America’s healthcare costs are astronomical and continuing to rise. How to solve this cost crisis is one of the most pressing challenges for our country today. By infusing more market forces into healthcare through value-based care, the U.S. can decrease costs while improving care quality.

The rules for hospital reimbursement are impressive. The Centers for Medicare & Medicaid Services (CMS) guidelines are sensible and easy to follow in a vacuum. The 4,000 plus page provider reimbursement manual outlines the what ifs in black and white: they are practical and implicit. The only problem? The overwhelming volume of best practices. It’s simply unmanageable at a certain point.

provider best practices

The transition to value-based care is further complicating the provider market’s approach and strategic plan to navigate the many impacts. Reimbursement, compliance, hospital quality scores, and the data used for ongoing patient care needs to be accurate and thorough. An organization’s ability to properly understand and manage the prospective payment system will determine which organizations survive and thrive.

This year’s AHIMA convention, one of the largest healthcare conventions in the country, took place in Miami, Florida. Let’s look at 4 key takeaways that speak to these concerns.

#1) Health IT companies are doubling down investments

The investments healthcare vendors have made to support the new reality are significant. Emphasis was on data storage and utilization. Prioritization models to streamline various revenue cycle functions were in abundance. Alert systems leveraging data that analyses work flow trends were heavily promoted. And over 90 percent of technology vendors have or are working towards a risk adjustment module and strategy.

#2) Staffing organizations are in wait and see mode

With all the changes taking place, human capital management firms are waiting to see what services will be most impacted by technology. At Harmony, we are exploring new areas of opportunity that we feel our clients will need while examining best practices for advising consultants on education and credentials to explore.

Other human capital organizations are weighing the opportunity cost of shifting focus which will largely be defined by provider adaptation.

#3) Early adapter providers exist, but are few and far between

Less than 15% of hospitals surveyed had active engagements focused on shifting reimbursement models. Despite not being the norm, early adapters do exist and are investing in data infrastructure and other strategies designed for the increased patient populations utilizing risk adjusted plans.

health information management

#4) The average provider is investigating

Most if not all other leaders were somewhere in the exploration stage. Finding more time to handle another initiative is a challenge for the clear majority. Other challenges include issues with data infrastructure, fragmented systems or lack of interoperability, finding someone or tasking a current leader to own a new process, identifying partners that will assist, budget and much more.

The challenge for providers and their service partners are many, and like most cases the providers have the biggest lift. It will take immense effort and require significant investment to successfully shift hospital cultures and change behavior and mindsets that have 30 plus years of reinforcement. My AHIMA takeaway; we don’t have all the answers as an industry, but we all know NOW is the time to start.

I am proud that we here at Harmony recognized this and acted early. Hospitals will always need expert staff in times of need, and we have a proven track record of success. That success allowed us to invest in subject matter experts that form our consulting practice with the primary focus of population health strategy.

Through our experience working with early adapters and through supporting our payer and consulting clients we’ve seen firsthand the potential impact the right strategy can have. To the many clients and consultants we saw in Miami—thank you! It is your talents, efforts, and energies that allow us to invest. Your belief in us is appreciated and inspiring.

We look forward to our continued partnerships and new relationships with the singular goal of being the service you can plug into for times of need and times of change.

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At Harmony Healthcare, we provide value-driven health information management leadership interim and consulting solutions that assist with change management, initiate strategic directives, and drive overall departmental performance.

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