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Modernizing Clinical Communications, Analytics, and the Revenue Cycle Process in the Era of ACOs. Jason Tipton , Director of Value Operations – Holston Medical Group Jim Lacy , CFO & General Counsel - ZirMed. Jim Lacy , CFO & General Counsel ZirMed. Learning Objectives. - PowerPoint PPT Presentation
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Modernizing Clinical Communications, Analytics, and the Revenue Cycle Process in the Era of ACOs• Jason Tipton, Director of Value Operations – Holston Medical
Group• Jim Lacy, CFO & General Counsel - ZirMed
Jim Lacy, CFO & General CounselZirMed
Learning Objectives
Identify the clinical and financial challenges that provider organizations face when moving to an ACO model
Assess the workflow, process improvements and strategies that HMG implemented while becoming an ACO
Evaluate the internal challenges and determine which tools, technologies and processes could be applied to their organization
Help attendees sort through the high volume of ACO advice to cut through the noise
The Technological & Financial Challenges Operating in an ACO World Changing market needs and regulatory requirements
Integration of healthcare IT systems
Exchange of clinical data on patient referrals and engagement
Expanding regional storage and of patient records and documents
Selecting the appropriate reimbursement model
Understanding and navigating risk
“A health information technology platform that connects providers in the ACO is essential, along with a strong financial database and reporting platform.”
-- Commonwealth Fund*
Powering ACOs & Reimbursement
How will new payment models impact your revenue?
Risk Not being paid for all of the care your organization has
provided
Opportunity Improve the quality of care you provide while becoming more
efficient and getting paid more for the care you’ve provided
Scott R. Fowler, JD, MD, FACOGHolston Medical GroupOnePartner HIEQualuable Medical Professionals – “ACO”
Holston Medical Group
Established 1977 – Kingsport, Tennessee 150 primary care physicians, specialists and mid-level
providers Preventive medicine focus More than 80 primary-care providers Emphasis on electronic medical record utilization, clinical
research and integrated health management Focused on delivering latest advanced technologies and
treatment
Patient Centered Approach to Care
How to Succeed – In a Value Based World
Provide the highest quality of care with limited resources
“Do more with less”
Care
Cost
Clinical & Financial Challenges: The Shift from Volume to Value
Integrating data from multiple different PMS & EHR systems
Aggregate cost data
Aggregate clinical data
Achieving the most critical success factor for ACO: Patient and Provider Engagement
Patients engaged in management / compliance
Providers engaged with patient and comprehensive record
Providing easy real-time access to comprehensive data from multiple sources
ACO Financial Models
Bundled PaymentsCapitation-basedCombinationMedicare Shared Savings
HOW HMG Built an ACO
Collaborative intelligence
Leveraging economies of scale
Chronic disease management
Less touch required throughout revenue cycle
Incorporating the right technology Coordinating clinical data
Workflow solutions
Analytics
5 Essential Components
Patient / Doctor Engagement
Interactive Data
Footprint – Economies of Scale
Patient Lives
Brand
Is It Working? Success Metrics
Contracts / renews
Financial Results ($)
Questions ?
