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GE Healthcare Camden Group Insights Blog

Five Focus Areas for Medical Groups in 2017

Posted by Matthew Smith on Jan 26, 2017 12:59:09 PM

By Lucy Zielinski, Vice President, GE Healthcare Camden Group

doctors-300.pngFor medical groups, the last few years have been tumultuous with the shift to value-based care. In 2017, medical groups will continue to experience change on all fronts, including payment, care delivery, and interaction and communication with patients. Medical groups must contend with new payment models, fierce competition in their markets, increased regulatory requirements, clinical advances, digital and information technology changes, and population health management implementation.

In response to these shifts, medical groups should focus on five key areas to position themselves for the future. As Socrates said, “The secret of change is to focus all of your energy not on fighting the old but on building the new.” And that is what medical groups need to do in 2017: build the new by transforming the old ways of practice management.

To read this article in its entirely, please click the button below to be taken directly to the HFMA website.

Medical Groups, 2017 Trends

Topics: Population Health, Medical Groups, Patient Access, Trends, Medical Group Transformation

Operationalize Population Health With a Focus on Consumer Access

Posted by Matthew Smith on Sep 16, 2016 12:53:53 PM

By Lucy Zielinski, Vice President, GE Healthcare Camden Group, and Fran Horner, Managing Partner, Singola Consulting

population_health-3.jpgHealthcare organizations are faced with the reality of value-based care. Many have formed a clinically integrated network (“CIN”) to manage patient populations while focusing on the Triple Aim (improve patient satisfaction, reduce cost of care, improve quality of care). Forming a CIN and setting a strategy is one thing, operationalizing clinically integrated activities is where the rubber meets the road. To succeed, organizations must bend the cost curve while improving quality performance and outcomes.

While in some areas, the opportunities to provide better care are obvious, other areas prove harder to improve. For example, 60 percent of referrals go unscheduled. This alarming statistic demonstrates how healthcare organizations can do better—namely by implementing operational processes that schedule referrals during the initial patient visit. Other examples include 23 percent of scheduled appointments are missed, and 36 percent of patients do not receive follow-up care. This lack of follow up and care coordination to manage patients may lead to complications resulting in increased healthcare costs, not to mention low patient satisfaction scores. Many payors, including CMS, are publicly reporting quality data and consumers are scrutinizing the scores and making decisions based on the scores. As a result, an organization may be negatively impacted from a reputational perspective, as well as a financial one.

To avoid a negative impact, organizations can focus on five strategic areas improve care, thus having an impact upon the Triple Aim.

1. Know Your Consumers

To gain market advantage, organizations must understand their consumer profile. Market segmentation enables organizations to segment consumers with similar needs and wants in an effort to match their expectations. Questions to ask include:

  • Who are your consumers?
  • What is important to them?
  • What services do they need/seek?
  • What are the socioeconomic profiles and physiographic elements?
  • Are they compliant, tech savvy, cost conscious, do they operate online, etc.?
  • How do they best receive messages?

Taking time to study your consumers is the first step.

2. Engage Patients

Patient engagement starts at registration by identifying the channels of communication—phone, email, web-portal and/or text—that the patient finds most convenient to receive appointment reminders, medical advice, and follow-up care. This is reconfirmed during discharge to streamline care coordination. Knowing how to communicate with the patient is key to truly engaging the patient in his or her care and effectively leveraging contact center technology to support outreach.

Knowing your patient population and how best to communicate with the different patient populations improves engagement. For example, if you are targeting medication adherence for your hypertensive patients, you may consider sending patient reminders for medication refills or educational material via the patient portal. You may also consider calling and reminding patients to schedule and complete routine wellness screenings such as mammograms. If patients fail to complete these screenings, then reminders can be sent via portal or text message. 

3. Focus On Outbound Communications

Outbound communications in healthcare include appointment confirmations, payment reminders, wellness updates, prescription refills, and claim status updates. A contact center can also be an efficient way to support outreach by leveraging omni-channel contact center technologies, including outbound communications, to improve care and engagement by contacting patients at the right time, with the right message, using their preferred channel of communication. Using outbound communications and technology, the contact center can play a vital role in reducing preventable readmissions. Many organizations are consolidating and centralizing contact centers to include the acute, ambulatory and post-acute environments to support care coordination.

4. Leverage Technology

As a result of the Affordable Care Act, many organizations have adopted electronic health records and reports from such systems can be leveraged to support care management. For example, using a targeted population list exported from the EHR, the contact center technology can be effectively deployed in both self-service or assisted care models. Case in point, patients who have scored 1-4 on the LACE Index may receive an automated call, voicemail, or text to reiterate their discharge instructions and remind them to call their primary care physician for a follow up appointment. Whereas patients with a score greater than 10 (indicating a high risk of readmission) would receive a phone call from the contact center nurse or care coordinator to personally follow-up on patient discharge instructions, make a follow up appointment, or coordinate referrals. Organizations, including clinically integrated networks, are focusing on the interoperability of technology to give them a leg up on patient safety, quality and cost. 

5. Optimize Change Management

Many healthcare organizations focus on technical change strategy and change management when executing tactical plans and projects. They are concerned with planning, budgeting, organizing, controlling, measuring, and problem-solving. Change management produces predictability and order in the organization. An essential but often-overlooked aspect of change strategy is change leadership—the human or cultural component that provides the spark needed to activate change. Change leadership aligns employees with a shared vision for the future of the organization, then mobilizes and motivates them to make that vision a reality. Organizations need to train their staff on how to best communicate to consumers so that consumers navigate the system with ease and satisfaction, resulting in positive surveys.

Consumers are making decision on a daily basis. Health systems, by focusing on these five strategies, can help consumers navigate their organization to make sure that the right care is delivered at the right time, at the right place and at the right price. Health systems will then be able to experience better outcomes, while attracting new patients and retain existing patients.


ZielinskiL.jpgMs. Zielinski is a vice president with GE Healthcare Camden Group. With over 25 years of experience in the healthcare industry, she specializes in helping private and hospital-owned medical groups achieve top financial and operational performance. Such optimization is achieved through physician-hospital alignment—including clinically-integrated networks, strategic planning, practice transformation, coding and revenue cycle improvement, physician compensation plan design, and health information technology, and data analytics optimization. She may be reached at Lucia.Zielinski@ge.com.

 

horner.jpgWith more than 20 years of experience in contact center operations and 11 of those in healthcare, Ms. Horner is a recognized industry leader who has guided numerous healthcare organizations through development of their patient engagement strategies with a focus on top-to-bottom contact center assessments, workforce optimization, outsourcing, referral management, and revenue cycle management. With extensive experience directing large-scale business operations and strategic initiatives, she is skilled at driving change and implementing cost-effective solutions while enhancing the customer experience.

Topics: Population Health, Patient Access, Lucy Zielinski, Access, Fran Horner

Redefine Your Practice's Care Team to Promote Patient-Centered Care

Posted by Matthew Smith on May 20, 2016 11:13:16 AM

Article and video courtesy of MGMA.com

Patient-Centered Care“If we’re not making the patient the boss right now, someone else is going to get our business. It’s as simple as that,” said William Faber, MD, MA, MS, senior vice president, GE Healthcare Camden Group, who spoke about the changing patient relationship during the MGMA/AMA Collaborate in Practice conference, March 20-22, Colorado Springs, Colo.

Faber and Marc Mertz, MHA, FACMPE, MGMA member, vice president, GE Healthcare Camden Group, elaborated on the topic during an exclusive video interview with MGMA [video below].

“We’re reaching a crossroads,” Mertz says. “Historically, practices have been very physician-centric in the way they operate [from scheduling appointments to physical exams]. Yet patients are increasingly demanding greater access and more information to be engaged in their care.”

Responding to that new dynamic requires a fundamental shift in practice operations. “In the past, practices competed against other practices,” Mertz adds. “Now there are retail clinics, urgent care clinics and concierge medicine. Patients will go where they can get the type of care they want.”

Accommodating Patient Demands

Meeting patient needs might require expanded hours, technology that allows patients to schedule appointments, get test results and ask questions online and a care team approach to increase access.

“The main issue is teamwork,” Faber says. “The doctor cannot just look at him- or herself as the full answer to the patient’s needs.” The more realistic answer, which will boost sagging morale, is to create a network. “Work with social workers, retail clinics, urgent care centers and care managers to address these needs,” he suggests. “Taking care of patients now is more of a team sport.”

Encouraging Change

“We are still incentivized to fill the schedule with as many patients as we can,” Mertz says. “Until some of the financial reimbursement models change, I think it will be hard for people to change.”

However, making small adjustments can ease the growing burden on doctors, Faber explains.  For example, he suggests that groups “Participate in new compensation programs that reward doctors for that which only doctors can do,” which means assigning low-acuity patients to other team members.

Collaboration between physicians and administrative leaders (dyads) is key for success. “I think of it as a marriage,” Mertz says. “They’re both jointly responsible and accountable for all aspects of the practice,” which means that neither party should shirk responsibility for clinical aspects or practical pieces of the business. “It’s a true partnership.

“Physicians are ultimately responsible for the clinical care but practice administrators need to be there to push and to challenge, to bring new, innovative technology, new processes and procedures to the table,” Mertz adds.

One new process they recommend: Create a network of facilities that provide convenient access for your patients and consider that network as your care team. “The biggest impediment is the human tendency to stay with what always worked before, just keep doing the same old thing,” Faber explains. “We’re practicing medicine as though it stayed stagnant in the 1970s or ’80s, and everything [has] changed around us.”

Watch more of the interview:

Webinar, Patient Experience, Patient Satisfaction

Topics: William K. Faber MD, Patient Access, Marc Mertz, Care Model, Care Delivery, Patient-Centered Care

Patient Access Infographic: How Consumers View the New Front Door to Healthcare

Posted by Matthew Smith on Apr 25, 2016 10:39:14 AM
Infographic.pngThis new infographic highlights results of a recent survey examining consumers’ experiences with alternative sites of care, such as retail health clinics, urgent care centers, and telehealth.
 
According to the new Oliver Wyman infographic and survey, consumers’ familiarity and use of alternative sites of care are on the rise. Furthermore, consumers who have used these “new front door” alternatives seem to like them and say they are willing to use them again. In fact, people who had new front door experience said they would be less willing to visit a traditional doctor’s office again.

NYC-MKT49701-002_infographic.jpg

Patient Access, Healthcare Networks

Topics: Infographic, Patient Access, Telehealth, Retail Clinic

PDF Download: The New Paradigm of Patient Access

Posted by Matthew Smith on Mar 9, 2016 2:18:02 PM

Patient AccessIn order for new clinically integrated networks (CINs) to achieve success, they must increase ways for patients to access care. To accomplish this, CINs and hospital leaders must embrace non-traditional access points that patients use to enter their systems.

Patients may choose to access the system through retail clinics because it is easy and convenient, and they are able to get what they need quickly. Those components, successfully integrated into a CIN, can serve as significant access points into a network.

In instances when CINs identify outside providers where their patients are going to get care, CINs should establish a contractual relationship with the provider. Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. 

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics. More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the patient outmigration rate (patients going outside the network—often referred to as "leakage") is more than 5 to 10 percent, the providers must find ways to keep more patients in the network.

Increasing access can also turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

This PDF download from GE Healthcare Camden Group provides insight surrounding:

  • How people rate access
  • What consumers want (old vs. new models)
  • Expectations surrounding access redesign
  • Consumer trust statistics
  • The new paradigm of patient access
  • Objectives of "best in class" patient access
  • Creating loyal patients for life
  • The continuum of organized care

Patient Access, Healthcare Networks

Topics: Patient Care, CIN, Patient Access, Continuum of Care

Uber-izing Healthcare: Applying Nowait's Philosophy to the Patient Experience

Posted by Matthew Smith on Feb 17, 2016 2:14:01 PM

By Robert Zisman, Vice President, GE Healthcare Camden Group

Patient Engagement, No-Wait HealthcareMost people hate waiting. If you’ve ever lived in a city like Pittsburgh (or almost any major city outside of New York and Chicago) getting a taxi used to be a challenge. First, you had to call and hope someone would pick up the phone. Maybe they would actually show up. Once they arrived (if they arrived), it likely wasn’t the most pleasant of experiences. When you finally get to your destination, like that hot new restaurant that doesn’t take reservations that you’ve been dying to try, you’re hit with the cold reality of a two-hour wait!

But along came the magical innovation known as Uber, as well as an app called Nowait. If you haven’t seen Nowait, it’s exactly that—an app for getting in line at a restaurant. It allows you to see how long the wait is and secure a spot in line all from the comfort of your couch—before your Uber arrives.

The pace of change really hit me the other day when I got off a plane and requested my personal Uber (feels very concierge). As I walked out of the airport, I saw two lines--one for Uber rides and one for taxi service. Only, there was no one in line for the taxis. I wish that I had taken a picture to crystalize that moment of a new market entrant rising to success while the other had been left in the dust, relegated to a time gone by.

Having the pain of waiting being lifted from our shoulders, it’s hard not to scratch your head when you look at other industries operating  in yesterday’s times, wondering if they will catch up or be left behind. Cable is certainly one, but one that really hits home is healthcare.

Access is a tremendous challenge in today’s environment. Getting specialist appointments can take weeks to months, even with provider organizations that advertise “same day appointments." Securing primary care appointments can often take days, weeks, or longer if you prefer a certain doctor. Even with an appointment, you may find yourself stuck in the waiting room for hours, wondering why it’s even called an appointment. Then, when you’re finally seen, your visit might only last 5-15 minutes. And the icing on the cake…you get several bills in the mail, and a huge chunk of your healthcare savings is gone.

Imagine if…Nowait entered the healthcare environment. Yes, some healthcare providers do have online scheduling, and they may even alert you when it’s time to schedule your next appointment. But what if a new technology made it possible to see the current wait times for all primary care physicians, ERs, and specialists, and you could get in line at the one of your choosing in a timeframe that suits you?

Imagine if…there was an app as easy as Trip Advisor or Zomato where you select your healthcare symptom or need just as easily as selecting your desired trip experience or cuisine. You could then see hundreds of reviews that people shared about their healthcare experiences, rating their physician and offering comments to help you make informed decisions. Yes, there are traditional websites like this out there, but news flash—the usage rate is way below that of most apps used on a daily basis.

Imagine if Uber brought surge pricing to healthcare. That’s right, I said it—and it could be a game changer for patients as well as providers. Do you want to go to the emergency room when it’s currently full if you know that you have to pay three times the normal rates? Or is your emergency not as much of an emergency, or are you willing to drive to another emergency room that is currently empty (or maybe even an urgent care center—after all, maybe it’s not an emergency)? Would this balance out supply and demand so physicians on call could see that the ER is on a three-hour backlog, and if they come in they get paid at a three times rate, thereby instantly decreasing the patient wait time?

And, what about the other aspect of Uber, such as how easy payment is. The technology understands the insurance payment, calculates the patient cost share, and collects it from a credit card on file. This would be an amazing win for healthcare providers as it would eliminate the costly administrative process and for patients who are tired of having to spend hours trying to figure out how to pay their medical bills.

It’s fun to imagine waiting less and being able to navigate the complex healthcare environment in a way that’s easier to understand while making it easy to pay a fair price for your experience.

The good news is the technology is here, and there are several start-ups out there beginning to get into this space such as Doctors on Demand, ZocDoc, and Pager. But in order to truly transform healthcare’s patient experience and access challenges, healthcare providers must adapt to these new innovations. Healthcare organizations must take a leap of faith and give up some control, create more transparency, and rethink their business models. Fortunately, the push to population health and value-based payments are driving many to reexamine their infrastructure across a broader setting to increase access, manage cost, and improve quality.

Here’s to imagining a no-wait future for everything and to wondering what we will do with all of our extra time. It may be closer than we think.


Robert_Zisman.png

Mr. Zisman leads the GE Healthcare Camden Group’s US operations team, responsible for recruiting, staffing, marketing, business development, operations and knowledge management. He also leads efforts related to 3rd party strategic partnerships and collaboration with GE Healthcare Partners consulting businesses around the world in areas such as Canada, Latin America, Europe and the Middle East. His previous roles included leading large and complex engagements focusing on improving key performance metrics such as growth, margin, quality, patient satisfaction, and sustainable results. He may be reached at robert.zisman@ge.com.

 

Topics: Patient Access, Patient Experience, Robert Zisman

Content Download: The New Paradigm of Patient Access

Posted by Matthew Smith on Dec 15, 2015 1:23:09 PM

Health-Clinic.jpgIn order for new clinically integrated networks (CINs) to achieve success, they must increase ways for patients to access care. To accomplish this, CINs and hospital leaders must embrace non-traditional access points that patients use to enter their systems.

Patients may choose to access the system through retail clinics because it is easy and convenient, and they are able to get what they need quickly. Those components, successfully integrated into a CIN, can serve as significant access points into a network.

In instances when CINs identify outside providers where their patients are going to get care, CINs should establish a contractual relationship with the provider. Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. 

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics. More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the patient outmigration rate (patients going outside the network—sometimes referred to as "leakage") is more than 5 to 10 percent, the providers must find ways to keep more patients in the network.

Increasing access can also turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

This popular download from GE Healthcare Camden Group provides insight surrounding:

  • How people rate access
  • What consumers want (old vs. new models)
  • Expectations surrounding access redesign
  • Consumer trust statistics
  • The new paradigm of patient access
  • Objectives of "best in class" patient access
  • Creating loyal patients for life
  • The continuum of organized care

Please click the button below to access the download page:

Patient Access, The Camden Group, Clinical Integration

 

Topics: Clinically Integrated Networks, Patient Access, Download, CINs

Patient Access Innovations: Integrating Patients Within the System of Care

Posted by Matthew Smith on Dec 1, 2015 3:21:44 PM

As the nation's healthcare system continues to be reshaped by the forces of reform, increased patient engagement will emerge as a defining outcome of this profound transformation. 

Networks, Patient AccessProvider coordination is of paramount importance for healthcare organizations preparing for the industry’s shift in focus from volume to value. The most ambitious coordination model that has been developed to date is the clinically integrated network ("CIN")—a contractual collaboration among hospitals, physicians, and other providers to manage patients across the entire continuum of care. A CIN uses population health management tools, including care management techniques, to build value through improving patient outcomes and controlling costs. This innovative model offers providers access to value-based payment contracts and an opportunity to improve quality and reduce costs.

Despite the compelling benefits of clinical integration, this approach also poses risks. Value-based payment contracts hold CIN participants accountable for both clinical and financial outcomes, although the ability to influence these outcomes depends largely on patient choice and patient compliance. Whenever a patient leaves the CIN, even if the patient returns to the network for certain services, network providers lose the opportunity to fully manage the patient’s care and utilization, ultimately undercutting their ability to coordinate the patient’s care and accrue the benefits of improved clinical outcomes and reduced costs.

This risk makes it critically important for CINs to keep patients within their organized systems of care. CINs need to make sure patients can access the network easily and are motivated to stay connected, requiring a strategic focus on patient access and engagement.

Based on the experiences of leading CINs, strategies aimed at improving patient access tend to be most effective when they are focused on three primary objectives: expanding entry points to the network, making access more convenient and inexpensive, and keeping patients engaged in the care they receive from network providers. The following five strategies, in particular, have been proven effective for ensuring in-network access and strengthening patient engagement.

To read the rest of this article in its entirety, please click the button below to immediately access the article on the hfm magazine site:

  Patient Access, Clinically Integrated Networks

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Networks, Patient Access, Patient Engagement, Daniel J. Marino, Value-Based Payments

New Download: The New Paradigm of Patient Access

Posted by Matthew Smith on Sep 29, 2015 1:04:53 PM

Patient Access, Clinical IntegrationIn order for new clinically integrated networks (CINs) to achieve success, they must increase ways for patients to access care. To accomplish this, CINs and hospital leaders must embrace non-traditional access points that patients use to enter their systems.

Patients may choose to access the system through retail clinics because it is easy and convenient, and they are able to get what they need quickly. Those components, successfully integrated into a CIN, can serve as significant access points into a network.

In instances when CINs identify outside providers where their patients are going to get care, CINs should establish a contractual relationship with the provider. Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. 

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics. More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the patient outmigration rate (patients going outside the network—sometimes referred to as "leakage") is more than 5 to 10 percent, the providers must find ways to keep more patients in the network.

Increasing access can also turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

This new download from The Camden Group provides insight surrounding:

  • How people rate access
  • What consumers want (old vs. new models)
  • Expectations surrounding access redesign
  • Consumer trust statistics
  • The new paradigm of patient access
  • Objectives of "best in class" patient access
  • Creating loyal patients for life
  • The continuum of organized care

Please click the button below to access the download page:

Patient Access, The Camden Group, Clinical Integration

Topics: Clinical Integration, Clinically Integrated Networks, Patient Access, Daniel J. Marino

Access is "Critical" for Hospitals, Clinically Integrated Networks

Posted by Matthew Smith on Jun 23, 2015 3:10:25 PM

Via HFMA News

Nurse, Primary Care, Retail Clinic, The Camden Group, Access, Patient Access PointsIncreasing ways for patients to access care through a hospital’s clinically integrated network ("CIN") is a key to the success of new CINs, one healthcare finance advisor said Monday during a morning pre-conference session at ANI: the HFMA 2015 National Institute.

Daniel Marino, senior vice president at The Camden Group, said CINs and hospital leaders need to stop fearing non-traditional access points that patients use to enter their systems, and instead find ways to embrace them.

“Patients are accessing the system through retail clinics because it is easy, it’s convenient, and they are able to get what they need quickly,” Marino said. “Just think how those components successfully integrated into your clinically integrated network can be significant access points into your network.”

In instances when CINs identify outside providers where their patients are going to get care, he urged the CIN to establish a contractual relationship with the provider. 

Such new access points come with their own challenges, including difficulty with sharing patient information and with communication. Marino described how one hospital client approached a primary care provider to act as medical director of a retail clinic.

“That helped create some alignment,” Marino said.

But hospitals need to think about the issue of access beyond patient visits to the emergency department, primary care, or even retail clinics.

One organization used social media to set up Facebook clubs to help patients manage diabetes and different cancer services, describing the step as a social support structure.

“What they found is that by creating that, they were able to monitor the information that went out, and it created a connection to the clinically integrated network,” Marino said. “The hospital wasn’t doing this, it was the clinically integrated network.”

More CINs are focusing on access points to help keep patients in their networks. When analytics indicate the leakage rate—patients going outside the network—is more than 5 to 10 percent, the providers need to find ways to keep more patients in the network.

“At the end of the day, if they leave your network then your ability to manage costs goes down dramatically and you have very limited ability to influence,” Marino said.

Increasing access can turn into a selling point for the CIN to increase volume by touting its ability to provide convenient care. Selling the CIN to patients is particularly important in the era of high-deductible health plans, where patients actively select providers based on price and quality. 

An additional reason to focus on patient access points and leakage is because a CIN’s focus on reducing costs and improving clinical care can reduce revenue.

“If you are going to make up the difference in the revenue, the short play from the hospital CFO perspective is that you have to drive members into your organization, you have to create that value,” Marino said. “However, if you have created that value, then you can then negotiate those contracts with your payers. So access becomes critical.”

Clinical Integration Networks, CIN, Daniel J. Marino

Topics: Clinical Integration, Clinically Integrated Networks, Patient Access, Daniel J. Marino, Access

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