Exploring the Benefits of Value-Based Healthcare

Value-based health care is an outcome-based approach to healthcare in which care providers are compensated based on patient health outcomes. This delivery model includes both hospitals and physicians. Under value-based healthcare agreements, care providers are remunerated for aiding patients in the improvement of their health, the reduction in the effects and incidence of chronic disease, and the enjoyment of a healthier life in a verifiable, evidence-based way.

Value-based care differs from a fee-for-service model or capitated approach in terms of how their providers are compensated on the basis of the number of healthcare services they deliver. The “value” in value-based healthcare comes from the measurement of health outcomes against the cost of delivering the outcomes.

The benefits of a value-based healthcare system encompass patients, providers, payers, suppliers, and society as a whole.

Patients spend less money to obtain better health

Managing a chronic illness or condition like diabetes, cancer, obesity, COPD, or high blood pressure can be expensive and time-consuming for patients. Value-based care models emphasize hastening a patient’s recovery from illnesses and injuries and avoiding chronic disease in the first place. As a result, patients have fewer visits to the doctor for medical tests and procedures. They spend less money on prescription medication as both their short-term and long-term health improves.

Providers achieve efficiencies and patients have a higher degree of satisfaction

Providers must may need to invest more time for new prevention-based patient services which also means less time on chronic disease management. Quality and patient engagement measures elevate when the focus is more on value instead of volume. The providers do not have the financial risk that comes with fee-for-service payment systems. Even for-profit providers who can generate a higher value per episode of care can expect to be rewarded under a value-based care model.

Payers control costs and reduce risk

Risk is more effectively mitigated when it is spread across a larger patient population. A healthier population with fewer claims minimizes the drain on payers’ premium pools and investments. Value-based payment also allows payers to be more efficient by bundling payments that cover the full care cycle of the patient or for chronic conditions, covering periods of a year or more.

Suppliers bring prices in line with patient outcomes

Suppliers benefit from being able to align their products and services with positive patient outcomes and reduced costs. This is an important selling point due to rising national health expenditures on prescription drugs. Many stakeholders in the healthcare industry are calling for manufacturers to correlate the prices of drugs to their actual value to patients. Such a process will likely become easier with the growth of individualized therapies.

Society becomes healthier while overall healthcare spending is reduced

People are spending less money to manage chronic diseases, costly hospitalizations, and medical emergencies. In the United States, where healthcare expenditures account for almost 18% of Gross Domestic Product (GDP), value-based care promises to reduce the overall cost of healthcare significantly.

Moving from a fee-for-service to a fee-for-value system will take time and the transition has been more difficult than expected. As the healthcare landscape continues to evolve and greater numbers of providers adopt value-based care models, short-term financial setbacks may be seen first before longer-term costs decrease. However, the transition from fee-for-service to fee-for-value has been and is still being embraced as the best method to lower healthcare costs while increasing quality care and helping people lead healthier lives.

About CSuite Solutions

CSuite Solutions works with healthcare providers throughout the United States to deliver innovative solutions that improve patient care while driving efficiencies and profitability. The professional health system advisors assist with direct-to-employer self-funded insurance plans, value-based care, revenue cycle management, and accountable care organizations. Founded by seasoned C-level healthcare executives, CSuite Solutions is expertly positioned to work alongside healthcare systems in an advisory capacity.

To inquire about healthcare consulting, visit the CSuite Solutions website at https://csuitesolutions.com/assessment/.

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Healthcare Consulting Firm Explains What is a CIN?

In healthcare reform, the shift from fee-for-service to value-based reimbursement is driving the most profound changes in the healthcare industry. Recent legislation such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is compelling health care organizations to consider more creative and viable alternatives to address concerns regarding quality, cost, and value. Clinical integration may be the way to meet the evolving complex challenges of health care reform.

Becker’s Hospital Review, in an article entitled “The 7 Components of a Clinical Integration Network,” explained clinical integration as “a health network working together, using proven protocols and measures, to improve patient care, decrease cost and demonstrate value to the market.”

Clinical integration is to healthcare what innovation and technology breakthroughs are to product manufacturing and service delivery industries.

Defining the Clinically Integrated Network

In response to the challenges of reform in health care, many providers find themselves joining with other physicians to form Clinically Integrated Networks (CINs). A CIN is a legal entity structured to enable approved collaboration and cooperation among health care providers. Possessing shared goals that encompass value, efficiency, performance, and quality, CINs can garner competitive advantage while achieving better quality and more efficient coordination of care at a more affordable cost. The goal is to be able to negotiate a more favorable reimbursement rate. 

The highly coordinated environment of a CIN is able to deliver market value through the health care network as well as provide value/risk contracts by improving the management of the MACRA Quality Payment Program and other state and commercial payment model alternatives. Furthermore, a CIN offers physician independence by providing an alternative to employment for independent community physicians. With a CIN, hospitals, physicians (both employed and independent), and other care providers can coordinate more easily and can work together to meet clinical and financial goals. Also, a CIN enables effective management of population health and coordination of care on a comprehensive scope.

What are the primary characteristics of a CIN?

According to the U.S. Department of Justice, a CIN has four main characteristics:

1. Leadership Teams That Include Physicians

CIN governance models must have physicians incorporated into its governing vehicle. Both private and employed physician practices are eligible to form a CIN.

2. Clinical Standards

All CIN members must officially agree to adhere to clinical guidelines and work on activities that improve performance. Performance improvement relates to all aspects and overall approach to care, including quality of treatment, accuracy, efficiency, timeliness, outcome, and satisfaction.

3. Information and Technology

The correct technologies and tools must be utilized to gain the network visibility necessary to transport clinical integration from theory to reality. To provide more coordinated care, information-sharing and performance monitoring are required. CINs need visibility across the care continuum to measure and analyze performance and patient outcomes.

4. Defined and Measurable Improvement

The CIN must demonstrate it is elevating value, not just using its size to negotiate better rates from payers. CINs use data analytics to identify and prove when performance objectives are met and use that information to negotiate superior reimbursement rates.

As health care reform continues to head in the direction of quality and value, CINs will play a central role in the process. Hospitals and physicians should carefully examine whether a CIN offers them the best path to satisfy the “Triple Aim” while being careful not to disrupt value through investment and reimbursement reduction.

Health care providers must develop and perfect care-delivery and value-based models that are effective and efficient to obtain the broader objective of achieving high-value care for patients.

CSuite Solutions works with healthcare providers throughout the United States to deliver innovative solutions that improve patient care while driving efficiencies and profitability. The professional healthcare system advisors at CSuite Solutions assist with direct-to-employer self-funded insurance plans, value-based care, revenue cycle management, and accountable care organizations. Founded by leading C-level healthcare executives with many years of experience, CSuite Solutions is expertly placed to work alongside healthcare systems in an advisory capacity.

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What is Population Health Management? And Why is it Important?

With the explosion of technology across a wide range of industries, the health care industry, in particular, has benefited significantly. One of the key focus areas has been in population health management. Leading healthcare consultancy CSuite Solutions offers their expertise in understanding this vital, and growing area by answering some of the most important questions about what it is, how it works, and why it’s important.

 

What is population health management?

Population health management can be viewed as the aggregation of patient data. Data is collected from multiple health information resources, then analyzed and compiled into a single patient record. This actionable record by health care providers allows for the improvement of both financial and clinical results.

 

How does population health management work?

The goal of population health management is to improve the health outcomes of an identified group using an intelligence tool. This tool will aggregate the data to provide a comprehensive report of each patient from a clinical perspective. From this report, healthcare providers are empowered to track and improve clinical outcomes, while at the same time lowering healthcare costs. 

A population health management program will collate clinical, as well as financial and operational data to provide actionable insights that will help improve the health care provider’s efficiency and the level of patient care. For the program to deliver useful analyses, the partnership network will need to be well-managed in addition to offering robust care.

An effective population health management program will provide real-time actionable information to clinicians and administrators, enabling them to identify and effectively address any care gaps that exist in the patient group. In doing this, better outcomes, as well as cost savings, can be expected, particularly in populations with chronic disease.

Population health management will prioritize care management looking at improving the patient’s ability to self-manage effectively, improve the management of medication as well as reducing the cost of care.

 

Why is population health management important?

There are a number of reasons that population health is important, and it all revolves the fact that it is people-focused. By improving the health of the average American person, there are tangible positive impacts on all aspects of society as a healthier population is going to be more productive than an ailing one, especially if the costs of health care interventions can be reduced. 

People expect high-quality health care, an increased proportion of earnings are being spent on healthcare, whether it be doctor appointments, lab tests, or prescriptions, and the expectation is that healthcare needs to respond commensurately. Central to this idea is balancing improved patient satisfaction for individuals, while also seeking improved levels of health for populations. There is also the additional benefit of reduced cost of care as population health management offers efficiencies in diagnosis, treatment, and self-care.

This proactive approach that provides improved access to care so that individuals can get the treatment that they need when they need it rather than putting it off until the problem escalates further, resulting in an emergency condition. Population health management also prioritizes better engagement with patients who are empowered to manage their own health better.

CSuite Solutions works with healthcare providers throughout the United States to deliver innovative solutions that improve patient care while driving efficiencies. In addition to offering professional population health management consulting services, they are also able to assist with direct to employer self-funded insurance plans, value-based care, revenue cycle management, and accountable care organizations. Founded by leading C-level healthcare executives with many years of experience, CSuite Solutions is expertly placed to work alongside healthcare systems in an advisory capacity.

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An Explanation of Accountable Care Organizations

Leading Healthcare Consultancy Answers the Three Most Frequently Asked Questions About Accountable Care Organizations and the Role of ACO Consultants in Driving Performance.

Accountable Care Organizations were formed as a result of the Affordable Care Act, which works to reduce healthcare costs. It does this through actively encouraging hospitals, doctors and other healthcare providers to form networks to coordinate patient care. ACOs also provide financial incentives when care is delivered more efficiently.

While ACOs have been making headlines, very few people understand what they are and how they work. Nationwide ACO consultants aim to educate individuals by sharing their insights into the three most frequently asked questions about ACOs.

What is an accountable care organization?

An ACO aims to share the financial and medical responsibility of offering coordinated care to patients. Made up of a network of hospitals and healthcare providers, the goal is to limit unnecessary spending. This network is built around a primary care physician who is responsible for each patient’s care.

Accountable Care Organizations seek to address the problem of disjointed treatment that lacks a full picture of the patient’s needs. This is accomplished through the development of a consistent network of healthcare providers committed to the coordinated sharing of patient information. Financial incentives further strengthen the coordinate care and dedication to reduce avoidable expenses.

Are ACOs a good option for patients?

Patients still retain full control over their treatment, so while doctors and hospitals are more likely to refer their patients to specialists within their ACO network; patients are still free to see the specialist of their choice. Patients can choose to see specialists or be referred to hospitals outside of the ACO network, and in most cases will not have to pay extra. Importantly, the patient does not have to opt-in to having their information shared within the ACO.

ACOs should make medical care more affordable for patients as there are incentives for doctors and hospitals to be more efficient and keep costs down, so providers are less likely to run unnecessary tests. The reduction of needless appointments saves patients not only time but also additional stress. In the end, the benefits produced by the ACO for both the patient and healthcare providers demonstrate their strong advantages.

How do ACO consultants help?

Top ACO consultants aim to assist individual health care providers and hospitals with ACO development and implementation. They are also able to assist with optimizing the performance of existing ACOs. This assistance can include strategic, financial, and operational support.

ACO Development

For systems in the development phase, an ACO consultant will look at, among other things:

• Risk and return
• Shared savings and division
• Investment requirements
• Development of the physician network

ACO Implementation

When it comes to ACO implementation, an ACO consultancy will assist with:

• Identifying opportunities
• Organizational structure development
• Financial structures and modelling
• Designing incentive models

ACO Optimization

ACO consultants will work with an existing ACO to help improve performance by analysing existing performance and opportunities for improvement.

They will assess costs and utilisation data related to:

• Locations
• Procedures
• Healthcare providers
• Post-care providers

Important pain points include out-of-network leakage, admissions that could have been avoided, and readmissions. They will make recommendations about what infrastructure needs strengthening, as well as engaging physicians to drive improved results.

CSuite Solutions based in Tampa, Florida, is a national strategic advisory firm that specializes in assisting Accountable Care Organizations with the development, implementation and optimization of healthcare networks.

The ACO consultancy was founded by senior health care industry executives with experience in the transformation of hospitals and other major healthcare systems into financially robust operating organizations. Their broad range of experience ensures that they are perfectly positioned to assist ACOs to perform optimally.

Contact Information:

CSuite Solutions

4830 W Kennedy Blvd # 600

Tampa, FL 33609

United States

Stewart Schaffer

(813) 866-5100

csuitesolutions.com

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Understanding the Importance of Healthcare Revenue Cycle Management

CSuite Solutions weighs in with answers to some of the most important questions on revenue cycle management for healthcare providers. They offer insights on how revenue cycle management works as well as some of the potential challenges and benefits of a well-managed revenue cycle.

 

CSuite Solutions is a consulting firm that works with healthcare companies to develop effective strategies for managing their organization. They focus on the areas of population health, self-insured health plans, clinical integration and ACO consulting. But they have found that the area of revenue cycle management is often the most pressing for healthcare providers. Here they answer some of the most frequently asked questions.

 

What is Revenue Cycle Management, and What Does it Cover?

Healthcare revenue cycle management or RCM is the utilization of billing software specifically in the medical field to track patient-care. It is an end-to-end solution that begins with the registration of a patient and runs to the final payment of that patient’s balance. RCM joins the business and clinical facets of the business. They do this by combining administrative information such as the patient’s name and insurance provider with the treatment that the patient receives and the healthcare data that is collected.

According to the Healthcare Financial Management Association (HFMA), these are the factors involved in the revenue cycle of a healthcare facility:

• Charge capture
• Claim submission
• Coding
• Patient collections
• Preregistration
• Registration
• Remittance processing
• Third-party follow up
• Utilization review

What are some of the challenges with managing revenue cycles?

Maintaining robust, reliable policies that are able to withstand the regular changes to healthcare regulations and the ever-updating reimbursement models are challenging. It also has a knock-on effect for payment collection at point-of-service, claim tracking and staff training.

 

Collection of Payments at Point-of-Service

This is challenging because of the perceived time and effort that it takes to collect payment, even though it is more efficient than follow-ups to try and extract payment. It is difficult as patients often do not have the necessary funds available to make payment upfront. There is also the risk that patients will transfer to another facility if they feel that they are being unduly pressurized.

This can be viewed at the ‘front-end’ revenue cycle management, and staff need to carefully determine Medicaid eligibility, as well as assisting uninsured patients to understand their options.

 

Claim Tracking

It can be difficult to track the lifecycle of a claim; it is important to be able to see where errors are being made as this can lead to lost revenue. Healthcare providers also need to receive alerts if payers regularly deny claims related to specific codes (procedures).

 

Staff Training

The root of many claim issues is as a result of human error from the inputting of incorrect codes, and incomplete capture of information, to patient insurance eligibility issues. It is important to prioritize education programs that emphasize correct coding and full documentation of patients.

 

Why is Healthcare Revenue Cycle Management Important?

 

It offers a number of benefits; an effective RCM system can:

• Reduce the lag between the provision of a service and receipt of payment
• Save time through the automation of administrative tasks such as upcoming appointments and payment reminders
• Cut down on denied claims through prompts to guide submissions by staff
• Provide data that pinpoints where there is room for improvement with a big-picture view of the revenue cycle
• Cognitive computing to reduce human error and ensure correct medical codes are assigned

 

CSuite Solutions understands the importance of a well-run healthcare revenue cycle management. This is why they work closely with healthcare providers throughout the United States to ensure that they have an effective RCM system in place. They work with providers to actively reduce costs and ensure their clients are able to collect outstanding payments efficiently.

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Challenging the New Executive Healthcare Roles Like Chief Innovation Officer

Stewart Schaffer is challenging the thought process behind some new and trending executive roles (titles) in healthcare, asking probing questions about the scope of the roles and if they even make sense. In a recent interview for Managed Healthcare Executive magazine, he was interviewed by Nicolas Hamm, who was investigating the qualities needed for filling roles of newer health system C-suite roles such as a  new trend in the title and role of “Chief Innovation Officer.”

In fact, the points that Schaffer put forward completely shifted the focus of the article from looking at the qualities needed, to whether the roles even make sense for healthcare organizations. In his position as co-founder and managing partner at CSuite Solutions, a national healthcare advisory firm, he has had extensive experience in top-level positions for healthcare organizations. He also has held senior-level positions in Fortune 50 non-healthcare enterprises and thus his views are based on what he is seeing in practice in the healthcare landscape today through the eyes of a healthcare consultant and also based on his decades of real-world experiences outside the industry.

Healthcare is moving towards a consumer-focused, value-driven approach but it can be difficult for organizations to keep up with the latest trends while also not falling victim to letting trends influence decision-making more than what is prudent. This is forcing them to redefine leadership roles to improve their responses, as well as to drive innovation. As a thought leader in the field of managed healthcare solutions, Schaffer shared his views on two of the newer roles: innovation officer and population health officer.

Chief Innovation Officer

The established view of the role of an innovation officer is that it means taking a fresh look or a new perspective on the way that things have always been done. In practice, this translates to critical thinking to make sense out of healthcare processes, and relationship building to get the whole organization on board when it comes to adopting the necessary changes.

Schaffer’s take is slightly different as he believes that innovation should form an integral part of the job description of every C-suite level executive saying that, “the CEO of a health system should require that every single department head be responsible for innovation within his/her function.” And it should then be the role of the chief strategy officer to coordinate the plans for innovation across the organization. The most important take-away is that by making innovation the sole responsibility of a single executive or department, it disenfranchises or excuses the operating units from a role in organizational innovation that should be a core shared responsibility.

Population Health Officer

The population health role is becoming popular as a way for organizations to offer a more personalized, coordinated care plan for each patient. In most healthcare organizations, this will mean applying a data-driven approach to addressing the needs of their patients and partnering with others to ensure that patients receive the care they need.

Although this approach makes sense, designating a specific position that will be responsible for adopting the policy does not. As Schaffer points out in the Managed Healthcare Executive article, “Rather than create a new department of population health,” Schaffer says, “this function should reside within every operating department and driven by the department head the same as innovation. In fact, population health is only one (albeit a major one) swim lane of an enterprise strategic plan which should be the domain of the chief strategy officer. Unfortunately, facilities planning seems to take up most of the bandwidth of health system strategy departments which impedes their ability to take on what I believe is the more important responsibility of implementing population health.”

His point is that creating a new department for population health shifts the focus away from operating departments and takes the responsibility off each department head who should be focusing on population health much the same as innovation. And again, this should be overseen by a chief strategy officer who should not be focused on facilities planning, but rather the important role of implementing population health (along with innovation) which should be supported by facilities planning.

CSuite Solutions, co-founded by Stewart Schaffer and Stephen R. Mason, former CEO of BayCare Health System headquartered in Tampa, FL, is a leading healthcare advisory firm with many years of experience in helping healthcare organizations define their executive roles so that both the organization and their patients benefit from an innovative, proactive, customer-focused approach to healthcare.

 

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Interim Executive Leadership Provided By CSuite Solutions

Interim Leadership for Healthcare Providers

Are key members of your leadership team in transition or stretched too thin to implement mission-critical strategies?  An interim leader may be the solution you need to bridge the resource or knowledge gap needed for breakthroughs.

The Executive Leaders Behind CSuite Solutions

CSuite Solutions was formed to attract the most senior and accomplished health care industry executives in their respective fields. They have spent most of their long careers transforming hospitals and major health care systems, physician groups and other providers into efficient and financially robust organizations. These C-Level executives are now dedicating their talents and connections to helping their peers successfully navigate during these transformative times.

The CSuite Solutions executive leadership team includes former CEOs, COOs, CFOs, CAOs, CSOs and enterprise business development executives all of whom have extensive experience with large healthcare systems. The partners include: Stephen R Mason, Stewart Schaffer, Jim Burkhart, Brian Paradis, and Dennis Phillips.

CSuite Solutions Announces Interim Healthcare Executive Leadership Service

Interim management is often a sourcing option provided by executive recruiting firms.  At CSuite Solutions, we approach interim leadership engagements with a long-term healthcare strategy approach.  An engagement with CSuite Solutions means we are committed to establishing, and then achieving, goals and objectives that support the organization.  Our experienced team of Interim Executives provides stability and insight that enables you to maintain focus on mission and strategy.

The CSuite Difference: We keep your organization moving forward, simply maintaining the status quo is not in our DNA.

CSuite Executives Currently available for Physician Enterprise assignments

The Interim Healthcare Leadership service offers medical group executives, experienced with employed and independent physicians, multi-specialty groups, service line, and institutional settings, for profit and not for profit, integrated delivery systems, ACOs and private practices ranging in size from 7 to 700.

Choosing an interim leader is much more than finding a person with the right skill set(s). The CSuite Solutions interim leadership service provides a qualified, C-level leader with actual past experience in solving complex problems at the highest levels of health care systems. This provides healthcare providers with a unique “interim” solution to their most challenging issues across the enterprise.

In healthcare, interim leadership is a strategic imperative to maintaining transformative momentum within your organization.

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