topic: Revenue Cycle
A leading health care system sought to develop, in partnership with a national insurer, a new health plan marketed to fully insured individuals and self-insured employers. This joint venture would emphasize using data analytics and population health technology to identify at-risk patients sooner and provide them with earlier care access.
We show how it is possible to maximize and systematize your risk arrangement opportunities by pursuing a two-stage, value-based care initiative. The key is adopting a team-based approach toward governance, shared vision, accountability, flexibility and execution.
With a focused effort and the right resources, it is possible to create a modern, efficient and timely referral process that enhances office practices and increases patient satisfaction and referral compliance.
A hospital merger or acquisition can easily complicate credentialing and re-credentialing. Rather than potentially alienating your physicians and jeopardizing your revenue stream due to post-merger credentialing issues, consider instead these five steps for credentialing success.
Why do some external consulting relationships seem to thrive, while others become challenging? In this article, we explore how and why a major health care provider significantly benefited from an external consulting relationship, and how you can apply these lessons to your organization, no matter its type or size.
Failure to effectively manage the CDM leads to incorrect bills and missed reimbursement opportunities, as well as potential compliance and regulatory risks and lower patient satisfaction scores. All of these items can cost an organization millions or even tens of millions of dollars annually.
It is a challenging dichotomy. Just as demand for health services continues to rise, health care payers and providers face difficult decisions around potentially changing their organizational structures to meet the health care industry’s upheaval.
As seen in Healthcare Informatics. In health care, “innovation” is often thought of in the context of life-changing tools and technology, such as the late 1970s introduction of magnetic resonance imaging (MRI) or the more recent advent of modern telehealth. Yet the reality in health care – steeped in tradition and entrenched cultural norms – is that “innovation” often initially comes in smaller bits and bursts before widespread, systemic adoption. Consider how often in health care new ideas...
Determining PAC Networks with Medicare's New CJR Program By Debra Mathias
As seen in Healthcare Informatics. Hospitals participating in Medicare’s mandatory new Comprehensive Care for Joint Replacement (CJR) reimbursement model need to develop a high-quality preferred post-acute care (PAC) network to which they can discharge high-risk CJR patients. Hospitals can do so either independently or by using an external consultant. The PAC must, per CMS, have a minimum 3-star rating or reimbursement will be negatively impacted. By developing a PAC preferred provider network based on objective criteria and supported...
Navigate Effectively through Medicare’s CJR Program – An Overview By Debra Mathias
As seen in Healthcare Informatics. Experience is no substitute for expediency. Consider the example of Edward John Smith, Captain of the maiden (and final) voyage of the RMS Titanic in 1912. Despite being one of the world’s most experienced sea captains, Smith failed to change the Titanic’s course or reduce speed, even though he knew his ship was headed straight into a massive iceberg zone. We all know how that story ends. Similarly, despite a massive sea change in health...
As seen in Health Intelligence Network. Just as “Rome wasn’t built in a day,” neither is an efficient, sustainable, and physician-focused accountable care organization (ACO). Instead, expect to embrace a stair-step approach to making the necessary changes in your care delivery and administrative practices. Competency and capability development is always multi-dimensional, so consider these five steps as a benchmark for your organization’s critical thinking on ACO development. Introduction In California, we’re now in what could be termed the “second generation”...