A 360° view of value-based healthcare: how to position your facility for success

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The shift from volume to value-based healthcare is underway and many outpatient providers are already participating. How are you preparing for this transition? This presentation will explore the move to value-based care, and share ways for your facility to adapt what it is doing today to thrive under collaborative service delivery models, including: revenue cycle management, data analytics, patient engagement and system interoperability.

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  • 1. A 360° view of value-based care: How to position your facility for success July 28, 2016
  • 2. AGENDA 1 The Move to Value-Based Care 2 Impact of Value-Based Models on RCM 3 How to Prepare for Value-Based Care 4 Q&A 2
  • 3. Today’s Speakers 3 Jho Outlaw SVP of Revenue Cycle Services, SourceMed Walter Groszewski VP of Professional Services, SourceMed Michael Cipoletti Product Manager of Analytics, SourceMed
  • 4. The Move to Value-Based Care 4
  • 5. Value-Based Care and the Triple Aim 5 New care delivery systems and payment models enabled by: • Convergence of healthcare and technology • More connected, coordinated care across entire treatment continuum • Focus on quality and outcomes http://www.cfha.net/blogpost/689173/193311/No-Triple-Aim-without-Collaborative-Integrated-Care http://www.hhnmag.com/articles/6953-care-and-payment-models-to-achieve-the-triple-aim
  • 6. Pressure for Change is Accelerating 6 Coordination • Focus on transitions and non-hospital sites • New models of care “Capitation” Consumerism Coordination • Focus on transitions and non-hospital sites • New models of care • Larger provider and payer organizations • Vertical integration – Insurance through delivery Consolidation Competition • Increased competition • Risk based organizations compete on value & customer service Consumerism • Patient and personalized medicine • Population health management • Shift of risk from payers to providers • Pay for value, not volume The 5 Cs!!
  • 7. Value-Based Programs - Not New to Healthcare 7 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html
  • 8. Early Outcome Initiatives Established Momentum 8 Lower readmission rates demonstrate hospitals’ response to incentives and penalties January 2015: HHS goal to link 85% of all traditional Medicare payments to quality or value by 2016, and then 90% by 2018 https://www.whitehouse.gov/blog/2014/12/30/getting-higher-quality-lower-costs-biggest-health-story-you-may-have-missed-year
  • 9. Spectrum of Emerging Models 9
  • 10. Varying Adoption and Buy-in 10 peer60 report: 2016 Healthcare Revenue Cycle Management, Trends in Alternative Payment Model Adoption “Nearly ½ of all US Physicians are unfamiliar with MACRA” Deloitte Survey of 600 Doctors “CMS Chief tells Senate panel MACRA delay possible due to rules requiring adjustment and Preparation” July 2013, Healthcare IT News Alert Forty-five percent of respondents said they expect a drop in profits due to the move to value-based contracts. KPMG 2016 Survey
  • 11. Comprehensive Care for Joint Replacement (CJR) 11 Testing for episodes of care related to total knee and total hip replacements Payment per 90-day episode capped at $25K, 39% tied to post-discharge care Participants penalized for poor cost performance ASCs and outpatient therapy clinics can participate as value chain partners ASCs typically reimbursed 53% of hospital
  • 12. Impact of Value-Based Models on Revenue Cycle Management 12
  • 13. What is Changing: Fee-for-Service vs. Value-Based 13 Factors Fee-for-Service Value-Based Payment Based on volume Based on results Cash Flow Multiple checks, at expected timeframes and amounts One check, disbursed based on available data and subject to change based upon outcomes Team Approach Assembly line, structured Cradle-to-grave, flexible, accountable Governance Top-down, separate doers and thinkers Results-oriented, tight process to govern payout, team based, highly responsive to change Data Static, siloed Dynamic, ecosystem-based Reporting Delayed, report-driven Timely, analytics-driven Systems Disparate, internally-focused Connected, interoperable
  • 14. What Won’t Change? Ongoing Focus on KPIs 14 Key Performance Indicators (KPIs) focus on aspects of the revenue cycle that drive overall success when accomplished Revenue cycle improvement is dependent upon ongoing monitoring of KPIs and effective management focus on accountability Keys: timely, accurate, digital data and an information-driven approach (analytics)
  • 15. Establish KPIs • Claim submission speed • A/R greater than 90 days • Cash collected as a % of net revenue • Overall cost to collect • Average claims worked per day Cadence • End of day report (Daily) • Weekly soft closes • Monthly score card • Structured accountability model across all RCM delivery resources Hold weekly revenue cycle team meetings Benchmark externally against peers Benchmark internally - question trends Track and Monitor KPIs Best Practices: RCM KPIs
  • 16. Where to Focus 16 Regardless of the payment model, RCM is all about data and people Re-engineer your systems, and also the expectations of your team Cultivating a results-only work environment is KEY Focus on KPIs and think about ways to impact value-based care with your data
  • 17. How to Prepare Your Facility for Value-Based Care 17
  • 18. Past and Current Factors 18
  • 19. Analytics is a Journey 19 Maturity Model Source: Gartner Healthcare IT is just getting started Which analytics capabilities do you need and how do you get them?
  • 20. Go Digital 20 How can outpatient surgical centers take steps toward the future? • Incremental Approach • Communicate • Focus on Interoperability • Cloud-based Technology
  • 21. Revenue Cycle Management Analytics 21 What is the current situation and how can outpatient surgery centers take steps toward the future? Reporting on quality measures • Patient burn • Patient fall in the ASC • Wrong site, wrong side, wrong patient, wrong procedure, wrong implant • Hospital transfer/admission • Rate of surgical site infections (SSIs) https://www.medicare.gov/hospitalcompare/asc-ambulatory- surgical-measures.html Competitive Positioning
  • 22. Ecosystem Collaboration 22 Market your facility to help delivery partners and patients understand: • Which services you specialize in • Which population you serve best • How you deliver quality care • Payer/ Hospital collaboration Host or participate in local events to showcase services and expertise Build referral opportunities ASCs reduce cost of commercially insured patients by $38B annually ASCA News, 2016 Patient
  • 23. Collaboration Drives Achievement of Triple Aim 23 Engage Communities • Identify patients • Establish proactive care processes • Focus on wellness • Implement community resource navigator Engage Patients • Identify and incorporate patient goals • Focus on continuity and coordination • Facilitate communication channels • Improve access to care Identify Opportunities to Reduce Waste • Avoid duplication • Improve coordination and transitions • Use automation to reduce resource needs • Improve screening and prevention • Align incentives to drive value
  • 24. Population Health Management: Foundation of Paradigm Shift 24 Data Integration Risk Stratification Care Management Patient Outreach PHM Elements Outcomes • Go Digital – Financial AND Clinical • Analytics Journey • Collaboration Strategy • Community Data Sharing Platform for Analysis Insights and Decisions Improved Outcomes Ongoing Healthy Lifestyle
  • 25. Patient Engagement in a VBC World Must be Ongoing 25 http://www.himss.org/himss-patient-engagement-framework HIMSS Patient Engagement Framework Establish an end-to-end communication connection to build confidence, satisfaction and loyalty: Before Visit During Visit Post Visit • Informed Consent, HIPAA • Pre-op instructions • Financial responsibilities and electronic payments • Secure Communications • Education • Payments • Education and Care Instructions • On-line Education and instructional videos • Secure Communications • Test Results • Wellness Tracking
  • 26. Get Creative: Explore Other Service Delivery Models 26 Offset the impact of value-based models on cash flow, and align with the focus on outcomes: • Telemedicine • Virtual visits • Free health monitoring app • Instructional videos Keep in mind that new service models will bring with them new ways of billing – you think we have a lot of codes NOW?!?
  • 27. Re-imagine Your RCM Team and Processes 27 Adaptability and scalability are critical to the value- based RCM staffing model The days of assembly line RCM processes are dead – focus on it as a ‘cradle to grave’ function How we submit bills changes very little - but how we assemble, interpret and use data produced by the bills changes dramatically Understand the data collection process and perfect it
  • 28. Rethink RCM Governance 28 A results-only work environment is key Understand expected outcomes and hold the team accountable to them Because incentive compensation is generally split among providers, have a solid process in place to govern the payout Be adaptable and responsive to change
  • 29. Divide and Conquer 29 In fee-for-service, the current coding determines future payment Value based care models punish the universe for only a few mistakes Teams of best practice entities that coordinate their unique set of services to deliver the best outcomes will succeed
  • 30. Where do We Go from Here? 30 American Hospital Association, Committee on Research. (2014, January). Your hospital’s path to the second curve: Integration and transformation. Chicago, IL: Health Research & Educational Trust. Keep a close eye on changing regulations Identify your sweet spot, build a network and collaborate Digitize, analyze and share data Hold teams accountable to measurable results Deliver a 360° positive patient experience including billing & collections There is no silver bullet or one-size-fits all answer Every facility will create its own path to success with value-based models
  • 31. Q&A 31
  • 32. Suggested Questions to Use from Registrants 32 1. If I have not started engaging my patients throughout there experience with us, where do I start? (Walter take lead in responding) 2. How can I best encourage the revenue cycle management process/finance dept to work more collaboratively with Quality? (Jho take lead in responding) 3. How to best use data to manage healthcare business? (Michael take lead in responding) 4. What dashboards are most effective for staff alignment and motivation? (Michael take lead in responding) 5. How do you get buy-in from physicians in a solo practice that come to your facility? (Michael to take lead in responding)
  • 33. Thank you Walter.Groszewski@SourceMed.net SourceMed.net @SourceMedCorp
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