Archive for the ‘Healthcare Administration’ Category

A New Era of Patient Engagement and Information Sharing

January 14th, 2021 by April Todd

Directory Assistance: The one thing payers and developers need before the full potential of the Final Interoperability and Patient Access Rule will be realized.

This summer, when the Centers for Medicare and Medicaid Services (CMS) issued the Interoperability and Patient Access Final Rule, they opened the door to a new era of patient engagement and information sharing.

The rule is designed to allow Americans to track their health insurance claims, prior authorizations, labs, scans and related information using commercially available mobile apps. Under the rule, when a member changes health plans, he or she will be able to use the app to share this information with the new insurer.

In addition to empowering patients with greater information about their claims, coverage and health history, the rule will facilitate better decision-making, care coordination and, in turn, health outcomes.

Yet, to make all of this a reality, one important piece is missing.

The CMS rule requires plans and app developers to use Fast Healthcare Interoperability Resource (FHIR) application programming interfaces (APIs) to share information. The FHIR standard was developed by the industry to allow thousands of disparate systems and apps to communicate with one another.

For this new ecosystem to work, payers and app vendors will need to be able to quickly and accurately find the digital address of the other parties with whom consumers want to share their health information. Today, there are more than 300,000 possible connections and, without a directory of FHIR endpoints, each plan or developer would have to find, catalogue, verify and maintain these addresses on its own.

The parties involved have recognized that this is a significant challenge, and the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) FHIR at Scale Task Force (FAST) determined an endpoint directory is needed to advance FHIR implementation.

CAQH, an alliance of plans and other healthcare stakeholders, was established 20 years ago to address just this kind of industry-wide challenge by streamlining and improving provider data management, coordination of benefits, health plan directories and other essential business functions. CAQH has also brought the industry together to develop the common operating rules that allow administrative information to flow seamlessly across the healthcare industry.

In close collaboration with a broad range of industry partners, including the technology company Edifecs, CAQH is developing an endpoint directory to build on the ONC FAST foundation and simplify the exchange of data between health plans and third-party app developers. CAQH presented a prototype at several recent industry events, including the HL7 FHIR Connectathon, to gather feedback and ensure that the solution effectively meets the task at hand.

At ONC’s “Accelerating APIs in Healthcare,” CAQH announced that it would continue to engage implementers and industry experts with the goal of launching a beta version of the directory in early 2021.

This timing is critical. Among other deadlines in the CMS rule, plans are required to implement the patient access APIs in January 2021 and a process for payer-to-payer exchange by 2022. The CAQH directory will enable plans to meet these aggressive deadlines.

It may be several months before consumers begin to manage their healthcare on their phones and claims history flows smoothly between health plans. However, with an endpoints directory at hand, that day is drawing near, and we may just be about to enter a new era in consumer-driven healthcare.

About the Author: April Todd, Senior Vice President, leads the CORE and Explorations initiatives for CAQH. She is responsible for leading multi-stakeholder collaborations driving the creation and adoption of healthcare operating rules for electronic administrative transactions, researching opportunities for further administrative automation, and establishing a common foundation for new interoperability initiatives.

Infographic: 5 Ways to Support Your Advanced Practice Providers

February 24th, 2020 by Melanie Matthews

Advanced practice providers (APPs) are becoming increasingly valued in healthcare delivery, seeing a 55 percent increase in number within the past 10 years alone, according to a new infographic by VITAL WorkLife.

The infographic examines how healthcare organization can best support this integral role.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial Outcomes While others wait for the healthcare industry to complete its transition to value-based reimbursement, Bon Secours Medical Group has already aligned itself with payment reform, leveraging its care team and providers and automating workflows to enjoy immediate rewards from its patient-centered approach.

Positioning for Value-Based Reimbursement: Leveraging Care Management for Clinical and Financial Outcomes describes how this 600-provider medical group has primed its providers to employ a broad mix of team-based care, technology and retooled care delivery systems to maximize quality and clinical outcomes and reduce spend associated with its managed patients.
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Infographic: U.S. Statistics on Surprise Medical Billing

February 21st, 2020 by Melanie Matthews

Out-of-network charges typically expose patients to higher cost-sharing when they use services and may lead to balance billing—in which healthcare providers bill patients directly, often at an unexpectedly higher rate. In the past two years, one in five insured adults had an unexpected medical bill from an out-of-network provider, according to a new infographic by Kaiser Family Foundation.

The infographic examines unexpected and “surprise” medical billing trends across the United States.

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: 2020 Medicare Physician Fee Schedule: Chronic Care Management

January 24th, 2020 by Melanie Matthews

The Centers for Medicare and Medicaid Services’ final 2020 Physician Fee Schedule contains specific changes to the chronic care management program, according to a new infographic by Navigating Cancer, Inc.

The infographic outlines the top-level CCM changes.


Healthcare Trends & Forecasts in 2020: Performance Expectations for the Healthcare IndustryGiven the powerful patterns disrupting healthcare, what will it take to succeed as a high-velocity healthcare organization in the coming year?

Healthcare Trends & Forecasts in 2020: Performance Expectations for the Healthcare Industry, HIN’s 16th annual business forecast, is designed to support healthcare C-suite planning as leaders continue to strive to improve healthcare quality and access and reduce costs as the industry continues its move toward a value-based system.

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Infographic: Strategic Pricing Factors for a Healthcare Provider

January 10th, 2020 by Melanie Matthews

Price is an increasingly important factor as consumers shop for product network benefits and choose healthcare services. Providers need a pricing strategy that is responsive to this new reality, according to a new infographic by BDC Advisors.

The infographic highlights essential factors to consider when determining a pricing strategy.

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: 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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Have an infographic you’d like featured on our site? Click here for submission guidelines.