Dean Dalili, MD, MHCM

KH's most recent Flash Report unveils promising signs of financial performance, with a notable slowing of margin decline. The widening gap between lower and higher performing organizations highlights the focus on long-term investment and innovation in high-performing orgs. Lower performing organizations must focus on enhancing efficiencies and reworking key elements like their operating model and portfolio management. Explore the insights in the report here: [National Hospital Flash Report May 2024 Metrics](https://lnkd.in/ggUcyDPh). For resources to boost performance, visit us at https://lnkd.in/enBa3Tp

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Mandatory bundles in surgery are a bi-partisan objective, and (in)ability to optimize cost/quality will dramatically impact hospital P&L. Regular insights from granular data , and AI-based decision support are the only way to systemically reduce unwanted variability and be both profitable and high quality.

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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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S&P: Medicare Advantage's growth a bad omen for hospitals - n8: and Many Health Systems Continue to Participate Under the Terms Dictated by the MA plans, Enabling this Abuse “Even beyond rates, MA adds more administrative and liquidity hurdles for providers. S&P pointed to MA plans’ “key strategy” of prior authorization requirements, which force providers to absorb associated refiling costs and sometimes keep patients locked in a longer hospital stay. That burden is exacerbated by insurers’ generally “high” denial rates, S&P wrote, which have led to instances where smaller providers without the resources to fight claim denials terminate their MA plan contracts and become more vulnerable to closure…. The report also notes that many MA plans have longer pay cycles than traditional Medicare. Combined with claims denials and payment uncertainty, the delayed reimbursement “can hurt cash flow and liquidity,” according to the report.” https://lnkd.in/g3-drT-S So it goes n8 #healthsystems #hospitals #valuebasedcare #medicareadvantage #valuebasedscam

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Here’s your recap of last week’s health IT news 🗞️ 👇 🤖 AI Clinician Assistant • Ochsner Health announced an enterprise-wide agreement with DeepScribe. 📋 Patient Administration • Weave is now integrated with eClinicalWorks.    • Phreesia is now available through Oracle Health's Marketplace.    • Samaritan Medical Center selected Loyal for managing provider listings. 💼 Provider and Practice Administration • MedStar Health is partnering with RLDatix on AI-based tools for analyzing patient safety events.    • Kontakt.io released a new solution to track hand washing and gamify compliance.    • Epic announced a new feature allowing users to securely release their healthcare information to apps of their choice. 🔁 RCM • Infinitus Systems, Inc. released a new instant benefits verification tool for commercial insurance patients seeking specialty medication.    • Providence expanded its implementation of Xsolis, designed to manage length of stay, mitigate denial risk, and ensure proper reimbursement.    • R1 RCM is being acquired by investment funds associated with TowerBrook Capital Partners L.P. and Clayton Dubilier & Rice. 📱 Patient Support and Communications • uMETHOD Health, Inc. is partnering with Linus Health on an integrated solution for earlier detection of cognitive impairment plus care planning. ⚙️ Clinical Operations • SimplePractice launched an ePrescribe platform following its acquisition of certain assets of Luminello, Inc.    • VitalHub Corp. is acquiring the clinical decision support vendor MedCurrent Corporation. 🧑‍💻 Virtual and At-Home Care • AvaSure has acquired the smart room technology vendor Ouva in an effort to expand its AI capabilities.    • VSee is partnering with Ava Robotics to give remote providers an inpatient presence. 🍎 VBC • Zing Health is leveraging Story Health for eligible members with the greatest risk of poor heart failure outcomes. 🧠 Food For Thought • A federal judge granted an injunction against PointClickCare for alleged information blocking tactics. Elion advisor Brendan Keeler shared a great post about some of the potential implications of this decision. https://lnkd.in/eb8F3FEr    • The The Cedars-Sinai Accelerator program announced its 10th class, and the theme was unequivocally AI with a strong bias toward clinical applications. We remain eager to see this shift from back-office use-cases toward patient- and provider-facing clinical solutions.    • UW Health and Epic announced the release of the National Roundtable on Artificial Intelligence in Healthcare’s recommendations to lawmakers. The TL;DR: Lawmakers should foster innovation across the patient experience (i.e. beyond traditional care settings, such as virtual, in-home, etc) and play a strong role in ensuring equitable access, minimal care disparities, and local validation.

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