In the post-ACA era, aligning physicians with organizational goals appears to be gaining traction in health systems and hospitals nationwide. Based on a February survey of the HealthLeaders Media Council, comprising executives from healthcare provider organizations across the country, physician alignment remains a complex challenge.
Even as value-based care continues to take effect, clinical integration or alignment is quickly emerging from a need to ensure quality, cut costs, and drive referrals across health systems and hospitals. Directly employing physicians has been one of the main strategies healthcare leaders are using to improve physician alignment with health systems.
Download this free report today, and learn about the results of aligning the goals of physicians and organizations.
Frost & Sullivan’s award was bestowed on GE’s Centricity Financial Risk Manager which enables healthcare systems to reduce the cost of administering risk-based contracts, thus improving profitability and maximizing efficient workflows.
Published By: MedAssets
Published Date: Aug 06, 2015
How can you prepare for regulatory reimbursement changes? Scenario planning is proving essential to cope with value-based reimbursement, shrinking networks and the Affordable Care Act. Strategize and plan for success by downloading this checklist.
Published By: MedAssets
Published Date: Nov 05, 2015
The shift to value-based care is one of the most significant financial, cultural and technological challenges ever faced by the U.S. healthcare system—and it will affect every stakeholder in the system. Healthcare providers can no longer focus solely on process-oriented measures and instead need metrics that gauge progress to deliver high-value care. This healthcare executive report provides three steps hospital executives can take now as they transition from volume to value and break down silos to create the infrastructure, processes and workflows required to succeed.
Creating a successful patient experience strategy is a long-term investment in planning, surveying, training, and technology. Healthcare organizations hope these efforts will pay off at the very least with a growing base of loyal patients, better care quality, and stable reimbursement. And then there are those organizations that are turning patient experience into a movement. What’s their endgame? They intend to build state-of-the-art service-oriented cultures that rival other industries, and they are doing it through data analytics, unique communication programs, radical cultural shifts, and consumer-centric technologies.
The Centers for Medicare & Medicaid Services, the nation’s largest payer, has set a clear direction with its publication of targets: By 2018, 50% of fee-for-service payments will be through alternative payment models, such as ACOs and bundled payments, and 90% of FFS payments will be tied to quality or value. And CMS has begun to introduce mandatory bundles. This suggests that all providers will
need to develop population health competencies, including the ability to manage risk for both cost and quality.
Alan Manning has an intimate view of what it takes to provide an outstanding patient experience, not only because he has been COO of Derby, Connecticut–based Planetree for four years, but also because he spent several months in the hospital with his critically ill daughter. That pivotal experience, while traumatic, solidified friendships with his daughter’s nurses and brought him several years later to Planetree, a nonprofit organization started in 1978 by a patient who wanted to help hospitals deliver stronger patient-centered care practices. Planetree works with 700 organizations in more than 17 countries.
The need for analytic tools to make sense of disparate data sources will certainly be expanding in the upcoming years. This report highlights what analytical data healthcare leaders are currently focusing on, as well as the challenges they expect to face when using analytics to support their organizations in the future.
This report outlines the top challenges providers are facing in the transition to value-based care. The results this year reinforce both the magnitude of the task and leaders’ reluctance to make a full commitment while details of emerging but still largely unknown payment models are unresolved.
Most providers are involved in at-risk payment models of one kind or another. Their experience now should help them develop expertise that will be vital when value-based payments are the norm. Among the lessons to learn today is how to benefit from closer working relationships with payers in the future. In this latest report, peer leaders examine ways to benefit from closer working relationships with payers.
Nearly six years after passage of the Patient Protection and Affordable Care Act, the healthcare industry is in the midst of a massive retooling that is dramatically altering the way we think about cost management, strategic partnerships, and customer service.
Fee-for-service reimbursement is giving way to new models of care delivery and payment to support a system based on pay-for-value. With financial risk or payments tied to value measures (such as patient satisfaction, clinical performance, and population health), compensation and reimbursement will increasingly be tied to value-based incentives.
Workforce management and the pursuit of productivity have formed a consistent pain point for hospitals for several years. The Affordable Care Act has only exacerbated the problem, increasing the demand on providers as the number of insured grows and the bar continues to rise on quality of care. According to a recent HealthLeaders Media Council survey, workforce productivity and acuity-based staffing will continue to be top priorities this year. Karlene Kerfoot, PhD, chief clinical integration officer at API Healthcare, says the survey results indicate a shift taking place as workforce management initiatives are expected to deliver more than reduced labor costs.
With the inception of Value-Based Purchasing, the measurement of successful patient care delivery has been redefined. The move from fee-for-service to pay-for-performance means that reimbursements are tied to the quality of care that is delivered.
The Truven Health 15 Top Health Systems study annually identifies those health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. Truven Health Analytics measures U.S. health systems based on a balanced scorecard across a range of performance factors: care quality, patient safety, use of evidence-based medicine, operational efficiency, and customer perception of care.
The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies hospitals that achieve the best performance on a scorecard of performance measures. This year, based on comparisons between the winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all cardiovascular providers performed at the level of this year’s winners, approximately 9,500 additional patients could survive, more than $1 billion could be saved, and almost 3,000 additional bypass and angioplasty patients could be complication-free. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.
The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies U.S. hospitals that have achieved the best performance on a balanced scorecard of performance measures. Based on comparisons between study winners and a peer group of similar hospitals that were not winners, winners are achieving better outcomes while operating more efficiently and at a lower cost. If all cardiovascular providers performed at the same level of this year’s winners, almost 8,000 additional lives could be saved; nearly 3,500 heart patients could be complication free; and more than $1.3 billion could be saved.
U.S. healthcare providers are venturing into the treacherous waters of value-based care, and many are starting their voyages in leaky boats, according to a recent survey of industry executives conducted by HealthLeaders Media and sponsored by RelayHealth.
Creating a state-of-the-art clinical documentation improvement (CDI) program isn’t just about boosting coding accuracy. It’s a key strategy in managing the transition from volume-based to value-based care, say healthcare leaders. That transition is a risky endeavor that is putting hospital and physician financial performance to the test. As hospitals participate in new care and business models aimed at improving value, leaders must ensure that their organizations are able to maintain reimbursement levels, effectively treat the chronically ill—especially in outpatient settings—and gather accurate data that will allow them to assess performance and segment their varying populations. While some organizations often believe they are leaving revenue on the table because of documentation and coding issues, CDI offers numerous opportunities for improving financial performance, finds a recent HealthLeaders Media survey of 149 healthcare executives at provider organizations.
Providers are increasingly making the leap and investing in their organizations in preparation for value-based care. However, while no one wants to be behind the competency curve when it arrives, it can be expensive to build competency for a new model before it is financially viable, causing providers to remain cautious.
Registered nurses, with targeted training, are the secret weapon in the race for comprehensive care coordination.
Accountable care organizations. Patient-centered medical homes. Value-based reimbursements. Bundled payments. Healthcare is experiencing a revolution brought on by the Patient Protection and Affordable Care Act that aims to put patients squarely in the middle of all their clinical and financial decisions. Payers, including government agencies and insurers, are tying the quality and safety of patient care to reimbursements, making patient-centered care a necessity in all settings.
In many aspects of healthcare, we see indications of change, with movement toward new payment models and investments in infrastructure to support the delivery of value-based care. Cost control remains a top financial lever, but the discipline is becoming more complex. From a brute-force perspective, controlling cost has a direct effect on operating margin, which provides the classic move of cost control through cost cutting. Now, though, organizations need new command over cost factors themselves.
The shift to healthcare’s value-based model is being accelerated by measurable goals and an aggressive timeline. With improved patient experience as the objective, addressing root causes that impact patient satisfaction scores is crucial to success.
In late August 2014, the Centers for Medicare and Medicaid Services (CMS) announced plans to reinstate the Recovery Audit program on a limited basis. CMS reports the delay in restarting the Recovery Audit program was to enable the various RAC regions to restructure, allowing time for the appeals to catch up. Soon, however, the hiatus will end and RACs in all regions will resume automated reviews; these will be in addition to select complex reviews based on topics chosen by CMS.
Savvy healthcare organizations are embracing strategies to simultaneously improve the bottom line and care quality. Sometimes responsible for two separate aspects of the health system, now CFO and CNO collaboration is vital to a hospital’s success.