Best Practices for Providers Looking to Improve the Quality of Care
In all areas of healthcare, organizations are looking for innovative ways to reduce costs and improve quality. According to a new study published in Health Affairs, MACRA could reduce CMS physician services spending from $35 billion to $106 billion. MACRA is also leading the way towards quality healthcare by creating incentives and penalties for providers who leverage the program to improve quality and efficiency of care. For providers to succeed under MACRA, they must work collaboratively with payers to meet the quality objectives defined by CMS.
In order to qualify for incentives and avoid penalties under MACRA, providers have the option to choose from two payment models: MIPS and APMs. Under MIPs, providers’ performance on quality, EHR use and practice improvements will be measured this year to determine the incentives or penalties they will receive in 2019. CMS is expected to notify physicians who are eligible for the program by the end of the month. APMs give incentive payments to providers that offer high-quality and cost-efficient care and can apply to a specific clinical condition, a care episode or population.
This week, our blog shares three steps providers can take to help ensure they are successfully meeting the requirements under these programs:
- Ensure Access to the Correct Tools - In a recent blog post, John Hansel, vice president of provider solutions, notes, “CMS’ quality reporting is complicated. There are numerous requirements that providers need to meet – from patient satisfaction to Electronic Health Record reporting – which can be difficult to manage. To ensure healthcare organizations are on track with these measurements, they need to have the right tools and insights in place to meet CMS’ various measures.” As providers look to improve quality and find success with the ever-evolving quality measures, they must ensure they have the correct tools in place to find success in improving patient care.
- Work with Payers to Break Down Data Silos - Although there has been some improvement in breaking down data silos, data preparation still accounts for nearly 80% of the work included in acquiring and preparing data. This can prevent the health system from getting a holistic look at the total patient record. To steer away from these data silos, providers need to leverage their relationship with payers, who typically are the only entity that have the data required to create a holistic patient record. Payers can provide access to crucial information, including the care received when the patient goes out of network. Overall, the shift to VBC requires that payers and providers work together in this aspect.
- Adopt Technologies Aimed at Improving Quality Measures - To truly succeed in improving the quality of care for the patient, providers must adopt technologies that serve as a basis for their collaboration efforts with payers. These programs must be able to successfully measure and monitor quality measures and create data driven conversations so payers and providers are aware of how to best improve quality for their populations. MedeAnalytics’ quality management solution offer insights that enable health plans to fully understand performance on quality measures and ultimately improve quality care for members.
At the end of the day, providers should be aiming for one goal: to improve patient care. To successfully provide patients with the best care possible, providers must work with the right tools, successfully leverage payer data and adopt technologies that serve as a place for collaboration with payer partners.
For more on how your organization can best improve the quality of care for your members, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To find out how MedeAnalytics can act as a strategic partner in this journey, learn about our quality management solution here.
Lessons Learned: A look back at the 21st Annual Compliance Institute
At this year’s 21st Annual Compliance Institute, compliance executives gathered to share insights and practical advice on common compliance challenges – from auditing and monitoring to privacy and security risks. Our partners from UT Southwestern (UTSW) Medical Center were selected to present their abstract, “Designing a Successful Analytics-Based Hospital Compliance Program and Securing Cross-Department Endorsement.” During their session, UTSW’s Kate Conklin, Chief Compliance Officer and Trissi Gray, Assistant Director of health system compliance, shared their knowledge on how automation, sophisticated algorithms and analytics played key roles in improving compliance within their organization.
At the conclusion of the conference, we connected with Conklin who shared her experience at the event, including trends and notable takeaways. Below you’ll find her feedback:
1. Were there any notable trends that you were surprised to see?
The most notable trend I found during the conference was a consistent message about the role compliance plays in establishing a culture for higher and more reliable performance across the organization. I was pleased to hear that this was a common theme amongst the keynotes and speakers that challenged Compliance Officers and other leaders to partner with the C-Suite to promote a foundational culture of compliance. I gained excellent insight into different methods for translating data into useful dashboards designed to educate the organization’s executive team.
2. What were your favorite parts of the event and what do you hope to see next year?
The keynote speakers were exceptional. I left the event feeling very inspired to elevate the importance of compliance and continue to advocate for automated analytics to lessen the burden. Next year, I hope to see more real-life examples from organizations that have faced significant challenges with a qui tam relator or non-compliance that resulted in serious penalty. I’m also looking forward to hearing topics that relate to leveraging data from hotline calls and other investigations to inform the institution about the work that is being done by the Office of Compliance. I believe this type of transparency is needed to encourage more reporting and strengthening of the organizational culture to ensure that their voice is heard and their concerns will be addressed.
3. Other post-conference takeaways that you’d like to share?
It’s always nice to network with your compliance peers. As compliance executives, we find ourselves in a unique situation, as we’re tasked to mitigate readmission, identify audit risk and find cost saving opportunities. However, when you hear so many compliance leaders share their best practices and tips, there’s a true sense of innovation and progress that empowers us all to continue leading the charge in improving our own compliance departments. In sum, it was one of the best conferences I have attended!
To read more about what Kate and Trissi discussed during their speaking session – such as manual vs. automated compliance monitoring and the importance of key stakeholder engagement – read highlights from their presentation, which were originally featured on the Compliance and Ethics blog. To learn more about how to act on your data and improve compliance, read about our revenue integrity solution.
How are you Tracking to Value-Based Care?
It’s no secret that today’s healthcare landscape is changing. As costs rise and reimbursement models change, healthcare organizations are continuing to track towards value instead of volume. With this transition comes the rising importance of quality, especially since payers and providers are now dependent on quality measures for reimbursement. According to CMS, these measures are meant to quantify healthcare processes, outcomes, patient perceptions and organizations’ structure associated with providing high-quality care. This journey requires a shift in mindset and new approaches to sharing information to enable quality improvements.
The first step in improving quality of care is the collaboration between payers and providers. Bruce Carver, associate vice president of payer services at MedeAnalytics, notes the importance of this collaboration in a recent interview with Becker’s Hospital Review, explaining that there are great opportunities between payers and providers, especially around data and best practices, to enhance value-based care, such as eliminating gaps in care and driving positive outcomes.
The second step is to use data as a guide to outline areas of opportunities. As payers and providers adopt technologies that enable value-based care, forward thinking organizations are collaborating on quality management programs that serve as the basis of their efforts. These programs must be designed to not only measure and monitor quality measures, but also lead data-driven conversations so payers and providers can collaboratively improve clinical outcomes for their patient populations. Through collaboration and the power of data, both payers and providers can leverage valuable information in the following ways:
- To measure and record an organization’s performance – Both payers and providers can benefit from understanding where their organization is succeeding in providing their members and patients with quality care. Among the many measures, HEDIS and CMS Star Ratings have the greatest impact as value-based care unfolds.
- To help avoid duplicative care – Today’s disconnected provider environment means that many providers operate in silos and do not have insight into care performed by other providers. Duplicative care is not only a waste of time for the patient, but it also negatively affects the healthcare organizations’ bottom line. By taking a holistic approach to a data strategy, organizations can better work together to avoid this.
- To better identify high-risk patients – Data, combined with population health tools and predictive analytics can identify high-risk patients immediately instead of waiting months for data to be generated. Identifying these types of patients early can allow organizations to step in to create personalized, automated interventions that lower healthcare costs and improve the overall health of the patient.
As healthcare industry continues to evolve, payers and providers must look toward a future defined by positive outcomes for their patient populations. The focus on quality and value will become more deeply ingrained. To meet these objectives, organizations must collaboratively design programs that enable them to meet or exceed quality measures and pay-for-performance expectations—today and for years to come.
To learn more about how to improve quality of care for your members in today’s changing healthcare ecosystem, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To learn how MedeAnalytics can help you on this journey, learn about our quality management solution here.
How Covenant Health Utilized Analytics towards Population Health
Despite the initial administrative concerns, the healthcare industry is continuing its journey towards value to curb costs and improve patient outcomes. The U.S. healthcare spending, which in 2015 hit nearly $10,000 for every person in the country, is 29 percent higher than the next most expensive country, Luxembourg. With rising costs, the industry is looking towards innovative programs that tap healthcare organizations biggest resource: data.
Both Richard Boehler, MD, president and CEO, and Rebecca Williams, RN, care coordination manager at St. Joseph Hospital of Covenant Health (Covenant) connected with Bill Siwicki of Healthcare IT News to discuss how Covenant tapped their timely information to curb costs and improve quality of care for their employees. Here’s a recap of the key takeaways from the discussion:
- Adopted a population health program – To better track and manage the health of Covenant employees across three hospitals and affiliated facilities they looked to population health as a solution. By operating as a self-insured entity, Covenant saw this move as a necessity to improve health and control increasing expenses. The goal of the program was to enhance the well-being of employees, decrease costs and better understand the healthcare utilization patterns of employees and their dependents.
- Harnessed data analytics – Through data and analytics, they guided their population health management efforts. “The first thing we started thinking about was where the money was going; it must be avoidable ER use. We dug into the data, and nope, that wasn’t the case. Then we thought back injuries, so let’s dig in there and maybe we could create a comprehensive back program. But it wasn’t even our employees, it was their spouses, so that went out the window,” said Williams. Executives and caregivers learned that they had to prioritize their employees in terms of healthcare consumption.
- Making insights actionable – “You cannot take a population and put a stamp on it and say let’s do things this way; we had to look at prioritizing people and we worked with sophisticated analytics to see where our time would be best spent,” Williams explained. “The high utilizers were on dialysis or had an organ transplant or an acute burn, those were not things we could make an impact on. But that middle 70 percent is where we could make an impact. Keep people in the middle 70 percent from moving up to the highest spend category.”
Through Covenant’s efforts, they could identify cost drivers and opportunities for preventative care, enabling one of their three facilities, St. Joseph Hospital, to spend $2.5 million less in 2016 and a 12 percent per member per month improvement over all of 2015.
For more insights on how Covenant created a successful population health program, check out the full Healthcare IT News article or their case study here. If you’re interested in learning more on how our population health solution can help your organization – check out details here.
Best Practices for an Enterprise Analytics Strategy
The healthcare economy is changing rapidly – from increased consolidation to the rise of consumerism in care, healthcare organizations face a market that requires a holistic understanding of their enterprise (from clinical to claims data) to succeed. To stay competitive and deliver the best quality of care and value, providers should think like payers and payers like providers. As such, strengthening integrated care remains a hurdle for organizations to overcome as they seek to improve clinical quality, reduce operational costs and support care management. To achieve these goals, healthcare systems must be able to have access to data not just within their own organization, but from outside sources – which is often siloed.
A HFMA Health Care 2020 report on consolidation points out that to succeed in an increasingly competitive marketplace, healthcare organizations are investing in data analytics capabilities to help them understand their patient – and entire business – better. While investing in analytics is an integral key to success, an overall best-practice strategy must be developed to make data actionable. Here are five best practices that should be adopted to initiate an analytics strategy:
- Identify enterprise champions – To ensure buy-in from key internal stakeholders, leadership and process changes must occur. Change to the entire organization’s attitude on data governance must come from the top and trickle down to the bottom.
- Find value in existing data – As new payment models are adopted, healthcare providers need to design a technical infrastructure that can integrate payer, health system and medical group data within an enterprise healthcare delivery system to create value. Organizations should leverage their core data set and claims data, but also pull in existing ancillary data to have a better understanding of their organization.
- Create data-driven culture – Establishing an enterprise analytics department ensures that the entire business is standardizing and handling data consistently, but also encourages the new analytics department to champion a holistic approach towards data management. Champions should include representatives across all departments, from clinical to claims teams.
- Outline and developing manageable goals – Instead of tackling all problems at once, start small. Is the organization focusing on obtaining a streamline, single view of their entire business? By setting a goal with real, manageable next steps, all stakeholders can quickly perceive value in an enterprise initiative.
- Train, train, train – Repeated trainings and regular communications across the enterprise ensure long-term initiative success. By holding teams accountable, while empowering them with resources to succeed, data sharing efforts across the enterprise are bound to improve.
Changing goals and evolving organizational structures require players in the healthcare industry to pivot quickly. Whether it’s to meet increasing consumer demands or to better align on value-based initiatives, organizations will need to rely even more on data to achieve their goals. When organizations embrace analytics, and have a go-to data analytics strategy, the procurement and actionable next steps will come naturally.
To learn more on how to take action with your data, check out our latest whitepaper here. If you are interested in ways we can help you on your analytics journey, learn more about our enterprise analytics options.