecessary emergency department (ED) visits
at Lankenau since the MSA Program was introduced. That’s success.
One patient had 13 ED visits during the previous one-year
period. An MSA connected with the patient and conducted a social needs survey,
determining that the cost of copays impeded the patient’s ability to obtain
asthma medication. The MSA worked with the social worker and case manager to
get the copay reduced. In the six months since this intervention, the patient
has not made any ED visits.
In addition to tracking ED utilization, we also track the
number of needs that have been successfully resolved. In the past year, MSAs
have successfully resolved over 80 percent of all needs identified. Tracking
the types of needs that have been identified, we find that the most common
needs for our patients include food access and transportation.
The MSA Program provides students with invaluable
exposure to the socioeconomic determinants of health. With the experience and
insight that they gain, MSAs have been noted to begin their third-year clinical
phase better prepared and with substantially greater sensitivity to their
patients’ concerns. This impression is verified by self-reports as well as by
Lankenau faculty who serve as mentors during third-year student rotations.
The MSA Program is creating the next generation of
healthcare professionals—physicians who know how to address both medical and
social issues. Participants have cultivated a knowledge of population health
and the patient-centered medical home
concept, and they know how to ask the right questions to alleviate potential
As more organizations move into population health, the ability
to improve outcomes for vulnerable patients is more critical than ever. The MSA
model of providing advocacy to the underserved is easily scalable and should be
replicable across the country. Lankenau has already extended our MSA Program to
a federally qualified health center in West Philadelphia, embedding MSAs from
PCOM in the center’s clinic. We also believe the program can move beyond the
clinical setting into community arenas such as schools, libraries, and corner
stores. This approach, too, is in the process of being implemented.
The MSA Program is a high-quality, low-cost model that effectively addresses the complex social and economic
issues faced by vulnerable patients, while helping medical students to become
better physicians. We believe it can fundamentally change the future of
Barry D. Mann, MD,
is chief academic officer, Main Line Health, Wynnewood, Pa..
MPH, is system administrator for graduate medical education, Main Line Health.
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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.
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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
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Key Capital Considerations for Mergers and Acquisitions
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Yuma Regional Medical Center case study
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Providers Focus Too Much On Revenue Cycle Management
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Lucille Packard Children’s Hospital Stanford Case Study
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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.
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