Today there are many steps to processing claims, and each one is an opportunity to gain or lose money. Practices are weighing the pros and cons of different approaches to managing their revenue cycle, including relying on experts from outside their organizations. Arbor Family Medicine (Westminster, Colorado, U.S.A.) Office Manager Mikie Gonzales talked about her experience with Allscripts Revenue Cycle Management Services™ (RCMS) in a recent interview: Gonzales discussed some of the myths that surround decisions to bring in a revenue cycle management services partner. Her experiences are similar to other clients and “bust” some of the most common myths: Myth #1 – We’ll lose control of our billing activities. As responsibility for claims – from submission to sorting out denials and beyond – shifts to a services partner, some practices fear that they are also giving up control. However, […]

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A new era of infinite computing in health care

Editor’s note: To hear more about the power of computing in analytics, listen to a free podcast here. Google Analytics, Microsoft Azure, Amazon’s Elastic Map and Reduce – these systems now enable entities to act very nimbly to do research and to run analytics on data without a lot of overhead.  Right now it’s less expensive to use a thousand computers in a single day then to run one computer for a thousand days. And this model is starting to shift many paradigms, especially in research. Essentially, it’s infinite capacity. This type of computing power underscores a dramatic breakthrough in different algorithms. There are a multitude of calculations that you can solve related to predictive models. Can we, for example, perform a thousand analyses in one day for a patient rather than have that patient come in for an annual […]

Forward-looking healthcare organizations know that big data and analytics will drive significant change in how they care for patients. A select group of healthcare leaders joined me recently in Chicago for an interactive Allscripts Analytics summit on this topic. We asked them: What are your high-level strategic priorities for population health analytics? Here are responses from the Berkshire Health Systems Chief Medical Information Officer Mark Snowise, M.D. and Health First System Vice President of Decision Support Analytics Frank Wang: Allscripts Analytics Asks: Mark Snowise, MD Allscripts Analytics Asks: Frank Wang Today’s clinicians need tools that help stratify populations, identify gaps in care, benchmark outcomes and provide pathways to patient compliance. Only then can they take action to improve care. That means they need point-of-care, real-time analytics, cohort management, predictive models and quality metrics and dashboards for population health insights across […]

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An ACO rookie’s most common mistake

To stay competitive in an evolving healthcare landscape, independent small physician practices are creating their own Accountable Care Organizations (ACO). It’s important for them to have accurate expectations before applying to Center for Medicare & Medicaid Services (CMS) and its Shared Savings Program. Unfortunately, new ACO applicants often miscalculate the number of CMS patients, or “attributed lives,” they are responsible for, putting their entire cost structure at risk. Whose patient is it? CMS assigns each patient to a provider who will be responsible for that patient’s cost and quality of care. A sophisticated algorithm determines where this patient belongs, based on claims data. A smaller primary practice may assume that every History and Physical (H&P) it performs for Medicare patients will count toward its attributed lives total, when in fact that is not the case. For example, if that patient […]

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Finding tomorrow’s high-risk patients

As the healthcare industry offers more ways to earn risk-based or value-based revenue, providers are more proactively coordinating care, engaging patients and managing population health. Analytics are fundamental to all of these strategies, even in small practices. To be successful, physician practices need analytics that are predictive across multiple populations. They need to know who the high-risk patients are today, but they also need to identify the “rising-risk” patients. With intervention, these patients can have a healthier future. The cost of unmanaged cardiac conditions One healthcare organization evaluated its Accountable Care Organization (ACO) population with Johns Hopkins Adjusted Clinical Groups (ACG®), an industry standard to adjust risk and predict future healthcare usage. With analytics, this ACO found that more than half of its patients were either high risk (30%) or very high risk (27%). Furthermore, it found that the average […]

Small, independent physician practices have the best of healthcare IT worlds, and the worst. On the plus side, they can control everything that happens inside their walls. They have access to their clinical and financial data. They can be more nimble with Healthcare IT decisions than larger organizations, from selection to implementation to governance. But if small practices don’t have analytics, they could be losing money. And they may not even realize it. Most practices don’t have the right tools Small practices likely have reporting tools in their electronic health record (EHR) and practice management solutions. “Canned” reports can help track and monitor certain aspects of a practice, which is essential to having a healthy core. But it takes more sophisticated analytics tools to really understand things like referral patterns, clinical pathways, care coordination – especially in context with cost […]

As health care moves away from fee-for-service to value-based care models, hospitals need better tools to compete. We recently published two eBooks, one about the key trends defining a new healthcare marketplace and one about the importance of critical analytics. You may be asking yourself: Does my hospital have the financial analytics capabilities to succeed? Take this quiz and see. 1. The CMIO asks for a cost report on readmissions, organized by diagnosis and physician. Can you give it to her? 2. You suspect one physician is underperforming on profitability. Can you compare his performance with others in his peer group and drill into the data to determine clinical or operational improvements to course correct? 3. Before ordering a knee replacement device, a physician asks if you have any comparative cost to outcomes data to help negotiate with the vendor. […]

Healthcare organizations are eager to address the rising problems of chronic diseases. They’re collecting a lot of data, adding analytics and even using genetic sequencing to spot potential health risks across patient populations. But are these strategies moving the needle on population health management? I address this question in a recent article with co-author Dr. Rasu Shrestha, vice president of medical information technology at University of Pittsburgh Medical Center (UPMC). The answer: Yes, but we have a ways to go. 3 steps to gain better insights from data Chronic diseases – such as heart disease, stroke, cancer, diabetes and arthritis – are among the most common, costly and preventable of all health problems. Caregivers recognize that harnessing data is key to managing the health of patients, especially those with chronic disease. Healthcare organizations need to focus on three areas to […]

Believe it or not, processes such as budgeting, cost accounting and strategic planning should make life easier. They should simplify the staggering complexity that healthcare organizations face today. Unfortunately, they are often disconnected from each other and lack analytics, limiting their effectiveness. They should all work together in a single system. This approach is the only way for healthcare organizations to evaluate true financial performance and plan for the future. Clients have turned to Allscripts EPSiTM for integrated performance management. Here’s how three organizations have used the solution: 1.        Recovered $4.5 million in underpayments Robert Wood Johnson University Hospital (New Brunswick, NJ, U.S.A.) recovered $4.5 million in underpayments its first two years of using the EPSi Product Line Analysis Contract Modeling tool. That includes recurring annual savings of at least $1.5 million. With EPSi, RWJUH better understands the […]

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Taming the Big Data frontier

In his keynote address at the Allscripts Client Experience, ACE13, Dr. Rasu Shrestha from University of Pittsburgh Medical Center said, “He who tames the data wins.” As healthcare organizations manage evolving delivery and payment models, an analytics strategy is top of mind for many.  Big Data is the next frontier for analytics and offers them access to rich data they can use for population health, research and consumer marketing and satisfaction. Quickly emerging Big Data technologies augment traditional business intelligence technologies by efficiently and affordably acquiring and storing enormous amounts of data. Providers can query and re-query information without retooling the data model every time.  This capability is particularly important with the mountains of data we have access to today. 3 opportunities to get value from Big Data With so much data coming from so many different places, how can […]