hfma national update: going beyond€¦ · being called to go beyond in an evolving healthcare...
TRANSCRIPT
HFMA National Update:
Going Beyond
Lorraine P. Schnelle, CPA
Director, Health Business SolutionsHFMA
Northeast Ohio HFMA Chapter
Go Beyond: Leadership Conference
March 23, 2016
Objectives of Today’s Presentation
• Identify areas where finance professionals are being called to go beyond in an evolving healthcare environment. (Rhymes with share…)
• Discuss what that means for you as individuals and for your organizations.
• Describe resources that can help you meet the challenges of the current environment.
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Go Beyond the Status Quo
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“Hope is not an effective
strategy for change.”
-Tom Atchison
Reform Across the Continuum
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Patrick Conway, MD,Deputy Administrator and Leader of the Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services
“For the hospital CEO or CFO out there who says, ‘I’m
doing really well in fee-for-service so I’m just going to
stick with it and it’s going to be OK,’ eventually it will
not be OK, and I actually predict it will not be OK in a
much shorter time frame than they might imagine.”
Reframe the Shift Toward Value-Based Payment
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“Providers should compare ACO earnings
not with what they could earn in today’s
fee-for-service payment environment but
with what they could expect to earn in the
future if they didn’t participate in such
alternative payment models.”
H. H. Pham, MD, MPH, et al, Centers for Medicare and Medicaid Services, “Medicare’s Vision for
Delivery-System Reform—The Role of ACOs,” The New England Journal of Medicine,
Sept. 10, 2015
CMS Accelerates the Tipping Point
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2011 2015 2016 2018
Traditional, Fee for Service Alternative Payment Models
“…HHS goal of 30 percent traditional FFS Medicare payment through
alternative payment models by the end of 2016… 50 percent by the end of
2018”
HHS Press Office 1-26-15
85% of payment tied to
quality and value metrics
(ex. Hospital Value
Based Purchasing,
Hospital Readmission
Reduction Program)
Realignment Is Erasing Traditional Healthcare Boundaries
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Driven by demands for care transformation, the healthcare industry is
realigning at an an unprecedented pace.
The Triple Aim framework was developed by
the Institute for Healthcare Improvement in
Cambridge, Mass. (www.ihi.org).
SHARED GOAL
HFMA is Reaching Out
hfma.org/healthplan
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hfma.org/physician
HFMA Website - Industry Initiatives
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HFMA Website
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HFMA Website - News
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HFMA Website - Education
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Provider Leaders Make Up Largest Segment of HFMA Membership
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More than 60% of members
are in provider/payer setting
Other
Administration/
Operations
Managed Care/
Reimbursement
Revenue Cycle
Finance/Accounting
Approximately two-thirds are in financial,
revenue cycle, accounting, or payment roles
~ 2/3
Executives Constitute the Largest Percentage of HFMA members
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HFMA Changes Health Care
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OUR MISSION
Leading the
financial
management
of health care
OUR VISION
HFMA will
bring value
to the industry
as the leading
organization
for healthcare
finance
Thought Leadership Shapes the Future of Health Care
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WHAT WE DO
CHANNELS
Official Comments
and Testimony
Media Other Associations and
Industry Groups
Chapters
Share finance
perspectives
to drive
improvement
Convene
healthcare
groups to build
consensus
Develop
strategic
frameworks
to guide action
Establish
principles
and guidance
to advance
capabilities
Foster
measurement
and
accountability
for outcomes
The Urge to Merge Is Strong
42% Senior financial execs who have entered into an acquisition or affiliation arrangement in the past 5 years
64% Interested in entering into an arrangement in the next few years
58% Cite cost efficiencies and economies of scale as the key driver for affiliations
57% Expect improvement in patient population data analytics across the organization as a result
Source: Based on a survey of HFMA’s senior financial executives conducted in Fall 2013.
HFMA Value Project, 2014. Acquisition and Affiliation Strategies. hfma.org/valueproject
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New Combinations Are Emerging
• Healthcare system & health plan
• Academic medical center & regional health system
• Health plan & multiple health systems [e.g., Vivity]
• Health system & large multispecialty physician group
• Multisystem collaborative
• Innovation company
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Health Systems Are Acquiring Clinics,
Physician Practices, & Digital Resources
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Market Power Value
Realigning Around Value:
A Fundamental Shift in Focus Is Needed
… throughthe care
purchaser’s lens
View value …
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Current HFMA Initiatives
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HFMA Guides the Value Transition
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hfma.org/valueproject
HFMA Convenes Stakeholders Around Payment Innovation
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THIS EVENT ENCOURAGES
PHYSICIANS, PAYERS, AND
PROVIDERS TO CONNECT AND
LEARN ABOUT SUCCESSFUL
STRATEGIES TO IMPLEMENT
VALUE-BASED PAYMENT
ARRANGEMENTS WITH PRIVATE
AND PUBLIC SECTOR PAYERS.
hfma.org/npis
Improve Patients’ Financial Experience
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hfma.org/dollars
Educate Consumers
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• Describes how to request price
estimates, step by step
• Clarifies what estimates may or
may not include
• Explains in-network and
out-of-network care
• Defines key terms
• Available for posting on your
website at no charge
• Hardcopies available for purchase
in bulk at a nominal price through
AHA’s online store:
ahaonlinestore.org
hfma.org/dollars
Train Front-end Staff for Expanded Roles
• No longer a purely
transactional role
• “Soft skills” and
communication skills
are key
• The patient’s financial
experience is in their
hands
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hfma.org/dollars
Demonstrate Your Commitment to Your Community
• Adopters to date include:
– Duke University Hospital
– Geisinger Health System
– MetroHealth System of Cleveland
– St. Luke’s Health System (Kansas City)
– UAB Medicine
• Recognition demonstrates commitment
to best practices in patient financial
communications
• Based on HFMA review of an application
and supporting documentation
• All provider organizations may apply.
Recognition valid for two years
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hfma.org/dollars
It Takes Collaboration
• Health plans should serve as the
principal source of price information
for their members.
– They need provider agreement
to do so.
• Providers should be the principal
source of information for uninsured
patients and out-of-network care.
• Referring physicians and other
clinicians should use price
information to benefit patients.
Source: HFMA. 2014. Price Transparency in Health Care. Report
from the HFMA Price Transparency Task Force. hfma.org/dollars
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Physician Groups Are Now on Board with Price Transparency
“We suggest that medical centers
take the following steps to promote
cost transparency and to train
physicians and patients how to have
open discussions about costs and
the risks of financial harm:
• Provide medical professionals
and patients with local cost
information about tests,
procedures, and medications.
• Publicize Hospital Compare data
on costs and quality.
• Increase monitoring of patients
who are at high risk for financial
harms…”
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But Physician Attitudes Vary
“
“One of our senior
physicians told a patient,
‘Don’t worry about what
they tell you it’s going to
cost. You don’t have to
pay it.’”
--HFMA focus group participant,
October 2015
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“Transparency, when used responsibly, is a good thing. To rein in the high cost of health care and eventually make doctors better healthcare providers, transparency is likely a necessary thing.”
--Robert Wong, MD, writing at
KevinMd.com, Oct. 27, 2015.
MAP Sets the Standard for Revenue Cycle Excellence
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HFMA Physician and Payer Resources
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hfma.org/physician hfma.org/healthplan
HFMA Launches HERe Initiative
• National & chapter events
• Virtual tools & opportunities
for engagement
• Ongoing discussion groups
• Newsletters, articles, & blogs
• Webinars
• Other resources
www.hfma.org/here
HFMA Strives to Develop and Support Future Leaders in Healthcare Finance
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hfma.org/earlycareerist
HFMA Resources
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Learn
• ANI: HFMA National Institute
– June 26-29, Las Vegas
• Virtual Conference
• Seminars
• Webinars
• e2Learning
• Revenue Cycle Conference
• HFMA onsite programs
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Explore Online Resources
• Reports
• Fact sheets
• Articles
• Analyses
• Roundtables
• hfm Buyer’s Resource Guide
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ONLINE KNOWLEDGE CENTER TOPICS
•Accounting and financial reporting
•Finance and business strategy
•Legal and regulatory compliance
•Operations management
•Payment, reimbursement,
and managed care
•Revenue cycle
•Technology
Read
• hfm magazine
– The #1 publication for healthcare CFOs
• Leadership publication
– Reaches all levels of the C-suite
• Newsletters:
– Revenue Cycle Strategist
– Healthcare Cost Containment
– Strategic Financial Planning
– HERe e-newsletter
– Physician Business Adviser
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Become Certified
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www.hfma.org/certification
Train Clinical and Operational Staff
HFMA BUSINESS OF HEALTH CARE:
1) Healthcare Finance: The Big Picture
2) Financial Accounting concepts
3) Cost Analysis Principles
4) Strategic Financial Management Issues
5) Managing Financial Resources
6) Looking to the Future
End of program assessment
Certificate of Completion43
Professional staff – new to field/early careerist
Management – experienced, seeking to advance career
Those who aspire to be managers, leaders in Healthcare roles, i.e. clinical, non-clinical providers, vendors, and payers.
No expectation for experience, degree/education
Online Program - Adult learning style
Learner feedback as a learning strategy
Learn at an individual pace
HFMA BUSINESS OF HEALTH CAREIntended Audience & Delivery Method
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Stay Connected and Up to Date
• www.hfma.org
• Daily and weekly online news
• Social media:
• HFMA Forums
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Get Involved
• Take your place in one of HFMA’s 68 chapters
• Pursue leadership opportunities
• Attend local education programs
• Take advantage of networking opportunities
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Connect with HFMA and Each Other
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Questions?
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Lorraine Schnelle
Director, Health Business Solutions
HFMA
Office: 708.492.3416
Email: [email protected]
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