Blog

Driving Cultural Transformation: Bringing an Innovative Mindset to Healthcare

Posted on February 15, 2017 at 9:00 AM, Mark Long

By Mark Long, Group Vice President, Digital Innovation, Providence St Joseph’s Health

During my time at NASA, Zynx Health, several startups and Amazon I learned a thing or two about innovation. The key lesson is best summed as “Success is not delivering a project or product; success is learning how to make your customers great at what your customers care about.”  This has been written about by many other thought leaders including Steve Blank (Customer Development) [1], Kathy Sierra (Making Users Awesome) [2], and Eric Ries (The Lean Startup) [3].  It’s grounded in a learning culture.

The healthcare industry is going through a transformation driven by many forces including changes in regulations, risk and price structures, and consumer expectations set by other industries. Technology is playing an increasingly important role in healthcare, but the answer is not to focus on the development of more tools and apps for their own sake. Instead success will come from an iterative learning process that leverages technology to focus on new ways to improve the lives of our patients, members, and providers.  

When we committed to digital innovation at Providence St. Joseph Health, we vowed we were not going to be a passive player in the healthcare transition game. We were determined to lead this revolution and reinvent healthcare along the lines of our mission.  Many Pacific Northwest organizations have reinvented industries such as Boeing, Microsoft, Costco, Nordstrom, Starbucks, REI, and Amazon. Now it’s our turn. 

After several years on the front lines of the revolution, Providence has identified four key concepts that we feel are essential for traditional healthcare organizations to disrupt the way they deliver services and stay relevant.

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Topics: healthcare transformation, Hayes Thought Leadership Blog Series

Verifying Patient Eligibility: Leveraging Epic Benefit Collection Workflow for Improved Collections

Posted on February 8, 2017 at 9:00 AM, Karen Lilly Castle

The turmoil in the healthcare industry is no more apparent than the effect it is having on patient health insurance. Rising costs in premiums and deductibles, the establishment of healthcare exchanges under the Affordable Care Act (ACA) and a workforce that continually changes jobs is forcing mass confusion in the healthcare insurance market.

As people assume more responsibility for payments, they are shopping for less expensive insurance options. To accommodate this new consumer mentality, insurance companies are offering a wider variety of plans than ever before. These dynamics place even more stress on the already overburdened front office function of most providers.

With patients moving from plan to plan, verifying eligibility has become crucial for hospitals and physician practices. The complexity of plan options makes the process even more challenging for front office staff. Determining coverage, benefits, co-pays and deductibles for each patient can be an overwhelming task.

Despite widespread use of electronic business transactions, many providers are still handling eligibility verifications manually. A recent report from CAQH Explorations reveals that health plans fielded more than 72 million phone calls on eligibility in 2015. The same report says the cost of a manual verification process is $8.39 per transaction, more than 17 times greater than the $0.49 cost of an electronic verification. In all, CAQH estimates the healthcare industry can save over $5 billion by using an electronic eligibility verification process.[1]

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Topics: clinical optimization, epic, Real Time Eligibility

How Analytics Can Benefit 4 Key Members of the Compliance Team

Posted on February 1, 2017 at 9:00 AM, Robert Freedman

As healthcare organizations have reached near universal adoption of EHR and practice management systems, the amount of available billing and claims data has grown exponentially. This data has the potential to offer insight to issues that can adversely affect the organization both from a regulatory and financial standpoint. Compliance and revenue cycle leaders are both coming to realize the benefits of collecting and analyzing this valuable information.

However, as compliance teams move from static auditing schedules to proactive risk-based programs to help identify and manage risks, it has become clear that it’s not just managers and supervisors who can benefit from data analytics. A robust analytics program can provide valuable insight that can help every member of the compliance team perform his or her job better.

In particular, use of analytics can significantly improve communication between the compliance team and other departments in the organization. There can often be friction between an auditor and those being audited, but focusing on data and providing a bigger picture view for both parties helps foster better working relationships and more effective issue resolution.

Using actual data instead of hypothetical situations can diffuse disputes and make audit finding discussions positive and more productive. It can also provide a wider view of a potential issue that can aid in instituting effective corrective action, both huge benefits for the compliance team.

For example, an auditor may find an instance of an incorrect E&M billing. It can easily be written off by the physician as a one-time error. However, analytics can reveal a pattern and show it was not an isolated instance. The auditor and physician can then rationally discuss the issue backed by data. That can be a tremendous advantage for compliance teams and helps take the emotion out of findings discussions.

Here are four key members of the compliance team that can get significant value from an organization’s analytics program.

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Topics: Healthcare Analytics, compliance programs

Leveraging the EHR as a Building Block for 3 Key Healthcare Initiatives

Posted on January 25, 2017 at 9:00 AM, Brent Magers

By Brent D. Magers, FACHE, FHFMA, CMPE, Executive Associate Dean and CEO, Texas Tech Physicians

With the advent of Electronic Health Records (EHR) in the late 2000s came rampant resistance. Meaningful Use requirements forced healthcare organizations to begin implementing an EHR but many were unhappy about it. As we transition from fee-for-service to value-based care – from volume to value – and move from current state to MACRA, adoption of EHRs has become both necessary and nearly universal.

As of 2015, nine out of 10 office-based physicians had adopted an EHR.  As of March 2016, more than 90 percent of hospitals eligible for the Medicare and Medicaid EHR Incentive Program have achieved meaningful use of certified health IT.[1] Overall, 96 percent of hospitals have adopted CEHRT.[2]

However, near universal adoption doesn’t necessarily translate to 100 percent acceptance. When it comes to incorporating an EHR, many providers have undergone the five stages of grief - denial, anger, bargaining, depression and finally now, to grudging acceptance. Like death and taxes, EHRs are here to stay and will remain an integral component of the healthcare landscape of the future.

The reality is that EHRs are essential if we hope to meet the overriding goal of providing better healthcare outcomes at reduced costs. EHRs form the basic building block for much of what needs to be accomplished in healthcare. Here are three key initiatives that rely on EHRs for their ultimate success.

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Topics: EHR optimization, evidence based medicine, Hayes Thought Leadership Blog Series, population health, patient engagement

How to Maintain Healthcare Security during Staff Augmentation: 4 Critical Areas

Posted on January 18, 2017 at 9:00 AM, Steven Botana-Gumbs

Every organization, at one time or another, will require staff augmentation. The reasons are common and include maternity leaves,
sick leaves and extended vacations. These absences while typical can cause disruption as management all too often does not have employees with bandwidth to cover their coworkers’ responsibilities and their own.

Many times, external resources are brought in on a temporary basis to help keep the wheels turning with minimal bumps in the road. This is necessary to ensure that all duties are covered and all deadlines are met.  

Unfortunately, what may seem like simple staff augmentation requires a great deal of forethought. Due to the security complexities in today’s healthcare environment, a cushion period is often necessary.

It is always a good practice for an organization to think about possible stumbling blocks that may lead to a break in the workflow process before the staff augmentation begins. Here are four critical areas to examine as you assess staff augmentation for your organization.

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Topics: clinical optimization, Change management, staff augmentation

The Devil is in the Details: Why You Need an Efficient Tracking System Now

Posted on January 11, 2017 at 9:00 AM, Paul Allen

Ten of the most frustrating words for an end-user have got to be, “Please submit a ticket and we will complete your request.”   Not the words end-users want to hear when trying to resolve an issue or make a dictionary addition. The natural and most common response of course is, “Why do I have to complete a ticket for every request, even simple ones?”   Great question.

Both analysts and end-users express weariness on what appears to be needless steps in order to resolve an issue or a request.   So how to you create a tool that can be provided to management, analysts, and end-users to end this frustration? In a word, or actually three, a ticket tracking system. There are two ways to go with ticket tracking tools, you can purchase one or you can develop your own in house using SharePoint or another database system.

There are three major benefits to a ticket tracking system for your organization – tracking, reporting and communicating.

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Topics: reporting, System optimization

3 Things That Most Likely Won’t Be Changing in Healthcare Under the New Administration

Posted on January 4, 2017 at 9:00 AM, Don Michaels, Ph.D.

The election and impending inauguration of Donald Trump combined with continued Republican control of both houses of Congress have sent waves of concern across the healthcare landscape. Predictions are running rampant on what the new administration will do, backed by a Congress itching to make changes – and cuts to existing programs.

The Affordable Care Act (ACA) – aka Obamacare – is clearly in the cross hairs, the target for significant change if not full repeal. There has been talk that the new administration will also address health insurance sales across state lines, health savings accounts, Medicaid payment methods to states and Medicare reform.

Although no one knows for sure what the eventual outcomes will be, there is little doubt changes are coming when it comes to healthcare in the next few years. However, not everything will be changing. Among the sea of uncertainty, there are islands of stability – certain things you can be fairly confident won’t be changing regardless of whatever else may be in store. Here are three foundational concepts we believe will remain as fixtures in the future healthcare environment.

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Topics: Change management, value-based care, MACRA

2017 Predictions from Healthcare Leaders Across the Country

Posted on December 28, 2016 at 9:00 AM, Thought Leaders

In this special edition of our Healthcare Leaders blog series, we have asked some of the country’s leading experts to give us their predictions for 2017. From analytics to consumer engagement to interoperability, we get a glimpse of best guesses on what is sure to be an interesting year.

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Topics: interoperability, Healthcare Analytics, Hayes Thought Leadership Blog Series, consumer engagement, 2017 Predictions

4 Ways to Meet the Growing Revenue Cycle Personnel Skills Gap

Posted on December 14, 2016 at 9:00 AM, Sondra Akrin

Eight out of ten hospitals under 100 beds are engaging in Revenue Cycle Management outsourcing because of lack of skilled staff.[1] The graying of the baby boomer generation and the resulting retirements is putting a personnel strain on all businesses and the healthcare industry is no exception.

Healthcare organizations are being hit particularly hard in regard to physicians and nurses, but they are also seeing a lack of trained personnel in unseen, under appreciated but critical areas. One particular skills gap involves revenue cycle management personnel, a workforce that operates in large part behind the scenes but one that is crucial to optimizing a healthcare organization’s revenue stream.

Filling revenue cycle roles can be difficult because historically these jobs haven’t been valued as much as other positions in the organization. That’s a major mistake and failing to change that attitude can lead to serious negative financial impacts.

From the beginning of the cycle where front end staff checks in patients to the back end business office where A/R representatives, payment posters, cash control representatives and customer service representatives toil in relative anonymity, the process relies on dedicated, trained personnel, operating at peak performance.

Individuals in these roles must understand a multitude of payer requirements and recognize the interrelationship of every step in the cycle. They have to know the process thoroughly and understand their customers intimately. Finding and retaining staff for these positions should be a high priority for any organization.

Unfortunately that’s not always the case. Many organizations underestimate the complexity of these jobs and the skillset required to carry them out effectively. Here are four things to consider to attract and retain the right people to keep your revenue cycle flowing smoothly.

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Topics: training, healthcare revenue cycle improvement

The MACRA Final Rule: Easing the Pain of Implementation

Posted on December 7, 2016 at 9:00 AM, Don Michaels, Ph.D.

When CMS released the Notice of Proposed Rule (NPRM) for the implementation of the Medicare Access and CHIP Reauthorization Act  - better known as MACRA – in April of this year, howls of protest could be heard throughout the healthcare landscape.  

Critics labeled the proposed rule “too complex, too onerous on small and solo practices, lacking in opportunities for many to participate in alternative payment models, and should be delayed for a full year at least.”[1] Some physicians claimed the rule was an attempt to drive them out of private practice and predictions of mass retirements were rampant.

In the six months after the release of the rule, nearly 4,000 public comments poured into CMS. The agency also collected feedback from over 100,000 physicians at outreach sessions held across the country.

The agency was paying attention. The final rule was released in mid-October and not only offers a series of clarifications, but also significantly softens some of the more aggressive components presented in the original proposed rule.

CMS addressed one of the biggest complaints – that there wasn’t enough time to absorb and comply with the new requirements – by essentially making 2017 a transition year. This gives organizations additional time to figure out what they need to do to implement the mandates of the massive new law.

Here are seven of the key outcomes, changes and clarifications resulting from the release of the final rule.

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Topics: value-based care, MACRA

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