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  • EPM Series: Providers, Follow these Best Practices to Optimize your Revenue

    October 19, 2017 Editorial Team in FeaturedPerformance ManagementRevenue CycleRevenue Integrity

    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:

    1. 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.
    2. 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.
    3. 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.

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  • National Health IT Week In Review

    October 9, 2017 Editorial Team in FeaturedMedeAnalytics

    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.

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  • Mississippi Division of Medicaid Remains the First to Establish Clinical Data Exchange

    September 20, 2017 Editorial Team in Big DataClinical Data InfrastructureElectronic Health RecordsFeaturedMedeAnalyticsMedicare/Medicaid

    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:

    1. 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.
    2. 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.
    3. 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

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  • CHIME Series: Are you making the most out of payer data?

    September 19, 2017 Editorial Team in Big DataFeaturedHealth Plan/Provider TransparencyMedeAnalyticsPayment Reform & Value-Based PurchasingValue-Based Care (VBC)

    This week, we continue to explore the results of our College of Healthcare Information Management Executives (CHIME) survey and the need for various data sources. Our survey asked the question: Do you have a strong grasp on how to deal with payer data today? The results show that the majority (57 percent) of provider organizations do not.

    As healthcare costs continue to rise and the industry focuses on value-based care, payers and providers need to look for ways to collaborate. This relationship is critical to payers as they leverage EHR data to better understand the cost of services rendered by the providers, measured against the outcome of care. For providers, combining both claims and clinical data can reveal some extremely valuable insights that can positively influence clinical decisions and drive down costs. However, many organizations still face challenges, including a lack of appropriate tools and an influx of data that is difficult to manage. This then creates a lag in insights being delivered to the right people at the right time. Bruce Carver, associate vice president of payer services, believes optimized organizational coordination can help address some of these issues.

    Here are two of his best practices for making the most out of payer-provider collaboration:

    • Trust Each Other– The first step in any relationship is trust. Are your goals aligned? Do you have redundant reporting or processes to get to these shared goals? Where can things be streamlined? This relationship will take time as both parties must work together to improve collaboration and ultimately gain more insights.
    • Establish Communication Processes – Communication is also key and establishing efficient processes can help ensure that organizations are on the same page when issues arise. Some of these issues include, gaps in payer data or instances when payer data is not directly aligned with provider data.

    Once organizations are aligned, payer data can be leveraged to better meet industry-wide demands of becoming more patient-centric and value-driven. This collaboration can also help providers manage medication adherence and establish cohesive strategies that address this issue.

    As providers continue to struggle with a lack of organizational resources and payers begin to shrink in numbers, payer and provider collaboration will be more important than ever. Additionally, creating this collaboration can help both parties ensure that they are on the right track towards value. To see more results from our CHIME survey, access recent blogs here and here. If we can help get your organization on the right track, make sure to contact us.

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  • CHIME Series: Creating Value Out Of Your Analytics Investment

    August 29, 2017 Editorial Team in Big DataEnterprise AnalyticsFeaturedMedeAnalytics

    We are continuing to focus on the insights from our College of Healthcare Information Management Executives (CHIME) survey. This week we’re exploring the response to one of the questions asked: Do you feel that you have realized the full ROI of your data warehouse and analytics investment? The results to this survey question were astounding with close to 100 percent (95.7 percent) of respondents stating they have not realized the full potential of their investments.

    In this blog post, we outline the necessary steps to take to ensure a return on your analytics investment. With nearly every healthcare organization somewhere along the value journey, it’s important to keep in mind that each step should be tailored to meet specific business objectives. Here are three guidelines to start: 

    • Offer Self-Service Access to Business Users: Although an investment has been made many organizations struggle to fully adopt the platform due to IT bottlenecks in reporting and analysis. By empowering business users with the ability to perform their own analysis to identify the root cause of trends, the speed from insight to action will increase.
    • Find New Value in Existing Claims and Billing Data: Most data warehouses focus on aggregating clinical data from EMRs, but many healthcare organizations fail to recognize the potential in claims and billing data. Most data models are built on this type of data, so their value should not be underestimated.
    • Achieve Quick Wins: Starting small is key. Sifting through and analyzing data can be a large and daunting task, so it’s important to remain focused at the start of your project and then expand. Focus on one or two small use cases such as medication adherence or hospital readmissions. Once those initiatives are deployed, set realistic metrics and timeframes to properly measure progress. If progress is being made, make sure to continue driving the initiative and look for additional growth opportunities. 

    With these best practices, healthcare organizations can begin to realize the value of their analytics implementation. To learn more, download our white paper here. If you’d like to partner with us – go to: medeanalytics.com/company/contact.

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