Access a PDF of this Breakthrough Map. Or scroll down and read the text version of the infographic.
To identify some key practices on this journey, we asked three healthcare innovation leaders to share their experiences.
Innovation does not just happen. Leaders need to cultivate and invest in it, laying out a culture and framework that encourages bright ideas to blossom and grow. Here is a sampling of the strategic questions leaders need to address.
Memorial Hospital of South Bend's Story
In 1998, unable to find any healthcare organizations to emulate, Memorial began knocking on the doors of large innovative companies. "We have been to about 60 companies, including Whirlpool and DuPont." says Diane Stover-Hopkins, chief marketing and experience officer, Beacon Health System, which is Memorial's parent organization.
From these "Inno-visits," as well as consultations with visionary gurus like Leland Kaiser and Tom Peters, Memorial gained insider knowledge on how to approach its own innovation journey. The organization defines innovation as: "A new idea or model that, when implemented, proves valuable to a customer or leads to a competitive advantage."
Presbyterian Healthcare Service's Story
Presbyterian's innovation lab, which opened in 2011, is exploring how to make health care better and different. "We're looking for disruptive innovation—40 percent to 50 percent improvement," says Doug Johnson, director of innovation. The lab was incremental in the launch of Presbyterian's new state-of-the-art hospital, Rust Medical Center. The lab tested many of hospital's leading-edge approaches, including an electronic ICU.
Presbyterian Rust Medical Center, of which Johnson is a member of the site leadership team, is also designing its culture around an innovation-driven mission statement: "We are healthcare professionals who partner with our customers to create an exceptional healthcare experience through innovation."
Memorial Hospital of South Bend's Story
Memorial invests up to 1 percent of the health system's annual net operating revenue on three innovation activities:
Core services. Memorial decided early on that it wanted to be an every-man model of innovation, says Stover-Hopkins. "We wanted the people who are closest to our customers to be able to be more innovative problem solvers." All employees are required to take at least four hours of training in innovation, with more advanced training available. To date, staff have launched more than 600 innovation projects—in areas as diverse as medication safety, well water quality, and debt reduction.
New revenue sources. Memorial's R&D arm, the Idea Propulsion Lab, pursues strategic alliances with outside companies, such as Best Buy and Underwriters Laboratories, to test new offerings or products in the hospital setting.
Enhancements in community health. Memorial launched the HealthWorks! Kid's Museum in 2000 to help children become more involved in health decisions. This model is now being replicated in communities around the country.
Presbyterian Healthcare Service's Story
Presbyterian's innovation lab is staffed by five employees with unique titles, such as customer solutions engineer and human factors engineer. Lab staff are currently investigating a number of confidential projects that have the potential to change the way Presbyterian delivers care.
At the same time, Presbyterian's Rust Medical Center is cultivating a culture that values improvement and new ideas. In addition to being trained in the Plan-Do-Check-Act improvement cycle, employees and leaders are assessed against competencies that encourage a management approach in which leaders support frontline staff in making patient care better. "In this reverse organizational model, the higher up in the organization you are equates to a lower innovation status because you are supporting everyone below you," says Johnson. Another key point: The higher up in the organization you are, the less creative and innovative you tend to be.
Memorial's innovation journey is championed by its CEO, Phil Newbold. "A lot of innovation projects are experiments that won't make money in 10 months," says Stover-Hopkins, who reports directly to Newbold. "The CEO has the authority to protect projects from budget cuts and encourage organizational patience."
Memorial's approach is decentralized with employees empowered to launch projects. "But this is not a suggestion-box model," says Stover-Hopkins. "We develop platforms, or big plays, that we want everyone to address." Current platforms include improving patient safety and home-going instructions. When employees have innovation ideas, they must consider seven criteria to determine if the idea is worth pursuing. The criteria range from the potential to improve value to the employee's passion about the project.c
Memorial has centralized key innovation functions, such as training and project support. In addition, Memorial's R&D arm that partners with outside companies is a centralized function.
Presbyterian Healthcare Service's Story
Presbyterian's innovation lab reports to a VP who reports directly to the CEO. "For innovation to happen, you've got to align the structure so that different departments can work together," says Johnson. "You can't expect people to be innovative in a silo environment. So we have a department of innovation that pulls people from different areas to work on innovation projects."
Innovation and improvement projects differ in one core aspect. "Process improvement always starts with a problem statement or a goal, such as reduce the left-without-being-seen rate in the emergency department," says Johnson. "From an innovation standpoint, we take a step back and try to understand the total picture from the customer's perspective. For example, why are patients coming to the emergency department in the first place?" In other words, innovation starts with identifying the gap(s) that is causing a myriad of problems and then testing possible solutions to fill that need, says Lindsay Martin, executive director, Research and Development, Institute for Healthcare Improvement (IHI).
The following highlights some of the steps that healthcare organizations might go through during an innovation project.d
Example: "We started with the question, 'How can remote monitoring be used to prevent people from going to the hospital.' That was more like a solution than a gap," says IHI's Martin. "So we took that up a level to ask, 'How can we keep people over age 65 in their homes, instead of in the hospital or long-term care facilities."
Example: "We found examples of older people being successfully kept in their homes, such as in Boston's Beacon Hill and the UK," says Martin. "We also created case studies of two older people, one who ended up in a long-term care facility and one who lived in her daughter's home. In these case studies, we identified trigger points, how those triggers were addressed, and how they could have been addressed differently."
Example: "In another project, we were exploring the best ways to have safe handoffs in hospitals," says Martin. "So we looked out of the industry to find examples of handoffs. We looked at runners handing off batons in relay races and underage minors who fly unaccompanied on airplanes and have to get handed off in a safe way. Then we created a theory of what a good handoff should involve."
Example: "On the handoff example," says Martin, "we asked a hospital, 'Can you try our handoff model on your next patient who was transferred from the OR to a post-care unit. Can you tell us if this model would be helpful?' Then the hospital called us back and told us what the experience was like."
Three leaders shared their expertise for this section (in order of appearance): Diane Stover-Hopkins is chief market-ing and experience officer, Beacon Health System, South Bend, Ind. (firstname.lastname@example.org). Doug Johnson is clinical project manager, Rust Medical Center, Rio Rancho, N.M., and director of innovation, Presbyterian Healthcare Services, Albuquerque, N.M. (email@example.com). Lindsay Martin is executive director, Research and Development, Institute for Healthcare Improvement, Cambridge, Mass. (firstname.lastname@example.org).
a. The term "disruptive innovation" was made famous by Clayton M. Christensen who has written several books on the topic, including The Innovator's Solution: A Disruptive Solution for Health Care.
b. Nagji, B. and Tuff, G., "Managing Your Innovation Portfolio," Harvard Business Review, May 2012, pp. 5-11.
c. Access Memorial's innovation blog that points to more information on innovation.
d. This graphic is not intended to be adopted as a formal research and development model. There are a number of rigorous models available that healthcare organizations might adapt for their own use.
ROi: Delivering a Complete Provider Driven Supply Chain and GPO Strategy
TriMedx: Unlocking the Full Potential of an Organization's Clinical Assets
Grant Thornton: Providing Robust Due Diligence to Facilitate Successful Health System Mergers and Acquisitions
Xtend Healthcare: Helping Organizations Optimize Their Revenue Cycle
In this business profile, Mike Morris, president of Xtend Healthcare, discusses the value of partnering with a revenue cycle management vendor that has deep experience in delivering strong ROI.
AvaSure: Using Video Monitoring to Improve Patient Safety and Achieve Cost Efficiencies
Professional Credit: ‘The New Deal’ Approach to Healthcare Collections is Data-Driven and Consumer-Focused
Medxcel Facilities Management: Working Smarter to Make Organizations Safer
The Claro Group: Partnering for Performance Improvement
In this Business Profile, Larry Volkmar, a managing director in the performance improvement
practice at The Claro Group, discusses key strategies for improving
clinical and financial performance.
Deloitte: Taking Data Analytics to the Next Level
In this Business Profile, Christine Santos, chief of strategic business analytics for
Providence Health Services and Chris DeBeer, principal at Deloitte
Consulting LLP explain the value of enterprise data analytics.
PatientMatters: A Patient-Centered Financial Experience
In this Business Profile, Sheila Schweitzer, founder and CEO of PatientMatters, offers insights
on ways hospitals and healthcare systems can address rising patient
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Building a Clinically-Integrated Network
As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs.
Winning in the Post-Acute Marketplace
Read more about factors contributing to the changes in the post-acute marketplace and what it means for manufacturers, physicians, clinicians, patients, and post-acute facilities as they anticipate the transition to the second curve.
Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy?
Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Adding Value to Physician Compensation
Today’s concerns about physician compensation are the result of the changing healthcare environment. The transition to value is slow, but finally becoming a reality. Proactive hospitals want to ensure that provider incentives are properly aligned with ever-increasing value-based demands.
This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
This publication identifies and outlines the necessary characteristics of a fully-functioning clinically integrated network (CIN). What it doesn’t do is detail how hospitals and providers can participate in the value-based care environment during the development process.
One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Therapy: Benefits at All Levels of Care
Nearly half of all Medicare beneficiaries treated in the hospital will need post-acute care services after discharge. For these patients, a stay in an inpatient rehabilitation facility, skilled nursing facility or other post-acute care setting comes between hospital and home.
Does Your Budgeting Process Lack Accountability?
With the proper process, tools, and feedback mechanisms in place, budgeting can be a valuable exercise for organizations while helping hold organizational leaders accountable. Having a proper monthly variance review process is one of the most critical factors in creating a more efficient and accurate budget. Monthly variance reporting puts parameters around what is to be expected during the upcoming budget entry process.
Cost Accounting: the Key to Cost Management and Profitability
Managing the cost of patient care is the top strategic priority of most hospital CFOs today. As healthcare shifts to more data-driven decision making, having clear visibility into key volume, cost and profitability measures across clinical service lines is becoming increasingly important for both long-range and tactical planning activities. In turn, the cost accounting function in healthcare provider organizations is becoming an increasingly important and strategic function. This whitepaper includes five strategies for efficient and accurate cost accounting and service line analytics and keys to overcoming the associated challenges.