Even though reimbursements remain heavily tilted to fee-for-service, healthcare organizations are making big mistakes if they aren't marrying clinical and financial metrics and engaging in data analytics, says HFMA's president.
I'm at the Healthcare Financial Management Association's annual ANI conference in Las Vegas, where healthcare executives are gathering on June 22–25 to hear their peers and industry experts talk about solutions to the laundry list of issues their organizations are facing.
Health reform, risk-based reimbursement structures, clinical care redesign, and the increasing need for reliable data analytics are just a few of the challenges provider organizations are grappling with these days, HFMA president and CEO Joe Fifer told me during a recent telephone interview.
"The healthcare industry is not for the weak of heart, that is for sure," Fifer says. "One major issue is that the intensity level within the industry seems to continue to rise. In any given year you think, 'I don't know if this can get any more complex,' and yet the complexity still seems to ramp up, while none of the old issues have gone away."
8 Key Themes
This year's ANI conference sessions are organized into eight themes: business intelligence and analytics; regulatory impact of reform; clinical integration and culture; organizing for value; payment trends; revenue cycle; cost management; and finance and operations. Each theme has a featured speaker as well as several breakout sessions presented by providers, consultants, and other industry experts.
"The thematic approach allows attendees to pick what is the most applicable to their environment," Fifer says, adding that the themes cover the largest areas of concern for most providers and are designed to acknowledge that many of the challenges overlap with each other.
Value-based reimbursement is on the minds of all financial leaders, yet Fifer notes that providers "still have 95% to 97% of their revenue coming from a fee-for-service environment.
But at the same time, they are making great efforts under the big umbrella of value to move toward value-based purchasing and shared-risk arrangements," he says. "They are trying to set up their organizations to be able to do these things by using business intelligence tools and data analytics to be able to operate in that changing environment."
"In addition to all of these kinds of insider issues, there is also a bright spotlight on pricing and how health systems are presenting themselves to their communities," he adds. "Consumerism is taking the industry to a whole different level when it comes to transparency."
Harnessing Data
In order to keep pace with the trend toward consumerism, providers need to figure out how to harness their data to improve quality, outcomes, and value, Fifer says, noting that the importance of data is a central message that will be woven throughout all eight themes at the conference.
"If you are not hiring an actuary or someone with very strong IT abilities to look at trend data, you are making a mistake," he says. "You need to have the people in place to take the data and turn it into usable, actionable information."
To be truly meaningful in the clinical setting, data also has to be available almost immediately, Fifer adds. "It is no longer acceptable to have clinical data that is based on claim summaries 60 days after the events have taken place. That is no longer good enough in healthcare. We need to get data to clinical decision makers on a much more real-time basis."
Integrating Clinical and Finance
Another key point that attendees will hear frequently at ANI, Fifer says, is that provider organizations have to break down the walls between their clinical and financial enterprises in order to enhance outcomes while protecting the bottom line in the new value-based payment world.
"If there is a CFO out there who isn't hooked at the hip with their CMO, they are making a huge mistake," he says. "This is one of the core ideas that we are incorporating into the program this year."
Blurring the Lines between Payers and Providers
When planning the ANI event, HFMA also took into account the growing intersection of industry stakeholders—something I frequently hear about from hospital C-suite executives. The line that has traditionally separated payers and providers is fading as more and more health systems launch health plans and take on the financial risk of managing the health of populations.
"In the simplest terms, we think of the industry as being three circles consisting of hospitals, physicians and physicians groups, and payers. Historically, those have been distinct groups, but as we all know, those three circles are coming together, whether through mergers and acquisitions or through new payment arrangements and contracts between the entities," Fifer says.
"We've made a concerted effort at HFMA to reach beyond the hospital sector, and we've organized the ANI conference as such because the distinction between the circles is blurring. We are staying current with what the needs are and providing attendees with a broad spectrum of issues and perspectives."