Using Data to Influence Patient Outcomes

Episode Overview

With the advancement of technology in health care organizations are recieving an excessive amount of data. How can organizations manage that data to create actionable insights? 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Rick Howard, Chief Data and Products Officer for an analytics vendor and former Chief Data officer of Ascension Health. The two discuss the management of data within four categories: claims/finance, lifestyle, and social determinant data.

Key points include:

  • Using retroactive and retrospective models to manage data

  • Analyzing the four categories of health care data: clinical, claims/finance, lifestyle, and social determinant data.

  • Building causation models

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Health Care Trends Shaping Strategy in 2023

Episode Overview

Throughout 2022, primary health care faced many challenges. Staffing shortages, high hospital costs, and the advancement of telemedicine forced health care organizations to rethink their strategic plan heading into 2023. 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Lucy Zielinski, Managing Partner at Lumina Health Partners. Dan and Lucy analyze health care trends in 2022 and take a peek into 2023. 

Key points include:

  • Health care leaders have felt continued pressure on finances. With an unstable economy and high hospital costs, organizations need to focus on operational effectiveness, reducing clinical variation deduction, and revenue cycle management.

  • Staffing shortages were a major issue for hospitals in 2022, the trend is expected to continue. Health care organizations will need to center their attention on staffing recruitment and workforce well-being in 2023.

  • Effective service line development will allow physicians to deliver consistent, patient-centric care.

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Evolving Primary Care Model

Episode Overview

Over the past few years, the primary care has gone through immense change. Everything from the incorporation of virtual health, to the shortage of primary care physicians to the building of new team-based models of care.  

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Dr. Michael Hanak, a board-certified family physician working with a large academic medical center in the Chicago metropolitan area. The two discuss common trends and challenges in today’s primary care model.

Key points include:

  • Exploring the challenges of the traditional patient care model and how primary care is evolving given technology and the new entrants of non-traditional providers

  • Using a digital experience to help promote a team-based care model and track performance outcomes

  • Incorporating technology into today’s primary care model to improve patient care and expand access.

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Emergency Department Visits: A Cure or a Symptom?

Episode Overview

Each year, one in five Americans visit the emergency department (ED) at least once  – and these costly ED visits are on the rise. Are they a symptom of a larger issue in our health care system? Many of emergency visits are preventable – this may be a symptom for inefficient care management, inadequate patient access, or lack of patient knowledge. As hospitals and payers transition into value-based care, interpreting ED visits may be a symptom of a larger problem. 
 
In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Dr. Nicholas Dodaro, Chief Medical Officer and co-founder of Medical Life Holdings, a portfolio of companies and practices founded in 2006 to improve the value of health care delivery. The two discuss common issues with emergency room visits, why they’re so costly, and what to do about them.

Key points include:

  • “Unmanaged” or “unengaged” patients seem to be a big contributor to unnecessary ED visits.
  • Understanding the financial impacts of ED visits on the performance of value-based contracts.
  • Reviewing ED visits can be insightful to future improvements with care delivery.
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Rural Health Care: What Works?

Episode Overview

Rural health care providers often encounter barriers that limit their ability to provide the care they need. Even well before the pandemic, rural health providers faced many challenges. Today, workforce shortages and access to health care services are at an all-time high.

On this episode of Value-Based Care Insights, host Daniel J. Marino is joined by the CEO of Great Plains Health, Ivan Mitchell. The two discuss modern-day challenges that exist in today's rural health care environment.

Key points include:

  • How to address rural health care challenges and deliver the right level of care while remaining economically stable
  • Strategies to provide access to primary and specialty care in rural areas 
  • The need for alignment between health care providers and insurance carriers within rural communities 
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Transforming Physician Burnout into Physician Wellness

Episode Overview

Today's health care has created many environmental challenges, which take a toll on physicians and contribute to burnout. Often, especially during the height of the pandemic, health care leaders guide hospitals and team members through difficult times. However, many physicians feel overwhelmed and undervalued without a healthy culture to fall back on.

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Lumina Managing Principal, Dr. George Mayzell, as they discuss the factors that contribute to physician burnout and tactics health care leaders can build to create a culture around physician wellness.

Key points include:

  • As organizations move to value-based care, leaders need to consider factors that enhance physician wellness.
  • Leaders must address staffing issues and administrative burdens to enhance direct patient care.
  • Health care leaders must develop a wellness-driven culture that aligns physicians with their core mission.
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Advancing into a High-Performing Value-Based Network

Episode Overview

Over the past few years, the shift to value-based care has slowed down as organizations struggle with leadership alignment around care delivery advancements. However, lessons can be learned from organizations that have successfully advanced value-based care – including how to position the organization for value-based success, how to build performance based contracts, and how to create strong physician incentives.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Christopher Crow, CEO and Co-Founder of Catalyst Health Group, discuss how to make changes in an organization’s culture, finances, and operations to successfully transition to value-based care.

Key points include:

  • Building a solid culture on trust is critical; it is all about physician alignment, performance outcomes, and transparency. A good trusting relationship makes it easier to align incentives over time.
  • Understanding the infrastructure requirements to support value-based contracts allows for timely recruitment and effective operational change management. Focus must be on team development, operational and clinical workflows, and technology to achieve high-performance and desired outcomes.
  • The cornerstone should be the physician-patient relationship - and these relationships take time and compound over time.
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Creating Financial Value Out of Quality

Episode Overview

When switching to value-based care contracts, alignment with the providers, physicians, payers, employers, and patients must exist through a model that benefits all. Health care providers must be strategic in selecting quality measures to track that identify areas to improve efficiencies and create real value.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Jon Burroughs, President and CEO of Burroughs Healthcare Consulting Network, discuss where to start on tracking quality outcomes and how to align a provider organization around value.

Key points include:

  • There are preliminary steps that are required; first, the organization must create alignment across its leadership team so that everyone is excited about the direction.
  • Measure selection is key. Finding the right measures will carry the greatest weight, for example, they will lead to lower expenditures and increased revenue. 
  • To support the strategy, the financial impact must be quantitated  to understand earnings. Additionally, resources necessary to reach the goals must be considered.
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Decoding Legalese of Value-Based Contracts

Episode Overview

As the health care industry shifts from fee-for-service to value-based arrangements, providers are facing a lot of challenges. A provider's relationship with payers is often strained by the new business model, and a provider's ability to collaborate with payers has never been more important.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Hal Katz, an industry leader in health care law, discuss how providers can successfully navigate value-based contracting with payers in a mutually beneficial way.

 
Key takeaways:
  • Previously there has been a lack of relationship between providers and payers; and with the shift towards value-based care, it is vital for those relationships to improve  
  • Risk sharing requires the provider to agree to be responsible for a specific set of services and the costs associated with such services, which can include hitting certain performance measures. The elements need to be entered into the agreement otherwise there’s no obligation for the payer to honor those terms.
  • With all risk-based contracts, it key for providers to include protections.  Such as, for example, that the financial arrangement doesn't kick in until a minimum number of members assigned to the provider has been reached.  Also, if there is a change in that threshold for two consecutive months, the payment bumps back down to the traditional fee-for-service rate.
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Importance of Revenue Cycle Management in Value-Based Care

Episode Overview

Revenue cycle performance is a hot topic across the country as organizations work to rebound from the difficult past couple of years caused by COVID. There are many things that impact and contribute to the complexity of the revenue cycle, but they boil down to three categories: people, process, and technology.

On this episode of Value-Based Care insights, host Daniel J. Marino discusses ways to identify areas of opportunity and increase the revenue cycle performance with revenue cycle leaders, Cecilia Gonzalez and Rachel Greenspan.

 
Key takeaways:
  • When aiming to increase revenue and create efficiencies, leaders must educate and properly train front-end staff so that they understand the entire revenue cycle and how to avoid costly denials.

  • Key performance indicators support operational effectiveness as they drive outcomes and improve the overall financial performance of the group.

  • Centralized pre-certification processes can reduce inefficiencies as staff members become subject matter experts who are focused on the requirements of the payers to ensure timely and proper payment for services.

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