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.
Today in healthcare the communication infrastructure is the backbone in IT. New reimbursement models are amplifying the need for care coordination, and communication between multiple departments, constituencies, and workflows is required. High-performing healthcare systems are adopting enterprise communication solutions to eliminate silos of information, improve patient care during critical situations, and make the most of their IT budget.
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.
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.
In a panel discussion at the 12th annual SAS Health Analytics
Executive Forum in May 2015, leaders from Dignity Health,
Horizon Blue Cross Blue Shield of New Jersey, Janssen
Pharmaceuticals and SAS shared what they have done to prove
the value of analytics to their business leaders – and what has
worked for them as they developed an analytic culture in their
organizations and put analytic insights to work.
This paper is divided into two parts. The first part provides some background and a comparison of the types of episode analytics. Part two explores the real-world experiences of payers and providers in using episode analytics for payment bundling and other purposes.
Finally, we offer some recommendations on how to use episode analytics to reduce variations and manage contracts that involve financial risk.
Published By: Evariant
Published Date: Nov 14, 2016
Changing healthcare market forces, such as value-based care models, consolidation, and payer mix erosion, have propagated declining margins and fueled hyper-competition among healthcare organizations vying for market share. In this new world, determining effective patient engagement strategies has become paramount for hospitals and health systems as they strive to acquire, retain, and re-activate patients, and, ultimately, drive revenue. Now, more than ever, it is critical that healthcare organizations create and maintain positive, lasting relationships with their patients, both current and prospective, working to attract them into their network and keep them there.
Download this whitepaper to learn five issues that are most relevant to leaders of faith-based hospitals and health-care systems and examples of how faith-based institutions around the country are already tackling them in innovative ways.
Published By: Allscripts
Published Date: Jun 17, 2014
To prepare for value-based care models, Mercy Health System uses interoperable solutions to attest for Meaningful Use, implement 24 ACO clinical quality measures in three months, and achieve PCMH Level 2 Certification in eight sites. With a healthy EHR core, Mercy is prepared for future growth.
"In healthcare, as the trends supporting eHealth accelerate, the need for scalable, reliable, and secure network infrastructures will only grow. This white paper describes the key factors and technologies to consider when building a private network for healthcare sector enterprises, including:
Transport Network Equipment
Outside Fiber Plant
Reliability, Redundancy, and Protection
Services, Operation, Program Management, and Maintenance
Download our white paper to learn more."
This white paper describes how cloud computing can help healthcare organizations reshape their business models and services, design innovative ways of providing better, patient-centered care, and empower consumers to take greater participation in their health.