Tag: value-based care
An estimated 82 percent of hospitals receiving Medicare and Medicaid payments in fiscal year 2019 are expected to have their payments reduced because their readmission rates are too high. The Centers for Medicare and Medicaid Services implemented the Hospital Readmissions Reduction Program to reduce the number of patients being readmitted to hospitals less than 30 days after leaving. This program’s goal is to improve patient care. While a number of factors influence hospital readmission rates, they often occur when patients are not communicating issues with their doctors or when more communication is needed between patient care teams. For example, when the attending physician in the Emergency Room (ER) doesn’t have the necessary background on a patient’s condition, a patient is more likely to be readmitted. This can lead to longer waits to get proper treatment. To best serve patients by reducing hospital readmissions, healthcare organizations need to improve patient care coordination. Technology enhances communication among inpatient, outpatient, and long-term care teams, and it gives patients more of a stake in their own care. Coordinating patient care USMD WellMed Health System set a goal to significantly decrease its readmission rates, so it needed a way to alert physicians if their patients showed up in the emergency room, particularly within 30 days of leaving the hospital. The organization implemented Experian Health’s Care Coordination Manager and MemberMatch® solutions. Care Coordination Manager provides a messaging platform for patients’ post-discharge care plans, which is a secure place for patients and providers to communicate. It helps hospitals and health systems provide solutions for 30-day and 90-day management of health episodes. In one case, a doctor was able to intervene when a patient with chronic obstructive pulmonary disease showed up in the ER. The doctor was notified, spoke to the ER physician, and developed a course of action that allowed the patient to go home without being admitted to the hospital. In addition to avoiding hospital readmission penalties, USMD WellMed provided better care with the service and made the patient happier as well. While healthcare professionals agree there is a growing need to help patients become more engaged in their care, many are uncertain about the tools and opportunities to make it happen. Care Coordination Manager introduces an easy way for patients themselves to communicate with their providers and get clarifications on follow-up care. USMD WellMed also implemented MemberMatch, which lets Accountable Care Organizations (ACO), ESRD Seamless Care Organizations (ESCO), and health plans better manage members’ clinical episodes by alerting care managers when a patient is admitted, discharged or shows up in the ER. Doctors appreciate notifications Despite the numerous benefits of reducing hospital readmissions, there was one major reservation when the phone alerts were implemented. While USMD’s physicians wanted to be more attuned to their patients’ needs, they were worried that they would be inundated with text notifications. The program was initially limited to high-risk patients. But once physicians started getting the alerts, they immediately realized the benefits . Some doctors even asked to expand the platform to all of their patients. Ultimately, this tool improved both USMD WellMed’s provider and patient satisfaction. USMD WellMed was able to reach its goal of significantly reducing readmission rates in a short period of time, according to Dr. Bryan Demarie Sr., Market Medical Director of USMD WellMed. The Care Coordination Manager helps physicians and patients take a more proactive approach to treatment by handling problems before they escalate to another stay in the hospital. Opening the lines of communication allowed the healthcare organization to meet its readmission goals, improve patient care and save USMD WellMed from costly penalties. Support the sharing of post-acute patient care information to help providers succeed in the new era of value-based reimbursement. Learn more.
Experian Health will be at HFMA ANI again this year–booth 1025–at the Venetian-Palazzo Sands Expo in Las Vegas, Nevada. Kristen Simmons, Senior Vice President, Strategy, Innovation, Consumer Experience, and Marketing, with Experian Health, chatted with Joe Lavelle of IntrepidNOW to provide her insights on this year’s HFMA ANI conference, consumerism in healthcare and much more! Excerpt below: Experian Health booth activities \"[In our booth this year at HFMA ANI, we want to focus] around peer to peer learning and exchanges, so we are doing less selling and more engaging and more understanding. Understanding folks problems and helping to collectively arrive at solutions. We are doing a lot this year in terms of hands on demos of our solutions. We\'ll be showing some of our patient engagement products which include, self-service portals and mobile options for getting price estimates for applying for charity care, and setting up payment plans. Likewise, on the revenue cycle management side to automate orders with patient access functionality, contract management claims and collections, all those types of things that we do to improve efficiency and increase reimbursement for our clients. We\'ll also be showing off some of our identity management capabilities to match, manage, and protect patient identities so we can safe guard medical information and reduce risks for our clients. And on the care management side, our early support and sharing of post acute patient care information to help providers succeed as we all move forward into a value based paradigm.\" How Experian Health is addressing the need for consumerism in healthcare \"When it comes to consumerism, it\'s interesting when you\'re a company that has a lot of data and a lot of capabilities to say, \'Hey what can we do for people?\' One of the things we really wanted to look at for our consumer approach, was to say, \'What is it that needs to be done?\' We had some great hypotheses coming in and a lot of those were borne out but we actually undertook a big national study to take a look at what consumers biggest pain points were. It has a qualitative and a quantitative component. But, we basically looked at the entire healthcare journey so we weren\'t just asking them about the administrative and financial aspects of care, but also the clinical aspects. As we walked through the journey and were able to get a lot of quantitative data about all these different aspects of their healthcare journey, what actually turned out to be the most painful for the most people, were all the things around the financial equation. And, so clearly there can be pain in a clinical side, especially if you\'re unhealthy, you\'ve got something chronic, you\'ve got something terminal. There\'s all kinds of awful situations there but, really affecting almost everyone is a lot of the pain around the financial aspect of healthcare. So, we were able to look closely at some of those pain points and decide on some of the biggest ones that we wanted to tackle.\" How Experian Health is helping providers address financial pain points for patients and providers \"Some of the big pain points for people is just the fact that you don\'t know what you\'re going to owe and as the patient portion of responsibility increases, understanding what you\'re going to be paying becomes more and more important to a consumer. So, understanding what I owe earlier, being transparent, and then helping me pay, those are some of the areas. And there are others but those are some of the absolute biggest pain points. And as you pointed out with some of our propensity to pay analytics, and some of the other capabilities that we have, we\'re able to help providers understand the financial situation patients are in much earlier in the process so they can get them to the right kind of funding sources. They can give them peace of mind so that they know what they\'re paying upfront, which may impact when they choose to go in for a major procedure or how they might want to save up for it or how they might want to access different funding sources.\" Listen to the full podcast
There has been a lot of uncertainty with regards to what the future holds for healthcare in the U.S., but the reality is that the move away from transaction-based services where providers are paid by transaction or by interaction with their patients, into a world where some of those services will be paid as bundles, is a reality. At Experian Health, our perspective is that there isn’t going to be one single form of payment. There isn’t going to be only fee for transaction or only fee for value type payments. There is going to be a variety. And our solutions can help providers handle that. When we talk to our largest providers, they want to make sure that they are prepared for the future of healthcare, and that their payment and revenue cycle is robust enough that they can handle whether it is a fee for transaction interaction with the provider or with the patient as well as fee for value. In order to do that, they have to optimize their operations. There is a lot of belt tightening happening in the industry and people are trying to see and understand how best to organize, how best to analyze and facilitate that payment cycle. We believe that data and analytics are two of the key ways to do that. Our software tools as well as the data that we embed into that software helps optimize the revenue cycle. Listen to the complete podcast
With the rapidly changing healthcare environment, many organizations are taking a hard look at their revenue cycle, seeking proactive ways to enhance both efficiency and performance in the era of value-based care. While the need to improve is clear, the opportunities for improvement may be obscured by myth and misperception. For example, consider the following long-standing myths about patient payment that, if not set straight, could limit your organization’s ability to optimize the revenue cycle and enhance financial performance. MYTH #1: All patients are equally likely to pay. Reality: No two patients are alike, whether you’re looking at their medical conditions or their financial data. Assessing a patient’s likelihood to pay at the earliest point in the patient encounter can help you design your collections efforts to not only increase the probability of patient payment, but also foster greater patient satisfaction. By leveraging data and analytics to segment patients, you can realize a proactive and customized approach to collections that takes into consideration a patient’s unique financial situation and payment history, and tailors payment amounts and collections strategies accordingly. MYTH #2: It’s hard to have meaningful financial conversations on the front end. Reality: Contrary to popular belief, most patients are receptive to a financial conversation with their healthcare provider. Patient access staff can serve as the gatekeepers of the patient experience, engaging patients even before their time of service with personalized and informed financial discussions about patient responsibility and payment options. With this unique patient data at their fingertips, staff can also assist patients who may have trouble meeting their financial obligations, checking eligibility for internal and external financial assistance programs and automating the enrollment process. MYTH #3: It\'s impossible to know what patients owe across a system in one look-up. Reality: Organizations can once again turn to data and analytics, using it to aggregate prior balance information from across the healthcare system. This allows patient access staff to view comprehensive open balance data as part of the registration process and use scripts to guide compassionate financial conversations. Even if these fact-based discussions don’t lead to immediate payment, the additional reminder that a balance is due often prompts a patient to action, yielding faster payment. Dispelling these and other myths is simple when an organization uses tools that leverage both clinical and financial information to increase reimbursement in an era of value-based care. These proactive efforts result in less risk, increased collections and enhanced patient satisfaction. That’s a reality that every healthcare organization should experience! What myths are you debunking at your organization?
