Archive for the ‘Healthcare Administration’ Category

Infographic: 5 Steps To Creating a Healthcare Culture of Accountability and Performance Excellence

November 20th, 2019 by Melanie Matthews

Many healthcare organizations fall short when it comes to creating and successfully implementing strategic and tactical initiatives. A lack of clear leadership accountability, insight into performance metrics, transparency and progress tracking cause many to lose sight of tactical actions that drive results, according to a new infographic by MedeAnalytics Inc.

The infographic provides five steps to create a culture of accountability and performance.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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Infographic: Violence Against Nurses: The High Cost of Patient Care

November 15th, 2019 by Melanie Matthews

Nurses are often subject to physical and verbal abuse while they’re taking care of patients, according to a new infographic by Rave Mobile Safety.

The infographic examines risk factors and trends in violence against nurses, the cost to healthcare providers, both legal and business.

With health coach support on two fronts, PinnacleHealth Systems is changing the patient engagement conversation—both among its staff of clinicians and its most disengaged patient population.

Dual Approach to Patient Engagement: Activating High Utilizers and Coaching Clinicians describes PinnacleHealth System’s two-pronged strategy for prioritizing patient engagement within its culture, and elevating key quality and clinical metrics in the process.

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Infographic: The Broken Healthcare Referral System

November 13th, 2019 by Melanie Matthews

Across the healthcare industry, it is generally agreed that in-network care coordination is important. However, with 19.7 million clinically inappropriate network referrals occurring each year, contradictions in referral behavior remain a concern, according to a new infographic by Evariant.

The infographic pinpoints shortcomings of the current healthcare referral system and highlights opportunities to solve these obstacles.

The release of the Centers for Medicare and Medicaid Services’ care coordination toolkit provides further evidence that care coordination is an integral part of the current healthcare delivery landscape. Whether part of the primary care office, emergency department or health plan, care coordinators are having a positive impact on both the clinical and financial outcomes for healthcare organizations.

2019 Healthcare Benchmarks: Care Coordination is a comprehensive analysis by the Healthcare Intelligence Network of care coordination settings, strategies, targeted populations, supporting technologies, results and ROI, based on responses from over 75 healthcare organizations to the May 2019 Care Coordination survey.

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Infographic: Key Strategies for Developing Successful Consumer-Driven Ambulatory Businesses

November 6th, 2019 by Melanie Matthews

To build a successful consumer-driven ambulatory care business in a value-based market, health systems must retool their ambulatory approach by investing time and resources in six key business strategies, according to a new infographic by BDC Advisors.

The infographic examines these six strategies.

2019 Healthcare Benchmarks: Patient EngagementThe perennial challenge for healthcare organizations as they continue to develop and refine programs aimed at improving healthcare quality while reducing costs is engaging patients in these initiatives. Actively engaged patients have been shown to have lower costs and improved outcomes.

In fact, a recent study released by Humana on its wellness rewards program, Go365®, found that high-engaged members had lower healthcare cost increases than members with low or medium engagement. These highly engaged members paid a per member per month average of 22 percent less in healthcare than low-engaged members, had 35 percent fewer emergency room visits and 30 percent fewer hospital admissions than low-engaged members and had 11 percent more preventive doctor’s office visits than low-engaged members.

2019 Healthcare Benchmarks: Patient Engagement is the third comprehensive analysis by the Healthcare Intelligence Network of programs aimed at improving patient engagement, including how patients are identified for patient engagement interventions, populations presenting the most significant challenges, program components and results and ROI, based on responses from over 50 healthcare organizations to the October 2019 patient engagement survey.

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Infographic: Healthcare Revenue Cycle Trends

October 14th, 2019 by Melanie Matthews

Electronic health record adoption challenges are still outweighing benefits, according to a study on the impact of EHRs, consumer self-pay, and IT budgets on revenue cycle operations by Navigant Consulting, Inc. and HFMA, highlighted in a new infographic.

The infographic explores: the struggles health systems face to optimize available EHR functions and upgrades; consumer self-pay concerns; revenue cycle IT budget growth; and more.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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Guest Post: 6 Barriers to Automating Prior Authorization

October 3rd, 2019 by April Todd

Automating prior authorizations could save the healthcare industry $417 million annually.

Prior authorization has been used for decades as an important check to ensure prescribed medical treatment is safe and appropriate. In recent years, however, it has become regarded by many as a frustrating, time consuming barrier to care.

Much of the frustration has to do with the fact that the overwhelming majority of prior authorizations are conducted using manual processes that can take days, and, in some cases, weeks, delaying patient care. Prior authorizations are also a financial burden on providers and plans. So much so that the industry could save $417 million annually if these transactions were automated, according to the 2018 CAQH Index.

In spite of the widespread frustration, the number of prior authorizations increased by 14 percent in 2018 over the previous year.

Increasing automation seems like an obvious solution, especially when there has been a federally-mandated standard for automating part of the process for more than a decade. But that just is not happening fast enough.

A recent CAQH CORE, an organization formed by the industry to develop common business rules to support healthcare transactions, white paper, identified six factors that have slowed end-to-end automation of prior authorization:

  1. Data is inconsistent

    Health plans use codes to communicate status, errors and next steps for prior authorizations—including the need for clinical documentation to prove medical necessity. But today, these requirements differ across (and within) health plans, and providers can’t easily identify what information is required. This lack of uniformity— and use of overly generic codes— limit adoption of the standard prior authorization transaction by providers.

  2. No federally mandated standard for “attachments” or clinical documentation

    As part of standard prior authorization requests, providers are asked to include “attachments” or clinical documentation. However, there is no national standard or uniformity for the supporting clinical documentation. This creates a sense of uncertainty about investments in various solutions, and results in workarounds that providers are asked to support.

  3. Lack of integration between clinical and administrative systems

    Electronic prior authorization requests typically require the use of practice management systems (PMS) and data from electronic health record (EHR) systems. But integration between PMS and EHR systems is limited. This forces most providers to retrieve clinical information from the EHR and manually enter it into the prior authorization request. This is not only an obvious source of human error, but also a frustrating drain on productivity and efficiency.

  4. Limited vendor products that support electronic prior authorization

    Only 12 percent of vendor products support electronic prior authorization, according to the 2017 CAQH Index. For all other electronic transactions, vendor support is between 74 percent and 91 percent.

    Some vendors indicated that, while their systems do currently support prior authorization, this functionality is not part of the core product offering. That is, prior authorization functionality may be available in some vendor systems, but only in a premium configuration.

  5. State requirements for manual intervention

    Some state legislatures have mandated that certain steps of the prior authorization process be handled manually. For example, in both Colorado and Rhode Island, health plans are required to give providers an opportunity to speak directly by phone or in person with a qualified medical professional before issuing an adverse determination. Some of these manual requirements are in place because a phone call or written letter may be a more trusted mode of receiving communication regarding determinations.

  6. Lack of provider awareness

    Many providers are unaware that HIPAA requires health plans to offer the standard prior authorization request to conduct prior authorizations electronically. Greater demand from providers can incent broader use of the standard and encourage development of vendor products to support its exchange.

How Do We Get to Automation?

Currently, there is a groundswell of support from a diverse group of stakeholders to improve the prior authorization process. The Department of Health and Human Services, federal and state policymakers, providers and health plans, industry coalitions and standard-setting organizations are all motivated to resolve the administrative burden associated with prior authorization—creating an unprecedented opportunity to find alignment and implement solutions.

So, Where Do We Start?

To reduce the prior authorization burden, it is important for all stakeholders to participate in developing standards that support automation, and follow them. CAQH CORE’s participating organizations, which encompass 75 percent of insured lives, have developed two sets of operating rules that are already addressing several of the challenges identified above. By adopting the Phase IV and V CAQH CORE Operating Rules, and participating in CAQH CORE’s prior authorization pilots, healthcare stakeholders can help accelerate the move toward automation of prior authorization.

This renewed spirit of collaboration is the pathway to reducing the prior authorization administrative burden. It is imperative for all stakeholders to actively encourage and participate in this collaborative momentum toward a more automated prior authorization end-to-end workflow.

April Todd

April Todd

About the Author: April Todd leads CAQH CORE, an initiative of CAQH that was formed to drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability and align administrative and clinical activities among providers, payers, and consumers. CAQH CORE is industry-led—representing more than 75 percent of insured Americans, including health plans, healthcare providers, vendors, government entities, and standard setting organizations. Five phases of CAQH CORE Operating Rules and Certification Test Suites have been issued to date.

Infographic: Four Ways To Navigate the Changing Landscape in Value-based Healthcare

September 27th, 2019 by Melanie Matthews

Value-based healthcare is, by all signs, the future of providing, and getting paid, for healthcare. Recent research indicates that hospitals are experiencing success by emphasizing several action areas, with changing mindsets being as important as altering operational models, according to a new infographic by Tork.

The infographic provides four opportunity areas every hospital manager or administrator should consider.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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Infographic: Physician Burnout: Critical Stats Impacting the Healthcare Industry

September 25th, 2019 by Melanie Matthews

Physician burnout is arguably the most pressing concern in healthcare today and impacts entire organizations. Between 40 percent and 60 percent (depending upon specialty) of practicing physicians experience burnout, according to a new infographic by SE Healthcare.

The infographic sheds light on the impact burnout has on the healthcare industry and presents ways that healthcare organizations can create positive change.

Proactive Care Management in a Top-Performing ACO: Closing Quality and Care Gaps in High-Risk, High-Utilization PopulationsAs one of 2016’s top 10 performing MSSP accountable care organizations, UT Southwestern Accountable Care Network (UTSACN) generated nearly $17.5 million in shared savings.

Proactive Care Management in a Top-Performing ACO: Closing Quality and Care Gaps in High-Risk, High-Utilization Populations divulges some of the secrets behind UTSACN’s success in the Medicare Shared Savings Program (MSSP) for ACOs. Winning strategies of the UTSACN ACO include a commitment to data analytics to inform programming and improve utilization and quality as well as holding its healthcare providers accountable for clinical and fiscal decisions. Click here for more information.

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Infographic: Transforming Your Patient Check-in Process

September 6th, 2019 by Melanie Matthews

The patient check-in process is a crucial moment for healthcare organizations. Using outdated, inefficient, and labor-intensive processes to collect, store, and transfer patient data during check-in threatens patient safety and satisfaction as well as the productivity and profitability of healthcare organizations, according to a new infographic by Formstack.

The infographic breaks down what healthcare organizations need to know to transform their patient check-in process.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action PlanUnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs. Armed with data from its Press Ganey and CAHPS ® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

During Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan a 45-minute webinar, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: Solving the Healthcare Performance Challenge

September 4th, 2019 by Melanie Matthews

Changes in patient expectations, reimbursement and technology are altering the course of healthcare, according to a new infographic by Optum, Inc.

The infographic examines the goals, power of expertise, design, alignment and results in this new landscape.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare UtilizationMedicaid expansion programs, newly covered individuals under healthcare insurance exchanges, the rise of big data, and shifts in healthcare delivery models have influenced emergency department and hospital utilization.

2019 Healthcare Benchmarks: Reducing Avoidable Healthcare Utilization is a comprehensive analysis by the Healthcare Intelligence Network of how healthcare organizations define and address avoidable healthcare utilization. The report captures key actionable metrics on reducing avoidable healthcare utilization initiatives, challenges, case studies and innovative programming.

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