Archive for October, 2011

Healthways, Inc.: Bending the Healthcare Cost Curve

“Managing healthy, at-risk and chronic populations simultaneously is the only sustainable way of slowing the demand on care and bending the cost curve,” says Darren Hodgdon, President, Provider Market, Healthways, Inc.

Ahead of the marcus evans National Healthcare CXO Summit Fall 2011 in Las Vegas, Nevada, October 24-26, Hodgdon discusses how healthcare Chief Executive Officers (CEOs) can better the well-being of their community, and subsequently their organization’s bottom line.

Improving well-being across populations requires an efficient process that begins with a full understanding of individual needs, according to the Healthways website. What insights have you gained from your research into this?

Darren Hodgdon: With Gallup, our joint scientific council has categorized six dimensions that define well-being: Life Evaluation, Emotional Health, Physical Health, Healthy Behaviors, Work Environment and Basic Access.

Life Evaluation is on how we view the future; Emotional Health is how we cope with the stressors in our lives; Physical Health is about managing the responsibilities in our busy lives and whether we function as well as our peers; Healthy Behaviors is on how our lifestyle choices affect our well-being; Work Environment is about how our work environment, where we spend most of our awake time, affects us; and lastly, Basic Access, informs us if people have access to primary needs to optimize their health and performance, including affordable fresh foods, safe exercise and access to quality healthcare. It is this information combined with clinical and claims data that allows us to personalize our solutions to the individual to change behaviors and achieve sustainable outcomes.

For health systems, we monitor populations in between episodes of care 24/7/365 providing patients with clear direction and appropriate coordination and support. We do this leveraging with over USD 1 billion invested in technologies and clinical intelligence which are tailored to each client to drive multiple resources including clinical intervention, health coaching, and online and mobile self-management tools. When this is distributed over a population, good health is maintained, actionable risks are mitigated to slow the progression of disease, adherence to care plans is improved and the well-being of communities is enhanced.

What could healthcare CEOs learn from the latest Gallup and Healthways Well-Being Index?

Darren Hodgdon: A significant share of healthcare utilization is driven by poor behaviors and has very little to do with the care that patients receive. Our Well-Being research clearly demonstrates that when we are able to identify barriers and stressors in people’s lives and teach them better coping skills or help coordinate access to needed resources, we can elevate well-being. Since access, affordability and quality of healthcare weighs in so heavily on people’s lives, working together with a high performing health system is critical to our purpose. When well-being is enhanced healthcare utilization is reduced and performance is improved.

Cost reduction is a top priority for healthcare CEOs. How could this be achieved?

Darren Hodgdon: We take a partnership approach  to address the real dilemma that most health systems are facing, that is, how to survive in an environment of declining reimbursement, overcrowded EDs, increasing regulations and adverse shifts in case mix. As the industry moves from volume to value, we focus on improving efficiency by providing a deep analysis of all service lines and cost centers, so our clients better understand where they make or lose money. Armed with good data, we then work with leadership developing a comprehensive plan to sequence a series of performance improving initiatives that result in better quality and lower unit costs. At the same time, we help phase in new programs like readmission avoidance and chronic care management as a means of strengthening the bridges to outpatient services and primary care. How these services get phased in is carefully paced to how well we can replace declining income through better contracting, increasing market share and driving better efficiency.

Why is it critical to engage a population with its well-being improvement, and how can it be done successfully?

Darren Hodgdon: In health our populations are aggregations of individuals who collectively represent financial risk. This can be a health plan, an employer or a physician’s panel. In an environment of accountability and a shift to value-based reimbursement, understanding how to manage populations is an effective hedge against impending risk. By managing an entire population you can better spread your risk. In simple terms, we aim to achieve zero trend, that is to say “to keep everyone where they are”; maintain the healthy, mitigate the progression of illness, and keep the sick from getting sicker. This requires managing the entire population. We help redesign care teams and care plans to support physicians with the appropriate clinicians, coaches and self-management tools and use predictive models to identify the needs of everyone within the defined population. This results in a trifecta, more patient encounters, improved outcomes and lower trend over time.

Any final thoughts?

Darren Hodgdon: We see a lot of confusion and dysfunction in the market and everyone is having to cope with so much uncertainty but some are doing it better than others. We are helping our clients take a hard look at their business today and helping them shape a vision of the future by identifying key market and legislative drivers that are quickly changing their world. By organizing this information for them, they are better equipped to develop their strategies and create their three to five year plans. We believe that regardless of Reform, improving quality and lowering costs must occur. Those that move first will be advantaged to capture more market share and contract with payors differently so they are rewarded for their efforts.

Contact: Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division

Tel: + 357 22 849 313
Email: press@marcusevanscy.com

About the National Healthcare CXO Summit Fall 2011

This unique forum will take place at The Red Rock Casino, Resort & Spa, Las Vegas, Nevada, October 24-26, 2011. Offering much more than any conference, exhibition or trade show, this exclusive meeting will bring together esteemed industry thought leaders and solution providers to a highly focused and interactive networking event. The summit includes presentations on solutions to the transformation of the healthcare system, improving patient care and safety and budget tactics to combat cost escalation. 

For more information please send an email to info@marcusevanscy.com or visit the event website

marcus evans group – healthcare sector portal

About Healthways

Healthways is the leading provider of specialized, comprehensive solutions to help millions of people maintain or improve their health and well-being and, as a result, reduce overall costs. Healthways’ solutions are designed to help healthy individuals stay healthy, mitigate and slow the progression of disease associated with family or lifestyle risk factors and promote the best possible health for those already affected by disease. Our proven, evidence-based programs provide highly specific and personalized interventions for each individual in a population, irrespective of age or health status, and are delivered to consumers by phone, mail, internet and face-to-face interactions, both domestically and internationally. Healthways also provides a national, fully accredited complementary and alternative Health Provider Network and a national Fitness Center Network, offering convenient access to individuals who seek health services outside of, and in conjunction with, the traditional healthcare system. For more information, please visit www.healthways.com

Contact: Darren Hodgdon, President, Provider Market, Healthways darren.hodgdon@healthways.com

About marcus evans Summits

marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, think tanks, seminars and one-on-one business meetings. For more information, please visit www.marcusevans.com 

All rights reserved. The above content may be republished or reproduced – kindly inform us by sending an email to press@marcusevanscy.com

Rothman Healthcare Corporation:
The Criticality of Continuity of Care in Hospitals Today

FOR IMMEDIATE RELEASE

Typically, hospitalized patients are seen by a succession of clinicians, says Michael Rothman, Chief Executive Officer, Rothman Healthcare Corporation. In the handoffs between nurses, and from one doctor to another, information is lost, risking the patient’s health, extending length of stay and impacting hospital finances.

As a solution provider at the upcoming marcus evans National Healthcare CXO Summit Fall 2011, in Las Vegas, Nevada, October 24-26, Rothman discusses why a lack of continuity of care in hospitals can lead to patient deterioration, longer lengths of stay and higher readmission rates, and what Healthcare Chief Executive Officers (CFOs) can do about it.

Why is the lack of continuity in patient care a problem today? How does this impact hospital finances?

Michael Rothman: Historically, a family physician was a patient’s doctor, but patients today are cared for by a succession of clinicians, none of whom may have seen the patient before.

It is in these clinician handoffs where information is lost and patient deterioration goes undetected. For instance, 60 per cent of sentinel events are related to failures in communication between caregivers. In addition to the needless suffering of patients, these can be costly events to both hospitals and patients. Electronic Health Records (EHR) were meant to address this problem. Instead, they often become digitized versions of the paper hospital. It is still difficult for a clinician to extract and synthesize the valuable information buried in the EHR.

Imagine an application that integrates with the EHR for the sole purpose of leveraging the existing data to empower clinicians. This could reduce lengths of stay, re-admission risk, and Rapid Response/Medical Emergency Teams’ response times. That is the power of the Rothman Index. For some hospitals (e.g. those with 500 beds), this visualization tool can lead to savings in excess of USD four million per year.

Can healthcare IT systems better track patient progress, shorten lengths of stay and reduce costs?

Michael Rothman: Unfortunately, complications are common, and are not necessarily easy to detect. Clinicians should be able to react before the patient becomes so ill that a transfer to an intensive care unit is required.

Systems which measure a patient’s condition over time, such as the Rothman Index, allow clinicians to spot downturns in a patient’s condition by viewing a simple graph. Real-time visualization of this “condensed” form of the entire patient’s stay enables clinicians to address problems earlier, help move patients more efficiently between units, identify patients slated for discharge who are in need of further examination in order to minimize re-admission risk, and reduce length of stay by generally improving process at each stage of a patient’s stay.

What long-term strategies would you recommend to healthcare executives looking to help patients and hospital bottom lines?

Michael Rothman: Healthcare CEOs cannot just implement a specific program into their hospital. To maximize their ROI they must understand how it can fit in with the workflow of caregivers and become part of their staff’s daily routine.

Additionally, healthcare executives need to be able to measure the impact of their initiatives, and be sensitive to any trade-offs between cost and quality of care. Cost effectiveness studies within a hospital can prove challenging due to a lack of adequate patient acuity metrics. Any strategy to help patients and reduce costs needs a yardstick to provide a standard quantification of patient acuity that follows a patient throughout the hospital. In addition to benchmarking, yardsticks can also enable nurse acuity staffing and rounding prioritization. This is the only way to know if the strategy is truly working, if there is an unseen trade-off or if there are other variables at play.

Contact: Stacey Melvin, Journalist, marcus evans, Summits Division

Tel: + 357 22 849 400
Email: press@marcusevanscy.com

About the National Healthcare CXO Summit Fall 2011

This unique forum will take place at The Red Rock Casino, Resort & Spa, Las Vegas, Nevada, October 24-26, 2011. Offering much more than any conference, exhibition or trade show, this exclusive meeting will bring together esteemed industry thought leaders and solution providers to a highly focused and interactive networking event. The Summit includes presentations on solutions to the transformation of the healthcare system, improving patient care and safety and budget tactics to combat cost escalation. 

For more information please send an email to info@marcusevanscy.com or visit the event website

marcus evans group – healthcare sector portal

About Rothman Healthcare Corporation

Rothman Healthcare Corporation is committed to improving the quality and efficacy of patient care with innovative, patient-centric software that enables healthcare professionals to easily access critical and actionable patient health data. The Rothman Index generates a graph of patient condition that allows for greater continuity and quality of care while reducing costs.

www.rothmanhealthcare.com

About marcus evans Summits

marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, think tanks, seminars and one-on-one business meetings. For more information, please visit www.marcusevans.com 

All rights reserved. The above content may be republished or reproduced – kindly inform us by sending an email to press@marcusevanscy.com

Medical Business Resources, Inc: Boosting Hospital Reimbursement

FOR IMMEDIATE RELEASE

Quality of care and cash flow are the lifeblood of healthcare organizations, says Eric Whitrock, President, Medical Business Resources, Inc. However, the seven largest insurers incorrectly pay one in five claims according to the American Medical Association. Reducing this gap in reimbursement is critical, Whitrock adds.

Medical Business Resources, Inc. will be attending the upcoming marcus evans National Healthcare CXO Summit Fall 2011, National Healthcare CFO Summit Fall 2011, National Healthcare CXO Summit Spring 2012, National Healthcare CFO Summit Spring 2012, National Healthcare CXO Summit Fall 2012 and National Healthcare CFO Summit Fall 2012. Ahead of these Summits, Whitrock offers his insights into boosting hospital reimbursement for services provided.

How can healthcare organizations improve their reimbursement rate?

Eric Whitrock: Healthcare organizations need to get data from their patient accounting system, and analyze it for payment patterns by each insurance company. This will identify the accounts that do not meet historic criteria for performance.

For example, if on average the hospital has been reimbursed for 40 per cent of service charges, a percentage lower than that should hit its radar screen.

Healthcare organizations are commonly underpaid due to missing documentation or because the insurance company was waiting for a response of some kind in order to release full or any payment. Our software finds these “needles in the haystack” which they can then follow up on to collect any amounts deficient.

How can this be avoided altogether?

Eric Whitrock: There is a constant process improvement initiative to discover the reasons behind deficient payments. This information would help catch these gaps upstream.

The recovery record of our clients is so accurate, that in essence there is no need for our regular involvement after a few years. But there is a need for the software.

What cost reduction strategies would you suggest?

Eric Whitrock: We recommend developing teams of large balance, middle-balance and low-balance teams who specialize in balance sizes. Amongst those, teams who specialize in particular financial classes such as Medicare, Medicaid or specific insurance providers.

Having the best talent on the largest balances would make the organization more efficient. Most of our clients get more than 80 per cent of their cash from around 20 per cent of their claims, by using the AnswerData suite of software developed by MBR. Deploying employees more strategically and effectively would help get better results.

To improve cash flows and save even more money, we also utilize a strategy whereby we determine the net cash yield value of a population of claims in the revenue cycle, instead of just the balance. This makes it 30 to 40 per cent more effective.

If you were to give one piece of advice to hospital CEOs and CFOs, what would that be?

Eric Whitrock: Benchmark, benchmark, benchmark.

At a glance reports with key financial indicators would help healthcare CFOs and CEOs see how their hospital is performing. Are they going in the right direction?

Can they track their total volume at a glance and analyze patient traffic patterns by zip code? That is very important for CEOs planning acquisitions and expansions. Analyzed data will give different results than if only geography was analyzed.

Author: Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division

For more information: Marthica Galvis, Marketing Manager, marcus evans, Summits Division
Tel: 305 358 6138
Email: enquires@marcusevansch.com

For more information on the marcus evans Healthcare Summits, please send an email to info@marcusevanscy.com or visit the website: www.healthcare-summit.com

marcus evans group – healthcare sector portal

Please note that the summit is a closed business event and the number of participants strictly limited.

About Medical Business Resources, Inc.

Medical Business Resources provides the tools and services for healthcare providers to improve net cash receipts and accelerate the revenue cycle. Through the innovation of the AnswerData suite of analytical products, MBR offers exceptional and state-of-the-art advantages to ensure satisfaction and create long term financial and quality of care sustainability.
www.mbrus.com

About marcus evans Summits

marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, think tanks, seminars and one-on-one business meetings. For more information, please visit www.marcusevans.com 

Follow us on Twitter @meSummitsGlobal  

All rights reserved. The above content may be republished or reproduced – kindly inform us by sending an email to press@marcusevanscy.com

The RCC Corp: Improving The Revenue Cycle   �

William F. Zimmerman and Jessy Gene Huebner from The RCC Corp, a solution provider company at the marcus evans National Healthcare CFO Summit Spring 2012, on improving a hospital’s revenue cycle through an up-to-date Charge Description Master (CDM). � Interview with: William F. Zimmerman, Chief Executive Officer, and Jessy Gene Huebner, Chief Compliance Officer, The RCC Corp

Healthcare providers may be losing millions of dollars every month due to an outdated Charge Description Master, according to William F. Zimmerman and Jessy Gene Huebner of The RCC Corp. This leads to incorrect billings, the potential of immense losses in revenue, and opens the door for a myriad of compliance issues.

From a solution provider company at the upcoming marcus evans National Healthcare CFO Summit Spring 2012, taking place in Hollywood, Florida, April 26-28, Messrs. Zimmerman and Huebner deliver their thoughts on how to improve the accuracy levels of a hospital’s Charge Description Master to boost revenue and ensure compliance with all laws and federal regulations.

How can the revenue cycle be improved?

William F. Zimmerman: With the uncertainty of healthcare reform and the constant need to keep staff informed on how to accurately charge for services provided, many healthcare facilities are missing significant revenue opportunities and placing themselves at risk of violating compliance rules.

Hospitals must recognize the need to implement an efficient, automated system to correctly maintain one of the facilities most significant assets, their Charge Description Master. Also known as the “heart” of the revenue cycle, an accurate CDM eliminates or resolves most compliance and reimbursement issues, providing a facility with the ability to capture the maximum amount of legitimate, optimized, revenue for the services they performed.

How can hospitals ensure a more compliant CDM?

Jessy Gene Huebner: With 600-800 coding changes affecting the CDM each quarter, considerable maintenance work must be performed on a regular basis. Most healthcare Chief Financial Officers (CFOs) believe that their CDM is up to date, and would be surprised to learn of the amount of risk they are exposed to and the amount of revenue they are potentially missing out on.

An accurate CDM fixes the front-end of the revenue cycle, before a bill goes out, and eliminates work at the back-end (processing, correcting, and attempting to collect denials). For example, if a nurse completes an X-ray on a patient, it should be charged and processed as an X-ray. The code, price and every word in the description must be 100 per cent accurate and backed by comprehensive documentation to secure the proper reimbursement. The entire process must be clear to the hospital staff and supportable to the payors.

To accomplish this, an appropriate education system must be available to the entire staff. Therefore, the CFO must create and maintain a comprehensive internal training program, to ensure that the staff is continually updated. This will reduce the amount of errors that usually plagues the process due to the ever increasing complexities of the reimbursement rules that govern our healthcare system.

William F. Zimmerman: The amount of maintenance required to keep the CDM current is significant. This data file, depending on the size of the hospital, could contain upwards of 25,000-100,000 line items, with complex reimbursement rules attached.

A comprehensive information processing system, updating the CDM weekly, supported by a knowledgeable and experienced reimbursement staff is an absolute necessity to ensure an effective internal process. It must also be accompanied by an extensive staff education program. These requirements make this important element in the revenue cycle a perfect candidate for outsourcing, to a firm that specializes in CDM reviews and audits using the latest in automated tools and modeling techniques, thereby reducing a significant portion of the need for highly qualified internal reimbursement staff and educators.

What piece of advice would you give to healthcare CFOs?

William F. Zimmerman: Treat your CDM as the valuable corporate asset it is.

Make the investment to keep it current with the ever changing regulations and provide your staff with appropriate, recurring education. Otherwise, outsource the process to a qualified business partner who has the sophisticated tools and staff in place and is committed to helping you maintain compliance and locate missing revenue. The latter approach may be the most felicitous solution available toward improving your hospitals compliance and financial performance.

Contact: Stacey Melvin, Journalist, marcus evans, Summits Division

Tel: + 357 22 849 400
Email: press@marcusevanscy.com

About the National Healthcare CFO Summit Spring 2012

This unique forum will take place at The Westin Diplomat Resort & Spa, Hollywood, Florida, April 26-28, 2012. Offering much more than any conference, exhibition or trade show, this exclusive meeting will bring together esteemed industry thought leaders and solution providers to a highly focused and interactive networking event. The Summit includes presentations on strategies for improving the revenue cycle, preparing for healthcare reform, and being in a position to be able to take advantage of the impending changes in our healthcare system.

For more information please send an email to info@marcusevanscy.com or visit the event website

marcus evans group – finance/insurance sector portal

Complementing our summit format, the Finance Network – marcus evans Summits group delivers peer-to-peer information on strategic matters, professional trends and breakthrough innovations.

About The RCC Corporation

The RCC Corp. provides a full range of Revenue Cycle Compliance solutions including Charge Master Validation Reviews, Compliance Audits, and Education Services.  Our Mission is to quickly resolve client compliance and reimbursement issues, reduce denials and potential risks for fraud, shorten the revenue cycle, and help reduce administrative operating costs.

www.thercccorp.com

About marcus evans Summits

marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, think tanks, seminars and one-on-one business meetings. For more information, please visit www.marcusevans.com 

All rights reserved. The above content may be republished or reproduced – kindly inform us by sending an email to press@marcusevanscy.com