Knowledge Center 2018-02-20T15:59:07+00:00

Knowledge Center

Providing insider perspectives to help health leaders rethink the business of healthcare.

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The 15 Minute Milestone: Are you Maximizing Your Registration Opportunity?

It’s said that you have only one chance to make a good first impression. In today’s healthcare environment, those words couldn’t ring truer. Providers need information to appropriately bill for services, and patients don't want long wait times. Make your registration process work for you and your patients, increasing efficiency without sacrificing accuracy with our 15 Minute Milestones.

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System Conversion and Your Healthcare Revenue | A Winning Playbook

Do you have a game plan to make sure your revenue performance doesn't suffer during or after a system implementation or conversion? Download the playbook to learn about the four critical elements to a winning strategy.

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Q&A: Proven ACO Strategies for Enhancing Care Quality and Generating Savings

Organizations that rely exclusively on hard numbers to measure ACO success don’t see the complete picture. The winning formula for one health system — that operates ACOs covering nearly 1 million patients in 80 percent of its markets — includes improving quality, increasing collaboration and establishing innovative relationships.

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4 Components of Effective Population Health Management

It’s more imperative than ever that providers have population health capabilities. As health plans look to improve the health of populations and contain costs, they are partnering with organizations that help them differentiate their offering to employers or consumers. Developing strong population health capabilities can appear daunting, as it requires careful planning on the part of the organization.

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How Much Is Your Unmanaged Population Costing You?

To achieve more effective results, organizations are establishing population health management programs to improve health outcomes and lower healthcare costs. In this infographic, follow the journey of two members to see the cost and quality impact of implementing a successful population health management strategy.

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Adventist HealthCare Achieves Sustainable Results through Focus on Care Management and Employee Health

To achieve the Triple Aim of healthier populations, improved patient experience and lower costs of care, AHC sought an innovative approach to population health management through a partnership with Conifer Health. AHC also wanted to create and continuously develop an overall culture of well-being and good health that started with health plan members and their families.

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Pursuing Risk: Hospital Takes Proactive Approach to Manage Risk, Improves Quality and Financial Performance

To manage the process for taking on risk, one community hospital contracted with Conifer Health to manage the risk pool and operate the utilization management and claims adjudication functions for the risk-bearing organization. Through Conifer Health’s ongoing management, the hospital has improved cash flow, significantly reduced outstanding accounts receivable (A/R), and increased opportunities to get paid upfront for services.

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Navigating the Transition to Value-Based Care: Physician Alignment Is Critical to Your Success

Physician engagement and alignment are critical components for healthcare organizations navigating the transition to value-based care. An engaged and aligned physician network is a major determinant for enhanced patient care, lower costs, greater efficiency, and improved quality and patient safety. Successful physician alignment, however, remains a challenge for many hospitals and health systems.

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Proven Mechanisms to Sustain Margins While Transitioning to Value-Based Care Contracts

It’s widely recognized that value-based contracts fundamentally shift provider revenue sources and negatively impact what were current profit centers. Conifer Health’s two-prong approach has helped clients employ pragmatic and proven mechanisms to sustain margin improvement during their transition period to value-based contracting..

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10 Questions to Answer Before Entering into Value-Based Contracts

In many value-based payment program engagements, hospital executives jump right into questions about the mechanics of implementing specific payment models. But that's a common mistake - without first assessing the organization's cultural, operational and technical capabilities in managing risk. For that reason, we've identified the top 10 questions providers should ask themselves as they evaluate value-based contracting strategies.

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5 Considerations for Success with Risk-Based Contracting

The saying is true: proper preparation prevents poor performance. It's no different when it comes to the effective negotiation of value-based contracts, which requires unique skills and capabilities in order to tie reimbursement to performance. Learn about the five key areas to help position your organization for success in negotiating risk-based contracts.

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Stop Denials Where They Start: 5 Key Steps for Success

Many healthcare organizations work the back-end denials management process without ever taking time to understand the root cause. Countless hours are spent appealing denials, but little attention is focused on fixing and preventing the issue. Often, the cause of denials can be achieved through process improvements - and sometimes the solution can be a relatively simple fix.

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The Success of Your ACO Depends on Selecting the Right Payment Model

Many ACOs have taken on increased risk and improved their clinical and financial performance. But with various complex risk models currently in place and on the horizon, there's no one-size-fits-all approach that guides ACO executives in taking on the right amount of risk. The right partner can help.

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  • Case Study Banner

University Health Achieves Additional $10M in Monthly Cash Collections

When University Health was faced with a 135-day privatization deadline and challenges in operationalizing and enhancing revenue cycle operations, the hospital emerged with a sustainable revenue cycle infrastructure and a significant increase in monthly cash collections.

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Are You Focused on the Right Metrics to Drive the Patient Registration Experience?

Despite all the data available today, most provider organizations are not routinely tracking some key metrics critical to supporting value-driven Patient Access. These important indicators can help revenue cycle leaders better assess their Patient Access operations, enhance the patient experience and improve financial results.

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Redefining the Hospital-Physician Relationship: How Integration is Evolving Under Value-Based Care

Becker's Hospital Review caught up with finance leaders from two distinct healthcare organizations - Moffitt Cancer Center (Florida) and Medical Center Health System/MCH ProCare (Texas) - to discuss how they are specifically approaching the shift towards value-based care and how this move is redefining the hospital-physician relationship.

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Brookwood Baptist Improves Patient Access Operations and Collections

Like many providers, Brookwood Baptist Medical Center struggled to provide patients accurate payment liability estimates which led to various revenue collection issues. Learn how Brookwood leveraged technology, analytics and governance to transform patient access and secure revenue.

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Rethinking the Revenue Cycle: Investment Trade-Offs Facing Physician Groups

With pressure to put quality of care at the forefront, physician groups must make challenging trade-offs in their capital infrastructure. Choosing between core and non-core revenue cycle competencies can be vital to financial performance. Examine five critical areas of the revenue cycle and learn how to make the right investment trade-offs for your future success.

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Third-Party Administrator Achieves Results for its Clients Through Cost Savings

As rising healthcare costs continue to be a concern for your employer clients, it's more important than ever to provide them with a care management solution that lowers costs and promotes health in the workplace. Learn how cost-effective care management is helping this third-party administrator grow.

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Rx for Healthcare Revenue Success

Are your revenue cycle operations achieving your performance objectives? A variety of treatment options exist to help. Learn about four essential components that can help your hospital or health system achieve a healthy, more modernized revenue cycle.

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How Hospitals and Physician Groups Benefit from a Strong CDI Program

Without a well-established clinical documentation improvement program in place, healthcare organizations' risk rankings falling short of achieving clinical documentation integrity which underscores how critical accurately delivered and documented care reflects the well-being of individual patients and an organization's financial health. Here are three reasons why implementing a CDI program can prove beneficial to your healthcare organization.

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Top Revenue Cycle Challenges Facing Providers

With value-based care penetrating deeper into the industry and uncertainty looming about the future of the ACA, the near-term future will continue to test revenue cycle professionals as well as bring new opportunities. We've compiled the five most impactful revenue cycle challenges and their implications to help position you for success.

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Technology-Driven Workflows Are Hallmarks of Optimal Care Coordination

Care coordination is only as successful as its underlying workflows and the technology that supports those workflows. Technology alone is not the driver or the answer. Rather, technology supporting carefully developed workflows and the teams that deliver care - this is the answer.

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How to Mitigate Social Determinants’ Impact on Clinical Care

As a nation, we have fallen short in accounting for the true impact of social determinants in the overall health of our nation. While we ask patients to assume accountability for their own health, we have not adopted community accountability where obstacles clearly exist.

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Negotiating Downside Risk with Your Payers

As your organization assumes downside risk, you must reevaluate the respective value you and your payer partners bring to the table. In such agreements, payers effectively transfer risk to the provider organizations. In turn, providers should negotiate to retain a larger share of the premium dollar.

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Executive Buy-In Key to Addressing Opioid Epidemic

Executive decision-makers have a big say in how aggressive workplace health plans are in addressing the opioid issue. Although corporate leaders are not expected to be experts in combating opioid addiction, C-suite awareness and engagement on this issue can drive treatments toward a more effective holistic approach that acknowledges addiction is a chronic and complex medical diagnosis.

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eBook: Ready to Improve & Sustain the Health of Your Revenue Cycle?

Several internal and external factors can perpetually strain your revenue cycle. Here are some baseline metrics that can help strengthen your revenue cycle performance.

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Downside Risk: The Endgame for ACOs

ACO programs and other value-based initiatives are not themselves the endgame for CMS, but the vehicles for its ultimate goal: the assumption of substantial quality-driven financial downside risk by providers.

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  • Case Study Banner

KentuckyOne Health Partners Thrives in the CMS Medicare Shared Savings Program

To achieve its top priorities of better health, better care, better quality and lower cost for managed lives, KentuckyOne Health Partners needed improved data integrity to transition its fast-growing provider network to a fee-for-value model. Learn how one of Kentucky's first Medicare ACOs generated $18.1 million in shared savings by optimizing its care management technology.

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ACOs Can Be Stepping Stone to Greater Risk & Reward

While it is almost certain that parts of the Affordable Care Act (ACA) may be altered during the new administration, many experts agree that the complete repeal and replacement would be very difficult and ill-advised, especially as it relates to the future of Accountable Care Organizations (ACOs) and other value-based care initiatives under Republican control.

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Data Is Key to Recouping Care Delivery Control from Payers

As the healthcare landscape shifts toward population health and value-based care, including alternative payment models, the payers in our country hold much of the data needed to be successful in the new world of healthcare - including care management. But are they the best source of truth to drive the collaborative, preventative strategies needed to succeed?

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Improving Patient Outcomes Through Care Coordination and Population Health Management

These five steps lay the groundwork for a successful care coordination platform that everyone - no matter how sophisticated your approach - can build off of to achieve improved outcomes (beyond health), optimal patient experiences and cost efficiencies.

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MACRA Final Rule: What No One Has Yet Told You about MIPS

You may have already read about the concessions CMS has made to ease providers onto one of the two MACRA tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). However, when one looks at the complicated details of how MIPS will unfold, it can leave your head spinning.

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Monitoring MIPS: The Driving Forces for Participation

The proposed changes associated to MACRA will begin to affect Medicare reimbursement as early as January 2017, allowing providers to choose from two paths that link quality to payments: MIPS and advanced APMs. Which track is right for you? Consider these driving forces for participation before deciding which path is in your best financial interest.

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Monitoring MIPS: Act Now or Wait and See?

CMS recently announced it would ease MACRA implementation by offering clinicians four options in order to "pick their pace" in 2017. Regardless of whether or not you know now which option best fits your future, one thing is certain: Medicare payment reform will put your practice at a crossroads related to quality measurement and reporting.

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Arm Personal Health Nurses With Data to Better Treat the Entire Patient

Complex challenges underscore the value of addressing opioid abuse with an approach that represents best practice in helping employees while also effectively managing costs: Put personal health nurses, armed with a steady stream of data and information, on the front lines to engage employees as advocates for their own wellness.

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Partnering to Achieve Improved Care Coordination, Reduced Costs

In a dynamic healthcare world, staying ahead of changes and evolving to meet the challenges of new care models and consumer-oriented care delivery - all while managing costs - is the new reality. For physician hospital organizations, this means not only meeting these challenges for their own organizations, but also helping their stakeholders succeed in this ever-changing healthcare climate.

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eBook: 7 Steps to a Clinically Integrated Network

The transformation towards more integrated and accountable healthcare delivery systems is aligning physicians, outpatient care, hospitals and ultimately payers in unprecedented numbers. Yet creating a successful clinically integrated network can be a daunting and complicated undertaking. Download the 7 Steps e-book and discover how to successfully navigate the many components of a clinically integrated network.

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  • Insights Banner

MACRA: Physicians’ Choice Puts Hospitals on the Hook Too

MACRA lays out two paths for adjusting providers' Medicare fee-for-service payments: MIPS and advanced APMs. Regardless of which track physicians choose to be reimbursed, hospitals and health systems have a vested interest in helping their clinicians succeed under MACRA - because hospitals are directly on the hook when it comes to the proposed rule.

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Revenue Cycle Visibility Benefits Provider & Patients

Providence Memorial Hospital's investment in revenue cycle management services provides visibility into payment trends that have reduced bad debt while improving patient satisfaction.

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Benefits Administrators Have Important Role in Fight against Opioid Epidemic

The nation's opioid epidemic continues to dominate news coverage, and with good reason. More than four in 10 Americans know someone who has been addicted to prescription painkillers. Large and small employers are grappling with this crisis. Front and center to the financial impacts of opioid abuse are benefits administrators in an environment where controlling costs is paramount.

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10 Tips for Effective ACO Compliance

Keep these 10 recommendations top-of-mind to meet ACO compliance required by CMS.

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Infographic: 7 Steps to a Clinically Integrated Network

Each step in the process of building a clinically integrated network (CIN) requires an understanding of the market to successfully navigate the many complicated aspects of network development. See what it takes to build a CIN.

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A Year into ICD-10: 5 Strategic Reminders

A year into the ICD-10 transition, many organizations have experienced only a few minor disruptions. As the industry continues to embrace the new coding routine, providers must now focus on processes and best practices to promote optimal revenue cycle performance for the long haul. These five strategic reminders can help your organization avoid impacts to cash flow.

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3 Tips for HIM Professionals Looking to Advance in the Workforce

HIM professionals perform a vital role in the daily operations management of health information and electronic health records by ensuring patients’ health information and records are complete, accurate, and protected. Here are three ways current and prospective HIM professionals can earn a competitive advantage.

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Healthcare Trends from an HFMA Board Director

Healthcare financial management professionals across the country are tackling head-on some of the industry's most pressing challenges. Tammie L. Galindez, HFMA National Board Director and Conifer Health Regional Vice President of Value-Based Care, shares her perspective and identifies key trends that are impacting leaders' decision-making.

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Value-Based Care – Adaptability is Key

Preparing for value-based care involves examining and prioritizing various IT and population health management approaches and models. For Robert Wood Johnson Health System, embracing uncertainty and moving forward with plan to adapt was a better approach.

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  • Infographic Banner

Infographic: Next Generation Accountable Care Organization

Did you know… you can achieve a higher financial reward with a Next-Generation ACO? To help achieve the goal of increased fee-for-value Medicare Spending, The Centers for Medicare and Medicaid Services (CMS) allows mature ACO provider groups to assume higher levels of financial risk and reward.

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The Evolution of the Hospital CFO

The role of the hospital chief financial officer has been undergoing a serious remodel. While all of the financial responsibilities remain, the new roles required of CFOs by healthcare's steady shift to value-based reimbursement necessitate the use and mastery of a whole new set of skills and approaches.

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Infographic: 5 Tips to Improve Productivity & Cash Flow

Health information management is the function that impacts every touch point in the care continuum. Keep these best practices top-of-mind to promote accuracy and productivity to sustain optimal cash flow.

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5 Steps to Build A Successful Population Health Program

A systemic, five-step approach can help hospitals and health systems manage the move toward population health management and value-based payments.

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7 Steps to a Clinically Integrated Network – A Roadmap for Success

Although there is no silver bullet to clinical integration success, health systems can follow seven steps to ensure their clinically integrated network is properly planned, implemented and measured.

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Moving Forward with Value-Based Payment Models, Despite Uncertainty Over Healthcare Reform

Becker's Hospital Review caught up with three health system executives to discuss key lessons learned from their experience with value-based payment models, how their systems plan for growth amid uncertainty in the industry and how to determine if a healthcare organization is ready to take on downside risk.

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Four Qualities in a Partner that Help Fuel the Evolution of Health Plan Administration Services

Outsourcing is viewed differently today than it has been in the past. Teaming with a trusted partner is now a strategic necessity to maintain a competitive edge and improve profitability and quality healthcare delivery.

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Filling the Health Plan Generation Gap

You may have already read about the concessions CMS has made to ease providers onto one of the two MACRA tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). However, when one looks at the complicated details of how MIPS will unfold, it can leave your head spinning.

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