Mitch Edgeworth

With so many hospitals trying to "more with less" in 2025, this is a great, quick read by Brad Robinson highlighting the value how to optimize your facility's #revenue cycle through maximizing your #Nursing Leaders! If there's a specific hospital department or RN Leadership role that is negatively impacting your facility's bottom line, let's talk! HealthLinx® can help! #PerformanceImprovement #FinancialBenefitGuarantee #ROI #TransitionalLeadership

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The time is now: Why addressing your revenue cycle challenges is critical in 2025 for healthcare leaders. Take a look at our eguide in the link below.

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If I asked you to choose between Trader Joe's or Target, which would you choose? It's a silly question, really. Because both offer unique benefits. As major GPOs shift in the market, exclusive agreements are becoming common. But are they truly driving value for health systems and patients? Exclusive GPO contracts limit choice. It's like forcing someone to choose between Trader Joe’s and Target. At Advantus Health Partners, we offer diverse vendor partnerships and PPI contracts, enhancing both economic benefits and patient care. By rethinking exclusivity, we prioritize patients and empower health systems with choice. Ready to supplement your supply chain with value-added partnerships? Contact Advantus today to learn more about our non-exclusive contracts. https://lnkd.in/deiYRgfE #SupplyChainStrategy #GPOExclusivity

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The latest Kaufman Hall National Hospital Flash Report reveals stable financial and operational hospital performance in October. While expenses declined on a volume-adjusted basis as discharges increased, supply and drug costs continued to rise. Stay informed on the latest hospital financial trends. #healthcareconsulting #hospitalperformance #healthcaremanagement #hospitaldata

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"Businesses will also explore alternative approaches, such as direct contracting with centers of excellence and steering employees toward high-value providers. The focus on cost control will also extend to innovative care delivery models, such as value-based care, advanced primary care programs, and chronic disease management initiatives that promise measurable impacts. Investments in these areas are seen as critical to addressing the dual challenges of rising costs and increasing demand for high-quality care."

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⚠️ Top High-Risk Compliance Zones in Healthcare ⚠️ Do you know where your compliance risks are highest? Our latest article identifies the top high-risk zones in healthcare and offers strategies to mitigate them. 🧐 See how prepared you are and get actionable insights to boost your compliance efforts. 📖 Read more: Top High-Risk Compliance Zones in Healthcare. https://lnkd.in/eRwkU3Qn

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Yesterday, CMS released the final rule for FY 2025, bringing several changes to overall reimbursement, primary, and NTA adjustments. Modifications were introduced to SNF VBP and SNF QRP. CMS continues to implement updates that demand ongoing learning and adaptation. Dynamic Reimbursement Services we are here to assist providers with education to ensure your MDS department is top notch. #Healthcare #Regulations #Adaptation

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Purchased services are vital to healthcare, but they can also become financial drains if not managed properly. A mature purchased services strategy includes insight into all expenses, reduction in unnecessary variation, and prioritized patient care, outcomes, and experience. By focusing on these areas, health systems can lower costs, improve clinical care, and enhance patient experiences. Learn more in Advantus Health Partners article about how to create a mature purchased services strategy: https://lnkd.in/g4UwCjCW #HealthcareSupplyChain #ValueBasedCare #SupplyChainManagement

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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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HEALTH MAINTENANCE ORGANIZATION (HMO) Have you heard of the acronym HMO in a healthcare setting? HMO stands for Health Maintenance Organization (HMO), a type of health insurance plan that provides healthcare services to its members through a network of doctors, hospitals, and other healthcare providers. HMOs are designed to emphasize preventive care and cost efficiency, often requiring members to choose a primary care physician (PCP) who coordinates all their healthcare needs. HMOs are often a good choice for individuals or families looking for affordable health insurance with a strong emphasis on preventive care. They are particularly suitable for those who are comfortable with having a primary care physician manage their care and do not require frequent visits to out-of-network specialists. In our next post, we will delve deeper into HMOs and how they function. #Healthcare #medical #cardiology #doctor #technology #administration #frontlineheroes #nurse #hmo

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⚠️ Top High-Risk Compliance Zones in Healthcare ⚠️ Do you know where your compliance risks are highest? Our comprehensive guide identifies the top high-risk zones in healthcare and provides strategies to mitigate them. 🧐 Assess your preparedness and gain actionable insights to enhance your compliance efforts. 📖 Read more: Top High-Risk Compliance Zones in Healthcare. https://lnkd.in/eRwkU3Qn

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Love this! Change is often necessary for growth and adaptation, especially in today's fast-paced world. It can lead to new opportunities, innovations, and improvements that wouldn't be possible otherwise. How are you managing change in your organization?

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What a great day for our team and community! Quint always provides such valuable insight to leaders at every level of an organization and his research and knowledge on employee retention and trust is so valuable in today’s healthcare environment. To learn more from Quint, subscribe to his weekly newsletter at https://lnkd.in/gQ8RRzZ6. #TheHumanMargin;Quint Studer

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RCM Connections - Fee Schedule Updates for 2025 right around the corner! Connect with me here, let's talk about data management and streamlining your organizations management of your fees, contract allowances and the power it provides when creating estimates for your patients!

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This is interesting to me. Lawsuits are occurring between employers and health plans based on runaway healthcare costs. Every large employer wants the largest network though with every hospital and provider in network. Leading network teams for way too many years, even when I would make the case to take a stand, we had very little support from employers as it relates to involvement even when we asked. If one plan took a stand, employers would just go to another carrier. This creates a never ending cycle of continued health care cost increases. Only way I see this ending is employers contributing a set amount and then providing numerous network options. Broad networks cost the most, narrowed local networks less. Let consumers decide like they do anything else. Some large employers have started offering 2 types of networks side by side but uptake small. I'm bullish on the concept of IHCRA's

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Our own Nathan Paulsen, MBA, who joined Oshi recently from a national payer, wrote a great article about value-based specialty care. Definitely worth reading in the post & link below. The main question underlying the transition to #valuebasedcare outside of the traditional primary care, full-risk for whole populations and government innovation models is this: Do commercial health plans have both the incentives and the resources to execute new ways of contracting for specialties that require more nuanced attribution of risk? Even when they acknowledge these specialties are driving the majority of the cost? Anyone seeing health plans that are leaning in? Anyone experiencing issues where plans talk a big game about VBC but then don't really have resources to do the actuarial, data and contracting work? I'd be curious to hear people's thoughts in the comments below. #specialtycare #AHIP2024

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Proud to Share Another Strong Quarter for Sienna Senior Living! Our third quarter marked another period of progress and success as we continue to grow and strengthen our impact on senior living: 🔹 Operating results improved for the seventh consecutive quarter 🔹 Recent capital-raising initiatives were met with overwhelming demand from investors 🔹 Our recent $182 million acquisition in Alberta marks a successful step in our expansion, enabling us to serve even more seniors across Canada These accomplishments did not happen by chance. They are the result of a continued commitment to improving our operating platforms, strengthening team member engagement, and driving forward our growth strategies. As we expand the number of seniors we serve, we are more committed than ever to prioritizing team member engagement and retention as a cornerstone of our success. Our 12,500 team members are the reason why we can care for nearly 12,000 seniors, and as owners of the company, they are deeply aligned with Sienna's success. David H., Jennifer Anderson, Geoff McIlmoyle, CFA, CPA, CA, Teresa Fritsch, MBA, MA, ICD.D, Olga Giovanniello M.Ed, C.Dir., Adam Walsh, Nancy A. Webb and I look forward to continuing our growth trajectory with them.

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