reception desk at a doctor's office

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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Male surgeon in Operating Room

Operational Effectiveness in Surgical Services

Episode Overview

Many challenges can arise when trying to implement standardized processes in complex surgical settings. Reviewing the data and performing prioritization exercises will help leaders identify inefficiencies and assist them with understanding where to begin to operate effectively. By utilizing data and engaging surgical staff, hospitals and ASCs will see tangible benefits to the financial bottom line and to staff and patients.

On this episode of Value-Based Care insights, host Daniel J. Marino has an informative discussion with Kate Geick on the benefits of implementing operational effectiveness tools in surgical services. 

 
Key takeaways:
  • One of the biggest mistakes that hospitals make is collecting data without taking the next step to understand and interpret it. After gaining analytic insights into the problems you are facing, you can move forward with an exercise like value stream mapping and identify opportunities for improvement right away.

  • It's really important to not only measure certain KPIs on a regular basis, but also share the analytic insights with the right people on a regular basis. If you aren’t informing the staff who are affected by the inefficiencies and are instrumental in enacting the changes needed, then it will be very difficult to make improvements in processes.

  • Making changes to processes that surgeons and staff have become accustomed to for years can be stressful. Necessary changes may involve more paperwork or more steps and this can create frustration. Bringing the focus back to the purpose and why you’re doing it will help maintain the level of commitment needed to implement meaningful changes for improved operational effectiveness.
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Female doctor on laptop

Value-Based Contracts: The Real Risk to Hospitals and Specialists

Episode Overview

Health care providers are in one of the most challenging times with payer contract negotiations. There are new economic pressures, changes in reimbursement structures due to shifts in site-of-care, and payers wanting providers to assume more risk. On this episode of Value-Based Care Insights, host Daniel J. Marino and Cliff Frank, a national expert in managed care contracting, discuss how health care providers must move forward and successfully perform under risk-based contracts.  
 
Key takeaways:

  • The COVID-19 pandemic created a large shift in the site-of-care from the inpatient to the outpatient setting. This caused payers to make changes to their reimbursement structure.

  • Reimbursement pressures are tremendous right now, with payers making frequent adjustments to policies and denying claims that previously would have been approved. This creates additional friction costs for providers, who are working hard to keep up with the shifting landscape.

  • Payers want providers to assume more risk, and in order for a provider to do so, they need to be able to contain and even reduce costs. If providers are going to enter into risk-based contracts, they have to reduce their cost structure internally and reduce friction costs with payers.

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Physician and finance leader shaking hands

Turning Conflict Into Collaboration – Successful Strategies for Finance and Clinical Leaders

Episode Overview

To be a high performing health care organization, finance and clinical leaders must work together to improve patient care. Many different factors play a part in the often fragile relationship between the two. But by aligning incentives and increasing communication, the dynamic can improve. On this episode of Value-Based Care insights, host Daniel J. Marino has a great discussion with Dr. George Mayzell and Steven Berger on the evolving relationships between hospitals and physicians.
 
Key takeaways:
  • Evolving incentives and changing financial dynamics can create misalignments between hospitals and physicians.
  • The ability to work together is really predicated on transparency, good communication, and some level of mutual governance.
  • In order to provide good quality care, hospitals and physicians need one another and need better financial alignment, whether that is entering something like a co-management agreement, integrated physician network, or a joint venture. Solutions are not one-size fits all, and the most critical piece still comes back to improving communication between hospital and physician.
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Direct-to-Employer Contracts: Benefits to Your Health System

Direct-to-Employer Contracts: Benefits to Your Health System

Episode Overview

Given the increasing health care expenditures and the pressures of the recent pandemic, a direct-to-employer (DTE) contracting strategy is an opportunity for employers to reduce administrative friction costs and preserve revenue. These arrangements can allow you to foster a better relationship between the employees and the provider.
 
On this episode of Value-Based Care insights, host Daniel J. Marino has a discussion on the benefits of DTE arrangements with Bradley Olson, VP of Managed Care, and Britney Bart, Business Development, at a large Midwest Clinically Integrated Network.
 
Key points:
  • There is great opportunity to reduce costs by developing a focused DTE relationship.  Starting a relationship doesn't have to be a large, complicated arrangement.
  • Through a strong DTE relationship, you can create value congruence. As the health care network reduces costs, you can be assured that cost is translated back to the employer and to the community.
  • Structuring wellness programs play a big part in fostering relationships between the employee and the provider.  Additionally, opportunities are created to meet the needs of employers and their employees.
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The Health Care Workforce Challenge: Three Solutions that Work!

Episode Overview

The health care industry has long been challenged with workforce issues: high turnover, recruitment and retention, escalating wage growth, and low morale.  Health care executives and human resource leaders could not imagine these challenges getting much worse, then along came COVID-19. Now surveys across the industry are indicating workforce issues are the number one challenge facing many provider organizations.

In this podcast episode of Value-Based Care Insights, Daniel J. Marino speaks with John Malone to highlight the extent of the COVID-19 impact and example solutions that work to address workforce challenges. Key points include: 

  • The importance of empowering frontline supervisors and managers to decrease burnout, and improve retention and turnover with a sense of ownership and decision-making authority 
  • The standardization of workflows to move work processes down to the appropriate resources to address staff burnout and dissatisfaction
  • Tailored retention strategies based on key workforce metrics that are accurate and understood by management
  • The conscious awareness of a positive culture leading to a high-performing organization
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2022: Tackling Critical Health Care Challenges

Episode Overview:

The way health care providers connect with patients has changed significantly since the onset of COVID. With new challenges, having care models that are consumer-focused and convenience-based is critical more than ever before. The need for a strategic focus is paramount for organizations to successfully bounce back from COVID. 

In this episode of Value-Based Care Insights, Daniel J. Marino speaks with Bill Bodnar to discuss several challenges health care organizations are facing as they transition out of COVID. Bodnar shares his insights on new challenges, including workforce dynamics, non-traditional health care models, and the pursuit of value. Key points include: 

  • The competition among primary care providers and specialists with non-traditional providers, shifting to consumer-focused and convenience-based models 
  • The use of automation and other innovative solutions to address workforce burnout and employee retention
  • The advancement of population health management and value-based contracts to improve patient care and financial outcomes 
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