Value-Based Care Insights

Electronic health record (EHR) systems can be powerful management tools, but using them improperly can present challenges for both physicians and patients. In this episode, we dive into the role of EHR systems in value-based care. Our guest, Dr. Kim Furry, a seasoned orthopedic surgeon and an Epic-certified Physician Builder, unveils the intricate challenges physicians encounter while building and augmenting EHR systems. Discover the time-saving techniques, the crucial importance of data quality, and the key enhancements that improve both physician efficiency and patient care.

The added pressures for medical groups, coupled with the limited resources and high demands, require an intentional, strategic roadmap to success. On this episode of Value-Based Care Insights, we sit down with Jeff Peters to discuss the evolving healthcare landscape and what medical groups should be thinking about to position themselves for the future. Gain valuable insights into innovative strategies for aligning with providers, improving financial performance, and fostering a healthy, physician-driven culture.

In the world of academic service lines, the alignment of physician executives and physician assistants is paramount. On this episode of Value-Based Care Insights, Jason Raidbard, Executive Administrator at the University of Chicago, unveils the challenges and strategies of crafting a dyad partnership of leaders within academic service lines. Gain insights on the importance of a shared patient-centric culture that unites academic, research and clinical operations under one resolute purpose. 

From its humble origins as an academic gathering of a few attendees, the Population Health Colloquium has evolved into a diverse gathering of brilliant minds in the field of population health and value-based care. In this episode of Value-Based Care Insights, we sit down with Dr. David B. Nash as he discusses the Population Health Colloquium taking place September 18-20th in Philadelphia. We dive into the colloquium’s focus on value-based care, health equity and AI’s innovation within population health.  Speakers will discuss the crucial link between delivering value and transforming the future of healthcare.

When it comes to making big decisions, strategic plans often overshadow the critical aspect of leadership culture. This episode of Value-Based Care Insights welcomes Keith Hadley, whose expertise lies in building healthy organizations and improving organizational decision-making through building high-performing teams. Discover the roots of misalignments in leadership teams and the significance of transparent communication in creating a unified voice to advance the culture of the organization.

Risk-based contracts are revolutionizing the healthcare industry, prompting a transition to value-based care. In this episode of Value-Based Care Insights, guests Cliff Frank and Dr. George Mayzell explore the key aspects of risk-based contracts and provide actionable insights for physicians and practitioners navigating this transformative shift.

Rising prices and sky-high interest rates are posing significant operational and care delivery challenges for hospitals. In our latest episode of Value-Based Care Insights, Nillie Djassemi, CFO of Houston Physician’s Hospital, shares valuable insights on navigating these challenges. Together, Dan and Nillie explore the importance of investing in vendor management and capital expansion to thrive in today’s economy.

To provide value-based care, providers need to address their process, their technology, and their people. But stakeholder priorities don’t always align. Knowing where and how to start can be the difference between a successful implementation and one that falls short.  

Tune into the latest episode of Value-Based Care Insights featuring host Daniel J. Marino as he welcomes Sarah Hartley and Dr. Purvi Shah, whose expertise in ambulatory clinical documentation improvement (CDI) will help illustrate the need to improve clinical workflows.  In addition, they discuss the risks, challenges and obstacles providers need to navigate in order to better deliver meaningful patient outcomes. 

Many issues are impacting today’s clinical service lines, especially cardiovascular services. Health systems, hospitals and physician groups are focusing on growing their cardiovascular service lines to address shifts in site-of-service, improve patient access and position themselves for enhanced financial performance under value-based contracts. 

In this episode of Value-Based Care Insights, Daniel J. Marino talks with Dr. Hani Salti, a clinical cardiologist and Clinical Assistant Professor at large academic-based health system.  Dr. Salti shares his insights on the growth of cardiovascular service lines, the need to develop strong physician leadership and the growing impact on population health on cardiovascular services.

As more and more provider organizations engage in risk-based contracts, including Medicare Advantage, understanding quality and performance along with clinical workflow integration is critical to contract success. On our third episode of our three-part series focusing on risk-based contract and performance, we invited two special guests from QRC to join the show to  dive deeper into Risk Adjustment Factor (RAF) scores and the impact of Hierarchical Condition Category codes (HCCs).

Tune into the latest episode of Value-Based Care Insights, as our host Daniel J. Marino speaks with Gene Rondenet and Paula Gallagher on how data and information critical to proactively build a prospective risk model is key to to manage the potential risks of health care cost increases and prepare the organization for the future. 

For the second part of our three-part series, we invited Cliff Frank back to discuss the changes among risk-based contracts. Daniel and Cliff explore the pushback with RAF scores, new CMS announcements with potential health equity indicators, and much more.

Listen now to our latest episode of Value-Based Care Insights, as our host Daniel J. Marino and guest, Cliff Frank, dive further into value-based contracts and what has changed over the last few months.

Many hospitals are experiencing increasing workflow challenges due to high inflation rates. As a result, government and commercial payers are responding in unique ways.  

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses economic challenges in health care, particularly hospitals and physicians. We’re joined by commercial insurance and government reimbursement expert, Cliff Frank. 

KEY TAKEAWAYS: 

• Hospitals and other health care facilities are facing a number of challenges, and inflation is a key component to internal issues. It’s essential that providers have an understanding on how to navigate an ever-changing infrastructure. 

• Risk contracting has been a common issue for hospitals as payers are making money on empty hospitals and slower ORs. This obviously increases the need for better contracts between payers and providers. 

• The ACO module has changed drastically, impacting how care is coordinated for Medicare patients. 

Since the pandemic, many healthcare provider organizations find themselves re-instituting empowerment initiatives initially created pre-COVID, however, the recent circumstances had a vast impact on the workforce culture. Today, organizations must focus on a transformative culture which allows the workforce members to prosper in their current roles while the fundamental needs of the employees are met. How can leaders ensure this? 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Todd Brook and Danica Wasser from Engagement Multiplier to discuss culture transformation and what it takes to have a thriving workforce.  

Insights: 

• The key to workforce engagement is meeting the three basic needs of the employees: physiological needs, safety needs, and a sense of belonging. 

• There is more to workplace happiness than just giving out raises; pay is no longer the only driving component people desire.  

• Obviously, all humans – and workforce members- are different, therefore, leaders must ask pertinent questions and be prepared to act. 

Today, most hospital physicians are experiencing some level of burnout due to increased challenges with greater work activities, high levels of patient needs, and low staffing levels. These challenges lead to a desire for early retirement and physicians looking for new medical-related career options. This has placed increased pressures on hospitals to either ramp-up their recruiting efforts or consider alternative staffing models to support their clinical specialty services.  As an alternative, many hospitals are turning to locum tenens for physician staffing support providing value to the hospital, its workforce, and most importantly, for patients.

In this episode of Value-Based Care Insights, Daniel J. Marino talks with Richard Heim from LocumsPro to discuss some of the benefits locum tenens bring to hospital patients and staff.

Insights

• Recent information shows that 53% of physicians today are experiencing some level of burnout which may impact care delivery.
• Malpractice and ongoing political struggles are having a negative effect on physician recruitment for hospitals.
• Personal situations such as maternity or paternity leave, or a desire for work/life balance, may require hospitals to consider alternative staffing in which locum tenens can cover.

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

• Health care providers are experiencing workforce challenges; effective management of your workforce is a requirement to enhance the denial management process across the revenue cycle ecosystem
• Timely data and information allows revenue cycle leaders to understand the root cause of denials and work productively to reduce them
• Sharing dashboard reports with key performance indicators with stakeholders, including physicians, engages them in the denial management process

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

• To drive successful performance of value-based contracts, health care organizations must have an aligned vision, operations, and IT systems, including the electronic health record
• The structure and leadership of the organization must be led through a clinical lens to achieve results in population health
• There are critical foundational factors that provider organizations must consider as they adopt technology

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.

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Lucy Zielinski, Managing Partner at Lumina Health Partners. Dan and Lucy analyze health care trends in 2022 and take a peek 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.

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Dr. Nicholas Dodaro, Chief Medical Officer and co-founder of Medical Life Holdings, a portfolio of companies and practices founded in 2006 to improve the value of health care delivery. The two discuss common issues with emergency room visits, why they’re so costly, and what to do about them.

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.

On this episode of Value-Based Care Insights, host Daniel J. Marino is joined by the CEO of Great Plains Health, Ivan Mitchell. The two discuss modern-day challenges that exist in today's rural health care environment.

Today's health care has created many environmental challenges, which take a toll on physicians and contribute to burnout. Often, especially during the height of the pandemic, health care leaders guide hospitals and team members through difficult times. However, many physicians feel overwhelmed and undervalued without a healthy culture to fall back on.

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Lumina Managing Principal, George Mayzell, as they discuss the factors that contribute to physician burnout and tactics health care leaders can build a culture around physician wellness.

Today, the health care environment is ever-changing and leaders must wisely set the future strategic direction for their organizations. To that end, the strategic planning process needs to define the future goals of and opportunities for the organization – and also must address the leadership and culture requirements for success.

In this episode of Value Based Care Insights, Dan is joined by Clinical Psychologist and owner of DLM Pathways, Dr. Doug McKinley. The two discuss the essential ingredients to align the strategic planning with leadership development while incorporating four critical steps for strategic initiatives combined with the five key behaviors of a cohesive team.

Many hospitals are experiencing increasing workflow challenges due to high inflation rates. As a result, government and commercial payers are responding in unique ways.

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses economic challenges in health care, particularly hospitals and physicians. We’re joined by commercial insurance and government reimbursement expert, Cliff Frank.

Healthcare industry leaders across the country are all facing the same challenges with their workforce. We are seeing record high turnover rates and record low job satisfaction. Now is the time to prioritize proactively listening to employees and making changes that will stabilize the workforce after a tumultuous couple of years.

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses how to create positive change while facing the current healthcare workforce challenges with Lumina Principal, John Malone and national expert and industry leader in workforce management, Kristi Roe.

Over the past few years, the shift to value-based care has slowed down as organizations struggled with leadership alignment concerning care delivery advancements. However, there are successful organizations that have advanced value-based care – and can provide guidance on how to position for value-based success, including how to build performance based contracts and create strong physician incentives.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Christopher Crow, CEO and Co-Founder of Catalyst Health Group, discuss how to make changes in an organization’s culture, finances, and operations to successfully transition to value-based care.

When switching to value-based care contracts, alignment with the providers, physicians, payers, employers, and patients must exist through a model that benefits all. Health care providers must be strategic in selecting quality measures to track that identify areas to improve efficiencies and create real value.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Jon Burroughs, President and CEO of Burroughs Healthcare Consulting Network, discuss where to start on tracking quality outcomes and how to align a provider organization around value.

Social determinant of health (SDoH) factors have a great influence on the quality and care management of a population’s health. As technology advances to better capture SDoH factors, clinicians can explore new ways to integrate this data into clinical workflows to proactively identify patients at high risk for adverse outcomes – resulting in better quality care.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Amy Valley, Vice President of Clinical Strategy and Technology Solutions at Cardinal Health, discuss the importance of incorporating social determinants into care management.

Telehealth is poised to see continued growth as the health care industry experiences the benefits of telehealth models, specifically supporting patient care delivery and closing care gaps.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Alan Kumar, Senior Vice President of Medical Affairs and Chief Medical Officer at Community Healthcare System, discuss the key factors for a successful rollout and how to increase adoption during the ongoing evolution of telehealth.

As the health care industry shifts from fee-for-service to value-based arrangements, providers are facing a lot of challenges. A provider's relationship with payers is often strained by the new business model, and a provider's ability to collaborate with payers has never been more important. On this episode of Value-Based Care Insights, host Daniel J. Marino and Hal Katz, an industry leader in health care law, discuss how providers can successfully navigate value-based contracting with payers in a mutually beneficial way.

Learn more at luminahp.com/insights

Revenue cycle performance is a hot topic across the country as organizations work to rebound from the difficult past couple of years caused by COVID. There are many things that impact and contribute to the complexity of the revenue cycle, but they boil down to three categories: people, process, and technology. On this episode of Value-Based Care insights, host Daniel J. Marino discusses ways to identify areas of opportunity and increase the revenue cycle performance with revenue cycle leaders, Cecilia Gonzalez and Rachel Greenspan.

Learn more at luminahp.com/insights

Many challenges can arise when trying to implement standardized processes in complex surgical settings. Reviewing the data and performing prioritization exercises will help leaders identify inefficiencies and assist them with understanding where to begin to operate effectively. By utilizing data and engaging surgical staff, hospitals and ASCs will see tangible benefits to the financial bottom line and to staff and patients.

On this episode of Value-Based Care insights, host Daniel J. Marino has an informative discussion with Kate Geick on the benefits of implementing operational effectiveness tools in surgical services. Learn more at www.luminahp.com/insights.

Health care providers are in one of the most challenging times with payer contract negotiations. There are new economic pressures, changes in reimbursement structures due to shifts in site-of-care, and payers are wanting providers to assume more risk. On this episode of Value-Based Care Insights, host Daniel J. Marino and Cliff Frank, a national expert in managed care contracting, discuss how to move forward and successfully perform under risk-based contracts.

Learn more at luminahp.com/insights

To be a high performing health care organization, finance and clinical leaders must work together to improve patient care. Many different factors play a part in the often fragile relationship between the two. But by aligning incentives and increasing communication, the dynamic can improve. On this episode of Value-Based Care insights, host Daniel J. Marino has a great discussion with Dr. George Mayzell and Steven Berger on the evolving relationships between hospitals and physicians.

Learn more at www.luminahp.com/insights

Given the increasing health care expenditures and the pressures of the recent pandemic, a direct-to-employer (DTE) contracting strategy is an opportunity for employers to reduce administrative friction costs and preserve revenue. These arrangements can allow you to foster a better relationship between the employees and the provider. On this episode of Value-Based Care insights, host Daniel J. Marino has a great discussion on DTE arrangements and its benefits with Bradley Olson, VP of Managed Care, and Britney Bart, Business Development, at a large Midwest CIN.

Learn more at www.luminahp.com/insights

In this very exciting 50th episode of our podcast, we discuss what we have learned over the past 49 episodes and revisit some of our most memorable moments. We reflect on the key insights we gained from speaking with so many industry experts and look forward to hearing more stories as we continue to glean insights and learn together.

Learn more by visiting our insights page at www.luminahp.com/insights.

The No Surprise Act went into effect on January 1, 2022. It protects patients from out-of-network surprise bills. Health care organizations must comply with these regulations for emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Hear more about The No Surprise Act with special guest Shawn Stack and host Daniel J. Marino.

For more insights, visit www.luminahp.com/insights.

Highly effective leaders have a high Emotional Intelligence or Quotient (EQ), understand when to manage and when to lead, and know how to handle complex situations. Two experienced health care leaders, Dr. Cheri Olson and Lucy Zielinski share techniques to increase EQ and grow in leadership skills. They share how you can create a personal action plan to help you advance as an effective leader.

Large vacancy rates – difficult to fill, high turnover rates, burnout with staff – physicians and non-physicians, and competitive nature with recruiting have been workforce trends in health care. Listen to John Malone share the causes and solutions to help the workforce win resolve.

Learn more at: www.luminahp.com/insights

Daniel Marino and Bill Bodnar discuss several challenges health care organizations are facing as they transition out of COVID. Bodnar shares his insights on new challenges, including workforce dynamics, non- traditional health care models, and the pursuit of value.

Learn more on our Insights page at www.luminahp.com/insights.

During the past 18 months, hospitals and health systems have focused on reducing expense mostly through FTE attrition.  Many health systems and hospitals are at a point where reducing costs cannot come from reducing FTEs but must occur from other places.

High performing healthcare organizations have focused not only on reducing costs through minimizing inefficiencies but maximizing revenues as well. Developing a culture of continuous improvement allows the organization to not only meet its clinical and financial goals but exceed them.  High performing organizations accomplish this by implementing Lean methodologies to eliminate waste, operate more efficiently and increase clinical outcomes with patients.

In this episode of Value-Based Care Insights, Daniel J. Marino speaks to Kate Geick of Lumina Health Partners to discuss how operational effectiveness through staff engagement and commitment can yield in improved operational and financial performance.

Read more on our insights page at www.luminahp.com/insights.

In this episode of Value-Based Care Insights Daniel Marino speaks to Phil Hasse who discusses the real-life implications of COVID on medical practices. We speak to Phil Haus who shares insights on how operations have changed drastically since COVID and how hospitals are managing now. Ultimately, we discuss the impact of physicians, revenue, patients, and the business practice of medicine as health care navigates through the COVID disease. You can learn more about this topic at luminahp.com/insights.

As we'e thinking about COVID and its impact on organizations, many still face unprecedented challenges. There are numerous studies that reveal that the financial performance of hospitals is still below where it was pre-COVID. As we move forward, it is important to ask, "What do CFOs need to think about going forward?" and "What does the future look like?" In this podcast Daniel J. Marino and Steven Berger discuss the role of CFOs and how their handle on leadership contributes to the success of healthcare organizations.

Learn more about this topic at www.luminahp.com/insights

In today's healthcare environment, we are starting to see trend with specialists who have become independent providers. They start their own practice or join large systems. Many see an opportunity to stand out in the market and want to embrace the entrepreneurial spirit to have more control of their business. Many have grown strong business acumen that have contributed to their success. In this episode of Value-Based Care Insights, we talk to Carlos Torre, who shares his experience as an independent provider and his keys to success.

Learn more at: luminahp.com/insights