From October 25-27, the MedeAnalytics payer community came together at La Cantera Resort and Spa in San Antonio, Texas for the 2017 Payer Solutions Summit. The event gave attendees the opportunity to collaborate to better understand how to keep up with the growth and evolution of the industry, with the support of MedeAnalytics’ solutions and thought leaders.
Our very own CEO, Paul Kaiser, kicked off the event, introducing himself and discussing his aspirations for the company. Kaiser highlighted how impressed he was with our committed associates, fantastic clients and great technology offerings. He realized how special of a company MedeAnalytics was within the first five months of his new role. Kaiser concluded his presentation by outlining his hopes for MedeAnalytics, which include continuing to evolve, innovate and scale in terms of client value management and transparency.
In addition to our CEO, Scott Hampel, SVP of product and strategy, and Tyler Downs, CTO, took the stage to discuss product innovation alignment and the payer portfolio. They also explored the company’s technology strategy and plans for growth, including platform innovations, machine learning, guided analysis, third-party integration and more.
In addition to key thought leaders within the company, several payer clients also delivered presentations that demonstrated their unique use of the MedeAnalytics platform and the results they achieved. Some of the representatives included Mississippi Division of Medicaid, St. Joseph Hospital, part of Covenant Health, Presbyterian Healthcare Services, MVP Health Care, and Kaiser Permanente.
EPM Series: Learn How to Create Organizational Alignment with Performance Management
With the shift to value-based care, new payment models now reward organizations that focus on improving quality and lowering costs and penalize those that do not. Under these models, organizations are now required to report on additional metrics and are faced with major time constraints as they try to ensure proper documentation. Because of this, health systems are looking for innovative ways to relieve doctors of their administrative jams and make all parties across the organization more productive. These efforts require a top to bottom initiative, with the organization taking steps to successfully transition to value-based care.
In this week’s blog, we share how one health system, Jersey City Medical Center (JCMC), part of Barnabas Health, a regional referral and teaching hospital, is driving transparency, communication, results and excellence across their organization by leveraging a Performance Management (PM) solution to ensure they are properly tracking and marching toward their organizational goals.
EPM Series: Providers, Follow these Best Practices to Optimize your Revenue
With the healthcare industry continuing to shift away from fee-for-service, healthcare organizations still face the challenge of properly tracking all their efforts and ensuring they are being appropriately reimbursed. A recent Healthcare Informatics report noted that:
“Ongoing changes in both public and private payment are shifting the landscape around revenue cycle management these days, and U.S. physicians and hospitals are facing considerable impacts on their healthcare reimbursement.”
The report also notes, that healthcare organizations are conducting procedures that are “more complex,” and so are the payments. Now more than ever, organizations need to be laser focused on their billing processes and revenue cycle. The ability to access data is obviously a key factor for success but transforming that data into a strategic plan to tackle revenue remains difficult.
The challenges around creating plans can come from a lack of leadership accountability, insight into performance metrics, transparency and progress tracking. These factors all play a role in losing sight of tactical actions that drive results. Critical data gets lost in various outlets within the organization which creates a gap between setting goals and achieving them.
Enter, Enterprise Performance Management, which offers a “closed-loop” system that organizations can use to combine robust data analytics with real-time action planning and progress tracking. Enterprise Performance Management enables organizations to clearly define, track and execute on strategic and operational objectives by empowering employees to track their day-to-day activities with the big-picture strategic plan in mind. For revenue, there are three potential goals to keep in mind:
- Increase point-of-service collections - Verify eligibility, confirm demographics and fully understand patient portions after insurance, so your registrars can collect payment prior to service.
- Understand denial root causes - Denials come from all parts of the revenue lifecycle. By linking denial trends to their origins, you can resolve errors and oversights that lead to payer rejections and denial write-offs.
- Monitor audit risk and reduce take-backs - Improving your financial health isn’t about finding maximum revenue. It’s about finding accurate revenue. By proactively identifying compliance risk areas, you can avoid revenue take-backs and track the audit appeal process.
National Health IT Week In Review
Last week marked the 13th annual National Health IT Week. This event is dedicated to celebrating the essential role of Health IT in transforming health and healthcare in the U.S. As a healthcare analytics provider, MedeAnalytics is dedicated to continued innovation of our platform and suite of analytics solutions to meet the ever-changing needs of healthcare providers and payers.
This year, National Health IT Week focused on four integral themes that highlight the value of health IT, including:
- Supporting Healthcare Transformation
- Expanding Access to High Quality Care
- Increasing Economic Opportunity
- Making Communities Healthier
Here’s our recap of each:
- Supporting Healthcare Transformation – Digital health is playing a critical role in driving transformation in care delivery, including improving quality and safety, interoperability, data sharing and patient-consumer engagement. Analytics tools play a major role in helping organizations achieve their goals in healthcare transformation, but what else can they do? Our blog shares steps for organizations to ensure they are making the most out of their analytics investment and successfully supporting their organization’s transformation journey.
- Expanding Access to High Quality Care - As the industry shifts to value-based care, organizations are putting a greater emphasis on quality care. Innovative technologies like telehealth and remote patient modeling are helping to increase patients’ access to the care and the support they need, which in turn supports the industry on its journey to value. As part of this initiative, HIMSS shared its health IT “wish list” with Congress. which included a request to improve and expand telehealth offerings.
- Increasing Economic Opportunity – The healthcare industry makes up 17.8% of the U.S. economy and employs over 12,000 people. This growing workforce is full of diverse, competent individuals who are passionate about supporting economic growth. Part of this growth is dependent on ensuring that all clinicians have the IT fluency needed for success. As reporting requirements evolve, value-based hesitancy grows and the industry looks to reduce physician burnout, this will only grow in importance.
- Making Communities Healthier – At the end of the day, efforts by the health IT community are focused on one outcome: keeping families and communities healthy. Population health has been a central theme across the industry as of late and recent technologies continue to support the health of the greater population. Learn how our client St. Joseph Hospital of Covenant Health leveraged data and analytics to create a population health program in their own organization to successfully improve the health of their employees and their dependents.
Mississippi Division of Medicaid Remains the First to Establish Clinical Data Exchange
Each year, state Medicaid leaders from all over the country gather at the Medicaid Enterprise Systems Conference (MESC) to talk about the role of technology in meeting Medicaid and industry initiatives, like value-based care. Our client, Mississippi Division of Medicaid (DOM), spoke on their use of the consolidated clinical document architecture (C-CDA) standard to coordinate care and improve outcomes for their Medicaid beneficiaries. DOM is the first Medicaid agency in the nation to establish clinical data exchange with healthcare providers to directly benefit patients and physicians at the point of care. DOM has successfully exchanged data with University of Mississippi Medical Center (UMMC) which resulted in more than two million clinical summaries. They also recently partnered with Hattiesburg Clinic and shared more than 100,000 clinical summaries.
To achieve this level of connectivity, DOM faced many challenges such as differences in vendor implementation of industry standards and providers’ use of unexpected medical codes. We connected with Ian Morris, Project Manager for the State of Mississippi DOM, to get his take on the overall lessons learned from this project and what fellow government organizations need to keep in mind for similar undertakings. Here are three key takeaways:
- Rely on Vendors’ Expertise – DOM would not be able to achieve this level of success without qualified vendors who have the expertise to develop and support the technology infrastructure and needs of real-time data exchange for hundreds of thousands of beneficiaries.
- Be Realistic – These projects are time and labor intensive and can take years to achieve. Be patient and work around your trading partner’s various schedules and technologies.
- Collaborate – Every stakeholder has different end-goals but these projects are a joint effort. This means that the conversation needs to move away from “my data” and towards “our data” to better coordinate care.
Looking ahead, DOM plans to continue integration with Medicaid-focused health systems, Health Information Exchanges and state and federal agencies. In fact, just last month they went live with their third clinical data exchange connection – Singing River Health System.
To learn more on UMMC and DOM’s success, read our announcement here.