Pat Tikkanen

https://lnkd.in/gywCYUvv AMAs continued advocacy to help #FixPriorAuth targeting ERISA plans.  Although very welcomed, part of the practical workflow challenge is keeping track of what federal/state regulations apply to which plans based on a specific services.  Not so easy to do in today’s legacy EMRs. #Valer can help keep track of payer rules as regulatory requirement for prior auth ramp up on an individual payer and service level basis. www.valer.health 

9

It can be all-consuming for medical practices and even medical groups to just run their businesses. Time for process improvement, contract management, and more can be scarce. ➡️ https://smpl.is/97ct3 ☎🏥💊🚑🚨#Affordable #revenuecycle consulting is the answer. 📊 . #revenuecyclemanagement #revenuecycle #sunlitcovehealthcare

2

The latest HTI-1 Final Rule changes crucial for Health IT Users and Developers: EHR updates, compliance, and interoperability insights. #BusinessOfHealthcare #hti1 🔔 Don’t miss any of our posts, tips, or insights about the business of healthcare. Click the bell underneath the banner on the right-hand side to get notified as soon as we publish!

2

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

22

9 Comments

Don't miss the latest post from Dr. Eric Lee as he joins Bill Russell on #TWH to discuss AltaMed Health Services' Health IT journey with Epic. Dr. Lee's conversation promises to be just as enlightening, shedding light on the innovative efforts and successes driven by our dedicated Clinical Informatics team and IT leaders. Their journey is a testament to the power of perseverance, creativity, and strong collaboration across our organization. Tune in to gain a deeper understanding of how we are leveraging technology to enhance healthcare delivery. #HealthIT #Epic #AltaMedHealthServices #ClinicalInformatics #InnovationInHealthcare

9

There are few things that can precipitate significant changes in US #healthcare, but Centers for Medicare & Medicaid Services will always be one of them. Quality measures are one aspect of how #hospitals (and #skillednursing facilities, for that matter) are measured on the quality of their care, and by adding a specific and publicly reported measure centered around 4Ms care (what Matters, Medication Mentation and Mobility), CMS is helping to ensure that older adults receive care focused on areas that don’t always get the attention they deserve. It may seem esoteric, but this is an important step forward in care quality for #olderadults.

9

2 Comments