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Meaningful Use Infographic | New Attestation Deadline Reminder

 

EHR, EMR, Electronic Health Record, Electronic Medical Record, The Camden GroupEligible professionals now have until 11:59 pm ET on March 20, 2015, to attest to meaningful use for the Medicare Electronic Health Record ("EHR") Incentive Program 2014 reporting year.

The Centers for Medicaid and Medicare Services ("CMS") extended the deadline to allow providers extra time to submit their meaningful use data. CMS continues to urge providers to begin attesting for 2014 as soon as they can.

This extension also allows eligible professionals, who have not already used their one “switch”, to switch programs (from Medicare to Medicaid, or vice versa) for the 2014 payment year until 11:59 pm ET on March 20, 2015. After that time, eligible professionals will no longer be able to switch programs.

Medicare eligible professionals must attest to meaningful use every year to receive an incentive and avoid a payment adjustment. Providers who successfully attest for the 2014 program year will:

Note: The Medicare extension does not affect deadlines for the Medicaid EHR Incentive Program. Additionally, the EHR reporting option for PQRS has been extended until March 20, 2015. 

For help, call the EHR Information Center: 1-888-734-6433

__________________________________________

The following infographic from athenahealth, titled, "Meaningful Use: On the Road to Attestation," presents results from a survey of over 1,400 Epocrates members who shared their concerns and progress on their way to meaningful use success.

A full-sized version may be accessed here (click image to enlarge).

EHR, Electronic Health Records, Infographic, EMR, Electronic Medical Records, The Camden Group

Hospital Readmissions: How Are They Impacting Your Bottom Line?

 
By Tawnya Bosko, MHA, MSHL, MS, Senior Manager and Tina Pike, RN, MSN, MBA, HCM, Senior Manager, The Camden Group

Hospital Readmissions, Readmission Reduction, The Camden GroupYes, there is controversy surrounding the Hospital Readmissions Reduction Program (“HRRP”). Many hospitals feel that the costs to effectively manage readmissions are more than the penalty that is incurred, thus making readmission reduction efforts a net loss; and still others feel that the formula is flawed and disproportionately impacts certain facilities such as academic medical centers and those hospitals serving communities of lower socioeconomic status.

While either of these scenarios may be true, the reality is that reducing readmissions is in the best interest of all hospitals as an initial step in transitioning to a more population health-based delivery system. Potentially avoidable readmissions result in approximately $17 billion in excess spending by Medicare alone. Additionally, potentially avoidable readmissions are a reflection of the quality of care provided across the continuum. Understanding your hospital’s current performance, the performance of care providers in the delivery network, and identifying solutions to reduce readmissions are of significant importance. Acting now will prevent larger revenue impacts in the future and will position the hospital for success.

Although readmission rates have been declining overall, 75 percent of all hospitals eligible for the HRRP (i.e., 2,610 hospitals) are receiving a penalty this year, which is an increase of 433 hospitals receiving penalties over the previous year. The average penalty is .63 percent of their Medicare reimbursement for every Medicare stay, not just those readmitted. Overall, the hospitals receiving penalties will experience an estimated $428 million reduction in Medicare reimbursements, with the largest readmissions penalty to any hospital being approximately $13.3 million.

While the financial implications are important, hospitals need to be aware of the data collection and reporting periods that impact their penalty. This year brings the maximum penalty allowed by law (3 percent) as well as additional measures, but the data for this year’s penalty was collected July 1, 2010 through June 30, 2013. This means that hospitals cannot impact their penalty for 2016 at this point in time and have only four months remaining to make any impact for 2017, which will bring a new diagnosis (Coronary Artery Bypass Graft [“CABG”]). Of importance is taking action now to protect revenue in 2018 and beyond.

Readmissions Measures, Hospital Readmissions, The Camden Group

If a hospital is subject to a penalty and/or attempting to improve current performance, a detailed analysis stratifying readmitted patients by payer, diagnosis, and source of the readmission should be completed in order to identify priority areas. From there, hospitals should assess the internal organizational processes related to care delivery and care management. This not only includes assuring high quality care during the hospitalization, but incorporates the preparation, planning, and communication needed for a successful transition of care to a post-acute or home-based setting. 

Determination of process effectiveness includes incorporating patient goals into discharge planning and instructions, including medication reconciliation with easy to use patient tools, as well as other tailored patient and caregiver education and programs focused on certain medical conditions. Coordination with community physicians for follow-up visits is imperative. Qualitative factors such as short patient or caregiver interviews at the time of readmission may also shed light on non-obvious reasons for readmission. Additionally, the hospitalist program should be assessed from a coordination perspective with care management, discharge planning, and primary care physicians. Paths for controlling readmissions include: pre-discharge processes internal to the hospital, performance of the post-acute network, and factors associated with discharge to home. Assessing and improving these pathways is recommended.

Readmission Reduction, Hospital Readmissions, The Camden Group

As the U.S. healthcare system continues its transition from volume to value, readmissions penalties appear to be here to stay. The penalties will impact each hospital in a different manner, and the costs and benefits of reduction efforts must be weighed. However, controlling and reducing avoidable readmissions is a solid first step toward delivering more accountable care. Hospitals should be aware of the penalties, the impact to their facility, and the drivers of potentially avoidable readmissions. Deploying proactive and effective strategies for improvement is necessary for success in today’s healthcare marketplace.

The Camden Group, Hospital Readmissions, Readmissions Reduction

Tawnya Bosko, The Camden GroupMs. Bosko is senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization (“PHO”) and MSO development, managed care strategy, and physician alignment. She may be reached at tbosko@thecamdengroup.com or 310-320-3990.

 

Hospital Readmissions, Tina Pike

Ms. Pike is a senior manager with The Camden Group with over 25 years of clinical, business, and management experience in the healthcare industry. Ms. Pike’s areas of expertise include business development, strategic planning, operations management, Lean strategies, and performance and process improvement. She may be reached at tpike@thecamdengroup.com or 585-512-3900.

Top 10 Considerations When Transitioning Physicians to Payment-for-Value

 
By Tawnya Bosko, MHA, MSHL, MS, Senior Manager, The Camden Group

Value-Based Payments, The Camden GroupWith increased focus on payment based on value, physician practices and those involved with physician practices need to plan for how to transition to new reimbursement models. Here are the top considerations to keep in mind when implementing value-based structures:

1. How do you define value? 

For all the talk of compensating physicians based on value as opposed to volume, there is no consistent methodology for measuring “value.” Often, payers define value in different ways, making it difficult for physician practices to understand what is required of them in order to meet criteria. Leadership should define what value means to the practice with insight from key payers. Typically, initial steps in measuring value are based on compliance with designated measures from the Healthcare Effectiveness Data and Information Set, but depending on the program, different criteria may be used. Further, the practice may include measures that it has identified as needing improvement, such as patient access, completing notes, meeting meaningful use, or responding to lab results in a timely manner.

2. How do you report on value?

Once the practice has determined the clinical measures or other criteria that will define value, it must proactively assess information system readiness for reporting on these measures. Historically, many payers have tracked these values based on claims data. Practices must be able to monitor, track, and report on performance related to value metrics. Assess the system, and ensure that necessary data can be extracted efficiently and accurately for reporting. Build custom fields within the electronic health record (“EHR”), or consider an add-on reporting tool if needed.

3. How do you document value?

Just as important as determining how to generate reports to measure the value metrics, practices must determine how physicians and other providers should document their work within the EHR in order to ensure their results are captured. Often, EHRs have several ways and areas in which documentation of a certain procedure or services can be documented. Best practice is determining the field or area to document each measure so that it is clearly communicated to physicians and easily reported on, retrospectively.

4. Incentive program - carrot or stick?

Once the metrics to measure value have been determined, what is the incentive (carrot) or penalty (stick) for meeting or failing to meet value as defined by the group? There must be enough incentive to gain buy-in so that physicians do not feel as though extra work is being added without additional benefit. And, there must be enough penalty at stake for the program to be taken seriously. It is about finding the right balance. Is it a withhold on revenues with the opportunity to earn X times the withhold in return if measures are met? Is there a “direct” line of sight between the incentive earned by physicians and the impact on their compensation? There are many models that could be implemented to meet the practice’s needs.

5. Educate, educate, educate.

This point cannot be emphasized enough. Often, healthcare leaders think the difficulty is in defining value, measuring value, and designing the incentive program. While those can be complex, educating the physicians on the measures, model, and how to document them is a very important step and could make or break your program. Remember that these situations often involve changing the way a physician has practiced and/or documented and that it takes time, education, and re-education. Ensure the appropriate processes and tools are in place to communicate and educate effectively.

6. Living in a grey world/burden of value.

Understand that during this transition to payment-for-value, physicians are living in a grey zone. They are expected to take extra steps to meet value criteria, but the majority of reimbursement may still be based on a fee-for-service or volume-based methodology. Essentially, they are asked to spend extra time with patients and on documentation in order to meet quality measures but also to continue to meet their productivity targets in order to sustain the viability of the practice. Typically, the burden of many of the value-based measures falls hardest on primary care physicians. Be aware of this when designing incentive models. Do not do too much at once and overwhelm physicians to the point where they give up.

7. Transparency of data.

Physicians, rightfully so, are often skeptical of performance-related data. They have questions...make sure tyou have answers. Be transparent with data. If a physician asks for the names of patients where they failed on a certain measure, ensure the information is provided. It is important to not only be transparent with data but to build confidence in results.

8. Timeliness of results.

Be timely with reporting. Provide information to physicians in a timely and regular manner so that they are able to improve any deficiencies in the measurement period. Do not wait until the point where it is too late to correct issues for the current performance year. It is in the practice’s interest to improve each physician’s performance. Use the data and reporting to provide feedback and to help them be successful in the program.

9. Impact on total compensation.

Understand the impact that the design of the incentive program has on total compensation. What percentage of total compensation does the incentive (or withhold) represent? Does the physician employment agreement need to be revised to incorporate the incentive model? If physicians are on salary guarantees, how is that addressed so that the incentive/penalty falls on them and not the employer?

10. Engage payer partners.

Work with payer partners and do it early. Discuss their needs when measuring value and pursue discussions on how they can support the transition. Make it a collective effort where initiatives are streamlined and convergent. It is not practical for practices to have multiple different models for multiple different payers; be open with major payers, and develop a program that is supported uniformly.

As medical groups and hospitals that own medical groups look for ways to be more efficient and seek stability in a quickly changing marketplace, embracing a transition to value-based reimbursement is necessary. The focus should be on managing the care of a population, and incentive models should be designed with the end goal in mind.

Tawnya Bosko, The Camden Group, Ms. Bosko is senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization (“PHO”) and MSO development, managed care strategy, and physician alignment. She may be reached at tbosko@thecamdengroup.com or 310-320-3990.

Top 10 Survival Tips for Physicians Straddling Fee-for-Service and Fee-for-Value

 
By Teresa Koenig, M.D., MBA, Senior Vice President and Chief Medical Officer and Tawnya Bosko, MHA, MSHL, MS, Senior Manager, The Camden Group

Volume-to-value, The Camden Group, Tawnya BoskoTransitioning payment systems from volume to value is a recurring theme in healthcare delivery. With this increased focus on payment based on value (“PFV”) as opposed to volume (fee-for-service or “FFS”), physician practices, or those involved with physician practices need to plan for how to transition to new reimbursement models. While challenges exist around every aspect, one reality is physicians have the largest impact in driving changes in cost and quality (i.e., value). The additional reality is that physicians must deliver care in both the fee-for-service and payment based on value worlds – a difficult actuality for those trained and living in a FFS system. Here are the top considerations for physicians that will allow success in both fee-for-service and payment for value systems as they begin to understand and transition to a value-based world.

1. Accurate coding. As electronic medical records become the norm, coding accuracies become more critical for both payment and population health data tracking. Busy practitioners often miscode, mistype, and use incorrect templates. This can result in incorrect documentation and/or insufficient documentation. These inaccuracies can lead to delayed billing and incorrect data for quality driven reimbursement and health plan audits. Educate and assist physicians in accurate and appropriate coding practices. This will be increasingly important with the transition to ICD-10.

2. Patient engagement. A physician’s understanding of the patient engagement process, strategy, and how it affects their daily practice is crucial for engaging patients and improving patient satisfaction. Whether the strategy has multiple IT facets (i.e., open access scheduling, patient portals, etc.) or paper-based educational materials and other tools, it is necessary for the physician to understand the goals and their role in the strategy. Engaging patients in their care will result in clinical and financial success in either payment model.

3. Care management. Faced with a plethora of programs, physicians may not be aware of how the numerous care management, disease management, or transitional programs impact their patients or the care they deliver. Programs need to include physician leadership and buy-in for success. Make the programs easy to access and support physicians – again these programs can drive clinical and financial success in both payment worlds.

4. New care delivery models. Patient-centered medical homes, chronic care service lines, accountable care organizations…each of these “new” delivery models has, at its core, the same goal: improving the overall value of healthcare and improving patient health. Identifying high risk patients and providing appropriate and early interventions to keep the patients healthier is integral to success and promotes improved quality, whether in a value-based or volume-based system. Engaging in more effective care coordination not only supports more effective referral networks but assures satisfied patients.

5. Price transparency. As patients become more engaged in their healthcare and responsible for larger shares of the financial responsibility of their healthcare, they want and need to know what their portion of the cost for services will be. This is good in a value-based system because it allows patients to make educated decisions regarding their healthcare. This is also effective in a volume-based system because if a provider is able to provide accurate cost estimates to patients, it then also enables them to collect the patient payment responsibility at the time of service. Increasing cash collections and decreasing resources needed to collect on the back end improves the revenue cycle while decreasing operational expense. Providers should use tools to manage insurance eligibility and estimate patient responsibility at the time of service to become more transparent.

6. Clinical transparency. Physicians are unaccustomed to having their notes in the patient medical record shared with patients. Ultimately, the medical record is the patient’s information, and they have a right to access it. Patient portals and other tools have eased the burden of access. Physicians should embrace this process, while following policies for disclosure. Providing patients with access to their information will ultimately help engage them in their healthcare and lead to improved outcomes. Providing patients with access to their information also has been shown to reduce medical malpractice risk, which is beneficial under either structure.

7. Preventive medicine. Embrace preventive medicine services. Healthcare reform has promoted access and coverage to preventive medicine services such as physical exams, health risk assessments, annual wellness exams, and other visits that focus on the overall well-being and health status of the individual. Again, this is necessary to improve healthcare outcomes and value but also generates additional appropriate visits in the volume-based world.

8. Timely completion of records. Whether for paper-based medical records or the electronic medical record, physicians should strive on getting their notes done in a timely manner. Completing notes as soon as possible after the patient visit is a good practice for many reasons:

  • The physician has a sharper memory of the visit and can more accurately convey information to the record;
  • It allows the practice to bill more timely for services, thereby increasing cash flow;
  • It allows crucial medical information to be accessed, if necessary, by other members of the healthcare team;
  • It enables information that recaps the information from their visit to be given to the patient at the time of service or shortly thereafter, thus allowing immediate engagement.

Timely completion of records not only improves overall value, but it is also best practice in a volume driven system.

9. Flexible access and appointments. Many people have very busy schedules and limited flexibility for routine healthcare visits. Providing non-traditional appointment hours (early mornings, evenings, and weekends) promotes patient compliance with follow-up visits and is less disruptive to both the schedules of working adults and a typical school day for children and adolescents. More convenient appointment times generate additional appointment volume for providers and improve patient satisfaction. Additionally, flexible access such as an after-hours answering service that is also able to triage calls and schedule appointments not only improves the quality of service provided to the patient but also helps fill providers’ schedules.

10. Patient satisfaction measurement and ratings. Measurement of patient satisfaction continues to be tied to reimbursement. Embracing patient satisfaction measurement in a practice is a positive, proactive step to take in transitioning to payment for value. Using a reputable survey tool to query the practice, results can then be compared across practices and regions. Pay attention to online ratings of physicians in the practice. While patient satisfaction and online ratings are becoming a large component of value-based care, they also have an impact on volume as patients begin to use online ratings to select their physician.

Teresa KoenigDr. Koenig is a senior vice president and chief medical officer with The Camden Group who specializes in developing and designing clinical integration strategies, medical management programs, and value-based care delivery and payment models. She has worked with a variety of healthcare organizations, from individual physician groups and health systems to academic health systems and Fortune 50 companies. She may be reached at tkoenig@thecamdengroup.com or 310-320-3990.

Tawnya Bosko, The Camden Group, Ms. Bosko is senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization (“PHO”) and MSO development, managed care strategy, and physician alignment. She may be reached at tbosko@thecamdengroup.com or 310-320-3990.


New Download: Managing the Newly Eligible Medicaid Population

 

Medicaid, The Camden Group, Tawnya Bosko, Medicaid EligibilityAs more states begin to take on newly eligible Medicaid populations, there are a number of lessons that can be learned from health systems that have already begun managing these patients. Not all institutions within a state will be equally prepared to manage the newly eligible population due to organizational, information technology, and provider network constraints.

This new download from The Camden Group examines challenges associated with the newly eligible Medicaid population and takes a closer look at:

  • Challenges facing hospitals
  • Approaches to assessing readiness
  • Key stakeholders
  • Key formation components
  • Expectations for clinically integrated network formation
  • Lessons learned from other providers

To download this PDF, simply click on the button below, complete the necessary fields, and press the "Click for Download" button. Your file will appear and will be available for you to save to your device.

Medicaid Population, The Camden Group, Population Health

Are Health Systems Positioned to Efficiently Manage the Newly Eligible Medicaid Population?

 
By William K. Faber, M.D., Vice President and Tina Wardrop, Vice President, The Camden Group

Population Health, Medicaid PopulationAs more states begin to take on newly eligible Medicaid populations, there are a number of lessons that can be learned from health systems that have already begun managing these patients. These lessons include:

  • Not taking on too many recipients at one time without understanding the costs
  • Not taking on a large value-based population without prior managed care experience
  • Creating financial incentives to build a provider network so there is sufficient access to care for this population
  • Providing adequate technology and connectivity to measure utilization and outcomes
  • Coordinating outreach services between providers and institutions
  • Using telemedicine to facilitate care

It should also be recognized that all institutions within a state will not be equally prepared to manage the newly eligible population due to organizational, information technology, and provider network constraints. Some of this depends on whether organizations have developed an ACO or ACO-type structure to manage other commercial or Medicare populations because these infrastructures can be modified to manage Medicaid patients as well.

Key questions healthcare systems should ask themselves include:

  • Is the organization’s leadership prepared to make the necessary investments to address the unique needs of this population, including time and financial resources?
  • Is the provider network sufficient to support this population? Typically this population has significant psycho-social, economic, and logistical issues that challenge care delivery capabilities.
  • Are the key payers aligned with the interests of the hospitals and ambulatory providers? Are they willing to fund the development of care delivery models and share in financial savings if improvements are accomplished?
  • Is there sufficient technology in place to integrate clinical data among providers and track individuals across a continuum of care? Typically this includes integrated EMRs, data registries and warehousing, and health information exchanges (HIEs) across areas within the state.
  • What quality metrics are put in place to monitor patient outcomes?
  • Are there care management programs in place to manage patients across the continuum with a focus on preventative and post acute care, behavioral health issues, and other psycho-social needs?

Once this assessment has been completed, health systems can determine the priority of key capabilities that should be implemented and what their optimal role should be in serving the Medicaid population. It takes significant time and resources to build value-based patient care models. Most important is the amount of cultural change that is needed among all stakeholders to make this initiative successful.

Taking on the challenges of health management for this population is not for the risk averse, but it may be a necessary skill for many health systems as Medicaid expands and grows in importance as a major segment of the market.

William K. Faber, Primary Care AccessDr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Tina Wardrop, The Camden Group, Medicaid, Population HealthMs. Wardrop is a vice president with The Camden Group. She has over 30 years of experience working in the healthcare provider sector. She has worked with a wide range of hospitals, healthcare systems, and independent and employed physician groups. Her key areas of expertise include strategic planning, medical staff development, physician recruitment and employment, electronic health record selections, hospital/physician integration, and population health. With a diverse background in hospital and physician arenas, Ms. Wardrop has in-depth knowledge of the political and economic factors and implementation processes that determine the success of strategic and operational turnaround initiatives. She may be reached at twardrop@thecamdengroup.com or 312-775-1714.

Medicaid Population, The Camden Group, Population Health

Infographic: The Social Media Shakeup in Healthcare

 

The Camden Group, Social Media, Facebook, Twitter, InfographicPatients are increasingly turning to social media channels to seek health information and become more informed about their care, rate the quality of care they receive from providers, and communicate with their peers regarding health advice. For their part, physicians are seeing increased value in social media for their own research discussions with colleagues — utilizing it to become more informed on patient care resources and for career development and networking. 

Social media is slowly starting to foster meaningful results in the healthcare industry. This infographic from CDW Community IT claims social media enables:

  • Better knowledge of health conditions
  • Increased dialogue
  • Connected support
  • Improved patient engagement

Doctors and hospitals alike are tapping into social media. Consider these stats:

  • 87 percent of physicians ages 26 to 55 use social media.
  • 65 percent of physicians ages 56 to 75 are interacting online.
  • In 2012, four in five (79 percent) of hospitals were using social media. That number increased to 91 percent in 2013.
To view a full-size version of the infographic, please click here and then click the image when it opens.

Social Media, Facebook, Twitter, The Camden Group

The Latest Thought Leadership from The Camden Group

 

The Camden Group, Thought Leadership, Population Health, Clinical IntegrationEach month, thought leaders from The Camden Group share their expertise through original posts, articles, speaking engagements, and interviews.

Below are links to the top thought leadership shared recently by The Camden Group. 

 

Email Newsletters

►“Top 10 Trends and Implications for Medical Groups in 2015” by Mary Witt

►“Prevent 2017 Medicare Penalties Now” by Lucy Zielinski

►“Improving the Financial Performance of Your Newly Acquired Medical Group” by       Tawnya Bosko

Bylined Articles

In the News

Upcoming Speaking Engagements

To request more information about scheduling a thought leader from The Camden Group to speak at your organization's next event, please click the button below.

The Camden Group, Speaking Opportunity

Bundled Payments and the Breakthrough Power of Partnerships

 

By Kimberly Hartsfield, MPA, Vice President, The Camden Group

Partnerships, bundled payments, The Camden GroupAs bundled payment programs are expanding across specialties, payers, and sites of care, it is becoming increasingly clear that the path to success can be summarized in one word: partnerships.

Who is your Apple?

Consider the successful partnership between Nike and Apple. Although they are in different industries, their commonality lies in their customers. As a result of their partnership, both companies have experienced enhanced brand recognition, in addition to significant market and sales growth. Nike CEO, Mark Parker said about their partnership with Apple, “As I look ahead at what's possible with Nike and Apple...technologically we can do things together that we couldn't do independently. So yeah, that's part of our plan, is to expand the whole digital frontier and go from...25 million Nike+ users to hundreds of millions (theverge.com).”[1] Who is that perfect partner that you had not previously considered, and what can you accomplish together?

Why it Matters

How do these strategic partnership examples apply to healthcare? The same patient that has an inpatient stay and is discharged to a post acute care facility has one goal: to get home pain-free as fast as they can. Bundled payment arrangements are holding both providers accountable very differently than the traditional fee-for-service model. How can potential partners leverage one another to expand their existing capabilities and utilize resources in innovative ways? All provider organizations are facing demand destruction pressures, and partnering may help both parties retain much needed volumes and revenues, while continuing to provide excellent patient quality.

New relationships between providers, and between payers and providers, are being forged to advance payment transformation efforts through bundled payments. Providers are looking beyond their four walls, obtaining, analyzing, and sharing data, and partnering across the care continuum to enable patient-centric care delivery with a new focus on value and total cost of care.

Identifying the right partner organizations is paramount to a successful bundled payment program. Providers should consider partnerships with organizations that are innovative, philosophically aligned around value-based care, cost-efficient, and high performing in their markets. Today’s strategic partnership evaluations require a willingness to look beyond the closest geographic provider or the provider organization that has historically been the preferred referral choice. Publically available data from sources such as CMS Hospital Compare, Nursing Home Compare, Home Health Compare, Physician Compare, and Dialysis Facility Compare enable providers to proactively evaluate and identify potential candidates for partnership.

The Right Sandbox

Bundled payments are the perfect testing ground for partnerships where gainsharing programs can be established to strengthen provider engagement and evaluate potential for long-term strategic alignment. This allows participants to demonstrate their ability to eliminate unnecessary variation in care and meet the agreed upon goals of the program without assuming risk that providers may not be prepared to manage. Bundled payment programs and ACO initiatives can be very complementary, and many organizations are choosing to pursue both simultaneously.

The ability to expand the external focus and consider the full continuum of care requires very different commitment and communication between providers. Partners must develop innovative solutions and continue to make IT investments to overcome the frequent inability of EMRs to transmit data between different platforms and providers. They must also be willing to collaborate clinically through the standardization of care protocols and/or seamless coordination across care settings. Perhaps more importantly, they must be willing to demonstrate mutual accountability for patient outcomes and the total cost of care.


[1] http://www.theverge.com/2014/10/23/7044999/nike-apple-wearables-partnership

Kimberly Hartsfield, Bundled Payment, Payment Reform, The Camden GroupMs. Hartsfield is a vice president with The Camden Group. She specializes in payment transformation strategies with a focus on designing and implementing Medicare and commercial bundled payments. She frequently presents on a variety of topics including value-based payment models and provider engagement. She may be reached at khartsfield@thecamdengroup.com or 501.940.2526. 

 
 

Bundled Payments, Payment Reform, Deirdre Baggot, The Camden Group  

The Payment Reform Mash-Up: Top 10 Smart Leadership Strategies for Managing in an Era of “Fusion” Reimbursement Models

 
By Deirdre Baggot, MBA, Ph.D., Senior Vice President, The Camden Group and Kimberly Hartsfield, MPA, Vice President, The Camden Group

Bundled Payment, Payment Reform, Clinical IntegrationFew would argue that this may be one of the most exciting times in healthcare – volatile and disruptive, yet also transformative and empowering for those organizations and innovative leaders who are able to move markets by embracing “fusion” reimbursement models. While not all leaders have relished these challenges, many of their more adaptable and failure tolerant counterparts are at the forefront of payment transformation and reconceiving their payer strategy today. Now is the time to for true transformation, and those innovators who meet the changes head-on are far more likely to succeed than their overly cautious counterparts, who may well find themselves left behind. Here are the top ten strategies of transformational leaders who are taking the healthcare “bull by the horns” and redesigning their business model to seize the inherent opportunity of payment transformation.

1.  Have great timing

In an era of payment transformation, building value is not enough. Moving from building value to extracting and trading value requires appropriate timing. The inherent threat of demand destruction that both bundled payments and ACOs drive require many providers to reconceive their business model. The key is to time new payer arrangements with the redesign of the care models. The transformation is already well underway, and the clock is ticking for those who have not embraced this as their future.

2.  Risk is your friend

Risk is described as the gap between opportunity and success. Without it, the greatest opportunities an organization holds will not have the possibility to develop. Organizations are charting new territory, and creating success in the future is contingent upon leadership’s willingness to “run to risk.” Keeping an open mind and viewing the future from a broad perspective will allow an organization to identify opportunities for risk that make sense. Risk tolerance goes hand in hand with failure tolerance (see number 7).

3.  Think like Google

In industry transformation, talent becomes the linchpin asset. Identifying all-stars and empowering them in a way never done before may mean beginning to build teams that look more like a group of Google interns. Ask them what unproductive activities are they wasting their time on each day? Who are the creative thinkers within the organization, and how much time are they spending envisioning the future? An organization must continually innovate to stay ahead of competitors, while recognizing both its market and the healthcare industry are in a rapid state of flux. A wait and see approach will not cut it. The experience people (both customers/patients as well as internal audiences) have within a system must be described as prompt/quick, high value, high quality, responsive, and personalized. These core principles must permeate everyday culture.

4.  Execution matters...a lot

The ability to execute is not inherent among all leaders. When it comes to payment transformation and complex change, it is often assumed that that a critical change can be “assigned” – and that is flawed thinking. Masterful execution requires process, project, and conflict management, as well as sharp communication skills, and most importantly, the ability to influence others. Time and again, seemingly good ideas are lost on poor execution. Payment reform becomes the impetus for care delivery reform which is a heavy lift. Simplifying the plan and managing the execution process will keep you on path to smart execution and foster the commitment to change.

5.  The imperative to adopt new payment models

Bundled payments are a natural introduction to value-based care delivery as the entry point is low, the investment is lower than ACOs by comparison, and the yield can be high. Certain other shared savings models with payers as your partner can also yield results in a relative “safe” environment. Bundled payment programs are moving out of the pilot stage and are becoming an integral part of healthcare finance in many markets. Many of the pilot initiatives focused on inpatient hospital stays and physicians performing procedures in high cost, high volume specialties like orthopedics and cardiology. Bundles are expanding across the care continuum into both the outpatient and post-acute arenas. Also, we are seeing many new joint venture arrangements with payers to facilitate population health management experience in commercial, Medicare, and Medicaid markets. The point is, successful leaders are pursuing new payment models rather than shying away.

6.  The next “dream deal" (Hint: It’s not a volume play)

No healthcare provider or setting is an island. The kind of thinking that connects cross-setting care delivery will change the world of healthcare in the United States. The next dream deal can be summarized in one word: Partnership. Successfully managing risk under the evolving reimbursement structures requires organizations to look beyond their four walls for partners to complete the care continuum, provide new capabilities, and live up to the goal of delivering patient-centered care. Partnership evaluation efforts across multiple healthcare stakeholders must be fact-based through a comprehensive market assessment. In a perfect world, who do you see as your long-term partners? What partnerships have you not considered that you should? Are you philosophically aligned with this potential partner? Are their practitioners and executive staff well aligned with yours? How do they perform on cost, quality, and customer satisfaction metrics, as well as key metrics like readmission rates, compared to their peers? Asking the key questions early will prevent the dream deal from becoming a nightmare.

7.  Failure tolerance as a leadership best practice

Managing “fusion” reimbursement models requires an understanding that innovation is the hardest work to do, and failure is not failure at all--rather, it is just a data point on the journey to transformation. Failure cannot be personalized, and future leaders understand the need to “roll with it” and move quickly through tests of change. Tomorrow’s healthcare leaders are “disruptive innovators” who do not subscribe to a “culture of nice,” are not afraid to fail, and are not constrained by the political implications of killing a bad project. These leaders view failure as merely new information and are already on to the next innovation. In order to effectively compete in a time of industry transformation, the really great leaders, those capable of transforming organizations, will demonstrate a high degree of failure tolerance.

8.  The courage imperative

The healthcare leaders who will survive understand that courage and bravery shape the kind of thinking needed to spur payment transformation. Transforming the way care is delivered is not an overnight exercise and requires extraordinary courage. This includes saying “no” to unsustainable cost structures, but not through slash-and-burn tactics, which are largely short-term fixes. Success with bundled payments or any risk-based reimbursement model requires the courage to speak truth to waste and duplication and resulting behaviors of fee-for-service.

9.  Proximity

Assumptions underlying collaboration and innovation are changing. The collaboration and innovation necessary to thrive during the payment reform mash-up do not happen over conference calls or in cubicles. Chance cafeteria encounters and hallway conversations are strategic opportunities to break down silos and achieve break-through care transformation. There is a natural rhythm to collaboration that is rooted in trust and transparency. Smart leaders are asking themselves how to best foster, enable, and invest in proximity. Face-to-face connections, often occurring on the front-lines, are communication tools, and innovation sessions must be promoted.

Cross-discipline, cross-setting collaboration is the vehicle that enables innovation. Tomorrow’s successful leaders demonstrate a unique ability to collaborate, even when it means partnering with their “frenemies.” It is not personal, nor is it about burying the competition. It is about promoting and achieving health in the community. That said, collaboration done poorly can lead to endless meetings and costly delays. Being open, intuitive, and deliberate about how and when to collaborate has never been more critical for healthcare executives.

10.  Payment reform best practices are still evolving

“First Generation” transformation is not the end game; however this does not give an organization a “pass” to do nothing. The devil is in the details. Methodologies are being refined and improved. Care patterns are being altered. Transparency in healthcare is increasing exponentially. Payers and providers alike want an industry standard defining the “new normal” that outlines those best practices and makes this transition straightforward with clear timelines. Those organizations that choose to embrace payment reform now have the ability to help lead and shape the future of what those best practices look like.

As we have seen in other industries, such as the rise and fall of the dotcom era, true leaders must accept nothing less than breakthrough innovation and must understand that technology will never replace the importance of high-quality relationships grounded in trust, courage, collaboration, and innovation. Actively, energetically, yet thoughtfully pursuing new payment models, such as bundled payments, offers current leaders a wonderful sandbox to implement innovative strategies today that will enable them to thrive tomorrow.

Deirdre Baggot, Bundled Payments, The Camden GroupMs. Baggot is a senior vice president at The Camden Group. She is a nationally recognized thought leader in bundled payments and was selected by CMS and the Innovation Center to serve as an expert panelist in Models 2 and 3 application reviews for the Bundled Payments for Care Improvement initiative. She may be reached at dbaggot@thecamdengroup.com or
303.335.7047.
 
Kimberly Hartsfield, Bundled Payment, Payment Reform, The Camden GroupMs. Hartsfield is a vice president with The Camden Group. She specializes in payment transformation strategies with a focus on designing and implementing Medicare and commercial bundled payments. She frequently presents on a variety of topics including value-based payment models and provider engagement. She may be reached at khartsfield@thecamdengroup.com or 501.940.2526. 
 
 
Bundled Payments, Payment Reform, Deirdre Baggot, The Camden Group
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