Archive for the ‘Hospitals’ 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: Fall Prevention Plan Implementation

January 13th, 2020 by Melanie Matthews

Accidental falls in a hospital or healthcare setting are
extremely dangerous for patients and detrimental to the healthcare institution, according to a new infographic by EBSCO Industries, Inc.

The infographic provides a competency checklist for nurses to ensure they are checking all the boxes when it comes to fall prevention plan implementation.

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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Infographic: 5 Recommendations for Improving Patient Experience

October 21st, 2019 by Melanie Matthews

Healthcare organizations are working diligently to improve patient satisfaction and the patient experience of care. After all, patient experience of care is a critical quality domain used to evaluate hospital performance under the 2016 CMS Hospital Value-Based Purchasing (VBP) Program (accounts for 25 percent of a hospital’s VBP score)—and comes with the potential for a penalty or bonus, according to a new infographic by Health Catalyst.

The infographic provides five key recommendations for improving the patient experience.

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: Top 5 Hospital Performance Metrics

August 16th, 2019 by Melanie Matthews

Hospital performance assessment is complicated, and parsing through the vast quantity of financial, clinical, and quality data can be overwhelming. There are hundreds of metrics for administrators to track, and every hospital has unique performance goals. While some prioritize financial performance, others may seek to improve clinical outcomes. Effective performance tracking and data analysis can strengthen a facility’s financial performance, improve clinical outcomes, and raise quality scores, according to a new infographic by Definitive Healthcare, LLC.

The infographic outlines five essential hospital performance metrics.

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: Healthcare Service Recovery 101

August 9th, 2019 by Melanie Matthews

Leading hospitals and health systems are practicing service recovery, stepping in when customers and their family members have questions about their care, listening to their concerns when expectations fall short and rectifying issues, whenever possible. This new approach can help traditional providers remain viable in an era of increased competition, according to a new infographic by Quality Reviews, Inc.

The infographic examines why service recovery is so critical in the changing healthcare landscape.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical OutcomesAs healthcare moves out of the brick-and-mortar traditional setting into patients’ homes and their workplaces, and becomes much more proactive, the University of Pittsburgh Medical Center (UPMC) has been expanding its remote patient monitoring program. The remote patient monitoring program at UPMC has its roots in the heart failure program but has since expanded to additional disease states across the integrated delivery system’s continuum of care.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical Outcomes delves into the evolution of UPMC’s remote patient monitoring program from its initial focus on heart failure to how the program was scaled vertically and horizontally. Click here for more information.

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Infographic: Millennials Are Reshaping Healthcare

May 27th, 2019 by Melanie Matthews

Millennials are redefining what is required of healthcare. Born between 1981 and 1996 and on track to become the largest generation in the United States, millennials are digital natives who use technology to manage every aspect of their daily lives. They expect the ease and efficiency that technology provides from their healthcare experience, according to a new infographic by UbiCare.

The infographic examines what the millennial generation means for healthcare providers as they try to engage members of this generation.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System Encouraged by early success in coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients. At that scaling-up juncture, the challenge for CHRISTUS shifted to balancing its mission of keeping patients healthy and in their homes with maintaining revenue streams sufficient to keep its doors open in a largely fee-for-service environment.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge.

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Infographic: 2018 Physician On-Call and Telemedicine Compensation Survey

May 8th, 2019 by Melanie Matthews

Some 40 percent of hospitals and healthcare systems have physicians providing telemedicine on-call coverage, according to a new infographic by SullivanCotter.

The infographic examines highlights from SullivanCotter’s Physician On-Call and Telemedicine Compensation Survey, including details on hourly rates for trauma and non-trauma call coverage by specialty group, the average number of physicians on a call panel by specialty, the most difficult specialties in securing physicians to provide call coverage and trends in providing shift differentials for evening, weekend or holiday coverage.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringArtificial intelligence. Automation. Blockchain. Robotics.

Once the domain of science fiction, these telehealth technologies have begun to transform the fabric of healthcare delivery systems. As further proof of telehealth’s explosive growth, the use of wearable health-tracking devices and remote patient monitoring has proliferated, and the Centers for Medicare and Medicaid Services (CMS) has added several new provider telehealth billing codes for calendar year 2018.

2018 Healthcare Benchmarks: Telehealth & Remote Patient Monitoring delivers the latest actionable telehealth and remote patient monitoring metrics on tools, applications, challenges, successes and ROI from healthcare organizations across the care spectrum. This 60-page report, now in its fifth edition, documents benchmarks on current and planned telehealth and remote patient monitoring initiatives as well as the use of emerging technologies in the healthcare space.

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Infographic: Mining Revenue Cycle Management to Optimize for the Gold Standard

April 15th, 2019 by Melanie Matthews

In a value-based market, accurate and streamlined medical billing processes are key to delivering gold-standard patient experiences. Through effective revenue cycle management tools and worklists, hospitals can increase the likelihood of precise timely payments while improving patient satisfaction, according to a new infographic by MEDHOST.

The infographic examines how hospitals can build more efficiency into their revenue cycle management steps and processes, empower staff to reduce billing errors, and set patients up for financial success.

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: Trends Driving Hospital Revenue Cycle Performance

March 29th, 2019 by Melanie Matthews

Most of the nation’s hospital and acute-care facility leaders believe revenue cycle solutions are optimized for coding and audits, according to a new infographic by BESLER.

The infographic examines the three biggest revenue cycle challenges, barriers to better revenue integrity and the stage where revenue is most at risk.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM RevenueSince the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM.

Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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Infographic: Strategies for Ensuring Post Merger & Acquisition Success in the Healthcare Industry

March 20th, 2019 by Melanie Matthews

Increasing competition, lower margins and a need for scale are continuing to drive hospital merger and acquisition (M&A) activity, according to a new infographic by Agiliti.

The infographic looks at three ways hospitals can improve post M&A integrations and outcomes.

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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