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  • Availity: Connect to the Future of Healthcare Information
    of ourselves as a platform and network that supports the standardization integration and automation of the critical data that needs to be shared between health plans and providers As the industry transitions to value based payment models from fee for service different kinds of data must be shared between physicians and providers for payments to be made It s Revenue Cycle 2 0 if you will Availity is uniquely positioned to efficiently move information and address these needs because of our experience working for both health plans and providers over the years Tell me more about Revenue Cycle 2 0 What are you seeing exactly In the past health plan and provider systems were built in silos and unintentionally worked against versus with each other which has led to a 30 percent average claim denial rate industry wide Under value based payment models clinical administrative and financial information systems need to be integrated Revenue Cycle 2 0 demands improved sharing of cost and quality data Models such as accountable care and shared savings programs are based around performance metrics Yet many organizations lack the tools to properly track and manage these metrics across care settings Without these metrics providers won t be able to demonstrate achievement of their efforts Proper data management and associated workflow practices must be in place for value based payment efforts to succeed How does Availity support this value based shift What s exciting about the platform we built and network we ve created is that they facilitate information exchange among providers and health plans in ways that will be vital to drive value For example one area of focus for us is automating the exchange of information between providers and health plans who are managing risk based agreements such as Medicare Advantage This is a very expensive and labor intensive process today that Availity can simplify By more efficiently sharing information about the patient s level of illness care providers and health plans can improve care delivery while simultaneously reducing risk when they focus on populations with chronic conditions such as diabetes and congestive heart failure Are there any other issues that should be top of mind for financial executives as they face the coming era of health care Another key issue is the shift that is occurring with the patient s role in revenue cycle For many years the healthcare economy has operated in such a way that patients didn t hold ownership for many costs Physician appointments and tests have been paid for by third parties in a fee for service world But this dynamic is changing as many individuals are now participating in high deductible plans These patients are far more engaged as consumers and want to know how much they will be expected to pay out of pocket Going forward it s critical to empower providers with cost estimation tools that help them to better anticipate and address patient financial responsibility We re supporting providers in addressing this need with our Patient Access solution The tool gives healthcare providers the ability to quickly capture and manage patient financial responsibility at the point of service to protect and accelerate cash flow It even assists point of service staff with guidance and scripting so they can appropriately educate patients about their financial responsibilities and payment options Our customers are seeing significant improvement with collections What tough questions should organizational leaders ask when evaluating companies that offer these types of data solutions It s important to ask vendors about their platforms from two perspectives security and innovation First what measures are they taking to keep their customers information secure And second do they provide a platform that will position their customers to innovate with the current pace of industry change I would also ask about a supplier s three year business plan and current ownership status Mergers and acquisitions are hot in this area right now but acquisitions can be disruptive When you look at companies that sustain success over time they typically remain true to their purpose at inception From the beginning Availity s solutions have been informed by the real time communication needs of both provider and health plan stakeholders So we bring more than a decade of experience in reducing wasteful transactions and adding value Also because we have no plans to go public our decisions are driven by the customer experience rather than meeting quarterly financial targets We measure success through a user experience that delights our customers as evidenced by net promoter scores that far exceed industry averages Any other advice for making the best match Ask to speak with a current established customer more than a year that is of a similar size geographical location and IT footprint Find out which products they are using ease of implementation and whether they are noticing any workflow improvements Ask if they are using a basic product or if they ve added any features that might have enhanced their user experience You should expect to see success with a like organization It s the best way to feel confident about your decision Where can readers learn more about Availity s suite of solutions I invite readers to visit us online to learn more about our products and solutions I also encourage them to look at our original e books research papers and training opportunities We have made a significant investment in creating original content that can help our customers understand and prepare for market changes that could impact their businesses Lastly watch for us at industry conferences and events throughout the year and make a point to visit our booth and speak with our representatives 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 Availity 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 Wednesday April 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Jeff Chester senior vice president and chief revenue officer at Availity shares his thoughts on Revenue Cycle 2 0 and how to best meet its challenges Tell me a little about your organization Availity was founded in 2001 by Florida Blue and Humana with the goal of making it easier for health plans to engage with providers in the state of Florida Currently Availity is one of the nation s largest healthcare information networks with more than 575 000 active providers and is now owned by Florida Blue Humana HCSC Anthem and Blue Cross and Blue Shield of Minnesota We re active in 26 Blue markets with a minimum of 60 percent of payers in those markets and we manage more than 7 million transactions daily through our web portal Over the past decade Availity has built a portfolio of Revenue Cycle Management Solutions with a continued focus on improving the exchange of information between health plans and providers Most recently Availity acquired RevPoint a patient access solution helping providers manage the impact of high deductible plans and increased patient financial responsibility Today we think of ourselves as a platform and network that supports the standardization integration and automation of the critical data that needs to be shared between health plans and providers As the industry transitions to value based payment models from fee for service different kinds of data must be shared between physicians and providers for payments to be made It s Revenue Cycle 2 0 if you will Availity is uniquely positioned to efficiently move information and address these needs because of our experience working for both health plans and providers over the years Tell me more about Revenue Cycle 2 0 What are you seeing exactly In the past health plan and provider systems were built in silos and unintentionally worked against versus with each other which has led to a 30 percent average claim denial rate industry wide Under value based payment models clinical administrative and financial information systems need to be integrated Revenue Cycle 2 0 demands improved sharing of cost and quality data Models such as accountable care and shared savings programs are based around performance metrics Yet many organizations lack the tools to properly track and manage these metrics across care settings Without these metrics providers won t be able to demonstrate achievement of their efforts Proper data management and associated workflow practices must be in place for value based payment efforts to succeed How does Availity support this value based shift What s exciting about the platform we built and network we ve created is that they facilitate information exchange among providers and health plans in ways that will be vital to drive value For example one area of focus for us is automating the exchange of information between providers and health plans who are managing risk based agreements such as Medicare Advantage This is a very expensive and labor intensive process today that Availity can simplify By more efficiently sharing information about the patient s level of illness care providers and health plans can improve care delivery while simultaneously reducing risk when they focus on populations with chronic conditions such as diabetes and congestive heart failure Are there any other issues that should be top of mind for financial executives as they face the coming era of health care Another key issue is the shift that is occurring with the patient s role in revenue cycle For many years the healthcare economy has operated in such a way that patients didn t hold ownership for many costs Physician appointments and tests have been paid for by third parties in a fee for service world But this dynamic is changing as many individuals are now participating in high deductible plans These patients are far more engaged as consumers and want to know how much they will be expected to pay out of pocket Going forward it s critical to empower providers with cost estimation tools that help them to better anticipate and address patient financial responsibility We re supporting providers in addressing this need with our Patient Access solution The tool gives healthcare providers the ability to quickly capture and manage patient financial responsibility at the point of service to protect and accelerate cash flow It even assists point of service staff with guidance and scripting so they can appropriately educate patients about their financial responsibilities and payment options Our customers are seeing significant improvement with collections What tough questions should organizational leaders ask when evaluating companies that offer these types of data solutions It s important to ask vendors about their platforms from two perspectives security and innovation First what measures are they taking to keep their customers information secure And second do they provide a platform that will position their customers to innovate with the current pace of industry change I would also ask about a supplier s three year business plan and current ownership status Mergers and acquisitions are hot in this area right now but acquisitions can be disruptive When you look at companies that sustain success over time they typically remain true to their purpose at inception From the beginning Availity s solutions have been informed by the real time communication needs of both provider and health plan stakeholders So we bring more than a decade of experience in reducing wasteful transactions and adding value Also because we have no plans to go public our decisions are driven by the customer experience rather than meeting quarterly financial targets We measure success through a user experience that delights our customers as evidenced by net promoter scores that far exceed industry averages Any other advice for making the best match Ask to speak with a current established customer more than a year that is of a similar size geographical location and IT footprint Find out which products they are using ease of implementation and whether they are noticing any workflow improvements Ask if they are using a basic product or if they ve added any features that might have enhanced their user experience You should expect to see success with a like organization It s the best way to feel confident about your decision Where can readers learn more about Availity s suite of solutions I invite readers to visit us online to learn more about our products and solutions I also encourage them to look at our original e books research papers and training opportunities We have made a significant investment in creating original content that can help our customers understand and prepare for market changes that could impact their businesses Lastly watch for us at industry conferences and events throughout the year and make a point to visit our booth and speak with our representatives 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 Availity 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 Wednesday April 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 MD MBA explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes HFMA RESOURCE LIBRARY Large Health System Drives 10 UP Patient Payments and 10 DOWN Billing related Costs Faced with

    Original URL path: http://www.hfma.org/Content.aspx?id=29284 (2016-02-10)
    Open archived version from archive


  • Deloitte: Leveraging IT for Value-Based Care Transformation
    industrywide their promise has yet to be delivered on Given the challenges you both mentioned with EHRs what do you anticipate will be different in organizations technology strategies going forward Morris Going forward focus is going to be on EHR optimization where installing an EHR is not simply a project with a start and finish date but rather an ongoing journey by which technology enables the transformation of payment models from volume to value based care What will be different this time around will be focusing on the cost and quality effects of care transformation and improved collaborations That said there are some promising tools already available Deloitte offers Evergreen for example an application management services solution that configures and maintains EHR content in a way that helps clinicians make decisions anticipate changes predict outcomes and manage populations The solution uses global delivery and economies of scale to save between 20 and 30 percent off of application maintenance costs from what the cost would be with internal resources O Rourke The goal of EHR use is to make clinicians more effective at the point of care by aiding evidence based decision making Better decision making can then help them deliver improved outcomes faster interventions and better management of disease states To realize these benefits however we still need to optimize our ability to bring information together from many sources and then measure impact of process change on cost and care As an industry we re early in this path toward ROI As part of care transformation many organizations are seeking to improve capabilities around population health management What are some of the IT implications of this focus Morris Healthcare providers and health plans are focused on how to converge functions effectively One aspect is improving analytics Having the ability to gather and analyze data from many different sources will be important to understand costs of care and actuarial risk associated with patient populations Whether providers and payers enter into population focused agreements around payment bundles accountable care organizations or full capitation it s important from a business perspective for both parties to understand for each DRG or disease state how much is being spent how to best manage risk and how to examine cost and revenue across the population served Having the right IT solutions and intelligence will be key in these efforts At Deloitte our wholly own subsidiary ConvergeHEALTH is developing advanced solutions that aid clients data integration management and analytics endeavors and that also go a step beyond and enable them to apply those insights We also have an alliance with the Northern New England Accountable Care Cooperative which is helping us develop best practices in this space What we are seeing through these relationships is that as the healthcare industry continues its shift to value based personalized health care it s the application of data driven insights that will be a market differentiator and become increasingly important to drive healthcare transformation O Rourke Whether IT users are providers or payers their ability to make effective clinical and business decisions comes down to delivery of information Exchanging data from many sources is going to be key to having the information needed to provide patients with the right care at the right place at the right time Also important operationally is exchanging data across the care continuum Many health systems including CHI are making investments so they can better manage care outside of the acute care environment Yet integrating cost and quality data between inpatient and ambulatory settings can be challenging particularly when the exchange may involve many physicians who are each operating with different systems Earlier we discussed some of the financial pressures organizations are under Can you talk about how IT outsourcing is being viewed in this regard O Rourke To be successful organizations are going to have to find ways to be more efficient and reduce their current spend because we as an industry simply can t do the same things operationally in the future that we have done in the past and succeed At the same time we can t afford incremental change Improvements in how organizational resources are managed and the quality of care provided must be transformational Because IT is one of the biggest expenses we need to be out front driving down cost and increasing innovation When every part of the business changes as fast as is being seen in health care today we have to adapt at least as quickly if not faster in putting new structures in place If you don t have the right skill sets on board to address the changing times get them Position your organization with the disruptive technology needed to move value based initiatives forward quickly Engaging vendors can be an efficient way to access the intelligence and analytics capabilities that are necessary to lower cost and optimize service delivery Bringing in IT support can also introduce the organization to different skill sets and ingenuity that can be applied to better understand each part of next era service delivery For example external companies may have experience working with physician organizations and health plans that are now part of integrated delivery networks These business partners who know the service lines and have been embedded in their processes for years can often more effectively identify cross continuum performance improvement opportunities than internal staff Are there any educational materials you would like to share to help providers in improving their IT strategies Morris Readers can learn more at Deloitte s Center for Health Solutions and the Deloitte Survey of U S Physicians and get more information on the Deloitte Evergreen TM solution 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 Wednesday April 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Mitch Morris vice chair and global leader healthcare Deloitte and Michael O Rourke senior vice president and chief information officer Catholic Health Initiatives CHI share perspectives on the need for transformational IT in health care today A key focus for Deloitte is information technology IT consulting What are some of the big picture challenges you see affecting healthcare CIOs Mitch Morris Many organizations have made large investments around meaningful use and ICD 10 As a result they are experiencing some capital exhaustion on IT Accessing future capital is more complicated these days because of competing priorities and many organizations diversifying revenue streams by buying physician practices and branching into retail and ambulatory practice At the same time there s a need to support operations in an environment of declining reimbursement All of these factors make it hard to drive additional funding around IT and are adding pressure for CIOs to demonstrate return on investment I think CIOs also are regrouping a bit after physicians tepid reception of electronic health records EHRs following such a big spend In fact in Deloitte s 2014 Survey of U S Physicians three out of four physicians said EHRs cost too much and take too much of my time Michael O Rourke So much of the industry s investment in EHRs has been driven by the opportunity to receive stimulus dollars and meaningful use reimbursement And yet even though billions of dollars have been spent on EHRs industrywide their promise has yet to be delivered on Given the challenges you both mentioned with EHRs what do you anticipate will be different in organizations technology strategies going forward Morris Going forward focus is going to be on EHR optimization where installing an EHR is not simply a project with a start and finish date but rather an ongoing journey by which technology enables the transformation of payment models from volume to value based care What will be different this time around will be focusing on the cost and quality effects of care transformation and improved collaborations That said there are some promising tools already available Deloitte offers Evergreen for example an application management services solution that configures and maintains EHR content in a way that helps clinicians make decisions anticipate changes predict outcomes and manage populations The solution uses global delivery and economies of scale to save between 20 and 30 percent off of application maintenance costs from what the cost would be with internal resources O Rourke The goal of EHR use is to make clinicians more effective at the point of care by aiding evidence based decision making Better decision making can then help them deliver improved outcomes faster interventions and better management of disease states To realize these benefits however we still need to optimize our ability to bring information together from many sources and then measure impact of process change on cost and care As an industry we re early in this path toward ROI As part of care transformation many organizations are seeking to improve capabilities around population health management What are some of the IT implications of this focus Morris Healthcare providers and health plans are focused on how to converge functions effectively One aspect is improving analytics Having the ability to gather and analyze data from many different sources will be important to understand costs of care and actuarial risk associated with patient populations Whether providers and payers enter into population focused agreements around payment bundles accountable care organizations or full capitation it s important from a business perspective for both parties to understand for each DRG or disease state how much is being spent how to best manage risk and how to examine cost and revenue across the population served Having the right IT solutions and intelligence will be key in these efforts At Deloitte our wholly own subsidiary ConvergeHEALTH is developing advanced solutions that aid clients data integration management and analytics endeavors and that also go a step beyond and enable them to apply those insights We also have an alliance with the Northern New England Accountable Care Cooperative which is helping us develop best practices in this space What we are seeing through these relationships is that as the healthcare industry continues its shift to value based personalized health care it s the application of data driven insights that will be a market differentiator and become increasingly important to drive healthcare transformation O Rourke Whether IT users are providers or payers their ability to make effective clinical and business decisions comes down to delivery of information Exchanging data from many sources is going to be key to having the information needed to provide patients with the right care at the right place at the right time Also important operationally is exchanging data across the care continuum Many health systems including CHI are making investments so they can better manage care outside of the acute care environment Yet integrating cost and quality data between inpatient and ambulatory settings can be challenging particularly when the exchange may involve many physicians who are each operating with different systems Earlier we discussed some of the financial pressures organizations are under Can you talk about how IT outsourcing is being viewed in this regard O Rourke To be successful organizations are going to have to find ways to be more efficient and reduce their current spend because we as an industry simply can t do the same things operationally in the future that we have done in the past and succeed At the same time we can t afford incremental change Improvements in how organizational resources are managed and the quality of care provided must be transformational Because IT is one of the biggest expenses we need to be out front driving down cost and increasing innovation When every part of the business changes as fast as is being seen in health care today we have to adapt at least as quickly if not faster in putting new structures in place If you don t have the right skill sets on board to address the changing times get them Position your organization with the disruptive technology needed to move value based initiatives forward quickly Engaging vendors can be an efficient way to access the intelligence and analytics capabilities that are necessary to lower cost and optimize service delivery Bringing in IT support can also introduce the organization to different skill sets and ingenuity that can be applied to better understand each part of next era service delivery For example external companies may have experience working with physician organizations and health plans that are now part of integrated delivery networks These business partners who know the service lines and have been embedded in their processes for years can often more effectively identify cross continuum performance improvement opportunities than internal staff Are there any educational materials you would like to share to help providers in improving their IT strategies Morris Readers can learn more at Deloitte s Center for Health Solutions and the Deloitte Survey of U S Physicians and get more information on the Deloitte Evergreen TM solution 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 Wednesday April 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

    Original URL path: http://www.hfma.org/Content.aspx?id=29287 (2016-02-10)
    Open archived version from archive

  • SSI: Preparing the Revenue Cycle for Changing Payer Roles
    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 April 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Tom Myers chief strategy officer The SSI Group discusses the shifting payment environment and how it affects providers patient access and claims management processes Tell us a little about SSI SSI s mission is grounded in providing reliable easy to use software solutions to improve revenue cycle efficiencies while reducing staffing requirements That s been our foundation for nearly 30 years now Over the past 10 years we ve also grown our revenue cycle tools and services to become a single source end to end solution including front end patient access workflow to claims management denial and contract management and analytics and business intelligence solutions We currently work with 2 700 client partners and handle 800 billion in claims annually Our strength has always been in providing accurate and comprehensive edits offering richness of focus around documentation requirements and recognizing what keeps payers from accepting claims These capabilities are particularly valuable as the industry shifts toward a value based revenue cycle where uniting the payer s rules with workflow is essential Can you share a bit about what you are seeing in relation to changing payer dynamics The payer side of the market is complex and becoming even more so due to ICD 10 accountable care organizations ACOs and population health initiatives As a result we re seeing a fundamental shift where payers own the revenue cycle In the past providers typically mastered their own revenue cycle and could pretty much count on getting paid once they sent a claim to the payer But now payers dictate highly complex rules that providers must follow in order to get paid Providers are challenged with stitching together dozens of these payer specific revenue cycles into a holistic view with unified definitions and workflow Supporting revenue integrity processes is challenging when every payer has its own rules and requirements Working with ACOs and population health based initiatives can be particularly complex because the rules under these types of arrangements are not specific to any one provider but are rather a federated arrangement to support the cross continuum nature of the relationship Also there once was an expectation in the industry that as providers shifted to mega healthcare information system vendors these suppliers would be perfecting the providers billing processes to consolidate separate best of breed clinical financial and other add on solutions In practice providers are discovering this expectation isn t feasible due to the complexity of managing thousands of payers nationwide It s a real industry problem How do you address these types of challenges at SSI This is an area we are known for Because of our long standing edit capability around electronic billing including a proven track record with the 5010 conversion and a leading position with ICD 10 testing we ve developed a strong relationship and excellent reputation across payers There are so many emerging trends with respect to meeting payer requirements during patient access performing eligibility checks preauthorization and providing admission notification as well as back end processes for claim statusing and remittance processing We address each requirement very specifically by payer while still supporting the provider s quest for a seamless revenue cycle Through database workflow we also support integrated denial management with an automated back end process even though payers differ Product capabilities are available payer by payer to help providers anticipate payments according to the contract and track claims through adjudication to understand any payment variance As a result we can isolate denials and underpayments in spite of differences in payer logic We also put denials and payment variances in normalized queues for staff to work on efficiently without them having to cobble together separate processes to determine denial category and prioritize efforts Are there other revenue cycle trends that should be on providers radar these days An emerging area that we are addressing on the front end in patient access is high deductible health plans including those originating from the Affordable Care Act Many of these plans have deductibles of several thousand dollars and thus have created much greater patient liability than we ve seen historically It s now mission critical for healthcare providers to be able to estimate patient payments and collect up front Doing so not only improves collection success but also supports patient satisfaction as patients are able to make more educated decisions about purchasing healthcare services By coupling eligibility requests with payer contracts and historical payment amounts we can provide patient estimates before a service is rendered and then reconcile them on the back end after the payer has adjudicated the claim Again there s so much complexity around specific payer rules on preauthorizations and admission notification to support a clean claim Our approach is to treat transactions as payer specific processes and keep the right provider centric definitions as well as workflow together for consistency That s the value we add Any important considerations as leaders review key revenue cycle product or service features to support effective claims management It s important to ask about a potential supplier s relationships with payers Given the complexity of the payment environment strong collaborative relationships are important to ensure the best results In terms of product selection seek connectivity and flexibility For example at SSI our software is all SaaS software as a service as we maintain a centralized data warehouse that enables workflow with consistent definitions between payers and across products This structure allows us to deploy new products or support existing products very quickly We are also able to capture best practices from clients and incorporate these practices out of the box going forward Also consider whether data will be synchronized if you start with one solution and later

    Original URL path: http://www.hfma.org/Content.aspx?id=29293 (2016-02-10)
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  • Apex: Cultivating Patient Payment while Elevating the Patient Experience
    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 Sunday March 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Brian Kueppers founder and CEO Apex discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction Tell me a little bit about your organization Apex is a revenue cycle management company that helps healthcare organizations optimize patient payment delivering strong financial results while enhancing the patient experience Founded in 1995 with a focus on demystifying the patient statement the company has expanded its offerings in the past five years to deliver a range of e services that drive patient payment Apex solutions include a flexible and dynamic patient revenue cycle tool customizable electronic statements a customer service portal and a variety of automated payment solutions Underpinning our diverse product line is deep revenue cycle knowledge which allows us to partner with hospitals health systems and group practices to create and implement robust and best practice fueled patient payment strategies What are some of the biggest challenges you see affecting healthcare organizations In my opinion the single biggest financial challenge is the massive increase in patient responsibility Over the past five years patient payment has grown 68 percent across the industry representing 420 billion This dramatic shift is causing healthcare leaders serious concern as they start to think about how their organizations are going to manage the change Historically healthcare organizations have not paid much attention to educating patients on their fiscal responsibility and proactively collecting copays deductibles and coinsurance However with the rapid growth of high deductible health plans organizations are quickly realizing the benefits of engaging patients early and often in financial discussions informing individuals up front of what they owe and working with them to collect payment in a timely manner Compounding the challenges of patient payment growth is the fact that organizations are already operating with razor thin margins and financial staff are continuously overtaxed in keeping abreast of new regulations payer requirements and reimbursement strategies This is not the most optimal environment in which to establish a new patient focused business process especially if that process warrants an investment in automated solutions How do you see Apex s products and services addressing these issues While we are able to offer our customers a number of tools that yield quick results often within 60 to90 days our ultimate goal is to drive long term success As such we dig deep into our clients current revenue cycle operations to identify ways to enhance workflows optimize existing technology and onboard new solutions if necessary For example after a comprehensive review of a hospital s processes and systems we may discover that the organization is using its existing front desk software at only 30 percent of capacity We could then make recommendations on how the hospital could better leverage its current technology On the other hand we may discover areas of a group practice s collection process that are not clear for the patient such as a hard to interpret billing statement We could work with the practice to retool the statement targeting its messaging to best meet the needs of the organization s patient population What are some key considerations for healthcare leaders when choosing solutions that encourage and enable patient payments Although organizations should seek vendors that offer an array of solutions it is even more imperative for the vendor to have a structure for measuring and communicating data about the tools performance Otherwise the healthcare organization can t be sure that the selected products are making a difference in patient revenue There are several metrics to measure including days outstanding patient satisfaction charity care percentage bad debt percentage and so forth Vendors should be willing and able to regularly share this data allowing the healthcare organization to gauge the impact of new software processes and workflows Organizations should also make sure a vendor has a strong track record in improving patient payment with similar organizations The more a vendor works with other entities the more it can see what best practices are in the field and apply those best practices to specific situations Seeking vendors that can deliver quick results is also important With most organizations in belt tightening mode there is a genuine need to make sure any technology investments rapidly move the needle toward more revenue For example Apex clients realize significant improvements in just a matter of months seeing on average a 10 percent increase in cash a 10 percent decrease in billing related costs and a 350 percent increase in online payments when patients take advantage of online payment opportunities the organization can see faster payments in fewer cycles In addition to optimizing revenue the vendor must keep the patient experience top of mind Although most people are happy with the clinical services they receive in a healthcare organization there can be dissatisfaction at the back end when the patient receives his or her bill especially if it s for an unexpected charge or the statement is overly confusing Apex products not only help meet a healthcare organization s financial goals they also address its patients needs facilitating clear financial conversations providing easy to interpret statements delivering greater payment opportunities and so on This improves the patient financial experience making it more likely that individuals will pay their bill and all the while preserving patient satisfaction Where can readers learn more about Apex s suite of solutions Readers can go to Apex s website to learn more about our products and how hospitals health systems and group practices are using them to revamp the patient revenue cycle I particularly recommend the following white papers Reduce Patient Balances Sent to Collection Agencies This report discusses the importance of patient statement segmentation Approaching segmentation with more strategic

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  • HealthPort: Ensuring Compliant Exchange of Protected Health Information
    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 Sunday March 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Brian Grazzini CFO HealthPort describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission critical projects Tell me a little about your organization With a national footprint HealthPort is the leading provider of release of information ROI services as well as audit management and tracking technology In fact established almost 40 years ago we are the nation s first ROI company and have really driven development of this segment of the industry In the United States we currently partner with more than 13 500 hospitals health systems physician practices and clinics to process and fulfill medical record requests and maintain compliance related to the release of medical information to all types of requesters We process 25 million requests per year Given our expertise we also provide thought leadership on HIPAA compliance governance and guidance pertaining to audit management and release of information through webinars seminars our national user meeting and presentations at state healthcare associations Because we work with so many organizations we feel a sense of responsibility for disseminating best practices in release of information services so that organizations can successfully adapt to changing practices What are most healthcare organizations seeing today with respect to requests for audits The volume of requests has increased tremendously which has caught many by surprise and created an overwhelming paperwork burden In fact for many the number of requests has doubled over the past few years And it s not going to slow down in the years to come HIPAA the Affordable Care Act increasing costs of health care and changing demographics relating to utilization are just a few of the factors that will continue to drive an increasing number of requests There are the government audits e g RAC MAC MIC as well as the health plan audits such as HEDIS Medicare risk adjustment and new this year a STARS program for all the plans that participated in the healthcare insurance exchanges The problem is that because organizations healthcare information services are increasingly tied up with responding to this volume of letters calls and administrative work they don t have the time they need to contribute at a mission critical level in their organizations Instead of sending records to attorneys they need to be actively involved in sharing data insights to better guide patient care In fact years ago healthcare information management HIM services used to be housed under a variety of functions and departments in organizations ranging from operations to compliance But increasingly we are seeing HIM reporting to the CFO as part of the revenue cycle due to the cost of IT desire for interoperability and importance of Meaningful Use in electronic health record technology I believe it s a trend that will continue to accelerate over the next decade Because HIM is so critical to the success of organizations in this new era we simply can t tie up these essential resources with responding to audit requests How can HealthPort s solutions address these kinds of challenges HealthPort Audit Relief manages audit requests securely and efficiently to eliminate this administrative burden By serving as the honest broker between providers and health plans we help everybody win For example for providers we advocate to negotiate deadline extensions when needed For health plans we offer complete automation of the request and direct delivery of medical records to drive efficiency By improving audit request turnaround time we reduce the natural friction that occurs there Providers can focus their resources elsewhere to improve patient satisfaction while health plans receive records faster Another way we aid both parties is that we are experts at increasing HIPAA compliance while reducing the risk of improper disclosure of health information Each year all HealthPort employees complete mandatory HIPAA training In short we protect revenue decrease costs and improve patient staff and requester satisfaction What are some key considerations when choosing a partner to manage audit requests Size and scale matter It s important to assess whether the company you are considering partnering with has the relationships to manage the volume to get the job done efficiently and effectively A solid track record of experience also is important Should something go wrong will they make it right Also focus on security Do they use defined practices to ensure they are compliant with HIPAA How will they keep privileged and confidential patient data safe Are they SOC certified Do they undergo penetration testing and rigorously enforce security measures Next assess whether there is seamless integration of technology It s important not to piece together a number of different technologies to support information exchange as that increases the risk of security exposures Ask Do they have a centralized intake process Centralization offers a distinct advantage in terms of efficiency for processing requests In fact we work with one California facility where staff find that it is faster to request internal records from us directly than to walk down to their mail room to procure them This is as it should be And finally choose a partner that understands both sides of the medical record request the provider and the health plan perspective The healthcare landscape has dramatically shifted with the implementation of the Affordable Care Act Collaboration with business partners is critical to success so it s important to identify suppliers who bring that mind set experience and capability Where can readers learn more about HealthPort s services Join us for a HIMSS webinar Three Ways to Strengthen the Provider Plan Relationship at 1 p m EDT April 2 Learn more about HealthPort s Audit Relief services or call 800 737 2585 HFMA is the

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  • Community Hospital Corporation: Supporting Community Hospitals
    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 Sunday March 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Cindy Matthews executive vice president Community Hospital Corporation discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions Tell me a little about your organization Community Hospital Corporation CHC is a not for profit corporation organized in 1996 by the CEOs of 13 not for profit health systems in Texas and New Mexico The CEOs goal was to preserve and protect community hospitals that were struggling financially by providing critical management resources so the organizations could remain viable to serve their communities And that s still our mission today to guide support and enhance the mission of community hospitals and healthcare providers Community hospitals are unique so they need different types of support There is no cookie cutter approach Through our three distinct organizations we offer consulting management and ownership models to meet these needs For example some organizations may require only strategic support through a menu of services on a consulting resource basis while others prefer a management agreement where we employ the CEO CNO and CFO and report directly to the board And sometimes hospital boards are interested in acquisition where we manage all aspects of the organization through a lease or ownership model It depends on what the hospital board and community need What are some of the biggest concerns you see among healthcare organizations The biggest challenge our community hospital partners face is reimbursement We work in many states Texas and Georgia for example where legislators have decided not to expand Medicaid These hospitals are extremely burdened with bad debt and indigent care And frequently independent hospitals find they need leadership resources to navigate these deeper levels of financial challenge At CHC we provide expertise to help hospitals maximize performance in the revenue cycle supply chain IT productivity and clinical areas among others Another issue facing many organizations around the country is the decline of inpatient utilization so we also assist with competitive strategy vision and growth We create new revenue growth strategies while also improving operations for greater efficiency What does the engagement process look like When we initially engage with a hospital whether we are consulting managing or leasing we begin with an operational assessment Our team of experts completes a desktop evaluation of data Then eight to 10 of our team members go onsite to evaluate what s occurring in the organization s areas of operation such as revenue cycle productivity and staffing and IT On the growth side we look at the medical staff needs through physician interviews to assess whether the community has the number of physicians it needs and to identify a recruitment and medical staff development plan that aligns with physician feedback We also conduct a community health needs assessment to understand unmet service needs in the marketplace for example whether there may be a need for cardiac or diabetic programming After the assessments are complete we provide a comprehensive report that identifies savings opportunities and then implement an action plan Can you share some key considerations for healthcare leaders when they consider partnering with an organization like yours When selecting a partner ask whether options are flexible so you can receive the right mix of resources Also seek the right level of experience Organizations need a partner able to understand what is happening in the healthcare industry and the marketplace from both a strategic and practical level Because we own hospitals we are not just consultants We put our recommendations into practice every day Also as a not for profit we don t answer to shareholders we answer to hospital boards and understand the importance of boards In fact all of our hospitals have a local fiduciary board even those we own or lease to ensure the community has a sense of control and a say of what happens to its hospital And of course cultural fit and mission compatibility should be at the forefront of any partnering decision Our mission at CHC is to ensure community hospitals are viable into the future We understand that these organizations are vital assets to those they serve As a result we will frequently work with the hospital board to identify a tertiary partner in the marketplace to team with us through a clinical affiliation Doing so creates a valuable reciprocal relationship In fact such partners will also typically help with physician recruitment by placing primary care physicians on campus for example and rotate their specialists through the community hospital to improve access to care Any other tips for how organizations can best set themselves up for success in integrating these types of services into daily operations Shared accountability is key Typically our team and the hospital team meet bi weekly especially in the early months of our collaboration to hold each other accountable and ensure it s very clear from the outset the ways progress will be defined the stakeholders assigned to each action item and the dates for completion The CHC team is deeply immersed in implementing operational improvements with our client hospitals We are there to answer questions when just a little help is needed or we roll up our sleeves onsite side by side with the local staff to get things done Reaching out for help is the first step a hospital can make toward financial and operational improvements Where can readers learn more about Community Hospital Corporation services Visit our website By clicking on the news and events tab readers can review more than a dozen case studies about our work with community hospitals and the results we have achieved together There is also a useful FAQ under that same tab as well as details on recent news awards and

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  • Deloitte: Solutions for Healthcare Transformation
    overall costs of care From a business point of view they are focused on how to grow their revenues and differentiate their services so their organizations can effectively serve their communities now and in the years to come They are looking for ways to be successful as they try to straddle the old world of volume based care while learning to manage for value based payment Value based care is outcomes focused so healthcare executives need to become adept at managing population health with the intended financial clinical and patient experience outcomes This transition isn t easy and every market is different Some organizations may be successful in managing the health of population segments in six months while others may take three years or more How do your services and solutions address these kinds of challenges Williams Much of what ConvergeHEALTH brings to the table is its currency with research and operations data coming out of a network of leading health systems that share data contribute leading practices share approaches to advanced analytics and share content In one example providers can benefit from the research outcomes that have come from working with academic medical centers to improve their disease management and population health management competencies By leveraging data analytics and these research insights other providers can learn how to better reduce unwanted variation improve care coordination leverage evidence based guidelines and support new payment models In the past we ve been data rich but information poor ConvergeHEALTH brings the opportunity to become data rich and information rich Also key is access to data that provide a more complete view of overall costs of care than previously possible We re able to move beyond just the clinical data that exist in the electronic medical record and the financial data that exist in the revenue cycle system to help providers also access claims data from the health plans so we can bring it all together for a 360 degree view Having all of the information integrated this way is providing new insights into ways process change can impact cost and quality metrics and ultimately how changes in care practices can support better patient outcomes Freiberger ConvergeHEALTH by Deloitte also helps providers understand how to use data to develop effective strategy ConvergeHEALTH s Insight solution aggregates many different data sources that we pull for clients we are vendor agnostic to deliver real time data analytics and patient stratification to guide an efficient care coordination process For example if your goal is to develop care protocols that address needs of particular patient populations you may first need to segment patients by risk from a population health standpoint You might then include this information as part of the workflows used by those who will provide services to these patients In this way the organization begins to leverage limited resources efficiently and focus efforts where improvement in patient outcomes may be greatest By applying predictive analytics to clinical risk and financial risk models healthcare organizations can provide clinical interventions where they will be most effective prior to patients needing care in more intensive and costly settings Williams It s really about helping everyone in the organization whether it s a physician nurse or administrator make better decisions When they have aggregated information at hand they can make real time decisions that are safer more effective and better for the patient experience By bringing information together in ways that answer your organization s most pressing questions you can support actionable real time decision making to advance care in a new and meaningful way What is important to evaluate when talking with potential suppliers to meet data analytics needs Williams First engage a company that understands health care very well and that can tailor its technical solutions to deliver the actionable insights you need in your organization These two capabilities are essential because the metrics that matter to you are likely to be different from those used by a different organization or marketplace Also look at the overall team s composition and expertise It takes a village to do this work because actuaries clinicians operations and technology folks must all work together to produce good analytics If you isolate these components you get far less effective solutions You need a team that is fluent in the languages all of these specialists speak Any other tips for maximizing the use of analytics in an organization Williams It s important to ask the right questions to yield actionable information For example common questions include How actionable are these analytics What are the core behaviors we need to change based on key biometrics How will I use these data to improve care and allocate resources differently to yield better results Also the future of health care is all about outcomes so measure those instead of tasks Freiberger Focusing on training also is important End users can benefit from training by someone in the organization who really understands the processes that already exist in the organization or the processes that need to be adopted Using a train the trainer approach can be a great way to embed the solution in the workflow so everyone uses it Also tools should be well aligned to normal workflow reflecting for example whether the user is an emergency department manager a contract manager for an accountable care organization or a care manager who is trying to help a patient navigate the system for the most efficient and cost effective care Where can readers learn more about Deloitte and ConvergeHEALTH by Deloitte Freiberger Learn more about Deloitte s Life Sciences Health Care practice and learn more about ConvergeHEALTH by Deloitte 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 Sunday February 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Robert Williams MD director Deloitte Consulting LLP and Arielle Freiberger product strategist ConvergeHEALTH by Deloitte explain how sophisticated retrospective real time and predictive data analytics can inform decision making to reduce costs and improve care Tell us a little about your organization Robert Williams MD Deloitte Consulting LLP serves providers health plans government and life sciences companies In fact we touch many industry stakeholders through our professional healthcare advisory services assisting with developing strategy around such areas as finance technology cost management population health and advanced analytics With ConvergeHEALTH we comprise a team that addresses the industry s complex challenges Arielle Freiberger ConvergeHEALTH is focused on answering the hard questions in health care What works for whom in what context and at what cost We use data and applied analytics tools to support organizations as they transition from volume to value based care so they can make better management and operational decisions to drive costs lower while improving the quality of care delivery and clinical outcomes What trends are you seeing in health care today that are really challenging businesses Williams CFOs we speak with today are typically concerned about operating efficiently and effectively as well as building the capabilities to manage utilization by populations and not just within the hospital but also in terms of the full care spectrum and in relation to controlling overall costs of care From a business point of view they are focused on how to grow their revenues and differentiate their services so their organizations can effectively serve their communities now and in the years to come They are looking for ways to be successful as they try to straddle the old world of volume based care while learning to manage for value based payment Value based care is outcomes focused so healthcare executives need to become adept at managing population health with the intended financial clinical and patient experience outcomes This transition isn t easy and every market is different Some organizations may be successful in managing the health of population segments in six months while others may take three years or more How do your services and solutions address these kinds of challenges Williams Much of what ConvergeHEALTH brings to the table is its currency with research and operations data coming out of a network of leading health systems that share data contribute leading practices share approaches to advanced analytics and share content In one example providers can benefit from the research outcomes that have come from working with academic medical centers to improve their disease management and population health management competencies By leveraging data analytics and these research insights other providers can learn how to better reduce unwanted variation improve care coordination leverage evidence based guidelines and support new payment models In the past we ve been data rich but information poor ConvergeHEALTH brings the opportunity to become data rich and information rich Also key is access to data that provide a more complete view of overall costs of care than previously possible We re able to move beyond just the clinical data that exist in the electronic medical record and the financial data that exist in the revenue cycle system to help providers also access claims data from the health plans so we can bring it all together for a 360 degree view Having all of the information integrated this way is providing new insights into ways process change can impact cost and quality metrics and ultimately how changes in care practices can support better patient outcomes Freiberger ConvergeHEALTH by Deloitte also helps providers understand how to use data to develop effective strategy ConvergeHEALTH s Insight solution aggregates many different data sources that we pull for clients we are vendor agnostic to deliver real time data analytics and patient stratification to guide an efficient care coordination process For example if your goal is to develop care protocols that address needs of particular patient populations you may first need to segment patients by risk from a population health standpoint You might then include this information as part of the workflows used by those who will provide services to these patients In this way the organization begins to leverage limited resources efficiently and focus efforts where improvement in patient outcomes may be greatest By applying predictive analytics to clinical risk and financial risk models healthcare organizations can provide clinical interventions where they will be most effective prior to patients needing care in more intensive and costly settings Williams It s really about helping everyone in the organization whether it s a physician nurse or administrator make better decisions When they have aggregated information at hand they can make real time decisions that are safer more effective and better for the patient experience By bringing information together in ways that answer your organization s most pressing questions you can support actionable real time decision making to advance care in a new and meaningful way What is important to evaluate when talking with potential suppliers to meet data analytics needs Williams First engage a company that understands health care very well and that can tailor its technical solutions to deliver the actionable insights you need in your organization These two capabilities are essential because the metrics that matter to you are likely to be different from those used by a different organization or marketplace Also look at the overall team s composition and expertise It takes a village to do this work because actuaries clinicians operations and technology folks must all work together to produce good analytics If you isolate these components you get far less effective solutions You need a team that is fluent in the languages all of these specialists speak Any other tips for maximizing the use of analytics in an organization Williams It s important to ask the right questions to yield actionable information For example common questions include How actionable are these analytics What are the core behaviors we need to change based on key biometrics How will I use these data to improve care and allocate resources differently to yield better results Also the future of health care is all about outcomes so measure those instead of tasks Freiberger Focusing on training also is important End users can benefit from training by someone in the organization who really understands the processes that already exist in the organization or the processes that need to be adopted Using a train the trainer approach can be a great way to embed the solution in the workflow so everyone uses it Also tools should be well aligned to normal workflow reflecting for example whether the user is an emergency department manager a contract manager for an accountable care organization or a care manager who is trying to help a patient navigate the system for the most efficient and cost effective care Where can readers learn more about Deloitte and ConvergeHEALTH by Deloitte Freiberger Learn more about Deloitte s Life Sciences Health Care practice and learn more about ConvergeHEALTH by Deloitte 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 Sunday February 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

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  • GE Healthcare: Delivering Sustainable Cost Reduction
    class patient care That requires an outcomes based approach to designing a holistic strategy The servicing of clinical assets provides an illustration Clinical device inventories tend to be excessive and service quality and consistency is often far from optimal Mergers and acquisitions have not improved this situation often contributing to service inefficiency Newly acquired hospitals bring more assets to already bloated inventories while disparate service practices from site to site hinder overall productivity Meanwhile clinical asset utilization from diagnostic imaging equipment to mobile medical devices hovers at all time lows Such inefficiency is one reason total service costs per bed increased by 90 percent on average over a 10 year period even as the hourly cost of providing service rose modestly at near the rate of inflation 3 Hospitals can address this trend by rethinking their clinical asset service approaches remaking and standardizing processes and letting data drive decisions Effective clinical asset service more appropriately called asset optimization has three pillars service model optimization mobile asset management and lifecycle planning Courageous strategies and actions in each area can bring rapid substantial and sustainable service cost reduction on the order of 10 to 20 percent What does an optimal service model look like There are two basic models in clinical device service in house service and outsourcing In house service offers advantages that include close oversight of variable expenses complete control of personnel and flexibility in setting priorities On the other hand outsourcing providers can bring economies of scale advanced training and assets not always available to in house departments such as the latest troubleshooting tools and analytical technologies that support planned maintenance compliance timely repairs high device uptime and efficient utilization all yielding cost savings of up to 15 percent However outsourcing versus staying in house is not an either or proposition Often the ideal model is a hybrid that takes the best from both approaches and avoids the cultural issues full outsourcing can bring In house teams retain their autonomy yet receive access to tools and expertise that external service providers bring Under hybrid service models cost reductions up to 10 percent are realistic A key issue is whether an organization has the will to challenge tradition and revisit its approach assessing the current model and its costs objectively analyzing alternatives and if the data warrant choosing a better and lower cost model that will help achieve the organization s goals Any other tips for examining cost structure Right sizing the asset fleet is also important Hospitals face a glut of equipment that is underutilized yet still needs to be maintained Devices such as ventilators infusion pumps and telemetry units make up some 95 percent of a hospital s clinical asset inventory The number of such devices per bed increased 62 percent over 15 years on average these devices are idle more than half the time 4 Still because of broken processes for storing distributing and cleaning equipment nurses often cannot find the right device when they need it Newer processes can boost utilization from the typical 40 percent to as high as 70 percent The staff can then deliver the same quality of care with much lower inventory while reducing service costs by 4 to 6 percent Of course this requires significant change The clinical team must dissect existing processes find the flaws devise fixes and set new procedures Leaders then must enlist the team to abandon old habits and embrace the new ways of working Once new processes are in place technology can help monitor progress and reinforce compliance For example real time location systems can monitor the new workflow and report exceptions such as assets improperly stored or an inadequate number of infusion pumps in a clean room The net results are lower spending on devices and less equipment to maintain Also important is focusing on using capital wisely Healthcare providers may invest millions more than necessary in equipment Again process is at fault Often a committee reviews department requests and decides to buy new imaging systems because a prominent physician wants one because an existing system is getting old or for other reasons not rooted in analytical rigor An effective technology planning process analyzes a range of factors such as asset ages and utilization patterns local healthcare market trends patient demographics and the organization s strategic objectives Data analytics then help produce an objective five year plan that spells out what to purchase and when which assets to retire and ways underused assets might be redeployed A technology plan of this kind helped one Midwest healthcare network avoid 12 5 million in capital spending in the first year alone Any last advice for readers No cost out initiative will succeed without strong advocates in the executive suite who develop the vision set meaningful targets and catalyze execution throughout the enterprise Leadership can provide the energy to drive new processes that help boost service efficiency increase asset utilization and preserve precious capital Also learn from others successes with standardization Systemwide methods of delivering service managing mobile assets and planning capital purchases can enhance productivity and drive down service costs I encourage readers to learn more about how we are helping others adopt such approaches to navigate the coming era s cost challenges 1 L E K Consulting and GE Healthcare analysis 2 Weber D J Rutala W A Huslage K et al Role of Hospital Surfaces in the Transmission of Emerging Health Care Associated Pathogens Norovirus Clostridium Difficile and Acinetobacter Species American Journal of Infection Control 2010 3 Out of Control How Clinical Asset Proliferation and Low Utilization Are Draining Healthcare Budgets General Electric Company 2012 4 Ibid 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 GE 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 Publication Date Sunday February 01 2015 BACK TO PAGINATION Advertisement In this Business Profile Scott Elston strategic accounts manager GE Healthcare Services describes how substantial cost reduction in health care requires rethinking business strategy and asset use Tell me about your organization GE Healthcare provides transformational medical technologies and services that are shaping a new age of patient care Our broad expertise in medical imaging and information technologies medical diagnostics patient monitoring systems drug discovery biopharmaceutical manufacturing technologies performance improvement and performance solutions services helps our customers to deliver better care to more people around the world at a lower cost Why is focusing on cost management so important at this particular time Consensus holds that healthcare organizations must cut operating costs by 10 percent or more to withstand reimbursement pressure and maintain a positive financial profile This new normal involves step function changes in delivering care and rethinking of traditional norms on optimizing hospital operations with a keen eye toward productivity How serious is the cost issue One analysis shows the average health system s operating margin is 3 5 percent today and it will be a negative 4 5 percent margin by 2020 1 Responses to this challenge include a wave of mergers and acquisitions undertaken for scale and efficiency Healthcare consolidation has increased more than 50 percent since 2009 2 However consolidation alone is not a remedy How else should organizations be approaching cost Experience with hundreds of healthcare providers shows that those most successful at cost reduction are those best able to identify meaningful and sometimes hidden opportunities to deliver sustainable savings without sacrificing the delivery of world class patient care That requires an outcomes based approach to designing a holistic strategy The servicing of clinical assets provides an illustration Clinical device inventories tend to be excessive and service quality and consistency is often far from optimal Mergers and acquisitions have not improved this situation often contributing to service inefficiency Newly acquired hospitals bring more assets to already bloated inventories while disparate service practices from site to site hinder overall productivity Meanwhile clinical asset utilization from diagnostic imaging equipment to mobile medical devices hovers at all time lows Such inefficiency is one reason total service costs per bed increased by 90 percent on average over a 10 year period even as the hourly cost of providing service rose modestly at near the rate of inflation 3 Hospitals can address this trend by rethinking their clinical asset service approaches remaking and standardizing processes and letting data drive decisions Effective clinical asset service more appropriately called asset optimization has three pillars service model optimization mobile asset management and lifecycle planning Courageous strategies and actions in each area can bring rapid substantial and sustainable service cost reduction on the order of 10 to 20 percent What does an optimal service model look like There are two basic models in clinical device service in house service and outsourcing In house service offers advantages that include close oversight of variable expenses complete control of personnel and flexibility in setting priorities On the other hand outsourcing providers can bring economies of scale advanced training and assets not always available to in house departments such as the latest troubleshooting tools and analytical technologies that support planned maintenance compliance timely repairs high device uptime and efficient utilization all yielding cost savings of up to 15 percent However outsourcing versus staying in house is not an either or proposition Often the ideal model is a hybrid that takes the best from both approaches and avoids the cultural issues full outsourcing can bring In house teams retain their autonomy yet receive access to tools and expertise that external service providers bring Under hybrid service models cost reductions up to 10 percent are realistic A key issue is whether an organization has the will to challenge tradition and revisit its approach assessing the current model and its costs objectively analyzing alternatives and if the data warrant choosing a better and lower cost model that will help achieve the organization s goals Any other tips for examining cost structure Right sizing the asset fleet is also important Hospitals face a glut of equipment that is underutilized yet still needs to be maintained Devices such as ventilators infusion pumps and telemetry units make up some 95 percent of a hospital s clinical asset inventory The number of such devices per bed increased 62 percent over 15 years on average these devices are idle more than half the time 4 Still because of broken processes for storing distributing and cleaning equipment nurses often cannot find the right device when they need it Newer processes can boost utilization from the typical 40 percent to as high as 70 percent The staff can then deliver the same quality of care with much lower inventory while reducing service costs by 4 to 6 percent Of course this requires significant change The clinical team must dissect existing processes find the flaws devise fixes and set new procedures Leaders then must enlist the team to abandon old habits and embrace the new ways of working Once new processes are in place technology can help monitor progress and reinforce compliance For example real time location systems can monitor the new workflow and report exceptions such as assets improperly stored or an inadequate number of infusion pumps in a clean room The net results are lower spending on devices and less equipment to maintain Also important is focusing on using capital wisely Healthcare providers may invest millions more than necessary in equipment Again process is at fault Often a committee reviews department requests and decides to buy new imaging systems because a prominent physician wants one because an existing system is getting old or for other reasons not rooted in analytical rigor An effective technology planning process analyzes a range of factors such as asset ages and utilization patterns local healthcare market trends patient demographics and the organization s strategic objectives Data analytics then help produce an objective five year plan that spells out what to purchase and when which assets to retire and ways underused assets might be redeployed A technology plan of this kind helped one Midwest healthcare network avoid 12 5 million in capital spending in the first year alone Any last advice for readers No cost out initiative will succeed without strong advocates in the executive suite who develop the vision set meaningful targets and catalyze execution throughout the enterprise Leadership can provide the energy to drive new processes that help boost service efficiency increase asset utilization and preserve precious capital Also learn from others successes with standardization Systemwide methods of delivering service managing mobile assets and planning capital purchases can enhance productivity and drive down service costs I encourage readers to learn more about how we are helping others adopt such approaches to navigate the coming era s cost challenges 1 L E K Consulting and GE Healthcare analysis 2 Weber D J Rutala W A Huslage K et al Role of Hospital Surfaces in the Transmission of Emerging Health Care Associated Pathogens Norovirus Clostridium Difficile and Acinetobacter Species American Journal of Infection Control 2010 3 Out of Control How Clinical Asset Proliferation and Low Utilization Are Draining Healthcare Budgets General Electric Company 2012 4 Ibid 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 GE 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 Publication Date Sunday February 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

    Original URL path: http://www.hfma.org/Content.aspx?id=28229 (2016-02-10)
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