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In this guest post, Joel Hoffman, senior vice president at OptumInsight, sounds off on the impact not knowing their “hurdle rates” has on organizations that have applied to CMS to be Medicare Shared Savings Program (MSSPs) Accountable Care Organizations (ACO).
For an MSSP ACO to succeed, it must deliver care to its attributed Medicare fee-for-service population for less than it costs CMS. Comparing an ACO’s actual cost of care to CMS’ pre-determined value of what it is expected to cost them ─ or the ACO’s “hurdle rate” ─ determines if an MSSP ACO will be able to participate in gain. But as of now, CMS hasn’t released these hurdle rates ─ making it very difficult for an MSSP ACO to ascertain whether success is possible under these parameters, and therefore to decide with any confidence whether or not to proceed to contract with CMS.
This week’s guest post comes from Dean Farley PhD, Vice President at OptumInsight. An advocate for collaboration across all constituencies for better patient care, here he explains how payers and providers can make bundled payments a reality.
The idea of implementing bundled payments can be intimidating for any hospital CFO. But, as a way of paying providers that combines all the services needed to treat a patient, bundled payments are an inevitable step for both payers and providers as the industry heads toward accountable care.
In this week’s guest post Dr. Miles Snowden, chief medical officer at OptumHealth, offers tips for stimulating patient accountability in the age of accountable care.
While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved in their own health is critical to improving outcomes and reducing costs as part of any accountable care environment. In fact, Optum found that when given more information about a planned elective surgery, 1 of every 15 patients change course – either deferring, choosing a less intensive option, or changing facility or proceduralist.
We’re excited to welcome Anand Shroff, vice president of product management at OptumInsight, to Healthcare-Exchange. A strong advocate for advancing the use of technology in healthcare, Anand discusses the role cloud computing may play in the industry’s future.
It’s no secret that healthcare has historically been slow to adopt the latest and greatest in technology and even slower to embrace technological paradigm shifts, as evidenced by the continued presence of client-server computing in healthcare in the age of the Internet. While strides to catch up have been made in recent years – with shifts toward electronic health records (EHR), advanced health information exchange (HIE), and mobile computing devices – the world of business is changing rapidly, and the industry needs to do a better job of keeping pace.
For this week’s guest post we welcome back Joel C. Hoffman, Senior Vice President with OptumInsight Payer Solutions.
Evaluating and managing population risk has traditionally been the payer’s role in the health care system. But as providers become increasingly accountable for populations, they will need to be equipped with many of the same competencies that payers have been relying on for years. This includes the right technology to capture both clinical and claims data, but also the ability to analyze and transform these data into actionable information that affords the delivery of high quality, efficient health care and ultimately real population health — that’s where actuarial services come in.
There’s a reason why actuaries are known for incessant number crunching, data collection and manipulation (along with the occasional pocket protector) — it’s a complicated field that first requires extensive training and then plenty of experience to practice effectively. Our team of over 175 actuaries, who are engaged on a daily basis to do this work, are hearing excitement, but also understandable caution from providers looking to assess and understand both the risk and the financial benefits of setting up any of a variety of accountable care models. Many providers — including some already approved for the more advanced CMS Pioneer ACO — just don’t know where to begin, so we’ve pulled together these tips for how to wear the “payer hat” when evaluating populations and assessing risk:
Donna Woelfel, Clinical Applications Manager at PeaceHealth in Bellingham, WA, discusses how she and her team tackled the communication and efficiency challenges of its health care system.
With the industry moving toward new models of collaborative care, one thing is clear: hospitals and health systems are under the microscope to improve efficiency, communication and quality across departments, facilities and regions. At PeaceHealth, implementing technology to improve patient throughput was one goal, but ultimately we aimed to move the needle on patient, family and employee satisfaction and quality of care across our facilities.
In this provider snapshot, Lu Mulla, Vice President of Emergency services and disaster management at Catholic Medical Center (CMC) explains how they leveraged a top-to-bottom evaluation of the emergency department (ED) and ancillary processes to improve patient flow, efficiency and revenue management.
In the emergency department (ED), where split-second decisions decide the life or death of a patient, coordinated clinical collaboration and protocols are needed to ensure rapid response, efficient patient flow and a high level of customer 
service. Identifying and evaluating work flow strategies can drive departmental changes that can help support these goals.
This week’s guest blogger is Ron Jones, senior vice president of hospital solutions at OptumInsight. This health care industry veteran and strong supporter of health care technology calls out an issue that isn’t yet — but should be — a top concern for hospital CFOs.
I’m lucky to have the opportunity to work closely with CFOs at a number of the nation’s leading hospital and health systems, and I give them a great deal of credit for tackling the challenges in front of them — from securing Meaningful Use funds to implementing pay-for-performance models to improving billing processes. But in recent conversations, I’ve been shocked to hear that ICD-10 is not on every CFO’s short list of issues to address — and in some cases, not even on their radar.
In our next ‘provider snapshot’, Jenny Blank, executive director of patient services at Winter Haven Hospital, shares the story of how her ED team achieved national recognition for their initiative to transform patient satisfaction and revitalize the department using technology.
The inevitable shift towards a pay-for-performance health care system has intensified the impact of patient satisfaction on hospital success, motivating hospitals and health systems to seek patient-centered solutions that promote quality of care. Access to patient data 
and efficient flow of information between clinicians, patients, and patient families are key to meeting both of these goals.
As part of our latest series on Healthcare-Exchange — provider snapshots — Kerry Tokla, senior information systems analyst at Cape Cod Healthcare, discusses how she and the Surgical Services team were recognized for leveraging technology to improve patient satisfaction while simultaneously managing costs within the organization.
Ask any hospital in the U.S. (or abroad for that matter), and they’ll tell you that the operating room (OR) and surrounding areas are major areas of concern when it comes to managing quality, costs and resources.
But there can be a disconnect between clinical and financial teams, making it difficult to align these initiatives. For clinical teams, the bottom line is taking unparalleled care of patients, but financial teams need help with cost control and that requires added visibility. The ORs of Cape Cod Healthcare are no different.
