risk

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.

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.

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 HealthLeaders Media Physician Alignment Survey confirms there is continued deep support for clinical integration across our industry. We see some clear trends in how hospitals and health systems use clinical integration and risk sharing to work toward physician alignment and better access.

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.

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.

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.

Truven Health Analytics™ evaluated the extent to which community need— a measure of the underlying economic and social factors that affect the overall health of a community, including income, cultural/language barriers, education, insurance and housing—is associated with elevated rates of preventable hospitalizations or an increased risk of hospitalization believed to be preventable with quality ambulatory care. The results of this investigation reveal a modest but statistically significant association between community need and an increased risk of hospitalizations that are believed to be preventable with good-quality ambulatory care.

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.

Driving financial performance in the outpa­tient setting is a top-of-mind priority among senior health system leaders. But managing the differing clinical documentation methodologies and risk assessment strategies present the great­est challenges to optimizing this important source of reve­nue, according to a recent HealthLeaders Intelligence survey. Provider organizations are finding the ambulatory setting is still a ‘Wild, Wild West’ in terms of assessing risk, clinical documentation, coding billing and medical record keeping practices. Download this report to discover key targets to improve ambulatory revenue.

For a non-profit enterprise seeking to design effective investment portfolios for its asset pools, understanding the role of each of those asset pools is a crucial first step. The organization's goals and exposures can impact all parts of its portfolio construction process, from initial broad decisions on risk tolerance to more targeted decisions on asset-class exposures and investment vehicle preferences.

Email is the most used communication tool in business. It's so easy to click that seemingly innocent 'Send' button that you may not realize the risk. Find out your next steps to an implementing an effective secure email strategy.

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.

Download this whitepaper to learn the following: 1. Background and basis of decreasing payments and increasing risks 2. Challenges and opportunities associated with the trend 3. How to thrive versus simply survive in this new healthcare environment

To achieve population health success, providers must identify high-risk patient populations, apply evidence-based care plans and interventions, and engage patients in their own care. Learn how.

To achieve population health success, providers must identify high-risk patient populations, apply evidence-based care plans and interventions, and engage patients in their own care. Learn how.

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.

There is a growing need for granular de-identified health information, but many organizations are unsure of where to begin. This Privacy Analytics white paper is designed to guide you through the process of risk-based de-identification.

"Extracting value from data is central to the digital transformation required for businesses to succeed in the decades to come. Buried in data are insights that reveals what your customers need and how they want to receive it, how sales, manufacturing, distribution, and other aspects of business operations are functioning, what risks are arising to threaten the business, and more. That insight empowers your businesses to reach new customers, develop and deliver new products, to operate more efficiently and more effectively, and even to develop new business models. "

SagecommissionedForresterConsultingtoconducta TotalEconomicImpact™(TEI)studytoexaminethe potentialreturnoninvestment(ROI)organizationsmay realizebydeployingits Enterprise Management solutionas part of Sage Business Cloud.Thepurpose ofthisstudyistoprovidereaders withaframework to evaluatethepotentialfinancialimpactof Enterprise Managementwithintheir organizations. Tobetter understandthebenefits,costs,andrisks associatedwithaninvestmentinEnterprise Management,Forrester conducted in-depth interviews withtwoEnterprise Managementcustomers. For a brief description of each customer, see the Analysis section. According toSage,Enterprise Managementis an integratedand globalenterprise business management solution for purchasing, manufacturing, inventory, sales, customer service,and financial management. Formoredetails ontheEnterprise Management solution,seeAppendix A. For this TEI study, Forrester has created a compositeOrganizationto illustrate the quantifiable benefits and costs of investing i

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.

To provide insight into the current environment for startups, and how emerging growth companies can best manage growth and risk, six prominent venture capitalists weigh in on the subject.

In today’s rapidly changing economy, business leaders are constantly thinking about how to attract, engage, manage, develop and retain their talent. The brisk rate of technology transformation, the increase in demand for unique skills and the expansion of regulatory requirements all create challenges as well as opportunities around attracting and developing a diverse workforce. Quickly and effectively responding to the business needs of your employees by optimizing processes and technologies—while mitigating risk—enables you to drive growth, productivity and profitability.