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AKSARBEN
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2016 ANI Conference October 5 - 7 , 2016
Caesar’s Palace in Las Vegas, Nevada
http://www.aaham.org/aksarben
Fall 2016
AKSARBEN AAHAM
2016 Fall Conference
Grand Island, Nebraska
Fairfield Inn & Suites
October 19th & 20th
http://www.aaham.org/aksarben
Greetings! Our Spring Conference for 2016 was well attended. Your AKSARBEN AAHAM Board is pleased to see our conference attendance increasing again. A BIG Thank-You to YOU… Our conference attendees and presenters for helping to keep our chapter successful. The individualized payer education sessions are always informative and appreciated. The round-table discussions are a great place to share your facility Successes & Stresses; peer networking is a great place for ideas. ICD-10 implementation was almost 1 year ago. I believe for most it was fairly non-problematic. MACRA… here we come! In October, I will be attending the 2016 AAHAM ANI (Annual National Institute) in Las Vegas. http://www.aaham.org/Events/AnnualNationalInstitute.aspx I had the great pleasure of attending my first ANI in 2015.
I cannot stress enough… GO! GO! GO! This great Educational – Networking – Information Sharing conference is attended by nearly 500 National members and over 70 exhibitors. You will be amazed at what information and connections you can bring back to your facility. Our chapter 2016 fall conference is just around the corner; scheduled for October 19th & 20th in Grand Island, Nebraska. Please watch your email or visit us at http://www.aaham.org/aksarben for more information on the upcoming conference.
Chapter nominations and voting for 2017 are quickly approaching. Please consider volunteering for an open board position or on a Chapter Committee. We have a GREAT mentor program, but need new faces and new ideas to keep our chapter successful. Association chapters are a team effort and we are always looking for individuals to help us improve and grow. We can only continue our progress with the assistance and input from our membership. I look forward to seeing you at the fall 2016 chapter conference. Cheers,
Cindy Vossler, President [email protected]
Message from the President
2017
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Medicaid Eligibility: The High Price of
Free Healthcare (Part 1) By Sandra Pinette, Vice President, Client Development, Financial
Health
Medicaid Eligibility: The High Price
of Free Healthcare (continued) Cultural bias. There are those who may be qualified
Medicaid patients whom are immigrants and
potentially considered (depending upon the program
and status) “qualified aliens.” However, they may
originate from countries where they have learned
from an early age not to trust the government, a belief
to have matters handled within their own family or community as well as language barriers.
Higher priorities elsewhere. Several Medicaid eligibles
have to make difficult choices about utilizing their
limited resources and time. Do I go to work or
complete a financial assistance application? Do I
spend money for food or on a taxi to get a birth
certificate? Do I pay a medical bill or keep the lights on for another month?
Medical conditions limiting patients ability to comply
with the application process. Many times qualified
Medicaid eligibles have a medical condition (physical
or behavioral) which hinders their ability to complete
the process to obtain coverage. This in essence can be
the difference between getting healthy and dealing
with a much more serious health dilemma that can be
fatal. If there are no family members or guardians who
can be the voice of these patients, they continue to be at risk.
As healthcare providers have learned, the need for
patient intervention is not going away with expanded
Medicaid. If anything, it has become more nuanced
and in some cases more difficult due to the
misconception of ease. At the same time the stakes
have grown much higher since reimbursements from
other revenue sources are shrinking dramatically. In
the next article, we’ll look at ways that providers can
fine-tune their patient championing efforts to get the
most from their limited resources.
Read Part Two Here
The Hospital Accelerator Model
By Alfredo Fernandez-Concha
Evolving reimbursement models, the Affordable Care Act and the activation of patients as consumers are among the
major drivers of anticipated disruption to the provider landscape. This shifting financial, regulatory and patient
preference has led to not only industry veterans attempting to recalibrate ways of doing business, but has also notably
attracted outside entrepreneurs and capital vying to establish a presence in a massive industry ($1.5 trillion was spent on
hospitals, physicians and clinics in 2013, according to the Kaiser Family Foundation) that historically has had large
barriers to entry. StartUp Health reported that capital flows for digital health increased from $1.2 billion in all of 2010
to $4.7 billion in the first three quarters of 2015.
Despite all the above tailwinds, however, adoption of new business models has been relatively slow. A number of
factors must be overcome, including:
Cultural Differences: Many new entrants come from outside industries, such as technology. Current health care leaders
may question new players’ understanding of the intricacies of health care, including fund flows, the level of control any
one entity has over an entire episode of care, privacy, compliance, etc. New entrants, for their part, may view
incumbents as slow adopters who have not faced the sort of innovation-driving market competition seen in other
industries. Both viewpoints have merit.
Financial Incentives: While the Centers for Medicare and Medicaid Services (CMS) is moving toward value-based
reimbursement models such as shared savings or capitated payments, many (if not all) regions of the country are still
highly incentivized along fee-for-volume payment models. Thus, adopting new technologies that may keep patients well
and reduce unnecessary utilization will not necessarily yield positive financial impacts in the short term.
Risks: As in all industries, new technologies and new firms have high failure rates. A large provider or system taking on
the risk of building, buying or partnering with novel technologies or nascent firms must be highly selective.
Complexity: While technologies and solutions from other industries may seem applicable to health care, many
intricacies must be navigated by new solutions and firms, including the complex dynamics among providers, payors and
patients.
care delivery, they must overcome these factors to tap emerging technologies and business models. A promising avenue
is through accelerators/incubators.
As providers seek to stay ahead of the innovation curve in health care delivery and advance their visions of value-based
care delivery, they must overcome these factors to tap emerging technologies and business models. A promising
avenue is through accelerators/incubators.
How Accelerators Work
Traditionally, technology accelerators invest a small amount of seed capital (e.g., $10,000 to $20,000 for a 6% stake)
and provide three to six months of intensive mentoring, which includes product development, business plan
development, networking, co-working space and introductions to similar startups and industry-based advisors. Many of
the health care delivery–focused accelerators are also now partnering with forward-thinking academic, municipal or
provider entities. These entities establish a presence within the accelerator’s space and work side by side with its
portfolio companies.
Through partnering with an accelerator, a provider can address learning curve concerns around innovation adoption,
such as:
Mitigating Risks: Working with portfolio companies to develop and integrate solutions allows for “failing quickly”
and iterating improvements before they are implemented by the provider or system. Additionally, leveraging
accelerators reduces the risk involved in acquisition costs as well as the risk entailed in developing in-house solutions,
which may be outside the core competencies of a hospital, physician group or system.
Providing Guidance: When entrepreneurs from outside industries gain a deeper understanding of the day-to-day
issues providers face and the complexities within the broader health care industry, these new insights can lead to even
better tailored solutions for care providers and to anticipation of, and collaboration on, future challenges.
Health Care-Focused Accelerator Models
Many accelerators and innovation centers for health systems operate with the following cycle:
‘
In “Survival of the Fittest: Health Care Accelerators Evolve Toward Specialization,” the California Healthcare
Foundation identified six accelerator models with differences in purpose, ownership structure and governance:
Key Takeaways
Leveraging accelerators could be beneficial for providers who are asking:
How can I integrate new technology or business models to help in the transition to value?
How can I get involved with health care startups without having to invest major capital?
How can I stay ahead of the innovation curve in a cost-effective manner?
How can I build a culture of innovation within my organization?
How can I differentiate my organization within the marketplace?
How can I develop new revenue streams as reimbursement rates stagnate?
Continued financial, regulatory and patient preference pressures will push providers toward the “Triple Aim” (enhancing
the patient experience, improving the health of populations, and reducing the per capita cost of health care). These goals
will be accomplished through the integration of newly applied technologies and evolving business models with the
current health care infrastructure. By leveraging accelerators, health care providers can mitigate risks associated with
nascent firms and technologies while also properly positioning themselves for the future landscape.
Alfredo Fernandez-Concha is a part of the Center for Healthcare Innovation at Kurt Salmon. He can be reached at [email protected].
Member Get A Member Who do you know or work with that could benefit from educational and networking
opportunities available through Aksarben AAHAM?
Aksarben AAHAM is looking for new members. Next time you talk with this person make it a
point to discuss the opportunities and benefits of being a member of AAHAM.
AAHAM is the premier professional organization in healthcare administrative management.
Professional development of its members is one of the primary goals of the Association.
Publications, conferences and seminars, benchmarking, professional certification and
networking provide numerous opportunities for increasing the skills and knowledge necessary
to function effectively in today’s healthcare environment. AAHAM actively represents the
interest of healthcare administrative management professionals through a comprehensive
program of legislative and regulatory monitoring and its participation in industry groups such as
ANSI, DISA, and NUBC.
Benefits of Aksarben AAHAM membership:
• Annual Membership Dues: $
Annual National Institute (ANI) • (Formerly CCAM)
• Technical Certification (CRCS - I (formerly CPAT) & CRCS - P (formerly CCAT)
• National job back to assist you in searching for and posting that special job
The membership application is located in this newsletter. Contact Terri Melvin at [email protected]
to discuss membership opportunities.
If you are attending the Conference and wish to become a new member of Aksarben AAHAM, complete this Membership Application and return it along with the Conference Registration Form and $180.
2015 PLATINUM LEVEL SPONSORS
Accelerated Receivables Solutions
Blue Cross Blue Shield of Nebraska
Credit Management
Wakefield & Associates
General Service Bureau/Early Out
Services Tiburon Financial, LLC
Alltran Health
2015 SILVER LEVEL SPONSORS
ARL Credit Services
Automated Accounts Management Services
General Collection
Mail Communications
Professional Choice Recovery, Inc.
Hauge Associates
Aksarben AAHAM Corporate Partners
The Aksarben Chapter wishes to thank all of our Corporate Sponsors
for their continued support.
