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  • Deloitte: Creating Value with Effective Care Management
    understood but is certainly important is promoting shared decision making getting people involved in their health care so they become active participants in making decisions respecting their preferences and values The same care coordinator can do all three of these functions if he or she is supported by technology What role does technology play in care management and what are some of the challenges of using it Scott Kolesar Technology by itself is not sufficient to drive patient care however it is absolutely necessary to facilitate care management across a large population In the early days of accountable care organizations managed relatively small Medicare populations typically fewer than 15 000 patients where they could manage them with some payer data and a spreadsheet Those days are gone Today s care management requires a comprehensive data integration solution which includes a health information exchange that ingests and normalizes population health data into a robust analytics solution that identifies and prioritizes clinically or financially at risk patients for care manager intervention What s more the solution must have a dynamic workflow capability that connects care teams and helps them work collaboratively to manage the patient s care whether that s providing chronic or complex care management managing care transitions monitoring self care or assisting with end of life The system should also curate evidence based clinical content which can help to standardize care delivery across the continuum Unfortunately such a comprehensive solution is hard to find There are literally hundreds of vendor products available that have many of the capabilities but no one system does it all Instead healthcare organizations may have to consider a multi vendor best of breed solution to meet all their needs At Deloitte we utilize technology and analytics solutions with a combination of vendor solution and best practices to provide that holistic approach How can effective care management improve outcomes while reducing costs Wennberg Patient navigation guides the patient to the most appropriate cost effective care setting If a healthcare provider is treating a diabetic patient and he or she developed a care coordination strategy and good relationship with that patient the patient is more likely to call the physician or provider first before heading to the emergency department ED This keeps patients out of the acute care setting because you can proactively address issues assess their symptoms telephonically or direct them to the primary care setting as opposed to the ER all of which reduce costs Also self management getting patients to engage in their care for chronic conditions such as diabetes or obesity is the least expensive and in many ways the most effective care strategy if you re in a risk based contract Kolesar Technology prioritizes those patients who are most likely at risk clinically or financially such as high care utilizers or those who frequent high cost sites An automated solution can put these individuals at the top of a care manager s to do list and thereby avoid escalating clinical conditions and related high costs In addition care management solutions that embed leading practices for a particular condition in provider workflow permit organizations to deliver care with less variance which has been shown to enhance outcomes and potentially lower costs What are the additional investments healthcare organizations will have to make to gain core competencies and does this mean they should consider outsourcing Kolesar Most care management organizations reside in entities outside the health system walls so there can be significant startup costs required to establish the enterprise invest in new technology and human resources Return on these investments will be a number of years away given that revenue is predicated on successfully delivering good care changing behaviors achieving improved clinical outcomes and effectively managing the risk based arrangement By working with third parties that provide technology and people solution platforms in an outsourced subscription or per member per month pricing model organizations can avoid the significant upfront capital outlay As healthcare organizations begin to operationalize care management with the move to value based payment what are some insights you can share for the future Wennberg Organizations will also need to rethink skillsets and how they will accomplish day to day tasks as some fairly radical changes are going to occur in the next 10 years Everyone from the care coordinator to the organization s CFO will have to shift their thinking For instance getting accustomed to tracking patient health using the telephone text or email will be challenging for some Certain organizations will embrace change while others may accept it gradually To be successful long term organizations must think about the competencies of their senior executives and care management staff as well as their abilities to enable stronger care management Kolesar Technology will continue to play an ever increasing role in gathering a wider array of data to both track patient care and alert providers to patient issues I m referring to technology such as fitness wearables and remote medical devices that monitor heart rate glucose levels weight and so on The challenge is what to do with this information and whether or not to encourage patients to use such devices A lot of this data is not actionable unless there are sophisticated algorithms and analytics that can take the information and provide insight either in the form of an updated risk score alert or direct to patient communication At Deloitte we leverage analytics platforms to provide solutions for healthcare organizations facing these challenges today It s very exciting innovative work Are there any additional materials you recommend for providers to improve their value based care strategies Kolesar Visit our website for more information on value based care insights and thought leadership HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by Deloitte This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Tuesday September 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Scott Kolesar principal and senior leader in Deloitte Consulting LLP s Value Based Care practice and David Wennberg MD MPH adjunct associate professor of The Dartmouth Institute and former chief executive officer Northern New England Accountable Care Collaborative discuss the challenges and competencies involved in creating a care management organization Care management has become a key issue in the implementation of value based care What should healthcare organizations keep in mind as they manage care David Wennberg A key challenge is having healthcare organizations rethink what care management and coordination really are They may have discharge planners navigators or even disease managers on staff and in their minds that constitutes care management In reality these roles exist in silos Staff members expedite acute care strategies not improvements along a care continuum Instead I would define care management as patient centric longitudinal support that reduces the overuse of undervalued services and increases the use of effective interventions What are the core competencies required for successful care coordination Wennberg What I would call the generalist model for care coordination requires three core competencies The first competency is having the skill to navigate the healthcare continuum Staff need to direct patients to the appropriate provider and setting for their care The second competency is enabling behavior change This means getting individuals engaged in behaviors that promote long term health such as stopping smoking controlling blood pressure and losing weight The last competency which is not as widely understood but is certainly important is promoting shared decision making getting people involved in their health care so they become active participants in making decisions respecting their preferences and values The same care coordinator can do all three of these functions if he or she is supported by technology What role does technology play in care management and what are some of the challenges of using it Scott Kolesar Technology by itself is not sufficient to drive patient care however it is absolutely necessary to facilitate care management across a large population In the early days of accountable care organizations managed relatively small Medicare populations typically fewer than 15 000 patients where they could manage them with some payer data and a spreadsheet Those days are gone Today s care management requires a comprehensive data integration solution which includes a health information exchange that ingests and normalizes population health data into a robust analytics solution that identifies and prioritizes clinically or financially at risk patients for care manager intervention What s more the solution must have a dynamic workflow capability that connects care teams and helps them work collaboratively to manage the patient s care whether that s providing chronic or complex care management managing care transitions monitoring self care or assisting with end of life The system should also curate evidence based clinical content which can help to standardize care delivery across the continuum Unfortunately such a comprehensive solution is hard to find There are literally hundreds of vendor products available that have many of the capabilities but no one system does it all Instead healthcare organizations may have to consider a multi vendor best of breed solution to meet all their needs At Deloitte we utilize technology and analytics solutions with a combination of vendor solution and best practices to provide that holistic approach How can effective care management improve outcomes while reducing costs Wennberg Patient navigation guides the patient to the most appropriate cost effective care setting If a healthcare provider is treating a diabetic patient and he or she developed a care coordination strategy and good relationship with that patient the patient is more likely to call the physician or provider first before heading to the emergency department ED This keeps patients out of the acute care setting because you can proactively address issues assess their symptoms telephonically or direct them to the primary care setting as opposed to the ER all of which reduce costs Also self management getting patients to engage in their care for chronic conditions such as diabetes or obesity is the least expensive and in many ways the most effective care strategy if you re in a risk based contract Kolesar Technology prioritizes those patients who are most likely at risk clinically or financially such as high care utilizers or those who frequent high cost sites An automated solution can put these individuals at the top of a care manager s to do list and thereby avoid escalating clinical conditions and related high costs In addition care management solutions that embed leading practices for a particular condition in provider workflow permit organizations to deliver care with less variance which has been shown to enhance outcomes and potentially lower costs What are the additional investments healthcare organizations will have to make to gain core competencies and does this mean they should consider outsourcing Kolesar Most care management organizations reside in entities outside the health system walls so there can be significant startup costs required to establish the enterprise invest in new technology and human resources Return on these investments will be a number of years away given that revenue is predicated on successfully delivering good care changing behaviors achieving improved clinical outcomes and effectively managing the risk based arrangement By working with third parties that provide technology and people solution platforms in an outsourced subscription or per member per month pricing model organizations can avoid the significant upfront capital outlay As healthcare organizations begin to operationalize care management with the move to value based payment what are some insights you can share for the future Wennberg Organizations will also need to rethink skillsets and how they will accomplish day to day tasks as some fairly radical changes are going to occur in the next 10 years Everyone from the care coordinator to the organization s CFO will have to shift their thinking For instance getting accustomed to tracking patient health using the telephone text or email will be challenging for some Certain organizations will embrace change while others may accept it gradually To be successful long term organizations must think about the competencies of their senior executives and care management staff as well as their abilities to enable stronger care management Kolesar Technology will continue to play an ever increasing role in gathering a wider array of data to both track patient care and alert providers to patient issues I m referring to technology such as fitness wearables and remote medical devices that monitor heart rate glucose levels weight and so on The challenge is what to do with this information and whether or not to encourage patients to use such devices A lot of this data is not actionable unless there are sophisticated algorithms and analytics that can take the information and provide insight either in the form of an updated risk score alert or direct to patient communication At Deloitte we leverage analytics platforms to provide solutions for healthcare organizations facing these challenges today It s very exciting innovative work Are there any additional materials you recommend for providers to improve their value based care strategies Kolesar Visit our website for more information on value based care insights and thought leadership HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by Deloitte This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Tuesday September 01 2015 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their organization HFMA RESOURCE LIBRARY 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

    Original URL path: http://www.hfma.org/Content.aspx?id=40649 (2016-02-10)
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  • American Express: Streamlining Supplier Payments and Boosting Revenue
    not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Saturday August 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Andrew Jamison vice president in the Global Corporate Payments division of American Express discusses trends and opportunities in supplier payments Tell us about your organization American Express is a multinational financial services corporation headquartered in New York City For healthcare organizations American Express offers a suite of payment solutions ranging from purchasing cards to electronic payments which providers can use to pay vendors suppliers and other entities to which they owe funds Not only do these products streamline accounts payable they also help organizations better manage their spend What are some of the unique challenges healthcare organizations face when paying suppliers With declining reimbursement and an increasingly competitive landscape many hospitals are seeing their margins shrink To deliver optimal patient care while remaining financially stable organizations must find ways to operate more efficiently increasing performance while reducing waste Accounts payable departments are ripe for improvement as a lot of organizations currently use paper based processes which are costly cumbersome and sometimes ineffective Cutting and mailing checks carries significant paper printing and postage costs and these costs can add up especially if an organization has a large number of vendors Checks can also get lost or stolen and there is a price associated with reissuing the check or responding to instances of fraud Moving from paper based processes to electronic solutions can be a low hanging fruit for many organizations with a little upfront time investment they can streamline payment processes to drive savings and improve efficiencies How is automation helping to address these challenges Automation presents an organization with an opportunity to make the payment process faster easier and more accurate It can also curb fraud and ensures suppliers receive payment in a timely fashion For example through our Buyer Initiated Payment BIP program an accounts payable department can direct American Express to make payments to vendors throughout the month when the department receives an approved invoice Unlike paying by check however the organization is not out any cash until it pays American Express back typically once a month for the total amount of those vendor payments This arrangement gives the facility the opportunity to extend float and better manage its cash flow BIP can also lead to operational advantages due to reduced overhead compared to a reliance on checks such as supply and printing costs postage and so forth Reconciliation is also easier because accounts payable staff do not have to manually match checks to invoices as it can all be done automatically at the end of the month In addition to the operational advantages a BIP system allows organizations to offer more favorable payment terms to suppliers without impacting cash flow which can foster goodwill and result in early payment discounts American Express also financially incentivizes a organizations that pay their vendors using the electronic platform letting its customers earn a return on their current spend What value does American Express provide to hospitals and health systems American Express offers a suite of integrated accounts payable solutions including purchasing cards virtual payment and buyer initiated payment We encourage a holistic approach to accounts payable consulting with our clients to determine a strategy that best meets their needs For instance an organization may use a purchasing card for one time charges or small dollar amount purchases Doing so cuts down on petty cash reimbursements which can be time consuming To facilitate large more frequently occurring payments the organization may turn to our BIP or virtual payment solutions American Express also assists with implementation For example with BIP an organization s vendors must agree to participate While there are advantages to suppliers reduced days outstanding less invoicing and collections costs and online payment tracking there are fees involved and it is important to effectively communicate the program s details and potential benefits to encourage these suppliers to sign up Because American Express has deep relationships with a variety of vendors it can act as a go between to cultivate supplier enthusiasm for this transition from paper based to electronic payment American Express also performs detailed spend analyses for its healthcare customers helping them target specific vendors on which to focus in order to reap the biggest benefit There is no silver bullet to optimizing accounts payable and every organization must determine a strategy that works for them Consequently organizations should look for a company that offers a variety of payment options and provides consultation on what combination makes the most sense At American Express we work with each of our clients to understand their vendor profile determine the right payment strategies and pinpoint which suppliers to target It is also critical to work with a recognizable and trusted name in financial services Because many vendors trust the American Express name they are often willing to participate if they know our company is involved Before starting down the road to automation organizations should make sure that all departments are on board with the move Leaders from finance purchasing IT and accounts payable should get involved to review different possibilities and outline implementation steps Meeting with the purchasing department in particular can be beneficial because it typically has the vendor relationships What do you see the future of spend processes in health care looking like Going forward organizations are going to have to take a holistic view of their spend and leverage tools that work together to smooth payment Healthcare entities will continue to be strapped and thus will keep looking for ways to ease costs and increase revenue As mentioned before the accounts payable department represents an ideal place to begin as automated solutions drive faster payment reduce costs and even add revenue

    Original URL path: http://www.hfma.org/Content.aspx?id=32544 (2016-02-10)
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  • RevSpring: Customizing a Technology Platform to Drive Patient Payment
    or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Wednesday July 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Martin Callahan Senior Vice President Healthcare Solutions RevSpring describes key industry trends affecting how patients engage with the revenue cycle and ways payment processes are changing as a result Tell us a little bit about your organization RevSpring is a healthcare technology company that uses an integrated platform to engage patients throughout the revenue cycle We offer a range of services including bidirectional appointment reminders transparent patient statements multichannel follow up communications and automated payment solutions The company uses data intelligence and analytics to tailor patient messages keeping in mind individuals needs preferences and response rate Our goal is to help healthcare organizations optimize consumer interactions to accelerate cash flow elevate business performance and enhance the patient payment experience We process around 400 million patient communications and 3 billion in payments every year By automating workflow targeting messaging and leveraging robust analytics for continuous improvement we help healthcare organizations see real growth in their patient payment and deliver a more consumer driven experience What are some of the biggest challenges you see affecting healthcare organizations The increase in patient payment responsibility is a significant issue As patient copayments premiums and coinsurance continue to rise hospitals and health systems can no longer afford to ignore the dollars that come directly from patients And yet most healthcare organizations don t have the tools or staff to effectively manage and collect this revenue stream Up until this point healthcare technology has focused primarily on improving clinical care and securing payer dollars with patient payment solutions receiving substantially less attention However health care can learn from other industries such as financial services and retail which for the past 25 years have refined ways to optimize consumer payment In particular healthcare organizations must embrace technology that segments a population and predicts payment behavior to allow for customized communications that grow receivables Heightened consumerism is another challenge for healthcare organizations As the amount that consumers pay for health care rises patients are becoming increasingly invested in where they seek treatment making decisions based on cost and quality How organizations engage patients the way they make people feel both in terms of their health and in relation to customer service has more impact today than it ever has before In addition to providing high quality care organizations must now meet patients financial expectations offering a smooth payment experience that respects an individual s preferences and takes his or her unique needs into account How does your organization help address these needs From a technology perspective we offer a completely integrated solution suite allowing our customers to use one platform for all of their patient financial communications Working in an integrated environment is certainly easier than using multiple products from various vendors and it also drives down the cost to collect while increasing payment rates If an organization implements all of our tools it can elevate patient interactions at every revenue cycle touchpoint For example when a patient comes through preregistration our system collects data from the patient and houses it A few days before the individual s appointment our system leverages the data to automatically send out a reminder Ten minutes before the appointment we send a text that gives the patient specific directions to the appropriate floor and room number When the patient arrives on site the registrar uses the data to collect the correct copayment or coinsurance We link front end processes with post encounter communication in case the organization wants to send follow up information or a thank you note Once the patient encounter concludes we reconcile any up front payments with the adjudicated claim and send out a clear easy to understand statement offering a payment plan if necessary We can even send a survey to solicit patient feedback about the entire experience Because we collect data throughout the patient encounter we are able to conduct testing on the back end showing our customers what works and what doesn t when reaching their patients Having this information allows us to segment patient populations and identify the ideal combination of communication strategies that will yield the greatest return taking some of the guesswork out of capturing patient receivables To address rising consumerism we help our customers communicate with their patients according to patient preferences boosting patient satisfaction If a healthcare provider wants us to interact with patients via text then we make sure to use that method Or if we are told a phone message with patients is preferred then we will make that work as well In addition we measure how patients respond to different communication vehicles to see if their actual responses differ from their stated preferences For example if a patient says he or she wants to receive texts but actually responds better to e mail then we can alter our strategy to respect preferences while still encouraging bidirectional exchange To further support optimal interactions we test all of our messages to make sure they are easy to understand We have a patient feedback mechanism which gathers opinions on the design and wording of statements so we can ensure the desired message is being effectively conveyed What are some key considerations for healthcare leaders when choosing a patient payment solution To fully optimize patient payment organizations should look beyond what has traditionally been siloed business tools You should instead seek vendors that provide a comprehensive platform geared to improving patient payment at the front and back end of the revenue cycle Otherwise you will spend critical time and resources trying to unify the different functions which can drive up the cost to collect An organization should also search for a company that rigorously measures its performance including analyzing service level

    Original URL path: http://www.hfma.org/Content.aspx?id=32038 (2016-02-10)
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  • Deloitte: Realizing the Potential of Your CDI Program
    the expected length of stay true clinical condition of the patient and severity of illness of the patient may be understated Also useful is providing scorecards Hospital leaders can better engage physicians by sharing individual performance compared with organizational and national peers In addition direct interaction can be powerful and should not be lost with the transition to electronic health records With the adoption of electronic health records clinical documentation specialists have moved from being out in the nursing units and interacting with physicians at the time of care to working out of an office and relying heavily on electronic communications Organizations need to still make sure their clinical documentation specialists are engaging face to face with key physicians and being visible Such visibility within workflow helps medical staff appreciate and make most effective use of clinical documentation specialists as a resource in translating clinical terminology into the diagnostic terms that are needed for coding Romberger Such opportunities for direct interaction work really well because the best way to obtain physician buy in to CDI initiatives is to speak their language and create an ongoing dialogue At first some physician leaders may be hesitant to work side by side with a CDI specialist because they may mistakenly believe the individual will be challenging their clinical perspective As a CDIP certified documentation improvement practitioner myself I always reassure them I m a nurse just asking questions like I always would Having this input is simply an opportunity to help you improve the accuracy and completeness of documentation so that the clinical data captured can accurately reflect the severity of your patient In fact physicians often become very receptive to working alongside a documentation specialist as they naturally start to discover that more accurately reflecting severity of illness will align with recommended length of stay and improve their physician profiles Given your experience what factors are most important for success of CDI programs Whitworth Because physician engagement is so important one key factor for success is often having physician advisors participate in the program These advisors or physician champions can serve as the voice of the physician as well as function in the practical role of being a liaison between the CDI team and physician leadership By bringing ideas from physicians to leadership they can break down the perception that CDI is just about the hospital reimbursement Also important is ongoing collaboration between the coding and clinical documentation specialists Both groups need to work together to have a robust DRG diagnosis related group reconciliation process where the DRG that a clinical documentation specialist identifies ends up being different from what is final billed You really need to take the time to review these mismatches together and go through the reconciliation process to understand the basis for the difference and future action plans to minimize the mismatches In addition organizations need to build the infrastructure and governance to ensure sustained focus over time Frequently when CDI initiatives start up a steering committee is put in place and there is a great deal of energy around activities But over time as programs mature some of this energy can fade To sustain success you really need an ongoing forum where executive leaders coders clinical documentation specialists and physician leaders can come together to share information and insights that will continue to move the program forward What are some key considerations for hospital leaders before implementing a CDI program Romberger The CDI program should align with areas of focus that the hospital has greatest need to address So it s important to audit for areas of opportunity and prioritize educational efforts accordingly For example the organization may notice great frequency or significant revenue impact associated with inaccurate documentation of severity of illness Having a shared sense of the top areas for focus will ensure documentation improvement programs yield the greatest benefit Whitworth To kick off a successful program there must be support from hospital executives and physician leaders Topmost engagement is important because success of the program depends on efforts of many across the revenue cycle quality and clinical operations Multiple stakeholders need to collaborate to ensure the alignment of the clinical documentation program coding operations and physician engagement A final consideration Think broadly about which clinicians to include in initial efforts Residents interns and mid level practitioners all can benefit tremendously from CDI feedback and education because they also spend their time completing documentation within the medical record HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by Deloitte This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Sponsor s Disclaimers This article contains general information only and Deloitte is not by means of this article rendering accounting business financial investment legal tax or other professional advice or services This article is not a substitute for such professional advice or services nor should it be used as a basis for any decision or action that may affect your business Before making any decision or taking any action that may affect your business you should consult a qualified professional advisor Deloitte shall not be responsible for any loss sustained by any person who relies on this article Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited a UK private company limited by guarantee DTTL its network of member firms and their related entities DTTL and each of its member firms are legally separate and independent entities DTTL also referred to as Deloitte Global does not provide services to clients Please see our website for a detailed description of DTTL and its member firms Please see our website for a detailed description of the legal structure of Deloitte LLP and its subsidiaries Certain services may not be available to attest clients under the rules and regulations of public accounting Publication Date Wednesday July 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Suzanne Whitworth director at Deloitte Touche LLP and LaVerne Romberger MSN CCM CCDS clinical operations manager Seton Healthcare share leading practices for maximizing the potential of clinical documentation programs under value based care How are payment trends influencing the role of clinical documentation Suzanne Whitworth As the market shifts from volume to value it s important to recognize that the information that feeds into safety and quality performance as well as population management is derived from clinical documentation and depends on its underlying accuracy and completeness Third parties analyze claims data to determine how well an organization is performing Failure to accurately capture severity of illness and risk of mortality for example can unfairly reflect on quality of care LaVerne Romberger Also important is to recognize significance in relation to the rise in consumerism As patients seek to compare healthcare providers on quality they are depending on third party websites that grade physicians based on the performance data that are reported Proper documentation allows the physician to accurately capture patient status throughout the period of care In addition accurate documentation becomes increasingly important when managing population health Collaboration across settings of care is impor tant for illness prevention and management of chronic conditions Documentation is the basis around which providers in inpatient and outpatient settings communicate their understanding of the patient s condition Without an accurate and complete patient record the patient becomes more vulnerable to gaps in care that can contribute to readmissions and adverse outcomes Given that physician engagement is so critical to a clinical documentation improvement CDI program s success how can hospital leaders best garner this support Whitworth Communication with physicians is essential Organizations should have an infrastructure in place to routinely and consistently provide physicians with feedback about their documentation performance particularly within the context of the effects on quality of care metrics and types of patients they are treating Typically programs will focus on areas such as severity of illness case mix index length of stay and risk of mortality For example when a patient s record lacks complete documentation to reflect the patient s condition the expected length of stay true clinical condition of the patient and severity of illness of the patient may be understated Also useful is providing scorecards Hospital leaders can better engage physicians by sharing individual performance compared with organizational and national peers In addition direct interaction can be powerful and should not be lost with the transition to electronic health records With the adoption of electronic health records clinical documentation specialists have moved from being out in the nursing units and interacting with physicians at the time of care to working out of an office and relying heavily on electronic communications Organizations need to still make sure their clinical documentation specialists are engaging face to face with key physicians and being visible Such visibility within workflow helps medical staff appreciate and make most effective use of clinical documentation specialists as a resource in translating clinical terminology into the diagnostic terms that are needed for coding Romberger Such opportunities for direct interaction work really well because the best way to obtain physician buy in to CDI initiatives is to speak their language and create an ongoing dialogue At first some physician leaders may be hesitant to work side by side with a CDI specialist because they may mistakenly believe the individual will be challenging their clinical perspective As a CDIP certified documentation improvement practitioner myself I always reassure them I m a nurse just asking questions like I always would Having this input is simply an opportunity to help you improve the accuracy and completeness of documentation so that the clinical data captured can accurately reflect the severity of your patient In fact physicians often become very receptive to working alongside a documentation specialist as they naturally start to discover that more accurately reflecting severity of illness will align with recommended length of stay and improve their physician profiles Given your experience what factors are most important for success of CDI programs Whitworth Because physician engagement is so important one key factor for success is often having physician advisors participate in the program These advisors or physician champions can serve as the voice of the physician as well as function in the practical role of being a liaison between the CDI team and physician leadership By bringing ideas from physicians to leadership they can break down the perception that CDI is just about the hospital reimbursement Also important is ongoing collaboration between the coding and clinical documentation specialists Both groups need to work together to have a robust DRG diagnosis related group reconciliation process where the DRG that a clinical documentation specialist identifies ends up being different from what is final billed You really need to take the time to review these mismatches together and go through the reconciliation process to understand the basis for the difference and future action plans to minimize the mismatches In addition organizations need to build the infrastructure and governance to ensure sustained focus over time Frequently when CDI initiatives start up a steering committee is put in place and there is a great deal of energy around activities But over time as programs mature some of this energy can fade To sustain success you really need an ongoing forum where executive leaders coders clinical documentation specialists and physician leaders can come together to share information and insights that will continue to move the program forward What are some key considerations for hospital leaders before implementing a CDI program Romberger The CDI program should align with areas of focus that the hospital has greatest need to address So it s important to audit for areas of opportunity and prioritize educational efforts accordingly For example the organization may notice great frequency or significant revenue impact associated with inaccurate documentation of severity of illness Having a shared sense of the top areas for focus will ensure documentation improvement programs yield the greatest benefit Whitworth To kick off a successful program there must be support from hospital executives and physician leaders Topmost engagement is important because success of the program depends on efforts of many across the revenue cycle quality and clinical operations Multiple stakeholders need to collaborate to ensure the alignment of the clinical documentation program coding operations and physician engagement A final consideration Think broadly about which clinicians to include in initial efforts Residents interns and mid level practitioners all can benefit tremendously from CDI feedback and education because they also spend their time completing documentation within the medical record HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by Deloitte This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Sponsor s Disclaimers This article contains general information only and Deloitte is not by means of this article rendering accounting business financial investment legal tax or other professional advice or services This article is not a substitute for such professional advice or services nor should it be used as a basis for any decision or action that may affect your business Before making any decision or taking any action that may affect your business you should consult a qualified professional advisor Deloitte shall not be responsible for any loss sustained by any person who relies on this article Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited a UK private company limited by guarantee DTTL its network of member firms and their related entities DTTL and each of its member firms are legally separate and independent entities DTTL also referred to as Deloitte Global does not provide services to clients Please see our website for a detailed description of DTTL and its member firms Please see our website for a detailed description of the legal structure of Deloitte LLP and its subsidiaries Certain services may not be available to attest clients under the rules and regulations of public accounting Publication Date Wednesday July 01 2015 Please login to add your comments HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Optum Enabling Transformative Change Elena

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  • KPMG: Readying for Healthcare Today and Tomorrow | HFMA
    they are learning to measure performance in new ways focusing on outcomes at the population level The second trend impacting operations is the increase in consumerism Healthcare is purchased much differently today than it was even 10 years ago Traditionally when you asked hospital executives about customer needs they would focus on how they could serve physicians That s not the case anymore Physicians are still a key part of the delivery model but they are not the sole decision makers Patients play a growing role choosing among care providers based on an organization s ability to deliver high quality and convenience at affordable prices Health savings accounts and high deductible plans are driving patients to assume greater financial responsibility for their care and to carefully consider how transparent organizations are about the relationship between quality and costs Finally the third trend we see is that provider organizations are intent on optimizing the enterprise healthcare IT systems they ve implemented to meet compliance requirements such as Meaningful Use and ICD 10 conversion Hospitals and provider organizations want to capitalize on these core and disruptive technology investments in order to gain operational efficiencies create innovative new revenue streams and positively impact population health management How does KPMG help address these needs As an organization we ve aligned our product and service offerings to help organizations meet current needs as well as prepare for the future We offer more traditional advisory services related to helping organizations identify opportunities for revenue growth and revenue cycle optimization cost management regulatory compliance and transactional assessments But we take that a step further and also focus on ways to position healthcare providers for opportunities ahead and help them answer fundamental questions such as What does business in this next era of healthcare look like and how will this new business model impact performance strategies and use of assets To help with the transition from volume to value we are working with healthcare providers to examine demand capacity and service line profitability for the coming years We also are helping them gain competencies in working with payment mechanisms that are different from fee for service and exploring how they can participate in ACOs partnerships and other arrangements with appropriate levels of shared risk An important aspect of this transition is analyzing the potential value of strategic relationships We assess opportunities for physician integration and examine an organization s physician acquisition strategy and role with health plans Such relationships are particularly important as continuity of care bridges across facilities and government incentives related to population health management continue to grow In response to greater consumerism in the industry we are working with healthcare providers to identify how to better monitor and report on quality measures KPMG provides assistance across the board from the process of selecting performance metrics to assessing clinicians ability to capture details of the patient encounter to performing experience mapping Our work in data analytics is assisting healthcare providers in understanding the relationship between process change and quality outcomes examining total costs of care and reducing hospital admissions and lengths of stay to help cost optimize the system When it comes to helping organizations derive greater value from their healthcare IT investments KPMG is well positioned to provide services along the entire business spectrum from strategy through execution Following previous technology investments over the past several years KPMG recently announced its acquisition of healthcare consulting firm Beacon Partners a top ranked management consulting firm providing clinical financial and operational improvements to health systems nationwide KPMG can assist healthcare organizations with implementing the strategies operational enhancements enablement of technologies security and analytics required to be successful in a new converged healthcare ecosystem The acquisition of Beacon Partners coupled with KPMG s existing capabilities provides clients with access to an integrated healthcare transformation service provider What are some key considerations for healthcare leaders when choosing a partner in such efforts Strategic alignment is important I think it s valuable to seek an advisor who can provide holistic approaches deep industry insights and next generation data intelligence Progress can t exist in silos taking into account long standing business models processes and technologies while setting the stage for further developments in the future is imperative This must be balanced with a changing regulatory environment And finally although the healthcare industry has a wealth of internal and industry data it is critical for this data to be mined using advanced analytics tools to achieve actionable insights that help organizations improve outcomes and elevate quality measures Cultural fit is also key Choosing an advisor is as much about the relationship as it is about the services being offered Select people you want to work with At the end of the day you want to team with people with whom you re in lock step who share a vision of where you re going and who inspire confidence in their ability to deliver Are there any educational materials you would like to share to help healthcare providers in these efforts Visit our website for the following white papers Revenue cycle 3 0 Harnessing the power of process analytics and automated workflow Seeing beyond the numbers Improving revenue cycle results through data visualization Bigger data better outcomes Healthcare providers can improve operational decision making The Big Data dividend Enhancing provider revenues in an era of change What works Creating value based healthcare organizations What works Creating new value with patients caregivers and communities 2015 KPMG LLP a Delaware limited liability partnership and the U S member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative KPMG International a Swiss entity HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by KPMG LLP This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Monday June 01 2015 BACK TO PAGINATION Advertisement Dion Sheidy a partner in KPMG s Healthcare Advisory practice discusses healthcare s changing landscape and how having the right advisor can help organizations navigate challenges and opportunities Tell us a little bit about your organization KPMG LLP KPMG is a professional services firm and part of what is known as the Big Four We offer a broad array of services to our clients through our Audit Tax and Advisory practices Healthcare is a key focus for us With more than 1 700 healthcare and life sciences professionals we serve about half of the 200 largest health systems and academic medical centers in the country as well as many of the top 25 health insurers We work with many state governments related to their activities with the exchanges And we serve all of the top 20 life sciences companies What are some of the biggest issues you see affecting hospitals and health systems these days Several key trends are dramatically affecting healthcare providers First there is the evolution of payment from a fee for service model to one based on value which may or may not include risk considerations Organizations are struggling with developing the competencies and accessing the resources needed for appropriate readiness in this era of changing incentives Business strategies should serve current needs of course which means continuing to operate under the traditional fee for service model However at the same time organizations need to start to accommodate the inevitable shift to payments based on value all while keeping an eye on containing costs and demonstrating quality For example organizations are improving efforts related to chronic disease management and wellness disease prevention programs In addition they are learning to measure performance in new ways focusing on outcomes at the population level The second trend impacting operations is the increase in consumerism Healthcare is purchased much differently today than it was even 10 years ago Traditionally when you asked hospital executives about customer needs they would focus on how they could serve physicians That s not the case anymore Physicians are still a key part of the delivery model but they are not the sole decision makers Patients play a growing role choosing among care providers based on an organization s ability to deliver high quality and convenience at affordable prices Health savings accounts and high deductible plans are driving patients to assume greater financial responsibility for their care and to carefully consider how transparent organizations are about the relationship between quality and costs Finally the third trend we see is that provider organizations are intent on optimizing the enterprise healthcare IT systems they ve implemented to meet compliance requirements such as Meaningful Use and ICD 10 conversion Hospitals and provider organizations want to capitalize on these core and disruptive technology investments in order to gain operational efficiencies create innovative new revenue streams and positively impact population health management How does KPMG help address these needs As an organization we ve aligned our product and service offerings to help organizations meet current needs as well as prepare for the future We offer more traditional advisory services related to helping organizations identify opportunities for revenue growth and revenue cycle optimization cost management regulatory compliance and transactional assessments But we take that a step further and also focus on ways to position healthcare providers for opportunities ahead and help them answer fundamental questions such as What does business in this next era of healthcare look like and how will this new business model impact performance strategies and use of assets To help with the transition from volume to value we are working with healthcare providers to examine demand capacity and service line profitability for the coming years We also are helping them gain competencies in working with payment mechanisms that are different from fee for service and exploring how they can participate in ACOs partnerships and other arrangements with appropriate levels of shared risk An important aspect of this transition is analyzing the potential value of strategic relationships We assess opportunities for physician integration and examine an organization s physician acquisition strategy and role with health plans Such relationships are particularly important as continuity of care bridges across facilities and government incentives related to population health management continue to grow In response to greater consumerism in the industry we are working with healthcare providers to identify how to better monitor and report on quality measures KPMG provides assistance across the board from the process of selecting performance metrics to assessing clinicians ability to capture details of the patient encounter to performing experience mapping Our work in data analytics is assisting healthcare providers in understanding the relationship between process change and quality outcomes examining total costs of care and reducing hospital admissions and lengths of stay to help cost optimize the system When it comes to helping organizations derive greater value from their healthcare IT investments KPMG is well positioned to provide services along the entire business spectrum from strategy through execution Following previous technology investments over the past several years KPMG recently announced its acquisition of healthcare consulting firm Beacon Partners a top ranked management consulting firm providing clinical financial and operational improvements to health systems nationwide KPMG can assist healthcare organizations with implementing the strategies operational enhancements enablement of technologies security and analytics required to be successful in a new converged healthcare ecosystem The acquisition of Beacon Partners coupled with KPMG s existing capabilities provides clients with access to an integrated healthcare transformation service provider What are some key considerations for healthcare leaders when choosing a partner in such efforts Strategic alignment is important I think it s valuable to seek an advisor who can provide holistic approaches deep industry insights and next generation data intelligence Progress can t exist in silos taking into account long standing business models processes and technologies while setting the stage for further developments in the future is imperative This must be balanced with a changing regulatory environment And finally although the healthcare industry has a wealth of internal and industry data it is critical for this data to be mined using advanced analytics tools to achieve actionable insights that help organizations improve outcomes and elevate quality measures Cultural fit is also key Choosing an advisor is as much about the relationship as it is about the services being offered Select people you want to work with At the end of the day you want to team with people with whom you re in lock step who share a vision of where you re going and who inspire confidence in their ability to deliver Are there any educational materials you would like to share to help healthcare providers in these efforts Visit our website for the following white papers Revenue cycle 3 0 Harnessing the power of process analytics and automated workflow Seeing beyond the numbers Improving revenue cycle results through data visualization Bigger data better outcomes Healthcare providers can improve operational decision making The Big Data dividend Enhancing provider revenues in an era of change What works Creating value based healthcare organizations What works Creating new value with patients caregivers and communities 2015 KPMG LLP a Delaware limited liability partnership and the U S member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative KPMG International a Swiss entity HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by KPMG LLP This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Monday June 01 2015 Please login to add your comments HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their organization HFMA RESOURCE LIBRARY 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

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  • Huron Healthcare: Readying Your Organization for Transformation
    its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Friday May 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Gordon Mountford executive vice president Huron Healthcare discusses business imperatives for undertaking transformative change Tell us a little bit about your organization Huron Healthcare is a consulting firm that provides performance improvement and clinical transformation solutions for hospitals health systems academic medical centers and physician organizations By leveraging an organization s strengths and addressing local market dynamics our solutions improve quality increase revenue reduce expense and drive physician employee and patient satisfaction across the enterprise Last February we acquired Studer Group a professional services firm that coaches healthcare organizations on how to achieve and sustain cultural transformation for exceptional clinical and financial outcomes This acquisition combines Huron Healthcare s performance improvement capabilities with Studer Group s Evidence Based Leadership SM framework We are excited about what this marriage will mean for clients What are some of the biggest strategic imperatives that organizations are struggling with in health care today First and foremost healthcare leaders need to find new ways to improve quality of care while reducing cost This shift toward value is being seen throughout the industry Also important is thriving in a fee for service environment while preparing for population health For healthcare organizations to support these value and population focused objectives we have identified that they will need to improve their financial performance between 20 to 40 percent over the next three to five years Every market is different but many organizations are experiencing significant reimbursement compression that is focused on government payers versus non government payers At the same time many hospitals are seeing continued suppression on volumes as care shifts toward less intensive settings These financial pressures can make it considerably more difficult to pursue large scale quality and cost management initiatives As for population health readiness organizations will need to focus on building a robust data analytics infrastructure and appropriately time transitions When value based revenue in a given market reaches around 15 percent the transition can accelerate At that point it will be important to be information rich rather than data rich knowing how to leverage clinical and financial data to appropriately design care models for patient populations under risk based arrangements And finally there is the rise of consumerism To excel in this new environment hospitals and health systems need to be able to meet the needs of empowered consumers Organizations will have to provide greater transparency around pricing and quality information so patients can make better educated decisions about elective care The ability to deliver operational excellence also will be key On a positive note this rise in consumerism has potential for positive effects all around There is growing evidence that patients who are more engaged and active in their care decisions are less costly to serve and have better outcomes than peers How can Huron Healthcare address these overarching industry challenges We are able to assist them in these efforts by providing solutions that address the four components required in our transformation strategy model Clinical transformation Revenue transition Scale and integration Operational excellence Such wide scale levels of change demand significant commitment from employees and physicians As such heightened levels of leadership will be needed to articulate an organization s vision for transformation instill passion and create effective levels of accountability Addressing cultural transformation within an organization will also be key and that is where Huron and Studer solutions help our client s efforts to improve their financial performance and quality of care objectives What advice would you give to healthcare leaders as they assess different types of vendors to assist in the types of business change you re describing Think outside the box Health care is evolving in new ways every day The industry we know today will look very different in five years So my advice is to choose a partner that is nimble flexible and collaborative You need a progressive partner to challenge your leadership and drive healthy change within the organization You need a partner who can help you anticipate what s coming rather than focusing on the past Also seek out those who are results driven We see many programs and projects in the field that are not well measured or do not deliver the anticipated benefits The ideal partner should have a demonstrated track record of being able to drive success through rapid process change Finally take a look at other industries We can learn a lot from others who were forced to tackle transformative change such as leaders in manufacturing or financial services for example Recognizing the value from such experiences is one reason why Huron Healthcare brought in executives from The Home Depot Turner Broadcasting System and Coca Cola to share insights at our annual CEO Forum Any additional reading you would suggest Download Huron Healthcare s Leading the Journey Cultivating Success in Healthcare A CEO Forum Report The report shares progressive practices in managing population health balancing risk and reward and consumerism It also provides insights from some of the most respected thought leaders in health care as well as other transformative industries Perhaps most useful readers will find 10 questions to help guide hospital and health system transformation strategies HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by Huron Healthcare This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA

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  • KeyBank: Helping You to Realize Your Strategic Vision in Changing Times
    warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Friday May 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Victoria Terekhova senior strategist for Enterprise Healthcare at KeyBank discusses key challenges when developing long term strategy in a rapidly changing industry and the role the right banking partner can play in helping healthcare providers navigate the opportunities before them Tell us a little bit about your organization KeyBank has about 90 billion in assets and more than 13 000 employees We re a full services bank and the healthcare sector is a strategic priority for us At this point we re partnered with nearly 10 000 healthcare clients and have approximately 7 5 billion in credit commitments to those clients comprised of hospitals outpatient systems physician and dental practices senior care facilities and other sectors within health care We provide everything from traditional financing to capital market solutions to revenue cycle management What are some of the biggest challenges you see affecting healthcare providers One of the biggest challenges for our healthcare clients is setting the right long term strategy As the industry addresses massive regulatory requirements and undergoes significant reimbursement and competitive shifts what we see is that healthcare providers are really forced to rethink how they do business and where they need to focus going forward Every organization from a small physician office to a huge health system has to have a well thought out strategic plan They need to know where they re going to be in the next five to 10 years who they are likely to be partnering with and the resources and performance strategies needed to get there Also as revenue streams and competitive dynamics change organizational priorities are shifting and decision making is becoming more complex Capital plans really have to be reshuffled and looked at differently For hospitals that want to remain independent the big topic is how to survive financially Independence will likely require some creative financing options that support locking in rates for longer terms so the organization can have the extra cash needed to weather bumps in cash flow and remain agile to competitive threats For large health systems that have economies of scale it s more about readying for new business models and optimizing their real estate Is the enterprise really making the most use of its assets Can some of the facilities be converted for different use based on shifts in service demand for example would the organization be better served if facilities were used for rehabilitation services or outpatient care It s rethinking asset use How is KeyBank helping healthcare providers address these needs Healthcare executives have compressed timelines to make lots of decisions What healthcare executives need is somebody who can come in and succinctly summarize options available and inform the decision process so leaders can quickly identify opportunities and make the right decisions to support their strategic goals As such we moved to what we call an enterprise approach with our banking services where we serve as a hub for the decision process It s very similar to how primary care physicians become the center of coordinated care One banker interfaces with the team from the hospital or physician group and assesses current state through a series of probing questions identifies and explains available options and works with the enterprise team to determine a successful course forward For example a couple of months ago leaders from a medium sized health system in the Midwest came to us and said they would like to build a new hospital but didn t have the money to do it alone To raise the necessary capital they would need to bring others to the table through strategic alliances Typically a bank would say OK here s the term sheet Here s how much we can give you for an interest rate for this duration But what our team started doing is asking more questions Is partnering what you really want to do How would a partnership impact your business Through these dialogues we discovered leadership really did not want the organization to partner if it didn t have to Executives preferred the organization remain independent to best serve community need and long term strategy but they didn t think the option was possible Our team was able to come up with several alternatives to allow the organization to fund the project independently in this instance through an FHA loan The CEO was ecstatic It ended up working out very well for them What are some key considerations for healthcare leaders when choosing a banking relationship You need to know your strategic priorities and examine how the bank you are partnering with can help you achieve them Will your bank be there when you reach your phase two three or four of strategy Will it have capabilities to support you on that long journey There are healthcare specific products in the banking industry for example revenue cycle solutions or government insured loans but not every bank is capable of offering these products and then appropriately supporting them Also the right banking partner should identify ways to bring cash back into your business As one example when looking at capital opportunities we may recommend sustainability improvements such as efficiency or advanced energy investments Many healthcare providers fail to recognize the real dollars on the table for them through incentives and rebates as well as reduced utility bills In the same regard investing in the right lighting and building controls can save approximately 27 percent in energy costs Within a year organizations pursuing such strategies will see more cash coming into the bottom line Providers often overlook these opportunities when banking partners aren t there helping to navigate options There are some real benefits to the bottom line

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  • Xtend Healthcare: A Custom Approach to Optimizing Revenue Cycle Performance
    many organizations this year as adjustment to the new system is likely to result in significant payment delays and much greater need to rework claims That s why it s so important for revenue cycle leaders to focus on supporting clean claim processes and preparing their coders now before the change Also a strong balance sheet and cash on hand will be important to fall back on when slowed coding and claims resubmissions cause payment delays Compounding these challenges the implementation of ICD 10 is expected to increase staff turnover and accelerate the number of coder retirements as the workforce encounters the challenges of adapting to the new system s higher demands for specificity Focus will continue to be on recruiting new staff and elevating the training and development of existing staff to ensure readiness of appropriate coding resources Another challenge facing many revenue cycle leaders is managing system conversions to support the transition to an electronic health record EHR The benefits of EHR conversion are great as most of the new systems are data driven and drive workflow to the front end of the revenue cycle to support clean claim submission and accurate charge capture up front versus traditional legacy systems that focus on follow up on the back end However for conversions to be successful organizations also need to implement many process changes train front end staff to adapt to the new roles they will be playing and recognize opportunities to optimize the new system At the same time the attention of revenue cycle leaders is divided because they must still manage collections of existing receivables on the legacy system This mixed focus can make the period of time up to and immediately after system go live particularly challenging for managing workflow In addition organizations are still trying to recognize the full impact of the Affordable Care Act There are many new insurance plans changes in patient eligibility and coverage and shifts in payer mix And I haven t even touched on the many challenges of shifting payment models under value based care How is Xtend helping healthcare providers to manage this complexity What all of these issues have in common is the risk of revenue leakage from suboptimal processes and errors by individuals With our experience and expertise we help healthcare organizations identify the right areas where they should focus their efforts identifying opportunities to optimize performance through process redesign and providing training that supports adoption of industry best practices With every engagement we begin with a deep dive and examine the current state of the organization s revenue cycle Then we customize our approach to the client s particular needs For example when an organization is in crisis we may provide an intensive and comprehensive outsourcing approach to quickly bring in cash so the hospital or system survives When an organization is stable and the goal is to improve we provide consulting assistance or partial outsourcing as needed For example the revenue cycle may be functioning well but a system conversion has brought new opportunities for improvement We can provide the expertise to help leaders understand and address these opportunities We also commonly help organizations move toward enterprise integration We recently worked with a 12 hospital system to merge multiple individual revenue cycles into one shared revenue cycle Other times a hospital just needs training due to staff turnover to ensure consistency and efficiency of workflow What types of partial or full outsourcing arrangements do you typically develop The client organization s goals drive our work For example small critical access hospitals are often located in communities where it can be difficult to recruit staff and leaders As such we might place an experienced leader on site to interface with the CFO HIM director case management utilization review admission and registration staff to improve processes and systems Then we might flow billing and collections through one of our four service centers Religiously affiliated hospitals which often have missions that support community first are frequently looking for solutions where they don t have to cut jobs In such instances we will typically retrain their employees and place some of them within their service center over time for a better cost model What are some top questions organizational leaders should ask when choosing the right partner for outsourcing some or all of their revenue cycle services Perhaps the most important questions to ask any potential business partner revolve around data security and compliance with data sharing provisions A data breach could impact thousands of accounts and have dire consequences Are all file and database servers encrypted What about laptops and desktop computers Are protections in place to ensure that access to patient identified data is limited to what employees need to perform work duties When was the last time the vendor went through a data security audit At Xtend we use Dell SecureWorks which is recognized as a top IT security service provider and represents Fortune 500 companies This state of the art technology allows us to help our clients protect valuable customer and employee data Also research the technology tools the partner will be using How well are technologies integrated into their workflow process to ensure the partner provides timely consistent and effective resolutions of receivables Finally it is important to understand how performance during the engagement will be monitored and reported What type of reporting does the company provide How transparent is it Where can readers learn more about Xtend Healthcare Basic information about our services can be found on our website But I would also welcome an email directly to answer questions about a particular situation HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by Xtend Healthcare Advanced Revenue Solutions This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Friday May 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Tom O Neill CEO of Xtend Healthcare Advanced Revenue Solutions discusses key areas where organizations risk revenue leakage and ways they can use outsourcing to better protect cash flow and support accurate payment Tell us a little bit about your organization Xtend Healthcare Advanced Revenue Solutions is the fastest growing healthcare revenue cycle solutions company in the industry We provide a comprehensive portfolio of end to end revenue cycle services up to and including full outsourcing of the revenue cycle We offer extended business office outsourcing for third party receivables or self pay balances We provide computer system conversion support and legacy system cleanup work this has been a big part of our engagements over recent years because so many hospitals are going through system conversions We provide outsource coding In addition we offer training and consulting on all aspects of the revenue cycle and health information management HIM assistance Our goal in every engagement is to maximize cash flow expedite accounts receivable and correctly handle adjustments We get to the root cause of why receivables aren t being paid and address those underlying issues whether they are related to process or technologies What issues are you seeing that keep hospital revenue cycle leaders up at night Any number of things ICD 10 if implemented will be a big challenge for many organizations this year as adjustment to the new system is likely to result in significant payment delays and much greater need to rework claims That s why it s so important for revenue cycle leaders to focus on supporting clean claim processes and preparing their coders now before the change Also a strong balance sheet and cash on hand will be important to fall back on when slowed coding and claims resubmissions cause payment delays Compounding these challenges the implementation of ICD 10 is expected to increase staff turnover and accelerate the number of coder retirements as the workforce encounters the challenges of adapting to the new system s higher demands for specificity Focus will continue to be on recruiting new staff and elevating the training and development of existing staff to ensure readiness of appropriate coding resources Another challenge facing many revenue cycle leaders is managing system conversions to support the transition to an electronic health record EHR The benefits of EHR conversion are great as most of the new systems are data driven and drive workflow to the front end of the revenue cycle to support clean claim submission and accurate charge capture up front versus traditional legacy systems that focus on follow up on the back end However for conversions to be successful organizations also need to implement many process changes train front end staff to adapt to the new roles they will be playing and recognize opportunities to optimize the new system At the same time the attention of revenue cycle leaders is divided because they must still manage collections of existing receivables on the legacy system This mixed focus can make the period of time up to and immediately after system go live particularly challenging for managing workflow In addition organizations are still trying to recognize the full impact of the Affordable Care Act There are many new insurance plans changes in patient eligibility and coverage and shifts in payer mix And I haven t even touched on the many challenges of shifting payment models under value based care How is Xtend helping healthcare providers to manage this complexity What all of these issues have in common is the risk of revenue leakage from suboptimal processes and errors by individuals With our experience and expertise we help healthcare organizations identify the right areas where they should focus their efforts identifying opportunities to optimize performance through process redesign and providing training that supports adoption of industry best practices With every engagement we begin with a deep dive and examine the current state of the organization s revenue cycle Then we customize our approach to the client s particular needs For example when an organization is in crisis we may provide an intensive and comprehensive outsourcing approach to quickly bring in cash so the hospital or system survives When an organization is stable and the goal is to improve we provide consulting assistance or partial outsourcing as needed For example the revenue cycle may be functioning well but a system conversion has brought new opportunities for improvement We can provide the expertise to help leaders understand and address these opportunities We also commonly help organizations move toward enterprise integration We recently worked with a 12 hospital system to merge multiple individual revenue cycles into one shared revenue cycle Other times a hospital just needs training due to staff turnover to ensure consistency and efficiency of workflow What types of partial or full outsourcing arrangements do you typically develop The client organization s goals drive our work For example small critical access hospitals are often located in communities where it can be difficult to recruit staff and leaders As such we might place an experienced leader on site to interface with the CFO HIM director case management utilization review admission and registration staff to improve processes and systems Then we might flow billing and collections through one of our four service centers Religiously affiliated hospitals which often have missions that support community first are frequently looking for solutions where they don t have to cut jobs In such instances we will typically retrain their employees and place some of them within their service center over time for a better cost model What are some top questions organizational leaders should ask when choosing the right partner for outsourcing some or all of their revenue cycle services Perhaps the most important questions to ask any potential business partner revolve around data security and compliance with data sharing provisions A data breach could impact thousands of accounts and have dire consequences Are all file and database servers encrypted What about laptops and desktop computers Are protections in place to ensure that access to patient identified data is limited to what employees need to perform work duties When was the last time the vendor went through a data security audit At Xtend we use Dell SecureWorks which is recognized as a top IT security service provider and represents Fortune 500 companies This state of the art technology allows us to help our clients protect valuable customer and employee data Also research the technology tools the partner will be using How well are technologies integrated into their workflow process to ensure the partner provides timely consistent and effective resolutions of receivables Finally it is important to understand how performance during the engagement will be monitored and reported What type of reporting does the company provide How transparent is it Where can readers learn more about Xtend Healthcare Basic information about our services can be found on our website But I would also welcome an email directly to answer questions about a particular situation HFMA is the nation s leading membership organization for more than 40 000 healthcare financial management professionals Business Profiles are funded through advertising with leading solution providers Learn more Content for this Business Profile is supplied by Xtend Healthcare Advanced Revenue Solutions This published piece is provided for advertisement purposes HFMA does not endorse the published material or warrant or guarantee its accuracy The statements and opinions of those profiled are those of the individual and not those of HFMA References to commercial manufacturers vendors products or services that appear do not constitute endorsement by HFMA Publication Date Friday May 01 2015 Please login to add your comments HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their organization HFMA RESOURCE LIBRARY 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 HFMA Business Profiles Somnia Bending the Healthcare Cost Curve Toward Improved Anesthesia Value Somnia President and CEO Marc Koch

    Original URL path: http://www.hfma.org/Content.aspx?id=30477 (2016-02-10)
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