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Perspectives

Insights into health care performance improvement

The Sustaining Success series

This digest of articles shares examples of how health care providers are pursuing value through both short-and long-term initiatives within the dimension of performance improvement. Providing a view beyond traditional cost cutting methods, the series places a data-driven lens focusing upon how providers can utilize data analytics to identify and implement innovative solutions.

In-sourcing retail pharmacy: An untapped opportunity for provider-sponsored plans

Provider-sponsored health plans (PSPs) are gaining market presence due to an increased focus on cost reduction and shifting incentives toward a value-based care model. By operating a PSP, providers stand to benefit from better integration with their communities, more effective management of population health, and higher alignment of care delivery goals through shared savings payment arrangements. While there are several risks that providers must consider when moving into non-traditional care delivery—namely, that a provider must assume the majority (or all) of the financial risk for insuring a patient population—there are also considerable opportunities, including bundled payment incentive programs, home health care services, and increased transitions to ambulatory care settings. While these opportunities are appropriate depending on provider and patient type, one typically untapped opportunity for financial benefit in operating a PSP is to in-source retail pharmacy.

With increases in drug prices and shifts from volume to value-based care, this piece explores how provider-sponsored plans can potentially earn substantial revenue gains by in-sourcing retail pharmacy.

Read In-sourcing retail pharmacy: An untapped opportunity for provider-sponsored plans

Care management transformation: Harnessing an analytics-driven approach

Changes to the health care industry, driven by the Affordable Care Act, demand improved care coordination, enhanced patient engagement and experience, and cost containment. As a patient transitions across the care continuum, there are disconnects within the current health care delivery system that tend to result in redundant testing, clinical services rendered at a higher level than medically necessary, and loss of financial information—all impacting quality of care, patient experience, and reimbursement.

This piece explores how patient stratification, a key differentiator of a leading care management model, can be utilized by health systems to coordinate care delivery to provide a better patient experience while reducing length of stay and the overall cost of care.

Read Care management transformation: Harnessing an analytics-driven approach

The impact of decentralization: How hidden connections reveal improvement opportunities

Providers today face a tough choice. Many health systems are consolidating often leaving front-end operations decentralized and disparate throughout the organization. These decisions can also impact patient engagement and satisfaction. As patient payment obligations rise, consumers continue to seek better access, improved customer service, and more involvement in care decisions.

With costs increasing and margins declining, determining when and how to centralize front-end operations can mean the difference of remaining profitable or not. This piece explores how the effectiveness of decisions to centralize or decentralize front-end operations can be determined by taking a closer look at registration related denials.

Read The impact of decentralization: How hidden connections reveal improvement opportunities

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The January effect: Turning patient receivables into cash

Rising patient payment obligations can affect hospital bad debt. This is the first of two insights which provide front-end and back-end tactics health care providers can take to minimize the impact.

Today’s health insurance plans include larger deductibles, higher co-insurance rates and co-pays which emphasizes the need to collect these payments. With more financial responsibility on the patient, what are the most effective ways for health care providers to timely collect those out-of-pocket payments? What are the current impacts of high deductible plans on cash collections? How do providers utilize data analytics to implement innovative solutions?

This piece explores front-end tactics providers can take to reduce the impact of the adverse shift in patient cash collections at the beginning of the year, and methods to optimize patient payment throughout the year.

Read The January effect: Turning patient receivables into cash

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The revenue evolution: Addressing the rise in consumer financial accountability

​Rising patient payment obligations can affect hospital bad debt. This is the second of two insights which provide front-end and back-end tactics health care providers can take to minimize the impact.

Shifts toward higher patient financial obligations require innovative ways to manage collections. This piece examines the back-end effect of total margin loss from uncollected patient revenue and offers ways to increase cash collections post-service.

It is the priority of provider executives to be efficient and effective in the way that they collect cash and revenue for the services they provide. They recognize that caring about compensation is essential to the ability to continue to care for patients. Since patient responsibility after insurance is a sizeable asset, closely managing this throughout the year is key to countering the effects of the new benefit year and sustaining or growing margin.

Read The revenue evolution: Addressing the rise in consumer financial accountability

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Leading hospitals and health systems are identifying performance improvement strategies which transcend traditional cost reduction and respond to new payment models. The Sustaining Success provides insights as to how providers are using data analytics to drive sustainable margin.

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