Archive for the ‘Physician-Hospital Organizations’ Category

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: 8 Steps to Solving Physician Burnout

July 12th, 2019 by Melanie Matthews

Physician burnout is at an all-time high. Taking active measures to increase physician satisfaction is good for the physician, the patient, and the healthcare organization, according to a new infographic by MDsyncNET.

The infographic examines six warning signs of physician burnout, physician burnout trends and eight steps to reducing physician burnout.

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: How Millennial Physicians Are Transforming Medicine

June 26th, 2019 by Melanie Matthews

The emerging generation of healthcare providers is becoming increasingly diverse and is changing the practice of medicine, according to a new infographic by Visual Capitalist.

The infographic examines how they work and where they work.

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: Physician Shortage Trends

January 2nd, 2019 by Melanie Matthews

The United States could be short as many as 120,000 physicians by 2030, according to a new infographic by BoardVitals.

The infographic drills down on where the physician shortages are, how the aging of the United States population is impacting healthcare and the physician workforce, what specialties are experiencing shortages and the top-five shortage-fueled recruiting challenges.

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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2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

June 29th, 2017 by Patricia Donovan

Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

  • More than half—57 percent—participate in the Medicare Chronic Care Management program;
  • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
  • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
  • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
  • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

Providers, Patients Outline Healthcare Priorities to New HHS Secretary

February 16th, 2017 by Patricia Donovan

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents' minds.

As HHS secretary Tom Price begins his tenure, the ACA and physician reimbursement are on constituents’ minds.

As Rep. Tom Price settles into his new role as secretary of the Department of Health and Human Services (HHS), organizations representing physician practices, nurses, patient groups and actuaries are making their healthcare priorities known to the newly confirmed administrator.

Concerns range from the future of the Affordable Care Act, which President Trump pledged to repeal in a January 2017 executive order, to specifics of new physician reimbursement programs resulting from MACRA (Medicare Access and CHIP Reauthorization Act of 2015).

In a news release from the American Association of Nurse Practitioners, America’s leading nursing organizations called on the Trump administration and Congress to prioritize patient health and the patient-provider relationship in any health reform proposals. Representing over 3.5 million nurses, the organizations affirmed their shared commitment to advancing patient-centered healthcare and healthcare policies that reflect five key areas ranging from ensuring patients access to healthcare with affordable coverage options regardless of preexisting conditions to creating greater efficiency in the Medicare system.

On the patient side, I Am Essential, a coalition of more than 200 patient groups, asked Price to preserve key ObamaCare protections, including one that guarantees coverage for those with pre-existing conditions.

In its letter, the coalition said certain ObamaCare provisions have provided improved access to care to millions living with chronic and serious health conditions.

“While it is not a perfect law,” the letter stated, “The ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized.”

The letter concluded with the following statement: “As you make any changes, we urge you not to go back on the promise of affordable and quality care and treatment for everyone, especially those living with chronic and serious health conditions.”

Meanwhile, a letter from the Medical Group Management Association (MGMA), which represents more than 18,000 U.S. healthcare organizations in which 385,000 physicians practice, asked the new administrator to “significantly reduce the regulatory burden on physician practices and improve the quality and efficiency of healthcare delivery in this country.”

Focused on the federal payor’s new Quality Payment Program resulting from MACRA, the MGMA requested the following from Price, who worked in private practice as an orthopedic surgeon for nearly twenty years prior to launching his political career:

  • A reduction in the cost and reporting burden of the Merit-Based Incentive Payment System (MIPS);
  • A careful review of the eligible Advanced Alternate Payment Program (APM) risk standard and contend there is significant inherent risk in moving from fee-for-service to risk-bearing arrangements, including substantial investment and operational costs, as well as misaligned financial incentives between the payment systems; and
  • Legislative relief from the Federal Physician Self-Referral Law, which MGMA referred to as “a regulatory monster of mind-numbing complexity.”

MGMA represents physician groups of all sizes, types, structures and specialties, and has members in every major healthcare system in the nation.

And finally, the American Academy of Actuaries released three new issue briefs examining a number of key public policy considerations policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act.

The three papers, which address high-risk pools, selling health insurance across state lines, and association health plans, are available on the academy’s site.

“Differences in a reform’s structure can have wide implications for stakeholders and for how it interacts with other reforms that have been or may be adopted,” said Academy Senior Health Fellow Cori Uccello. “For example, high-risk pools can be structured in different ways, with different implications for access to coverage, premiums, and government spending. Further, how regulatory authority is defined for both cross-state insurance sales and association health plans affects whether insurers would compete on a level playing field.”

Infographic: Overcoming 5 Data Challenges Preventing Effective Physician Alignment

November 14th, 2016 by Melanie Matthews

Achieving physician alignment, critical to the success of health systems, requires a view into physician activity and referrals, according to a new infographic by Evariant.

Claims data is the best source of information to help analyze and identify referral patterns to move toward achieving physician alignment, but analyzing this information does not come without its own unique set of challenges. The infographic examines five data challenges preventing effective physician alignment and how to overcome them.

Overcoming 5 Data Challenges Preventing Effective Physician Alignment

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability In today’s value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts—models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians’ skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

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Infographic: Building a Million-Dollar Physician Relationship

August 1st, 2016 by Melanie Matthews

In today’s competitive healthcare environment, hospitals and health systems are looking to drive patient volume and attract and retain physicians, according to a new infographic by Evariant.

According to Evariant, the financial results of physician relationship management are compelling: A single physician, whether in primary care or a specialty, can generate more than $1.5 million in revenue each year, so it’s a heavy price when referrals and procedures are lost to competitors.

The infographic drills down on how to build an effective physician relationship management strategy.

A profitable by-product of CMS’s aggressive pursuit of value-based healthcare delivery is a menu of revenue opportunities associated with care management of the Medicare population.

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results details the ways in which Bon Secours Medical Group (BSMG) leverages a team-based care approach, expanded care access and technology to capitalize on four Medicare billing events: transitional care management, chronic care management, Medicare annual wellness visits and advance care planning.

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Guest Post: 5 ACO Competencies to Create Value-Based Change

May 3rd, 2016 by Bob Wadsworth, Client Executive, Freed Associates

Only when an accountable care organization (ACO) succeeds in both delivering high-quality care and spending healthcare dollars wisely will it share in savings it achieves from its efforts. In this guest post, Bob Wadsworth, Client Executive with Freed Associates, suggests five steps for organizations to consider as they think critically about ACO development.

Step 1: Set Holistic Quality Goals

In care management, simpler is often better, especially if the same program can be used across numerous payor-specific ACOs. Some program capabilities are needed to address unique and specific line-of-business needs; others work across multiple insurance lines. If several ACO contracts delegate medical management, healthcare delivery organizations have the opportunity to set up across-the-board quality and cost/utilization management programs to achieve steadily improving quality, resource efficiency, and patient satisfaction improvements.

To prevent assumptions about the burden of illness in attributed populations, get smart on their risk profiles. Find the target populations for risk/care management, and match them to specific programs. Better-performing ACOs have high-cost stratification in place for common episode treatment groups (ETGs) with high incidence rates and uncommon ETGs with lower incidence rates, allowing them to proactively address care coordination needs for an all-encompassing set of expensive chronic episodes.

Integrated care management efforts require clinical staff to re-think and remodel their care approach, from a physician-only care delivery model to one involving team-based care across the medical, behavioral health, and social services continuum. It requires empowerment of care team members, and ensuring all roles are operating at the “top of their license” with clear delineation of who’s coordinating what across a range of medical and non-medical services.

Step 2: Emphasize Financial and Organizational Goals

Your board and physician leadership need to be aligned with your long-term plan for reimbursement mix changes. Establish how you plan to grow at-risk lives over your planning time horizon, specify percentage shifts in fee-for-service (FFS) and at-risk revenues. Given the increasing exposure to downside insurance risk in shared risk and capitation contracts, this is a difficult, yet essential, dialogue. This value-based transformation should be led by your CEO, CFO, and clinical leadership in visible ways.

Be clear about the financial impact of the value-based ACO model and the individual contributions required of clinicians and administrative staff to reach sustained financial viability under new reimbursement models. Align financial incentives, such as individual physician bonus programs, with the new ACO financial contract structure.

As second-generation ACOs gain steam, they get smarter on their end-to-end risk/care management models. Many ACOs build up internal HIT knowledge and secure objective, third-party input on enterprise-wide HIT strategies. These strategies will address overall enterprise needs and narrow the unique line of business needs. The objective of this effort should be to align senior staff on a multi-year, holistic vision of the organization and its operations. It can pay for itself by identifying technology rationalization opportunities (latent or un-identified by staff who could be wedded to a particular solution/vendor because of convenience or other subjective criteria).

Step 3: Involve People and Roles

Aligning the roles of patient care delivery staff to support an ACO model is a cultural and operational shift. First, educate clinical and administrative staff on management expectations for their departments and how individual roles might change. The dual focus on both quality and cost efficiency can be a difficult transition. Provide real examples and proof points, such as showing how reduced utilization through use of evidenced-based medicine guidelines (and joint physician/patient decision-making) can benefit the patient, curb medical cost inflation, and increase patient satisfaction.

As you examine roles in a new ACO world, there may be duplicative roles across your organization and others, particularly payor medical management and inpatient case management. Remind staff that moving along the ACO ‘change curve’ will require a series of steps, with changes happening incrementally inside and outside the organization. Management’s goal is to orchestrate these changes in ways that incremental quality, cost, and patient satisfaction improvements can be readily seen as “waypoints” toward the desired future state of the enterprise.

Step 4: Create and Maintain Sustainable Processes

Process orientation and management is becoming a valuable competency in most ACOs. First, develop a process to identify the right group of patients for care coordination. If you don’t have the patient “risk score” data needed in-house, collaborate with your payors; they’re likely rich with the information needed to make informed decisions about areas of focus. Staff the care coordination of higher risk patients accordingly, using conservative case load benchmarks in the beginning, so case managers/care coordinators are not initially overwhelmed by productivity expectations. Work intelligently to determine the location of care coordination roles and their work activity —those that should be situated centrally or at physician offices. Measure results and continuously modify and improve processes.

Being process-oriented means being “performance tracking”-oriented. Develop measurement capability so leaders can be informed by dashboards that tell them the health of the processes along with results. Inform and engage physicians continuously during the change process, so they can effectively champion the improvements.

Step 5: Connect with the Right Technology

One area of potential long-term financial gain is making better use of existing technologies, or replacing them with simpler, cheaper, and more effective technologies. Your organization may have purchased a veritable hodgepodge of niche technologies. But are they all working together to your utmost advantage? Might a narrower set of existing and new solutions be far better than, say, six disparate systems? As your ACO begins accepting more financial risk, the need to enhance IT systems increases, so people and processes supporting ‘risk management’ can be sufficiently supported.

In an ACO world, it’s essential that technology be placed within the natural workflow of clinical staff. If they’re taking a lot of extra time training and re-training themselves to use a particular technology, they’ll be relieved when provided with a less time-consuming, superior solution in one or a few, easy-to-use software applications.

Be sure your technologies meet multi-payor needs, so that a simpler technological footprint can be realized, which has speed and cost-to-market benefits when trying to improve overall operations. A simpler and easy-to-use technology portfolio will likely yield improved patient service and quality, and provide the benefit of higher staff satisfaction with their work environment.

Bob Wadsworth joined Freed Associates in 2015 as a Client Executive. He has significant experience in deploying technology for cost, quality, and service improvement in both payor and provider operational settings. Prior to this position, Bob was a senior vice president of healthcare delivery networks with an integrated care management software company. He also has held executive positions at a large health plan and leadership positions in other health care technology companies, in addition to his management consulting experience.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

CMS Postpones LOI Deadline to May 2, Readies for Next Wave of ‘Next Generation ACO’ Participants

March 10th, 2016 by Patricia Donovan

Update: On March 11, 2016, the Centers for Medicare and Medicaid Services (CMS) pushed back the deadline for letters of intent for 2017 Next Generation ACO participation to May 2, 2016.

ACO

April 1 is the deadline to submit a letter of intent to participate in the Next Generation ACO Model in 2017.

Letters of intent from healthcare organizations interested in applying to the Next Generation ACO Model for the January 1, 2017 start date must be submitted by April 1, 2016, according to an update from the Centers for Medicare and Medicaid Services.

The letter of intent (LOI) as well as more information about CMS’s newest accountable care organization model, including dates and times for Application Open Door Forums, can be found on the Next Generation ACO Model web page.

Only organizations that submit an LOI will be able to complete an application. Even applicants that submitted an application previously but are not participating in the Next Generation ACO Model for 2016 must complete and submit an LOI if they wish to apply to participate in the Next Generation ACO Model beginning in 2017, CMS stated.

Subsequent to the organization’s LOI, applications for 2017 Next Generation ACOs will be due in two parts:

  • The narrative portion is due May 25, 2016; and
  • The Participating Provider list is due June 3, 2016.

If an organization plans to submit more than one LOI, it should use a different email address for the primary contact listed on each LOI submission, CMS said in its Next Generation ACO LOI and application FAQs.

In 2016, there are currently 21 ACOs participating in the Next Generation ACO Model, an initiative for ACOs that are experienced in coordinating care for populations of patients. The Next Generation ACO model allows these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer and Shared Savings Program (MSSP) models. The goal of the Next Generation ACO model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.

2015 metrics from the Healthcare Intelligence Network (HIN) found that one-fifth of healthcare organizations expect to participate in CMS’ new ‘Next Generation’ ACO Model in the future.

View an infographic on the Next Generation ACO model.

An April 5th webinar hosted by the Healthcare Intelligence Network will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general. Click here for more details.