Kaleida Health’s Stroke Care Center at the Gates Vascular Institute
February 8, 2016
Healthcare economic policies are changing rapidly since the Patient Protection and Affordable Care Act was passed in 2010. Today’s healthcare system is transitioning from volume-based to value-, quality- and outcome-based. Today, there is a new focus on “bundled payments,” which reimburses based on specific clinical episodes rather than fees for service, with a heavy focus on clinical episodes that result in the highest costs, such as stroke.
As the new bundled payment programs become a reality, stakeholders need to prove clinical utility, operational efficiency and financial performance of technology. The goal is to challenge clinicians to develop innovative solutions to contain the cost of service while continuing to deliver high-quality care.
Registered nurses, with targeted training, are the secret weapon in the race for comprehensive care coordination.
Accountable care organizations.Patient-centered medical homes. Value-based reimbursements. Bundled payments. Healthcare is experiencing a revolution brought on by the Patient Protection and Affordable Care Act that aims to put patients squarely in the middle of all their clinical and financial decisions. Payers, including government agencies and insurers, are tying the quality and safety of patient care to reimbursements, making patient-centered care a necessity in all settings.
In the coming era of accountable care, providers will finally have something to gain by actively engaging patients in taking care of their health—and a lot to lose by not doing so. The best way to do that is to manage every aspect of their care. But the patients themselves will remain free to defect to another provider whenever they choose, either temporarily or permanently. Persuading them to centralize their care will rapidly become job 1. This report explores survey results about the primary forces enabling patient engagement and features a case study about the active care management program in development at Beaufort Memorial Hospital in South Carolina.
ICD-10 has presented monumental preparation challenges to U.S. healthcare providers, who have had to overhaul their billing departments and systems and retrain their staffs. And many may now think the heavy lifting is done, according to a recent survey of industry executives conducted by HealthLeaders Media and The SSI Group, Inc. But while providers may successfully get a bill out the door with a valid ICD-10 code, they may not be prepared for a payment delay or an actual drop in revenue when the payer sends it back for more details.
How CDI is Revolutionizing the Transition to Value-Based Care
September 30, 2015
Creating a state-of-the-art clinical documentation improvement (CDI) program isn?t just about boosting coding accuracy. It?s a key strategy in managing the transition from volume-based to value-based care, say healthcare leaders. That transition is a risky endeavor that is putting hospital and physician financial performance to the test. As hospitals participate in new care and business models aimed at improving value, leaders must ensure that their organizations are able to maintain reimbursement levels, effectively treat the chronically ill?especially in outpatient settings?and gather accurate data that will allow them to assess performance and segment their varying populations. While some organizations often believe they are leaving revenue on the table because of documentation and coding issues, CDI offers numerous opportunities for improving financial performance, finds a recent HealthLeaders Media survey of 149 healthcare executives at provider organizations.
Insights on Reimbursement Risk From a True Industry Insider
September 21, 2015
Financial stability is top of mind for every healthcare organization. Recent industry activity, such as announcements from the Centers for Medicare & Medicaid Services (CMS) and large payer organizations earlier this year, show a definite shift away from traditional fee-for-service reimbursement models. Provider organizations looking to position themselves to thrive in the emerging value-based healthcare system must make decisions around taking on risk, and the extent of that risk, in their reimbursement arrangements. Here, Elena White, Optum’s vice president of risk, quality, and network solutions, discusses how providers are approaching decisions around risk-based contracts in the new healthcare economy.