Lisa Crymes

What equity frameworks does your organization use? Have you seen the Agency for Healthcare Research and Quality's "Practical Guide for Implementing the Digital Healthcare Equity Framework"? AHRQ takes an intentional approach to considering equity throughout the digital healthcare lifecycle aims to promote improvement in: • Clinical outcomes such as mortality, morbidity, and health/quality of life • Process outcomes such as care continuity, care coordination, and care quality • Healthcare experiences such as patient satisfaction/engagement and provider satisfaction/engagement #HealthcareEquity #ClinicalOutcomes #PatientExperience https://lnkd.in/eTA9d9Gn

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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If you build it, will they come? I’ve heard countless organizations - #MA plans, #Medicaid plans, risk-bearing providers, vendors, PBMs, and retail players - say “we need to build the capabilities to XX”. Many are looking to vendors for solutions, but few vendors are ready to invest in new capabilities without contracts.  Anyone else sensing this (problematic) new conundrum? Here’s my quick take and a few ideas to break through this barrier. Many sales meetings are often held with functional departments, and often do not include the #MedicareAdvantage #StarRatings, #RiskAdjustment, #HEDIS, IT or P&L owners. We must collaborate to get those departments’ urgent needs integrated into new vendor purchases in order for new activities to meet new and emerging needs, remembering that: 🌟 Vendors are vital to your success.  🌟 Vendors operate in a more volatile environment than plans. 🌟 Vendors have smaller budgets than plans. 🌟 Vendors need signed contracts to make significant investments.   🌟 Vague RFPs waste vendors’ time and resources. Collaboration creates win-win contracts which expand capabilities of both parties. I encourage plans to: ✅ Ask vendors about their roadmap; including timing and certainty of planned enhancements. ✅ Include the #Stars, Risk Adjustment and #PartD teams in new vendor discussions. ✅ Consider adding a vendor's roadmap capabilities to contracts. ✅ Co-create with trustworthy vendors. I encourage vendors to: ✔ Ask about the customer’s unmet needs. ✔ Offer to co-create solutions to new and emerging needs with willing customers. ✔ Offer to accelerate roadmap capabilities with willing customers.   ✔ Articulate the things you would be willing to do if a customer would be willing to contract for it. This is a #MarketMakingMoment as #CMS has thrown down the gauntlet with #NewNeedsOfStars and #NewNeedsOfMA. This is a stellar time for vendors to review current and planned capabilities with a broader lens on new and emerging MA, #Compliance, Stars, #ECDS, #Interoperability, #HealthEquity, Medicaid & #SNP Aligment, and Risk Adjustment needs. If you need help, reach out to us.  #WhatGotYouHereWontGetYouThere  ⭐ ⭐ ⭐ ⭐ ⭐

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#ATANexus is off to a great start. Honored to join Helen Hughes in an important conversation about mastering the execution of inpatient virtual care. When it comes to measuring the Return on Innovation, the call to action is clear: 1. Identify, and align, on the problem your program is solving. 2. Quantify data in the current state-you need to measure what your program achieves. 3. Look for partners who are ‘in it’ with you.

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An Outpatient Clinical Documentation Improvement (CDI) program offers substantial advantages to healthcare organizations by elevating patient care and operational efficiency. By integrating risk stratification with chronic conditions, enhancing quality measures, addressing social determinants of health, and establishing a collaborative team empowered by technology, such strategic initiatives result in improved patient outcomes and streamlined operations.

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AVAILABLE: This 77-second video introduces a Greater Atlanta (onsite) or remote Revenue Cycle Optimizer, who I'm pleased to represent. She has: - Large Health System Experience (on the ProFee side) - ID'd and released $1M worth of unposted charges that were caught in EMR - Helped reduce AR by $200K with the review of incorrectly billed charges Contact me privately for information, or please pass this long to someone who might be in need of this type of talent. Cheers! Grant NOTE: Images are iStock Getty Images chosen as representations of the individual referenced to assure her initial confidentiality (I can reveal in private inquiry). #healthcarefinance #healtheconomics #recruitment #recruiting #medicalbilling #medicalcoding #healthcarerecruitment #healthcarejobs #medicalbillingcompany #hospitalmanagement #hospitaladministration #hospitalbilling

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ICYMI: I wrote about HCA Healthcare's Q3 results. Here's a nifty one-pager for LinkedIn and what you missed in Hospitalogy: Volume + Utilization: • Another quarter of broad-based growth. OP surgeries down (from Medicaid/Uninsured), but revenue increased 5% (acuity & payor mix grew 7% to counteract the decline). HCA specifically called out cardiac procedures, rehab, and obstetrics in prepared remarks on the earnings call itself.   Medicare vs. MA: • Same-facility Medicare admissions grew 5.3%. Traditional Medicare was flat. MA admissionsgrew11%inQ3; HCA attributed 2% of this growth to the 2-Midnight Rule.   • Same-facility adjusted admissions declined 8.5% in Medicaid, increased ~4% in commercial, and increased 43% in exchange. Uninsured adjusted admissions increased +7.2%.   Revenue + Payor Mix: • 7.1% = Same-facility revenue growth. 7.9% overall revenue growth. ‘Modest’ benefit from Medicaid supplemental payment programs.   TOO MANY DENIALS: • Point of emphasis for all hospitals in 2024. HCA has seen ramp-up in payor denial activity but didn’t see a $$$ impact. Still, HCA observed a few large MA players driving the most denials. MA patients have higher LOS (around 10% higher) even adjusting for acuity. HCA blamed but is working with payors on this inefficient dynamic.   Expenses + Margin: • 0.9% increase in adj. EBITDA from improved labor (down 1.6% as a % of revenue) and contract labor (4.6% of total labor spend, down 18% over 2023). 2.5% - 3.5% wage increases for 2025. Supplies & other operating expenses squeezed revenues a bit. HCA sees opportunity with AI and other investments to improve admin functions. It recently announced an expanded partnership with Commure to deploy ambient AI system-wide.   Capital Allocation + CAPEX: • ~$1.2B in CAPEX in the quarter. ~$1.8B in share repurchases and ~$170M in dividends distributed. HCA plans to have added 600 IP beds and 100 new OP facilities by the end of 2024. $6B in capital projects under development. 2,600 sites of care by the end of 2024.   Outlook + Guidance: • HCA thinks elevated volume growth will continue at 3% - 4% while reimbursement will increase 2% - 3%, resulting in growth ‘near or slightly above’ long-term HCA targets in 2025. $50M or $0.15/share lost estimate from hurricanes in Q3. Exchange growth will moderate in 2025 to 8% - 10% vs. 30% in 2024 (commentary prior to election results).   My Take: • While we may have reached peak ‘hospital multiple’ HCA continues to benefit from a strong & stable operating environment entering 2025 in its markets: broad-based growth with ‘very few challenges.’ Expect HCA to continue to win IP market share over less efficient competitors as it drives toward having 13, and more like 17 to 20 access points per hospitals in its selected markets.

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Here’s your recap of last week’s health IT news 🗞️ 👇 🤖 AI Clinician Assistant • Ochsner Health announced an enterprise-wide agreement with DeepScribe. 📋 Patient Administration • Weave is now integrated with eClinicalWorks.    • Phreesia is now available through Oracle Health's Marketplace.    • Samaritan Medical Center selected Loyal for managing provider listings. 💼 Provider and Practice Administration • MedStar Health is partnering with RLDatix on AI-based tools for analyzing patient safety events.    • Kontakt.io released a new solution to track hand washing and gamify compliance.    • Epic announced a new feature allowing users to securely release their healthcare information to apps of their choice. 🔁 RCM • Infinitus Systems, Inc. released a new instant benefits verification tool for commercial insurance patients seeking specialty medication.    • Providence expanded its implementation of Xsolis, designed to manage length of stay, mitigate denial risk, and ensure proper reimbursement.    • R1 RCM is being acquired by investment funds associated with TowerBrook Capital Partners L.P. and Clayton Dubilier & Rice. 📱 Patient Support and Communications • uMETHOD Health, Inc. is partnering with Linus Health on an integrated solution for earlier detection of cognitive impairment plus care planning. ⚙️ Clinical Operations • SimplePractice launched an ePrescribe platform following its acquisition of certain assets of Luminello, Inc.    • VitalHub Corp. is acquiring the clinical decision support vendor MedCurrent Corporation. 🧑‍💻 Virtual and At-Home Care • AvaSure has acquired the smart room technology vendor Ouva in an effort to expand its AI capabilities.    • VSee is partnering with Ava Robotics to give remote providers an inpatient presence. 🍎 VBC • Zing Health is leveraging Story Health for eligible members with the greatest risk of poor heart failure outcomes. 🧠 Food For Thought • A federal judge granted an injunction against PointClickCare for alleged information blocking tactics. Elion advisor Brendan Keeler shared a great post about some of the potential implications of this decision. https://lnkd.in/eb8F3FEr    • The The Cedars-Sinai Accelerator program announced its 10th class, and the theme was unequivocally AI with a strong bias toward clinical applications. We remain eager to see this shift from back-office use-cases toward patient- and provider-facing clinical solutions.    • UW Health and Epic announced the release of the National Roundtable on Artificial Intelligence in Healthcare’s recommendations to lawmakers. The TL;DR: Lawmakers should foster innovation across the patient experience (i.e. beyond traditional care settings, such as virtual, in-home, etc) and play a strong role in ensuring equitable access, minimal care disparities, and local validation.

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Here's a shocker -- the AHA and the FAH are pushing back against Medicare's mandatory hospital-based bundled payment program. The hospital associations are asking for more time to get ready for a program that will start in 19 months.... It's laughable, of course, but what else should we expect from the agents of the status quo? For those who hadn't kept up, Medicare announced the Transforming Episode Accountability Model several months ago and it's finally going through the end of the rulemaking process. So what's TEAM? A slimmed down version of the Medicare Bundled Payment Model (BPCI and its successor BPCIA) that has been in place for over a decade. There's nothing new about TEAM except that it only covers a handful of inpatient stays and the accountability is reduced to 30 days post discharge instead of 90. Four years ago a dozen or so highly respected leaders in the industry recommended that CMS institute a "DRG+30" across the board. Not just for five DRGs, but all DRGs. And here we are, four years later, and TEAM is set to start in 2026....yes, 2026, not 2025. The first cohort of the original program launched in April 2013, more than 11 years ago. By the time TEAM starts it will have been close to 13 years. Isn't that enough time to get ready Chip Kahn???? All of the published analyses on the Medicare Bundled Payment program showed the same source of savings -- post-acute care. And the savings never negatively impacted outcomes. So it's logical that Medicare makes this mandatory. What's not logical is that it's taken so much time to get to this decision. So let's just get on with it because the taxpayers deserve it and so do Medicare beneficiaries. #TEAM, #BundledPayments, #CMMI

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Walmart Exits Healthcare Market: RPM Steps Up to Fill the Gap... Walmart's departure from the healthcare market, including its virtual health care services, will leave a void in care services for underserved communities. While hospitals and primary care providers (PCPs) remain the backbone of our healthcare ecosystem, their resilience is rooted in the trust relationships they've built with patients. This trust is a cornerstone of effective care, and RPM can help hospitals and PCPs extend their reach. RPM uses digital technologies to monitor patients' vital signs, health data, and other relevant information remotely, enabling healthcare providers to deliver timely interventions and preventive care. By leveraging RPM, we can: - Increase access to care for underserved communities - Detect health issues early, preventing complications - Deliver personalized care plans - Reduce healthcare costs - Empower patients to take a more active role in their healthcare As we move forward, RPM can help address the disparities in healthcare access and ensure that everyone has access to quality care, regardless of their zip code or background. Let's harness the power of RPM to create a more equitable and accessible healthcare ecosystem! #RemotePatientMonitoring #Telehealth #DigitalHealth #HealthcareAccess https://lnkd.in/eD7CcaEm

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Which physician specialties spend the most time in the EHR? According to this study of >200K physicians that analyzed data from Epic's analytic tool "Signal," it was ID, endo, nephrology, primary care, and heme. (My guess is that the heme findings were largely driven by malignant heme.) Oncology was in the middle of the pack. Notably, over 40% of time was spent on clinic days but outside of appointment hours and unscheduled days https://lnkd.in/ebzZCnCD Here's the link to the original article: https://lnkd.in/eprzynWq

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My Friday good news celebrates the heroes of value-based care: primary care physicians and teams. The most successful #Medicare ACOs, those delivering value for Medicare and Medicare beneficiaries and sharing in that value, are primary care-centric #ACOs. We know how they do it; the playbook often includes support from enablers like Aledade, Inc.. Dr. Menard and his colleagues didn't give up when success wasn't immediate. How do we grow more primary care-centric ACOs and generate more value for Medicare and more access and quality care for beneficiaries? There are some health system ACOs investing in primary care and integrated teams. But it might take more forceful nudges from Medicare to get big health systems participating in total cost-of-care risk models. Or, we might need payment policies to give primary care more independence to practice comprehensive care. Congress could also consider restructuring the APM bonus to reward primary care "centricity". #primarycare #valuebasedcare Primary Care Collaborative David Raths David Muhlestein AAFP Foundation Thomas Culhane, MD, MMM, MS Darrin Menard, M.D. Stacey Richter https://lnkd.in/dThMvJrQ

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I was looking at a RFP the other day for a Digital Health solution. There was not a single question about the company track record, clinical evidence or processes & playbook. The whole RFP looked like this: → Do you have feature X? → Do you have feature X? → Do you have feature X? → Do you have feature X? → Do you have feature X? So yes the RFP was almost certainly baked for another vendor. And maybe they do care about the other elements, but just really didn’t care to ask since it’s baked. But then I spoke to another health system recently that was evaluating several vendors and I asked them: 𝘞𝘩𝘢𝘵 𝘳𝘦𝘢𝘭𝘭𝘺 𝘮𝘢𝘵𝘵𝘦𝘳𝘴 𝘵𝘰 𝘺𝘰𝘶? Their answer: 𝘑𝘶𝘴𝘵 𝘵𝘩𝘦 𝘧𝘦𝘢𝘵𝘶𝘳𝘦𝘴 & 𝘧𝘶𝘯𝘤𝘵𝘪𝘰𝘯𝘢𝘭𝘪𝘵𝘺. 𝘞𝘩𝘪𝘤𝘩 𝘮𝘦𝘢𝘯𝘴 𝘴𝘦𝘷𝘦𝘳𝘢𝘭 𝘷𝘦𝘯𝘥𝘰𝘳𝘴 𝘭𝘰𝘰𝘬 𝘵𝘰 𝘣𝘦 𝘱𝘳𝘦𝘵𝘵𝘺 𝘮𝘶𝘤𝘩 𝘰𝘯 𝘱𝘢𝘳 𝘸𝘪𝘵𝘩 𝘦𝘢𝘤𝘩 𝘰𝘵𝘩𝘦𝘳. Hmmm 🤔 Recently I also spoke to another health system which was already using a Digital Health product for several years, was getting frustrated with their current vendor and was now looking to switch. I asked the same question: 𝘞𝘩𝘢𝘵 𝘳𝘦𝘢𝘭𝘭𝘺 𝘮𝘢𝘵𝘵𝘦𝘳𝘴 𝘵𝘰 𝘺𝘰𝘶? Their answer: 𝘛𝘩𝘪𝘴 𝘵𝘪𝘮𝘦 𝘸𝘦 𝘸𝘢𝘯𝘵 𝘢 𝘳𝘦𝘢𝘭 𝘷𝘦𝘯𝘥𝘰𝘳 𝘱𝘢𝘳𝘵𝘯𝘦𝘳 𝘸𝘩𝘰 𝘢𝘤𝘵𝘶𝘢𝘭𝘭𝘺 𝘥𝘦𝘭𝘪𝘷𝘦𝘳𝘴 𝘰𝘯 𝘸𝘩𝘢𝘵 𝘵𝘩𝘦𝘺 𝘴𝘢𝘺 𝘵𝘩𝘦𝘪𝘳 𝘱𝘳𝘰𝘥𝘶𝘤𝘵 𝘤𝘢𝘯 𝘥𝘰 𝘢𝘯𝘥 𝘸𝘩𝘢𝘵 𝘵𝘩𝘦𝘺 𝘸𝘪𝘭𝘭 𝘥𝘰. 𝘞𝘩𝘰 𝘢𝘤𝘵𝘶𝘢𝘭𝘭𝘺 𝘩𝘢𝘴 𝘴𝘶𝘣𝘫𝘦𝘤𝘵 𝘮𝘢𝘵𝘵𝘦𝘳 𝘦𝘹𝘱𝘦𝘳𝘵𝘪𝘴𝘦 𝘰𝘯 𝘩𝘰𝘸 𝘵𝘰 𝘮𝘢𝘬𝘦 𝘶𝘴 𝘴𝘶𝘤𝘤𝘦𝘴𝘴𝘧𝘶𝘭 𝘸𝘪𝘵𝘩 𝘵𝘩𝘦 𝘵𝘦𝘤𝘩𝘯𝘰𝘭𝘰𝘨𝘺. Sometimes experience is the biggest teacher… although in healthcare, the challenge is we really don’t have time to waste. Probably every health system leader reading this will tell me their organization is in the latter example of this story, not the former. But I’m telling you, if you actually unpeel the layers… the former story of focusing on just the Tech and not the People and Process… is happening way more than you think in your organizations. And when you’re wondering why that piece of Tech you invested in doesn’t work… it might very well be that you focused on the wrong things in the initial vendor selection process. Agree or Disagree? #digitalhealth #healthcareinnovation

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"Are You Prepared for Your Electronic Health Record Upgrade?" Upgrading to a new version of an EHR (Electronic Health Record) software application is a significant task that requires careful planning and execution. Here are some best practices that Fivebase employs to ensure a smooth transition: ✔️ Understand Benefits: The organization must complete all due diligence on the upgrade and its benefits for clinical, revenue cycle, frontline, quality, and administrative leadership. This will give all team members an elevator pitch of the system's top “X” improvements. ✔️ Define and Prioritize Goals: Clear leadership and governance are crucial to aligning the upgrade with your organization's strategic goals. Defining the exact future state will keep the team focused on the end goal, ensuring a successful upgrade aligned with the organization's strategic direction. ✔️ Understand Current System: Document your current EHR workflows and core reports. You want to make sure you can discuss and review any updates that will be happening and let the team know the benefits of moving forward. This understanding will prepare you for the changes and make you feel more comfortable and knowledgeable about the process. ✔️ Review Project Plans: Your EHR vendor will provide a project plan for every implementation. Your team must thoroughly understand all timelines and their interconnections, especially if other projects are running in parallel. This understanding will ensure smooth coordination and successful implementation. ✔️ Review Upgrade Team: Software vendors constantly add and train new staff. This is core for any company. The main thing to focus on is coordination and training. You must have senior staff on the team to help and direct any upgrade. It’s okay to ask what type of experience people have regarding your upgrade. By following these best practices, you can minimize disruptions and maximize the benefits of your electronic health record system. The goal is to reduce electronic health record frustration and maximize quality time with clients. Fivebase is your partner for clinical process optimization. With a strong focus on integration and database reporting solutions, Fivebase aims to connect customers to their clients and data through innovative technology solutions. Let's connect today! #BehavioralHealthEHR #MentalHealthTech #DigitalHealthRecords #BehavioralHealthIT #EHRIntegration #CuresAct #EHRinteroperability

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A well-written Forbes article on how the Centers for Medicare & Medicaid Services Hospital Price Transparency Rule has evolved since its initial implementation in 2021, and why hospitals need to make more investments into complying as 2025 New Years Day fast approaches. "Given the lackluster level of enforcement and penalties to this point, many hospitals have understandably downplayed action on price transparency regulations—but it is time to pay attention. New Year's Day will be here soon, and continuing to count on lax enforcement seems like a risky strategy. Hospitals must begin preparing now to avoid the prospect of future penalties and public shaming."

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