Answers for a Healthier World

Depending upon who you ask, population health may not be too popular. Some of the apprehension concerning population health concerns stems from the ability for Big Data to provide actionable insights that improve the level of care. Additionally, some apprehension around population health comes from the fear of a disconnect between quality care and financial success under new reimbursement models.

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Within the healthcare industry, it can be easy to get lost in the numbers. Sources such as Healthcare Finance even suggest that hospitals looking to gain control over finances and protect their revenue streams should perform tasks such as verifying compliance of financial connectivity software. Although a myriad of activities exist that hospitals can use to potentially secure their revenue stream, in a larger sense, protecting revenue streams relies mostly on a hospital’s ability to achieve Revenue Cycle Readiness.

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It’s common knowledge that U.S. healthcare spending is astronomical. According to the Centers for Medicare and Medicaid Services (CMS), the average U.S. healthcare organization spend in 2015 increased 5.8 percent to reach $3.2 trillion. And that number has only grown. Health spending is projected to grow 5.4 percent in 2017 related to faster growth in Medicare and private health insurance spending. Health expenditures are also projected to grow at an average rate of 5.9 percent for 2018-19, the fastest of the sub-periods examined, as projected spending growth in Medicare and Medicaid accelerates.

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EHRs have profoundly impacted the healthcare industry. The EHR was initially seen as a way to digitize the patient’s chart and record, but by doing so EHRs have impacted the healthcare industry through the exponential increase in the amount of data that is now available to clinicians. The healthcare community is at the early-stages of trying to figure out how to use this onslaught of data to change and improve patient care. Organizations are trying to leverage the EHR as a database, not only for quality improvement and safety, but also for general population health.

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Strategic planning is essential in healthcare- particularly when implementing and operationalizing an EHR. One key extension to proper strategic planning is project and portfolio management. According to the Project Management Institute, 89% of high-performing organizations value project management and 81% of high-performing organizations actively engage sponsors.  An overall Portfolio Management Framework, however, is a necessary component to effective project management since it can instill a programmatic but practical approach towards implementation and optimization initiatives. To sum it all up, portfolio management helps projects align with overall enterprise strategies.

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A regulation-based, seismic change recently hit the healthcare industry. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a Medicare payment reform, went into effect January 1, 2017. MACARA and the associated Quality Payment Program (QPP) regulation will shift the reimbursement model from a straight fee for service model to a more comprehensive value-based framework.

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Understanding and optimizing the revenue cycle is not easy. There are so many activities and steps pertaining to all administrative and clinical functions within healthcare, that the ability to capture, manage, and collect patient service revenue can seem daunting. Gaining an effective capability to do so requires that healthcare providers achieve revenue cycle readiness by examining and mapping each step from patient admittance to the release of their final bill. Each step in between represents a piece that leads to a complete revenue cycle. Successful and profitable healthcare institutions often have a firm grasp on every individual step, including visibility into the revenue cycle as a whole.

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