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.
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.
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.
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.
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.
Learn about the HPE Intelligent Data Platform and the new IT realities it addresses. With digital transformation underway in many organizations, more dynamic business models are becoming the key to success. This means infrastructure modernization and the introduction of technologies such as solid state storage, artificial intelligence and machine learning, software-defined infrastructure, and the cloud. At the same time, it means IT infrastructure management becomes much more complex. Enter HPE’s Intelligent Data Platform. With comprehensive coverage and AI/ML-driven real-time optimization that enables intelligent management of the entire data life cycle, the HPE Intelligent Data Platform enables an organization to get the most out of its IT resources while also meeting its evolving needs over time.
U.S. Flood is a high-gradient, intricate peril incorporating various sources, and causing a variety of effects. It requires sophisticated models, data science, and analytics technology to properly understand and assess each risk.
PKI is becoming a critical underpinning to help organizations succeed as they roll out new digital business models. Establishing a trusted infrastructure through PKI will help businesses take smart risks, evolve quickly and manage relationships with customers, partners, vendors and employees more effectively.
Certificate management is a crucial part of a robust PKI implementation, ensuring visibility and adherence to policy throughout the certificate lifecycle: from identity vetting, to issuance, to renewal to revocation. As Gartner noted in its recent report, “PKI is Gearing Up for the Internet of Things”
"Agile BI requires more than just agile dashboards. True agility means prototyping data models quickly so business users can continuously iterate on them. Application development and delivery professionals working on BI initiatives should consider adding DWA platforms to their BI toolbox.
This Forrester report discusses how seven data warehouse automation vendors bring Agile options to all phases of BI/analytics application development. Read more to find out how these platforms help facilitate shorter development cycles."
Forces such as consumerisation, expanding regulatory requirements and the shift to outcome-based pricing are all compelling procurement leaders to re-evaluate strategies.
Read this briefing to find out:
• the key disruptors shaping the future of procurement
• how to develop an agenda to deal with disruption
• seven key areas of difference between current and future procurement models
• essential questions to inform your strategic thinking.
If procurement organisations are to sustain their value to the enterprise, they must pivot to new operating models that embed customer-centricity in their technology, process and people.
Read this report to discover:
• the four convergence trends driving change and opportunity for procurement organisations
• the nine differentiators for customer-centric procurement leaders
• how and why you should be leveraging CX procurement technology."
In this guidebook, learn how modern retailers are using integrated hardware and software POS solutions to expand the range of their customer interactions. One thing is certain, hardware and software must work together to readily accommodate new consumer demands.
Digital commerce platform complexity continues to increase due to constant changes in product offerings and functionality, technology delivery, and pricing models. We evaluate the viability of 13 vendors to assist application leaders supporting digital commerce in making an objective evaluation.
A perfect storm of legislation, market dynamics, and increasingly sophisticated fraud strategies requires you to be proactive in detecting fraud quicker and more effectively.
TIBCO’s Fraud Management Platform allows you to meet ever-increasing requirements faster than traditional in-house development, easier than off-the-shelf systems, and with more control because you’re in charge of priorities, not a vendor. All this is achieved using a single engine that can combine traditional rules with newer predictive analytics models.
In this webinar you will learn:
Why a fraud management platform is necessary
How to gain an understanding of the components of a fraud management platform
The benefits of implementing a fraud management platform
How the TIBCO platform has helped other companies
Unable to attend live? We got you. Register anyway and receive the recording after the event.
AA Ireland specializes in home, motor, and travel insurance and provides emergency rescue for people in their homes and on the road, attending to over 140,000 car break downs every year, 80% of which are fixed on-the-spot.
“In each of the last five years, the industry lost a quarter billion in motor insurance," says Colm Carey, chief analytics officer. "So, there's a huge push for new data, models, ways to segment and pick profitable customer types—and get a lot more sophisticated. Our goal is to optimize pricing, understand the types of customers we're bringing, and the types we're trying to attract. We would like to tie that across the business. Marketing will run a campaign, trying to attract a lot of customers, but maybe they're not the right type. "We wanted to step away from industry standard software and go with something that was powerful and future-proof. In 2016, we had an opportunity to analyze all software.
We chose the TIBCO® System of Insight with TIBCO BusinessWorks™ i
FINANCIAL SERVICES’ HISTORY OF DISRUPTION
Financial Services is an industry driven by disruption. Transformative business models such as low-cost brokerages, innovative investment products like ETFs, and the huge regulatory mandates like Gramm-Leach-Bliley are but a few examples. Here are some others:
• New fintech firms such as a recent nine billion dollar investment in Ant Financial Services Group and myriad other venture capital-led fintech startups targeting well established segments across the financial services industry
• Robo-advisor services powered by artificial intelligence and machine learning intermediating financial advisors and portfolio managers alike
• Ever changing regulatory and risk management mandates, such as GDPR, Basel III, and Open Banking, transforming customer engagement and capital allocation
Read this whitepaper to learn how you can overcome these and other disruptions.
The current trend in manufacturing is towards tailor-made products in smaller lots with shorter delivery times. This change may lead to frequent production modifications resulting in increased machine downtime, higher production cost, product waste—and the need to rework faulty products.
To satisfy the customer demand behind this trend, manufacturers must move quickly to new production models. Quality assurance is the key area that IT must support.
At the same time, the traceability of products becomes central to compliance as well as quality. Traceability can be achieved by interconnecting data sources across the factory, analyzing historical and streaming data for insights, and taking immediate action to control the entire end-to-end process. Doing so can lead to noticeable cost reductions, and gains in efficiency, process reliability, and speed of new product delivery. Additionally, analytics helps manufacturers find the best setups for machinery.