Value-Based Care Insights

As hospitals and medical groups continue to focus on financial performance, optimizing their revenue cycle through denial management drives results. To effectively reduce denial rates, revenue cycle leaders must first discover the root cause of denials. A focused approach to denial management can provide health care leaders considerable financial and operational improvements.

In this episode of Value-Based Care Insights, Daniel J. Marino sat down with Tina Hodges and Michael Brown from RSM to discuss some of the revenue cycle challenges facing hospitals and medical groups today, as well as tactics to reduce denials and increase financial performance.

Insights

Over the past year, we have seen substantial investments in healthcare made by non-traditional health care providers such as CVS, Walgreens and Amazon and others as they position themselves as strong participants in healthcare delivery.  Last year, 2022, was one of the highest years for health care deal-making with private equity investing considerable resources into technology, physician services and analytics. How will these new deals impact the health care industry?

In this episode of Value-Based Care Insights, Daniel J. Marino sat down with Brian Greenberg and Zach Eisenberg from Greenberg Advisors, to discuss trends and “hotspots” of investments in health care.

As health systems, integrated provider networks, clinically integrated networks (CINs), and accountable care organizations (ACOs) engage in population health initiatives, aligning technology with value-based contracts' performance goals is a key success factor. The lack of alignment can be attributed to a disjointed vision, fragmented operations, and misaligned information technology (IT).

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Julie Bonello, Founder of Integrate Health, along with Brian Bentley and Nick Frenzer from Epic Health Technologies, to explore how to optimize value-based technologies and drive a higher level of population health performance.

Insights

Part of CMS’ journey in regulating coordinated care with providers, a value-based exception and safe harbor was enacted in early January 2021 under the Physician Self-Referral “Stark” law and Anti-kickback Statues. The new provision allows value-based enterprises eligible for safe harbor protections under the Stark and Anti-kickback statute.

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Jim Carr and Luis Argueso, cofounders of InHealth Advisors. Dan, Jim, and Luis discuss the framework of a Value Based Enterprise (VBE).

The nursing industry has faced many challenges in recent years, including COVID-19, which has resulted in staffing shortages and clinician burnout. As the nursing workforce shifts from baby boomers to millennials, the pressure placed on nurses and clinical staff continues.  Contributing factors to the increased pressure include untimely nursing recruitment in the hospital environment, lack of leadership support and resourcing with operational improvement initiatives, and minimal focus on nurse wellness.  High-performing nursing leadership is required to steer the ship in the right direction.

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Nancy Lakier, CEO and Founder of Novia Solutions. Dan and Nancy evaluate the current state of nursing and the need for effective nursing leadership.

With the advancement of technology in health care organizations are recieving an excessive amount of data. How can organizations manage that data to create actionable insights?

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Rick Howard, Chief Data and Products Officer for an analytics vendor and former Chief Data officer of Ascension Health. The two discuss the management of data within four categories: claims/finance, lifestyle, and social determinant data.

Throughout 2022, primary health care faced many challenges. Staffing shortages, high hospital costs, and the advancement of telemedicine forced health care organizations to rethink their strategic plan heading into 2023.

Over the past few years, primary care has gone through immense change. Everything from the incorporation of virtual health, to the shortage of primary care physicians to the building of new team-based models of care.

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Dr. Michael Hanak, a board certified family physician working with a large academic medical center in the Chicago metropolitan area. The two discuss common trends and challenges in today’s primary care model.

Each year, one in five Americans visit the emergency department (ED) at least once  – and these costly ED visits are on the rise. Are they a symptom of a larger issue in our health care system? Many of emergency visits are preventable – this may be a symptom for inefficient care management, inadequate patient access, or lack of patient knowledge. As hospitals and payers transition into value-based care, interpreting ED visits may be a symptom of a larger problem.

Rural health care providers often encounter barriers that limit their ability to provide the care they need. Even well before the pandemic, rural health providers faced many challenges. Today, workforce shortages and access to health care services are at an all-time high.