What's the right population health management approach for your organization? In this white paper, you'll get a working definition of population health and learn why it's more important now than ever before. Plus, you'll gain insight into the 12 criteria that every health system should consider when evaluating population health management companies for success today and into the future.
As healthcare organizations become more adept at collaboration, data mining, and understanding the unique populations they serve, they are designing innovative care programs that involve higher risks and rewards.
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.
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.
Healthcare reform regulations, increasing costs, and more competition are driving employers and their health plans to focus more than ever on opportunities to reduce cost trends. For example, the country experienced a 3.0% growth in per capita gross (allowed) medical and pharmacy costs from 2012 to 2013. Truven Health Analytics anticipates those costs in 2014 and 2015 will increase by 4% to 5% or more. By taking a data-driven approach, payers can manage costs and, ultimately, make their benefit programs sustainable in the context of healthcare reform. They can also maximize opportunities to improve population health and productivity and optimize the delivery of care.
In response to concerns raised by healthcare leaders that the absence of adjustment for socioeconomic status (SES) and race characteristics in patient populations impedes the fair comparison of hospitals on risk-standardized 30-day unplanned readmission rates, Truven Health AnalyticsTM evaluated the extent to which risk-adjusted readmission rates for acute myocardial infarction, heart failure, and pneumonia are affected by adjustments for community-level SES factors through its Community Need Index (CNI) and patient race. The study shows there is, indeed, a statistically significant effect. For more, visit truvenhealth.com/wp/readmissionpenalties.
Published By: Parallon
Published Date: Sep 16, 2015
A recent HealthLeaders Media Intelligence survey asked respondents to rank their top challenges impacting financial performance and to identify specific areas of concern within each of those issues. Their top three issues were system implementation and interoperability, recruiting and retaining talent, and reengineering the revenue cycle. On the surface, it’s tempting to think these findings aren’t surprising. Yet emerging external factors, including the cumulative effects of the HITECH Act (meaningful use), the Affordable Care Act, and an aging U.S. population, are creating new frameworks in which to view and solve these traditional problems.
Published By: Parallon
Published Date: Dec 18, 2015
Download the free, on-demand version of this webcast that took place on December 16, 2015.
Change is commonplace within the healthcare industry. Executives are faced with many of the traditional challenges of operating hospitals. Now emerging external factors like the HITECH Act (meaningful use), the Affordable Care Act and an aging U.S. population are pushing providers to change the frameworks in how they view and solve these traditional problems.
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.
We know that primary care is challenging today, but these challenges don’t have to derail your practice’s success. This resource from Greenway takes the top three challenges in primary care and explains how specialty-specific tools can help you meet them by achieving better clinical outcomes, improving population health, lowering costs and increasing practice profitability, while still providing compassionate care to patients.
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.
The healthcare industry continues to debate the definition of population health, but for San Diego–based Scripps Health, it’s pretty simple: Population health is the future of healthcare.
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.
Published By: McKesson
Published Date: May 27, 2015
The shift to value-based care creates a sharp increase in healthcare organizations and networks’ need for data collection, aggregation and analysis. This white paper outlines the challenges involved with performing population-level analyses, developing cost accounting and profitability analyses across care settings, evaluating care episodes and integrating quality data. It explores the limitations of targeted software solutions to provide cross-enterprise insights. Finally, it provides advice for healthcare executives regarding how to approach gathering quality and cost-related data and how to leverage technology and analytical expertise to drive risk-based contract success.
Rehab programs will experience a major infux of medically complex patients, including those with neurological conditions, in the coming decades. The drastic increase is being spurred by an aging population. For instance, stroke prevalence is expected to rise by 21% by 2030, and more than 1.2 million citizens are projected to have Parkinson’s disease.
This leaves rehab leaders with one signifcant question: What can be done to prepare for the increase of medically complex patients? By evolving to meet the needs of this changing population, rehab programs can successfully meet the challenge, providing patients with the highest level of care while achieving greater performance standards.
In this whitepaper, we’ll examine the three areas that drive the greatest impact on treating medically complex patients: • Clinical staff • Tech innovation • Patient and family member experience
This playbook outlines how insurance companies can evolve their business architectures to meet user demand, reduce risk and comply with regulations.
Insurers’ employees, partners and customers are increasingly interacting at the digital edge, where commerce, population centers and digital ecosystems intersect. A distributed interconnection platform at the digital edge allows insurance companies and ecosystem participants to accelerate their transformation and effectively compete with increasingly nimble challengers.
Building on the popular Threat of the Month series, Cisco researchers looked at notable 2018 cybersecurity incidents with a fresh perspective: what do they reveal about future adversary tactics? With this lens, they chose threats that best embody what defenders should expect in the year ahead. The report contains in-depth analysis, best practices, and trends to watch.