Lon Hecht

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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Telehealth can be an effective strategy for reaching rural and underserved communities in the United States by overcoming barriers such as access to care, transportation issues, and shortages of healthcare providers in these areas. Reimbursement rates for healthcare providers play a significant role in supporting the structure of telehealth services. Higher reimbursement rates for telehealth services can incentivize healthcare providers to offer virtual care options, which can in turn improve access to care for rural and underserved populations. Additionally, reimbursement policies that allow for reimbursement of telehealth services at the same rate as in-person services can help ensure that healthcare providers are adequately compensated for their time and expertise when delivering care remotely. Overall, a combination of telehealth services and appropriate reimbursement rates can help bridge the gap in healthcare access for rural and underserved communities in the United States.

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The healthcare system is moving to a value-based model by 2030. Are you ready for the change? After attending the recent 2024 value-based care learning conference, hosted by the CMS Innovation Center, I’m dedicating this month’s entry of CareMadeClear to an important element of value-based care: risk, and why providers should take it on. In the context of value-based care, taking on risk means that providers are accountable for both the quality and cost –– the total outcome –– of the care they deliver. Shifting from the traditional fee-for-service model to a value-based care approach requires a fundamental change. So why should providers do it? Risk in a value-based framework incentivizes providers to focus on outcomes rather than volume. By assuming risk, providers are encouraged to deliver more efficient, effective and patient-centered care. This not only enhances patient outcomes, making them happier and healthier, but also reduces unnecessary costs, improving the overall patient experience. Consider a healthcare provider managing a chronic condition like heart disease. Under a value-based model, the provider has a vested interest in keeping patients healthy and out of the hospital. Proactive measures can take a variety of forms: regular case management, high-touch interventions, patient and family support, follow-ups, lifestyle interventions and more. By taking on risk, providers can reap the rewards of improved patient health and cost savings, aligning their financial incentives with patient outcomes. And of course, it’s also better for patients when their providers have a vested interest in their long-term health. At CareNu, we support providers in this transition by offering the tools and resources they need to manage risk effectively. We walk side by side with providers as they gradually take on risk. Through predictive analytics, individualized patient care plans and robust support systems, we empower them to confidently embrace risk and reach better health outcomes for their patients. Risk isn’t something to be feared –– it's a catalyst for innovation and improvement in healthcare. By taking it on, providers can help create a more sustainable, patient-centered future. And at CareNu, we’re leading the charge. #CareNuCares #CareNuIsNow #ValueBasedCare #Risk

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