Why CFOs and CIOs Need to Collaborate at HFMA ANI
The upcoming HFMA ANI conference (June 25-27) in Orlando, FL, will bring together thought leaders in the healthcare finance space to connect, discuss and explore the opportunities ahead. This year’s show theme – collaborating for the future – is particularly timely since the healthcare industry continues to rapidly consolidate, and the fate of the Affordable Care Act still hangs in the balance. The Trump administration’s potential new healthcare bill increases the likelihood that there will be a rise in uninsured patients, high-deductible plans and a continued focus on cost-cutting and value-based reimbursement for healthcare providers.
The lack of clarity and fast-paced changes in the market places even more pressure on Chief Financial Officers (CFO), whom are already challenged with juggling the transition to value-based care while managing fee-for-service (FFS). In addition to these pressures, many CFO’s feel like their issues are often de-prioritized in the long list of tech projects led by Chief Information Officers (CIO), who are more focused on clinical initiatives. With so much technical effort and budgets directed toward clinical transformations and electronic medical record (EMR) installations over the past 10 years, the financial analytics tools required to thrive under payment reform have been neglected.
Building a better community through better health with Mede/ACTS
Interest in employee-sponsored volunteering programs is on the rise. According to a 2016 National Study on Satisfaction at Work, employees are drawn to employers who support charitable causes and community volunteering. In turn, employers are recognizing their role in spearheading philanthropic efforts. We recently connected with our very own Eric Roth, VP of Human Resources, to hear how MedeAnalytics approaches volunteerism in the workplace.
As a company dedicated to promoting employee wellness, MedeAnalytics launched Mede/ACTS in 2016, an initiative that helps give back to local, charitable organizations. Building off a previously existing wellness program, Mede/ACTS combines physical and community wellness into one. The premise is simple, but powerful: for each physical activity Mede employee’s complete – whether it’s yoga, biking, or kickboxing – senior leadership matches their efforts by contributing $1 for every 10,000 steps and for every 60 minutes of exercise that has been logged into wearables, fitness apps and FitBliss, a health & wellness technology platform available to all Mede employees. All the raised funds are donated to the charity of Mede/ACTS’ choice. Each quarter the charity varies; the Mede/ACTS committee selects charities that are nominated by Mede employees.
Driving Enterprise-Wide Change by Breaking Down Data Silos and Creating a Data-Driven Culture
This year’s Big Data & Healthcare Analytics Forum brought together payers, providers, government and academia decision-makers who shared their successes and lessons learned from their transition to value-based care. Of the many thought leaders who participated in the discussion, our client, Soyal Momin, Vice President of Data & Analytics at Presbyterian Healthcare Services (PHS), presented his abstract, “Eliminating Data Silos and Driving ROI.”
As a large integrated healthcare system consisting of eight hospitals, a statewide health plan and a growing multi-specialty medical group, PHS found it increasingly challenging to oversee its entire business from one integrated view. After investing in an enterprise data warehouse (EDW), PHS continued utilizing several reporting tools from different vendors for each of its business lines that created data silos. For PHS to thrive under the value-based care model, the organization knew they needed to balance their costs, utilization, quality, risk and outcomes. During Soyal’s presentation, he outlined how through their partnership with MedeAnalytics they could strategically differentiate themselves and add value within their integrated data analytics model. To achieve this success, PHS focused on three distinct categories:
- Creating Value for Key Stakeholders – Creating an integrated, enterprise approach, extends meaningful, actionable insights across PHS and to their business users so they’re able to access content, business rules, benchmarks, best-practice analysis and views.
- Integrating Payer and Provider Analytics – Through an enterprise approach to analytics, PHS has an integrated overview into their provider groups and health plan. The insights are extended across financial, operational and clinical areas throughout the provider-side of the organization. For the health plan, they can analyze payer data for cost and utilization.
- Promoting a Data-Driven Culture – Data literacy and data democratization is the foundation for creating a data-driven culture. A key component in creating this was tapping data analysts whose sole job is to gather data and analyze it in a meaningful way to generate results. PHS gave their analysts the appropriate training and mentoring to ensure they were developing a consultative skillset that met the needs of their diverse organization.
PHS has achieved ROI in its clinical, operational and financial areas within their enterprise. Additionally, PHS recognized operational efficiencies by replacing seven analytics vendors with MedeAnalytics, reducing redundancies and achieving quick wins with business stakeholders. More so, PHS expects to save millions in 2017 by improving collection for Medicaid encounters and increasing business development revenue.
Putting a stop to revenue cycle leaks and tracking towards MACRA goals
Performance measurement under MACRA has started in 2017, but only one-third (33 percent) of hospital-affiliated physicians have reported feeling prepared for its implementation, according to a recent Black Book Research survey. With several payment pathways to choose from, providers and their physicians have an added layer of complexity around clinical documentation, which increases their reimbursement risk. Though many providers feel strapped for time as more of their attention needs to be spent on properly categorizing claims data, analytics can help those organizations have a better grasp of their revenue cycle, especially as it ties back to value-based care goals.
Our very own Tom Schaal, director of product management, recently spoke with Jeff Lagasse at Healthcare Finance News to discuss the common revenue cycle management (RCM) challenges and opportunities as they relate to preparing for MACRA. One such challenge is the lack of time to consider revenue cycle leaks. Schaal shares three key takeaways that can help healthcare organizations have a better grasp of their revenue cycle and measurement:
- RCM shouldn’t be a second job – However, many times it feels like it. Physicians want to focus on providing the best quality care to their patients. Focusing on the minutia of RCM draws their attention away from their primary job. Technology and data can turn the RCM job into a seamless task that can be incorporated into their everyday workflow.
- Revenue leakage can happen at any stage of the care continuum – From registration to insurance verification to billing. Data analytics can help you identify where the biggest opportunity for improvement lies. Are patient no-shows causing you to lose money? Data analytics spots these trends and help you course correct the problem (i.e. set up appointment reminders for patients).
- Physician quality is the biggest opportunity for RCM – As Schaal noted in his interview, “as we look toward patient satisfaction and payment structures around things like lack of readmissions, physician quality really becomes a focal point in terms of maximizing revenue.” Ultimately, physician quality measures are going to be a “cornerstone when it comes to any enterprise's [financial] health,” and data analytics helps physicians make meaningful decisions that will impact their bottom line and future.
As MACRA moves full steam ahead, providers will need to have a good understanding of their clinical, financial and operational data to succeed. Implementing revenue cycle data analytics helps providers track towards value-based goals, while minimizing their reimbursement risk.
Want to Know How to Receive Higher Quality Scores?
In our last webinar, titled: Streamlining Your Quality Processes, our very own Bruce Carver, Associate Vice President of Payer Services, addressed the challenges and strategies needed to ensure health plans were succeeding with quality management. The healthcare landscape, especially for payers, has changed. With the introduction of MACRA and now with nearly 500,000 physicians submitting data towards it, the shift towards value is in full swing. The promotion and adoption of value-based care and the importance of quality outcomes (from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare’s Star Ratings) has moved quality from a measurement system to an operational workflow. Payers now more than ever need to create a strong quality management program by establishing processes, leveraging data and establishing best practices to properly benchmark and track their progress.
Bruce outlined the common challenges health payers face when achieving a successful, streamlined quality management program. The challenges range from inaccessible, inaccurate data to inefficient processes and workflows. The bulk of these challenges can be alleviated with organizational processes and analytics which create checks and balances to ensure quality management programs are moving in the right direction.
Today, achieving high-quality outcomes requires an all-hands on deck, year-round effort. To work towards these programs, there are a few stepping stones that will enable health plans to implement effective processes of measurement. Here are some of the key components to quality improvement:
- Continuous, objective, and systematic process for monitoring and evaluating key indicators of care and service
- Identification of opportunities for improvement
- Development and implementation of interventions to address the identified opportunities
- Re-measurement to demonstrate effectiveness of program interventions