Published By: MedAssets
Published Date: Aug 01, 2014
While the challenges of implementing ICD-10 are well documented, the impact to the revenue cycle is not as well known. Revenue cycle leaders must model their payor contracts now to mitigate the risks that ICD-10 will bring.
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.
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.
An innovative staff scheduling model is reinventing how hospitals leverage their employees for better outcomes; including staff satisfaction, labor costs, and improved quality of care.
View the paper to learn the research behind this new approach!
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.
What do standard best practices for radiology look like? Without them, it is impossible for a hospital to identify the strengths and weaknesses of its current radiology services and strive for improvements.
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.
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.
Published By: Caradigm
Published Date: Feb 16, 2015
Many organizations joined the ACO program with the idea of using it as the first step in the transition to new reimbursement models. It’s a critical time for more ACOs to achieve the milestone of shared savings in order to demonstrate the ability to lower costs for an “at-risk” population. As best practices are emerging from early participants in the ACO program, ACOs have the opportunity to evolve their strategies in order to achieve more success.
How can providers and insurers reduce costs and increase patient satisfaction? In the evolving value-based care (VBC) model, better healthcare IT is a must have. L.E.K.'s Joseph Johnson and Harsha Madannavar identify key success strategies in our latest Executive Insights.
CEP America provides three case studies illustrating how integration across the acute care continuum and innovative models of care help manage populations by improving throughput, reducing readmissions, and producing superior hospital-wide metrics.
Published By: Parallon
Published Date: Oct 12, 2015
To succeed in today’s healthcare environment, hospitals and health systems must evaluate the best operating model for key functions to enhance efficiency and optimize performance. This often involves determining whether partnering with another organization to perform a business function makes sense for you.
In the rough-and-tumble world of community and rural hospitals, the phrase “innovate or get left behind” is no longer a scary suggestion thrown out by expensive consultants, but a daily reality for CEOs. Rocked by reform and big changes in areas including financing, care models, and population trends, chief executives are getting used to making bold leadership decisions on a regular basis.
In this in depth report, readers will learn about the factors driving companies toward a human resources outsourcing model, along with the risks and advantages of outsourcing human resources functions and processes, and the approaches available.
Basic diagramming tools allow business users to define an initial business process and provide a good path to getting your processes off of sticky notes and into a digital format. However, if company-wide collaboration, real-time change management and integration with automation tools are important to you, a dedicated process modeling tool may be your better choice.