Every hospital or health system has money that can be salvaged from past accounts — it's only a matter of how much can be saved and how it's done.
Mark Bodnar, CEO and founder of Global Care Delivery, shared this idea in a recent webinar titled, "Will My ACO be Successful? Ensuring Profitable ACO Reimbursement Through Contract Value Analysis and Alternate Funding Methods." The presentation — which also included Kevin Fickenscher, MD, president and founder of CREO Strategic Solutions, and Steve Rasnick, president of Accountable Care Administration — focused on how hospitals and other healthcare providers can salvage money in their revenue cycles and, more specifically, what that means for funding an accountable care organization.
What ACOs mean for healthcare providers
Dr. Fickenscher said the U.S. healthcare system is making the transition to ACOs because people are expecting three main criteria: low costs, high-quality delivery and healthcare services when they need them.
There are several examples of integrated delivery systems, such as Cleveland Clinic, California-based Kaiser Permanente and Geisinger Health System in Danville, Pa., but Dr. Fickenscher says those integrated delivery systems are not necessarily the future ACO model. ACOs will focus on the entire continuum of care, especially the preventive side of medicine, but there will not be a cookie-cutter approach. "There are some essential attributes," Dr. Fickenscher said. "But these are evolving models over time, so there is no singular answer for how we're doing this down the road."
A big component of ACOs is the management of the Medicare population. Systems that make CMS' three-year commitment must care for a group of at least 5,000 Medicare beneficiaries, but Mr. Rasnick said that should not be the sole focus. If an ACO wants to be successful as well as profitable, it must look from a broader point of view. "The system that exists today is a non-integrated system, and the advantage of an ACO is clearly the ability to integrate a healthcare system," Mr. Rasnick said. "But if you're considering an ACO only for the Medicare population, then you're really not evaluating the benefits of an ACO from a 360-degree perspective."
ACOs need to involve local employers, which are some of the most common non-governmental sources of health insurance. "Employers in an area and other small groups are very responsive to a major institution that forms an ACO with high-quality outcomes and low costs," Mr. Rasnick said. "They are very interested in working with them because they help keep the profits local."
When it comes to the patients, Mr. Rasnick said it will be the population health management tools that will help organizations identify which individuals they need to target and which individuals are most likely to incur the most expenses.
How ACOs and revenue cycle management are linked
Hospitals, health systems and other providers that want to take the plunge into the ACO pool usually want to know one basic fact: How feasible will it be financially, and how can it be funded?
Mr. Bodnar said ACOs can offset the initial financial uncertainty by linking their strategy with revenue cycle management. If revenue cycle management technology is coalesced with the technological requirements of ACOs (e.g., electronic health records), organizations will be able to capture revenue that would have otherwise gone unnoticed.
In order for ACOs to maximize collections, Mr. Bodnar said they should set up a contract value analysis. A CVA is a target strategy that looks at any problems or issues a hospital has, leading to robust data collecting through automation. "Every hospital has as systemic list of issues in their managed care department or other departments," Mr. Bodnar said. "The [CVA] is just a way of identifying those issues within the organization, reporting on them on a live basis and making sure those issues never repeat themselves."
As hospitals take on risks through ACOs, they can turn that medical data into "business intelligence," Mr. Bodnar said. For example, a hospital might diagnose it has issues with its claims regarding diabetes treatments. If data show the top X percent are accounting for a majority of the diabetic costs, the hospital can reconfigure its claims process through live reporting to try and curb diabetes claims, perhaps focusing more on preventive care with diabetic patients.
Mr. Bodnar said he encourages all hospitals to re-engineer their data collection processes in the revenue cycle so mistakes are caught on the back end. If hospitals, especially those who venture into ACOs, can gain insight on gaps in their data flow, then they will always have the ability to collect old money. "Issues start off small, but they build over the years," Mr. Bodnar says. "It's surprising what slips through if you don't have a safety net and audit what's going out in your revenue cycle management."
Download the webinar presentation by clicking here (pdf).
View the webinar by clicking here (wmv). We suggest you download the video to your computer before viewing to ensure better quality. If you have problems viewing the video, which is in Windows Media Video format, you can use a program like VLC media player, free for download here.
Note: View archived webinars by clicking here.
Mark Bodnar, CEO and founder of Global Care Delivery, shared this idea in a recent webinar titled, "Will My ACO be Successful? Ensuring Profitable ACO Reimbursement Through Contract Value Analysis and Alternate Funding Methods." The presentation — which also included Kevin Fickenscher, MD, president and founder of CREO Strategic Solutions, and Steve Rasnick, president of Accountable Care Administration — focused on how hospitals and other healthcare providers can salvage money in their revenue cycles and, more specifically, what that means for funding an accountable care organization.
What ACOs mean for healthcare providers
Dr. Fickenscher said the U.S. healthcare system is making the transition to ACOs because people are expecting three main criteria: low costs, high-quality delivery and healthcare services when they need them.
There are several examples of integrated delivery systems, such as Cleveland Clinic, California-based Kaiser Permanente and Geisinger Health System in Danville, Pa., but Dr. Fickenscher says those integrated delivery systems are not necessarily the future ACO model. ACOs will focus on the entire continuum of care, especially the preventive side of medicine, but there will not be a cookie-cutter approach. "There are some essential attributes," Dr. Fickenscher said. "But these are evolving models over time, so there is no singular answer for how we're doing this down the road."
A big component of ACOs is the management of the Medicare population. Systems that make CMS' three-year commitment must care for a group of at least 5,000 Medicare beneficiaries, but Mr. Rasnick said that should not be the sole focus. If an ACO wants to be successful as well as profitable, it must look from a broader point of view. "The system that exists today is a non-integrated system, and the advantage of an ACO is clearly the ability to integrate a healthcare system," Mr. Rasnick said. "But if you're considering an ACO only for the Medicare population, then you're really not evaluating the benefits of an ACO from a 360-degree perspective."
ACOs need to involve local employers, which are some of the most common non-governmental sources of health insurance. "Employers in an area and other small groups are very responsive to a major institution that forms an ACO with high-quality outcomes and low costs," Mr. Rasnick said. "They are very interested in working with them because they help keep the profits local."
When it comes to the patients, Mr. Rasnick said it will be the population health management tools that will help organizations identify which individuals they need to target and which individuals are most likely to incur the most expenses.
How ACOs and revenue cycle management are linked
Hospitals, health systems and other providers that want to take the plunge into the ACO pool usually want to know one basic fact: How feasible will it be financially, and how can it be funded?
Mr. Bodnar said ACOs can offset the initial financial uncertainty by linking their strategy with revenue cycle management. If revenue cycle management technology is coalesced with the technological requirements of ACOs (e.g., electronic health records), organizations will be able to capture revenue that would have otherwise gone unnoticed.
In order for ACOs to maximize collections, Mr. Bodnar said they should set up a contract value analysis. A CVA is a target strategy that looks at any problems or issues a hospital has, leading to robust data collecting through automation. "Every hospital has as systemic list of issues in their managed care department or other departments," Mr. Bodnar said. "The [CVA] is just a way of identifying those issues within the organization, reporting on them on a live basis and making sure those issues never repeat themselves."
As hospitals take on risks through ACOs, they can turn that medical data into "business intelligence," Mr. Bodnar said. For example, a hospital might diagnose it has issues with its claims regarding diabetes treatments. If data show the top X percent are accounting for a majority of the diabetic costs, the hospital can reconfigure its claims process through live reporting to try and curb diabetes claims, perhaps focusing more on preventive care with diabetic patients.
Mr. Bodnar said he encourages all hospitals to re-engineer their data collection processes in the revenue cycle so mistakes are caught on the back end. If hospitals, especially those who venture into ACOs, can gain insight on gaps in their data flow, then they will always have the ability to collect old money. "Issues start off small, but they build over the years," Mr. Bodnar says. "It's surprising what slips through if you don't have a safety net and audit what's going out in your revenue cycle management."
Download the webinar presentation by clicking here (pdf).
View the webinar by clicking here (wmv). We suggest you download the video to your computer before viewing to ensure better quality. If you have problems viewing the video, which is in Windows Media Video format, you can use a program like VLC media player, free for download here.
Note: View archived webinars by clicking here.
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