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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.
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:
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.
The rise of various accountable or collaborative care models across the country is already driving new demand for the right technologies to support them. These technologies are especially critical for those aiming to achieve Sustainable Health Communities, where all parties are connected, intelligent and aligned. While hospitals and health networks are already familiar with electronic medical records (EMRs) and health information exchanges (HIEs), they will need to become comfortable with a group of new solutions — some that the payer community has relied on for years and others that will put the data from EMRs and HIEs to the test.
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.
What a difference a year makes! I am amazed how mindsets are changing in an industry that typically takes its sweet time to make any changes of significance.
In a sense, the whole debate around healthcare reform — both before and after it was enacted — shocked those who were not happy with the proposed models into starting their own initiatives around new models of care. We have entered a new era of collaborative care and provider transformation and, whether you believe in state-sponsored health insurance exchanges and ACO’s or not, one fact holds true: the lines between payer and provider are becoming blurred. Take the recent controlling interest that Pittsburgh insurer Highmark Inc. took in West Penn Allegheny Health System as an example. Hospitals, which are the core of this new wave of accountable, integrated care, are moving to models where they will take on more risk, and they are in dire need of new expertise and tools to help them manage populations rather than care episodes. This is something that payers have done for over 50 years, and they are now jumping in to help hospitals get there.
I commented several months ago about how the hurried healthcare reform bill became so imperfect that there was no way it would not add to already escalating costs. But in accordance with the rule of unintended consequences, all the debate around the bill, along with the fear that some of its most onerous provisions like large cuts in Medicare for hospitals, has spurned a tidal wave in thinking and planning about new models of care that will be more efficient. We now hear the words “accountable care organization,” or ACO, more often than you heard “web strategy” during the dot.com boom. ACO is a technical term originated by the Brookings think-tank and adopted by CMS to cover the rules around ACO eligibility and qualification. However, the term “Sustainable Health Communities” (SHC) is a more descriptive term with the obvious connotation that left to our present course, the current system is unsustainable, and the addition of “community” extends all the way into all the pre- and post-acute care entities.
