Modernizing Clinical Communications, Analytics, and the Revenue Cycle Process in the Era of ACOs Jason Tipton, Director of Value Operations – Holston Medical.

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 Payments

Capitation-based

Combination

Medicare 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 ?

Thank You!

Scott Fowler, [email protected]

423-857-2091

Jim [email protected]

502-779-4302