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Archive for the ‘Regulatory Compliance’ Category

Includes 4010/5010, ICD-10, EHR, State-wide HIE

ACA and QRS – Shoot for the Stars Part 3

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In Part 2, I discussed some factors to consider for the data derived measures. In this blog, we will take a closer look at the survey derived measures and what factors a QHP issuer should consider to achieve high scores.

surveyAgain, for reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the Enrollee Satisfaction Survey (ESS) derived measures:

Leverage CAHPS Processes
As mentioned in Part 2, it was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS ESS measures with current CAHPS measures that are typically required during accreditation. And just as an organization should leverage HEDIS for data, make sure to leverage current investments in CAHPS to keep initial costs low while jump starting ESS efforts.
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ACA and QRS – Shoot for the Stars Part 2

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In this blog, we will take a closer look at the data derived measures and what factors a QHP issuer should consider to achieve high scores.

HC DataFor reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the data derived measures:

Leverage Accreditation Processes

It was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS data measures with HEDIS measures that are typically required during accreditation. So, make sure to leverage current investments to keep initial costs low while jump starting QRS efforts.
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ACA and QRS – Shoot for the stars! Part 1

Last month I posted “ACA’s Quality Rating System – An opportunity to gain market share”, which explained how QHP issuers can gain market share in the individual space.  In that blog I mentioned that, as part of the Quality Rating System, plans offered on the Marketplace will receive a “Star” rating based on a 5 star rating system. Over the next few Shoot for the stars!posts, I would like to take a look at what this means from a health plan’s perspective.
As background, there are 43 measures that will need to be tracked. Out of the 43 measures, 31 are derived from data and 12 are derived from the survey. In addition, the draft QRS scoring specifications published by CMS organizes the 43 required measures into composites that roll up into eight domains. These domains are as follows:

  • Clinical Effectiveness
  • Patient Safety
  • Care Coordination
  • Prevention
  • Access
  • Doctor and Care
  • Efficiency and Affordability
  • Plan Services

The eight domains are then rolled up in to three summary indicators: 1) Clinical Quality Management; 2) Member Experience; and 3) Plan Efficiency, Affordability and Management. And of course, the final result is a star rating.

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Changing Delivery and Spending of Medicaid through DSRIP

Well, folks, here’s another acronym for you to add to your healthcare dictionary…DSRIP. DSRIP, or more formally known as the Delivery System Reform Incentive Program, is a demonstration program through the Centers for Medicare and Medicaid Services (CMS) that is designed to result in achieving the triple aim: better care for individuals, better health for the population, and lower costs by transitioning hospital funding to a model where payment is contingent on achieving health improvement goals1.Changing Delivery and Spending of Medicaid through DSRIP

CMS is using the Section 1115 Waiver of the Social Security Act, which gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that support the objective of Medicaid programs2, to encourage hospitals to build innovative service delivery systems. Hospitals may qualify to receive incentive payments for implementing quality initiatives within their community and achieving measurable, incremental clinical outcome results demonstrating the initiatives’ impact on improving their states health care system3.

The program’s main goals are to:

  1. Develop a program that supports hospitals’ efforts to enhance access to healthcare, the quality of care, and the health of patients and families they serve.
  2. Develop a program rooted in intensive learning and sharing that will accelerate meaningful improvement.
  3. Ensure individual hospital DSRIP plans are consistent with their mission and quality goals, as well as, CMS’ overarching approach for significantly improving health care through the concurrent pursuit of the triple aim.

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How Enterprise Mobility Management Can Improve Patient Care

Healthcare is an ever-changing industry, and healthcare organizations continue to face the challenge of improving the quality of care while remaining compliant with industry standards. Depending on the diagnosis, the patient journey can include transfers between acute, post-acute, ambulatory care and home-health care organizations. As a result of these often-frequent transitions in care settings, the patient’s quality of care and overall safety can be compromised.

How Enterprise Mobility Management Can Improve Patient CareEnterprise Mobility Management (EMM) allows healthcare organizations to securely and more efficiently exchange clinical data while remaining compliant with industry regulations such as HIPAA requirements. The use of mobile technologies and applications can help make this transition across the continuum of care smoother resulting in fewer hospital re-admissions and better patient outcomes.

By 2020, a projected 70 percent increase in home health aides signifies the importance of secure device management solutions outside of traditional care facilities. EMM provides organizations with the technology needed to positively impact patient care throughout the entire patient journey regardless of the treatment location.

 What will it take to get us there?

  1. IT administrators need to begin to focus on how they can extend existing standard health data processes to mobile devices.
  2. These mobile devices need to enable care providers to access and enter data into Electronic Medical Records (EMRs), manage prescriptions and patient financial data, among other data sources. This should all be able to happen in real time, from anywhere and is especially important for home health providers, so they can enter data from the patient’s home, on their mobile devices.
  3. Home health organizations need secure tablets and smartphones to ensure secure and protected medical record access. The need for mobility management and security are now more important than ever as the delivery of care continues to expand beyond the traditional clinical setting.

EMM will provide the security and medical record access needed to ensure quality of care and patient safety across the entire continuum of care.

 

Improve care coordination with direct secure messaging #HIMSS14

Direct secure messaging (DSM) is a transmission standard promoted by the Office of the National Coordinator for Health Information Technology that meets the Meaningful Use Stage 2 requirements of electronic health records (EHRs).  It works much the same way as regular email, but the message is encrypted, which prevents unintended use of the protected health information that is included within.  DSM can be used to send patient information among physicians, among provider organizations and to other 3rd parties, including patients.  

shutterstock_157839875Healthcare providers have been using direct secure messaging for care coordinating for a while but there may be ways to use it more fully to reduce readmissions, reduce unnecessary testing and procedures and even increase provider productivity.  Some benefits may include:

  1. Providers can insert secure messages into any point of their workflow.
  2. Primary care providers can interact with specialists to potentially result in fewer referrals; ultimately reducing costs to the healthcare system.
  3. Hospitals can improve transitions to nursing facilities and nursing homes can improve the communication with providers to reduce the need for readmissions back to the hospital.
  4. Medical records departments can interact with the patient send their records more easily saving them time and money.
  5. Researchers can seamlessly interact with patients on release of health sciences information.

Once HIEs are fully implemented, query based networks will provide robust data exchanges, but DSMs will continue to be valuable especially for smaller practices and hospitals that do not have the means to implement sophisticated EHRs.  Read the rest of this post »

Balancing clinical effectiveness with profitability – #HIMSS14

A former boss of mine, who happened to be the CFO of a large academic medical center, used to say the phrase “no margin, no mission”  all the time.  I’m not sure I really took the time to understand it at that point in time, but I have since then, “grown up”.  My understanding of the intricacies of determining true profitability is now burdened by the awareness of how many different business transactions occur in the hospital setting and how hard it really is to capture each correlated business transaction at the same point in time.  

ON THE (1)Still, producing a monthly income statement is one thing, and there is certainly no shortage of guidance whether considering GAAP or public sector fund management reporting requirements, but how do we merge the clinical effectiveness discussion with the finance and accounting discussion? 

In my view, these two areas converge at the decision support team who have been supporting contract management and costing activities for decades.  Perficient views the costing activity as an enabler for business to deliver strategic advice, moving away from low value transactional activities, through increased focus on:

  • cost reduction and ability to support the introduction of new products/services or new markets
  • understanding spend according to the value a function or activity creates
  • promoting transparency with a wider view to cost data to allow management to better understand spend through driver-based information on “cause of cost”.

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Manage health system costs with insightful analytics – #HIMSS14

Healthcare systems must be able to provide timely and accurate financial information for decision making and planning. Many hospitals and health systems are targeting hefty reductions in their operating budgets to maintain financially viable without interrupting investments in facility, information technology and other areas needed to remain competitive.  This cost management culture requires organizations to fully understand and ensure transparency exists for key performance indicators that drive consumption and reflect service line profitability.

PRODUCT NAMEWhether it is supplies, labor or productivity or clinical effectiveness, the quality/cost/value equation requires the organization to truly understand their data.  This includes not only considering the right product at the right place, but also applying a broader perspective on clinical evidence for resources used and approaches employed.

A hospital can’t just make across-the-board financial target reduction a sustainable approach. Perhaps a place to start would be to identify opportunities to reduce variation in care delivery by standardizing clinical processes.

But how do we understand cost of care?  There are “experts” within the organization for sure, but a better approach would be to couple these experts with technology that enables us to understand the fully burdened margin by service, by patient or by procedure.  Costing software technology and spreadsheets have been around for a while; we must now transform these systems to leverage clinical and financial / administrative data to create transparent costing models that tell us about profitability across service lines, patients and encounters.

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Agile Forecast Planning for Healthcare Providers – #HIMSS14

In today’s rapidly evolving healthcare environment, provider organizations must be able to identify financial performance gaps continuously and quickly change course when needed.   As we discussed in my blog:  Elevating the Role of Finance within the Hospital, this requires a partnership with operations to ensure that the correct metrics are correlated within the budget process, but being agile is also influenced by the mechanism the hospital uses for budgeting.

A rolling forecast model can replace orThe use of a rolling forecast to replace or supplement the annual budget process

What is a rolling forecast?  The rolling forecast is usually a quarterly budget with a two to three year horizon that keeps a close eye on the organization trajectory.  Typically the forecast budget is not prepared at the department level but may instead focus on divisions or even at a hospital level.  Global budget drivers and assumptions will typically be the same as the annual budget but those unique to a department or division may not be line itemed.

The forecast is built using historical trends, current conditions and future assumptions for budget drivers.  Some forecasts may be primarily driven by revenue drivers with expenses flowing from ratios defined to the model.  The forecast feedback process fosters the partnership between finance and operations to allow the healthcare organization to course-correct sooner and reinforce the cause effect relationships that effect reality.   Some organizations use the rolling forecast process in conjunction with the annual budget and others have moved to using the forecast only.

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The Role of Finance Within the Hospital has Elevated – #HIMSS14

Performance monitoring within the hospital can be accomplished through strategic partnerships between finance and operations.  These partnerships serve the organization well and lead to financial steadiness.  Let’s examine how this might work.

Data-driven decision making has (3)A recent case study within the November issue of HFMA Magazine explores how Mary Lanning Healthcare in Nebraska showcased how data-driven decision making has elevated the role of the hospital finance department from a back-office operational function to a more strategic, advisory one. The article goes on to discuss how finance can strategically deliver data that drive informed business decisions that support sound strategic and tactical planning and execution.

Mary Lanning is a 183-bed acute care facility which offers 29 medical specialties. Embracing data-driven decision making requires agile thinking to pinpoint and respond to the short-term and long-term needs of the organization. This shift requires finance to transcend from the typical focus on aggregating data to a value added analytic team that could provide greater visibility into changes in variables and assumptions.

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Trends to Watch in the Healthcare World in 2014

What’s transforming the ways in which healthcare is provided?

  • legislation
  • new competition
  • innovative incentives
  • a call to refocus on priorities
  • a more empowered and digitally engaged consumer, who has more and greater expectations for quality of care and convenience of care.
  • a renewed attention on healthcare by the consumer market thanks to ongoing press about healthcare.gov and the Affordable Care Act
  • new services and business models in healthcare that we’d never seen before recent reform

Susan DeVore, Premier healthcare alliance…and much more.

Susan DeVore, CEO of our partner and client Premier healthcare alliance, wrote a post yesterday fro HealthAffairs.gov titled, “The Changing Health Care World: Trends To Watch In 2014.” In the article, she introduces the new trends she expects to see in healthcare this year. We are also seeing each of these trends impact conversations about investments our clients need to make this year and next year.

I have summarized the trends below.

1. Investments in Chronic Care

  • Chronic conditions increase costs by 3X, so, “The biggest health care consumers are those with multiple chronic conditions.”
  • We should see more investments in Ambulatory ICUs and patient-centered medical homes as providers work to improve their shared savings payments and better manage chronic conditions within primary care facilities.

2. New Job Roles in Healthcare

  • DeVore has seen an increase in the popularity of hiring “health coaches” who are there to listen, inspire and motivate and spend time getting to know the patient’s family and life situation as it affects their ability to both access care and to care for themselves.

3. Home Health Care

  • Back to the days of the house call.
  • “Marketing firm BCC Research predicts that the market for remote monitoring and telemedicine applications will double from $11.6 billion in 2011 to about $27.3 billion in 2016.”
  • Technology is increasing access and convenience of healthcare from outside the traditional care setting, especially for rural, hard-to-access locations.

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Healthcare CIOs are carefully moving to the cloud

Recently our company has increased our focus on what healthcare organizations are looking for when it comes to cloud computing, in large part due to our acquisition last year of two fantastic Salesforce partners (ClearTask and CoreMatrix). I found this article in Healthcare Informatics to be very interesting. It’s titled “The Many Flavors of the Cloud” and includes interviews with some key CIOs regarding how they view private vs. public cloud solutions and the sensitivity – and often the mandated security requirements – around health data when stored in the cloud.

There are some obvious advantages to providers moving to private cloud storage for all types of data across the organization, but also some critical considerations for any CIO or CMIO. Here are the key takeaways I got from this article.

MedicalImaging_AndroidTabletApp

Medical imaging takes up a lot of storage space in the healthcare space. Imagine a 24 hour study of your heart that takes up a terabyte of space. The cloud can enable better scale for this type of need.

Key insights about cloud computing in healthcare:

  • CIOs interviewed prefer “private cloud” solutions over public cloud solutions like those of Google, Amazon and Microsoft – more control around access & rules
  • CIOs don’t want to deal with power issues, cooling issues, and capitalizing hardware over time – 3 reasons they enjoy Cloud
  • They enjoy reduced costs in scaling a storage room, servers, etc..
  • CIOs take personal ownership over creating their own stringent security requirements for their cloud vendor, making them feel better about storing PHI or other sensitive healthcare data in it.

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