Matt Reed

I love this post! It highlights the 9 ways strategic HR impacts the overall business success, and I couldn't agree more. As someone who's passionate about HR and being a business leader in the hospitality industry, I love seeing how HR can drive results and make a real difference in organizations. This is my dream job - to be able to make a meaningful impact on business success through HR. #HR #BusinessSuccess #StrategicHR #HRBP

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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Modern Patient Care Doesn’t Stop at the Bedside! Learn how Hackensack Meridian Hackensack University Medical Center is now employing virtual patient sitting, through AI, to better care for our patients.  Hackensack University Medical Center is thrilled to partner with the technology company, @AvaSure, to implement a new virtual care platform that will allow just one trained team member to monitor up to 12 patients at once. It’s called the TeleSitter Solution and it gives the team the ability to consistently see and communicate with up to 36 patients through video monitoring. The TeleSitter is now a critical resource in hospitals and healthcare networks around the country and we are thrilled to be an early adopter. Historically, hospital systems have used “patient sitters” to provide one-on-one monitoring support for patients. However, sitters are expensive and there are added risks, including lack of training or staff experience, and issues in preventing the spread of infection. AvaSure AI utilizes computer vision to identify patients at risk of falls or elopement, directing the virtual safety attendant's focus to those in need, enhancing their efforts, and helping ensure timely detection of patient safety events. This virtual care program, which is a unique branch of telehealth, is designed to provide 24/7/365 continuous care technology to keep patients safe, protect staff, and conserve vital resources. Nurses at the bedside report that virtual care helps them better balance their workload and that patient satisfaction has increased due to more focused attention from the care team.  #artificialintelligence · #Technology · #Future · #Tech · #Innovation

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Great defense of “private equity medicine” from former CMS administrator Leslie Norwalk. Though few clinicians fully understand it, PEM has become a popular bogeyman for a wide range of complaints about US health care. A few key takeaways: ·      All health care organizations require working capital. They should be judged on their behavior, rather than their source of capital. ·      Pushing health care organizations to more expensive sources of capital (e.g,, high interest loans) doesn’t serve anyone’s interests (except the banks). ·      The financial successes of private equity-backed companies accrue to everyone with a 401K or a mutual fund, not just a small number of wall street elites. ·      Reducing competition in health care (based on investment class) only accelerates market consolidation by integrated health systems, and the higher prices that come with it.

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Something to consider for #vbc: The average Medicare beneficiary sees two specialists, and 30% of beneficiaries see five or more(!). Managing VBC contracts with multiple providers and overlapping episodes can be complex (think a pregnant woman with diabetes, a diabetic/CHF patient undergoing hip replacement). Some helpful ideas in the blog here (e.g. the importance of provider transparency), but of course, it's all about the specifics of your situation.

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Major Changes Coming For The KC Market 📢 Blue KC to Exit Medicare Advantage Market by 2025 Due to Regulatory Demands 📢 Blue Cross and Blue Shield of Kansas City (Blue KC) has announced its departure from the Medicare Advantage (MA) market by the end of 2024, citing increased regulatory demands and financial pressures as primary reasons for the decision. The company will shift its focus to employer-sponsored health plans, Medicare supplement plans, and Affordable Care Act plans while ensuring uninterrupted, quality service to current MA members through 2024. With a smaller MA membership base, Blue KC finds it challenging to compete economically at scale, leading to the difficult but necessary market exit. In a statement, Blue KC's President and CEO, Erin Stucky, expressed disappointment, saying, “We explored every alternative path for our MA members and are disappointed we must exit this line of business.” This move aligns with industry trends, as other insurers, like Oscar Health, have also exited the MA market due to similar challenges, including the impact of regulatory changes such as the CMS's benchmark payment adjustments on the profitability of MA plans for smaller insurers. #Healthcare #MedicareAdvantage #BlueKC #RegulatoryChallenges #InsuranceIndustry #HealthPlans #CMS #MarketExit

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The PDP market is something that we at Healthsperien LLC have been closely watching and advocating around. The demo and the $15 premium waiver are laudable adjustments to a marketplace that is facing a perfect storm of financial pressures. However, more work has to be done around other aspects of the Part D program - namely Star Ratings - as applied to particular subsets of the Part D program. Specifically, those benchmark plans with high % of LIS beneficiaries (~20% based on the data we've looked at). Those plans have extreme difficulty satisfying minimum Stars thresholds and while financial amelioration is necessary, it is not sufficient for an all around response to the woes of that particular market subset.

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Join us today at 2:00 PM ET for our webinar, "Cutting Through Prior Authorization Headaches: Strategies to Thrive," by Matt Bridge and Ryan Chapin. #PriorAuthorization #PriorAuth #RevenueCycle #PatientExperience #RevenueCycle #RevenueCycleManagement

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#RESCUETHEREVENUE 🔷 AMBETTER HEALTH - NORTH CAROLINA 🔷 AMBETTER PUBLISHED THEIR Q2 2024 PROVIDER NEWSLETTER WHICH NOTES THAT EFFECTIVE 08/01/2024, THEY HAVE CONTRACTED WITH COTIVITY TO CONDUCT PRE-PAYMENT INPATIENT AUDITS. ⬇ LINK BELOW ⬇ https://lnkd.in/eCzDtkWy TIPS/TRICKS/TIDBITS Inpatient claims can be sometimes account for the highest dollars in an organizations open accounts receivables. When it comes to any sort of audit, education, organization, and time management can make or break the success rate. 🔳 Educate 🔳 - What do these audits look like? When should the team expect to begin receiving them? What is the turn around time to process the audit? What information/records are required to be submitted? Where does the audit get submitted to? 🔳 Organize 🔳 - Leaders should work with their team on a way to organize and track audits sufficiently. Ideally, being able to determine how many audits have been received, fulfilled, and paid or denied can give the organization a summary of the audits and may even identify if any internal review/changes are required. 🔳 Time - Management 🔳 - Audits run on a tight timeline and ensuring team members are fulfilling audits in the order they are due is crucial to not missing due dates. Ensuring team member are prioritizing audits based on due date and recognizing when to put audits ahead of other tasks is key to being able to submit them on time.

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Today’s workforce is comprised of five generations. There have been thousands of articles pointing out the differences between the generations and the importance of understanding them. This week’s blog focuses on one common need present among all generations and what it takes for leaders to engage each individual. Read more: https://lnkd.in/dCE9iEap #Leadership #Communication #Empathy #Healthcare #HealthcareLeaders #BairdGroup

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HCA, Tenet profits spike in Q2: 10 things to know: HCA Healthcare and Tenet Healthcare, two of the largest for-profit health systems in the U.S., reported higher net incomes in the second quarter of this year than in the same period of 2023.  http://dlvr.it/TB3gTQ

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Update to MA 2025 Final release ( more details are still required). The final (4/23/24) introduces changes to the regulations concerning agents, brokers, and Third-Party Marketing Organizations (TPMOs) in several areas: Unified Compensation Framework: The new regulations implement a unified compensation structure for agents and brokers across all plans. A single compensation rate is set for all plans, updated annually, which also includes a revision of the scope of items and services within agent and broker compensation. Separate payments for administrative services by agents and brokers are eliminated (administrative is defined but more details coming). Oversight and Compliance: Enhanced oversight measures are introduced to ensure that agents, brokers, and TPMOs (includes FMO’s) comply with the updated compensation structures and marketing rules. TPMO Marketing and Data Privacy: TPMOs are now subject to stricter marketing and communication rules. The final rule prohibits TPMOs from selling or sharing personal beneficiary data collected during marketing activities without explicit beneficiary consent. A new one-to-one consent structure is required, where TPMOs must obtain explicit consent from the beneficiary for each TPMO that will receive their data, ensuring more transparent and controlled use of beneficiary information. Prohibitions on Overrides: The regulations explicitly prohibit compensation structures that include additional payments known as "overrides" for TPMOs, which could influence the marketing and enrollment practices in favor of higher-paying plans. As we all know this will need further evaluation but recordings; trainings; portals etc will all be included in the total capped enrollment comp. #MAfinal2025 #medicareadvantage

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CMS Preparing to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack On June 17, 2024, the CMS announced that payments under the Accelerated and Advance Payment (AAP) Program for the Change Healthcare/Optum Payment Disruption (CHOPD) will conclude on July 12, 2024. CHOPD accelerated payments have been issued to over 4,200 Part A providers, such as hospitals, totaling more than $2.55 billion. CMS also issued 4,722 CHOPD advance payments, totaling more than $717.18 million, to Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment suppliers. Providers of services and suppliers are now successfully billing Medicare, and to date, CMS has already recovered over 96% of the CHOPD payments. After July 12, 2024, CMS will no longer accept new applications for CHOPD accelerated or advance payments. Any providers of services or suppliers that are having difficulty billing or receiving payment should contact Change Healthcare, owned by UnitedHealth Group, by visiting https://lnkd.in/ePxwAT2r  and/or their Medicare Administrative Contractor (MAC). To find your MACs contact information, please visit  https://lnkd.in/exSbpg9v. All new CHOPD program applications must be submitted from eligible providers and suppliers prior to that date. CMS will continue to monitor for other effects of the cyberattack on Medicare providers of services and suppliers and will continue to engage industry partners to address any remaining issues or concerns. CMS encourages all providers of services and suppliers, technology vendors, and other members of the health care ecosystem to double down on cybersecurity, with urgency. Please visit the HPH Cyber Performance Goals website at  https://lnkd.in/eWwhgDU3  for more details on steps to stay protected.

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Healthcare organizations should be tracking more than claim denial rates. Having insight into the bad debt rate, clean claim rates, and payment turnaround times can help measure a practice's revenue performance.

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CMS Proposes Over 4% Cut to Home Health Medicare Payments in 2025: "To rebalance the Patient-Driven Groupings Model (PDGM) and make it budget neutral... CMS is proposing a permanent prospective adjustment to the CY 2025 home health payment rate of -4.067%." Let Bartlett Strategy Group, LLC help you navigate these cuts and ensure that you're maximizing your reimbursement with accurate coding and OASIS outcomes! https://lnkd.in/eTWtJBQG

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Quick read with interesting perspectives on leadership and culture.

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🔍 Exploring MultiPlan's Healthcare Billing Practices: A Critical Analysis 🔍 In a recent investigation, concerns have been raised about MultiPlan's billing practices within the healthcare industry. MultiPlan, known for its preferred provider organization (PPO) network product and related services, has come under scrutiny for potentially violating the No Surprises Act. MultiPlan's PPO product offers health plans the flexibility to utilize their networks as primary or complementary options. However, recent revelations suggest that clients may bypass agreed-upon rates, leaving providers and patients in the dark until after services are rendered. The No Surprises Act, implemented earlier this year, aims to protect patients from unexpected medical bills by requiring providers and health plans to disclose specific cost breakdowns before services are provided. This raises questions about MultiPlan's practices and whether they comply with these regulations. While MultiPlan has issued statements defending its mission of affordability and fairness, questions linger about the extent of their responsibility and transparency in decision-making. Expert analysis from Jack Hoadley of Georgetown University's McCourt School of Public Policy sheds light on how the No Surprises Act addresses these issues, particularly through advance explanation of benefits (AEOBs) to provide patients with financial transparency before services are rendered. As discussions around healthcare billing transparency continue, it's crucial for stakeholders to understand the implications of these practices on patients, providers, and insurers alike. Read more about the investigation and expert insights in the full article. Let's ensure transparency and fairness in healthcare billing practices for the benefit of all involved. #HealthcareBilling #Transparency #NoSurprisesAct

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