CCM CoP

Community of Practice

Increase Profitability

The challenge for any care provider running their own practice is to focus on keeping their current patient base satisfied whilst working towards attracting new patients to ensure probability of business. This section aims at proving actionable insights and best practices to primary care providers and hospitals wishing to increase their profitability by reducing costs, increasing revenue and reimbursements.The guidelines described in this section will help practices put mechanisms in place to improve efficiency for physicians, nurses, and support staffto deliver person-centred care whilst making initial investments in technology to support these initiatives and reducing unnecessary costs that can help generate greater profitability and enhance patient acquisition. To summarise, the aim of this CoP is to provide adequate and evidence-based information and case studies that can help chronic care providers to find creative solutions to problems that plague their care businesses.
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Keys to Effective Remote Patient Monitoring in the COVID-19 Pandemic

Keys to Effective Remote Patient Monitoring in the COVID-19 Pandemic

COVID-19 has impacted our health system in some very clear ways and in ways that we are only beginning to predict the longer term impacts. It has led to exhausted clinicians, delayed care or treatment

Managed Care – A Path to the Future

Managed Care – A Path to the Future

Despite MCOs’ efforts to improve the quality of care delivery over the past four decades, the value-based care revolution that was supposed to usher in a new era of better, cheaper healthcare has not

Automating 'High Level' Healthcare Tasks Can Create High Value Savings

Automating 'High Level' Healthcare Tasks Can Create High Value Savings

With the recent influx of data across the healthcare industry, the time to fully implement artificial intelligence and machine learning are now, according to Brandon Sim, the chief technology officer,

Leveling Up Your Telehealth Strategy: How to Evolve for Long Term Growth

Leveling Up Your Telehealth Strategy: How to Evolve for Long Term Growth

For organizations that launched a solution early or embraced their existing telehealth solution as a lifeboat to survive the pandemic, it may be time to take a step back and assess your strategy to

Intelligent Automation: Helping Deliver Better Healthcare

Intelligent Automation: Helping Deliver Better Healthcare

Years before the pandemic, many hospitals were already facing a crisis. They struggled to manage operational inefficiencies and, as a result, unnecessary expenses, overworked and stressed staff, and

Consumers Want a Better Way to Pay for Healthcare

Consumers Want a Better Way to Pay for Healthcare

“Physicians and health systems lost billions in revenue during the first few months of 2020, and barriers to positive consumer experiences, like unwieldy payment processes or handwritten registration

The Four Steps You Must Take to Prepare for Price Transparency

The Four Steps You Must Take to Prepare for Price Transparency

Under the Affordable Care Act (ACA), hospitals are required to publish “list prices” for all their procedures, which in theory would allow patients to shop around for the lowest price for a given

11 Best Practices of a Successful Care Model Transformation Plan

11 Best Practices of a Successful Care Model Transformation Plan

Health systems across the country will require a plan to react to government deep spending cuts and revenue shortfalls due to the COVID-19 pandemic. Hospital services have seen a significant downturn

New business: Succeeding With a CCM Program via Effective Patient Enrollment …

New business: Succeeding With a CCM Program via Effective Patient Enrollment Strategies

Value-based care is defined and measured by dividing patient health outcomes by the cost of achieving those outcomes. Simply, it is the cost of keeping someone healthy. For too long, our industry has

Why Back-Office Systems Are More Critical to Healthcare Providers Today Than …

Why Back-Office Systems Are More Critical to Healthcare Providers Today Than Ever Before

The financial plight of healthcare providers amid the Covid-19 pandemic makes it more imperative than ever for HCPs to modernize their back-office systems in order to improve visibility and efficiency

Three Trends That Will Drive Healthcare Revenue in the Future

Three Trends That Will Drive Healthcare Revenue in the Future

Most notably, provider organizations will notice a shift in revenue from the general hospital to more specialized care sites, experts wrote.“Care is already shifting away from hospital-based settings

How Banner Health Modernized Its Revenue Cycle

How Banner Health Modernized Its Revenue Cycle

"Protecting our staff and pushing things to work from home was a big focus and continues to be a refining focus in 2021. Banner continues to grow and acquire, so that keeps us busy. The patient

Providers Overhauling Patient Collections Strategies for COVID-19

Providers Overhauling Patient Collections Strategies for COVID-19

Hospitals and health systems are finding that their patient collection strategies must be more flexible to accommodate evolving patient needs. The survey found that 70 percent of providers have

What Are Capitation Reimbursement Models, Key Strategies?

What Are Capitation Reimbursement Models, Key Strategies?

Compared to traditional fee-for-service models, which pay physicians for the volume of services provided, capitation models pay physicians a fixed amount per patient, per unit of time, whether or not

How to Improve Collections and Patient Satisfaction With Contactless Payments

How to Improve Collections and Patient Satisfaction With Contactless Payments

Social distancing measures and fears about face-to-face contact prevent many patients from visiting healthcare facilities, and it’s becoming harder for providers to collect payments and maintain a

How Digital-First Payments Create More Transparent Patient Experiences

How Digital-First Payments Create More Transparent Patient Experiences

According to the report, 4 in 5 patients end up confused or frustrated when paying for healthcare services, and they blame both providers and health insurers, signaling that it’s time for tech

Healthcare Consumerism Will Be the Driving Force Post-COVID-19

Healthcare Consumerism Will Be the Driving Force Post-COVID-19

Healthcare cost, quality, and convenience are the driving forces for healthcare consumerism—or how patients use information and technology to make informed decisions. Today’s environment has pushed

Using Telehealth to Enable Value-Based Care

Using Telehealth to Enable Value-Based Care

When it comes to developing competencies to prepare for value-based care, an overwhelming number of healthcare executives (81%) responding in a new HealthLeaders intelligence report say building their

Three Ways Digitization Is Changing Healthcare Payments

Three Ways Digitization Is Changing Healthcare Payments

The irony of receiving telemedicine or a high-tech treatment—and then getting a paper bill in the mail—is not lost on patients. In terms of medical innovation, the US healthcare industry leads the

Post COVID-19: Medical Billing Finally Realizes the Value of Text-to-Pay

Post COVID-19: Medical Billing Finally Realizes the Value of Text-to-Pay

Although today’s consumers are used to accomplishing almost anything via an app on their phone or online, it is common for health systems to rely on legacy channels to communicate with patients and

How Real-World Providers Are Confronting the Shift to Value-Based Care in the …

How Real-World Providers Are Confronting the Shift to Value-Based Care in the COVID Era

The core principle driving the value-based care movement is that by focusing on a defined set of key variables and continually benchmarking performance against those criteria, organizations will start

How to Deal With Prior Authorization in Medical Billing

How to Deal With Prior Authorization in Medical Billing

The trick to a successful pre-authorization is to have the correct CPT code. The obstacle is that you must determine the appropriate procedural code before the service has been rendered (and

Transforming the Prior Authorization Process to Improve Patient Care and the …

Transforming the Prior Authorization Process to Improve Patient Care and the Financial Bottom Line

One of the biggest challenges in providing timely care to patients is prior authorizations. An American Medical Association (AMA) survey of 1,000 practicing physicians found that 86% described the

Consumer Decision Making in Healthcare: The Role of Information Transparency

Consumer Decision Making in Healthcare: The Role of Information Transparency

While rising customer expectations are driving new business models, increased choice pressure is also affecting existing healthcare systems. Increased price transparency is driving more pricing

How to Calculate the Elusive ROI for Care Management

How to Calculate the Elusive ROI for Care Management

We know that successful care management programs require significant investments in personnel, IT support, and collateral resources to support cross-continuum care coordination and ongoing quality

The Importance of a Clinically Driven Revenue Cycle to Improve Outcomes and the …

The Importance of a Clinically Driven Revenue Cycle to Improve Outcomes and the Bottom Line

In a busy ED where physicians see a broad cross-section of conditions, this can be challenging. But this one decision can have significant ramifications on the hospital’s bottom line. The problem

Driving Patient Financial Experience to Boost Consumer Satisfaction

Driving Patient Financial Experience to Boost Consumer Satisfaction

In order to achieve good financial experience, healthcare organizations need to invest in data and price transparency, as well as digital tools that streamline the patient access and intake process,

Scale, Efficiency Key to Provider Success in 2021 and Beyond

Scale, Efficiency Key to Provider Success in 2021 and Beyond

The number of facilities and square footage a system like UW Health needs for in-person care will look different and likely smaller in 2021, Flannery explained.COVID-19 had a significant impact on the

Strategizing to Overcome Volume Deficits and Maintain a Healthy Revenue Cycle in …

Strategizing to Overcome Volume Deficits and Maintain a Healthy Revenue Cycle in 2021

When it comes to revenue cycle management (RCM) — during COVID-19 or normal times — it’s important to remember some best practices, on the payer and patient side, that make groups profitable.

Using the Patient Portal to Support Healthcare Consumerism

Using the Patient Portal to Support Healthcare Consumerism

When high-deductible health plans became more prevalent ten or so years ago, patients began to assume more of their healthcare bills. And with that, they assumed the role of not just the patient but

Six Tips to Improve the Patient Financial Experience

Six Tips to Improve the Patient Financial Experience

If your health system doesn’t embrace self-service digital payments, it will be left behind.According to a Pew Research study, 77 percent of Americans own a smartphone, and 88 percent of Americans use

Revamping Patient Engagement and Collections — Digitally

Revamping Patient Engagement and Collections — Digitally

Imagine if simply scanning a QR code on a hospital billing statement could give patients instant access to an avatar that could explain each aspect of the statement in detail, from the portion paid by

Decrease Costs and Increase Revenue by Proactively Avoiding Denials

Decrease Costs and Increase Revenue by Proactively Avoiding Denials

Getting paid for clinical services should be a straightforward process. You capture the patient’s insurance, verify eligibility and obtain the needed pre-cert or prior authorization. Then you see the

More Ways AI Can Boost Both Patient and Provider Experience

More Ways AI Can Boost Both Patient and Provider Experience

DrFirst President Cameron Deemer explains how practical machine learning applications can help improve safety and efficiency – automating medication history in hospital EHRs and aggregating patient

Best Practices for Optimizing Revenue Cycle Management: Why Credentialing …

Best Practices for Optimizing Revenue Cycle Management: Why Credentialing Matters

While the primary focus remains on keeping patients healthy and safe, today’s providers are continually challenged with attending to the business side of their practice, too.For many practices,

Automating Revenue Cycle on the Back End Improves Patient Engagement on the …

Automating Revenue Cycle on the Back End Improves Patient Engagement on the Front

Revenue cycle directors see a clear path for automation to increase revenue, decrease denials, speed up prior authorization and claims, and remove many of the repetitive clicks that hamper daily

The Business Drivers for Telehealth After the Pandemic

The Business Drivers for Telehealth After the Pandemic

The surge in telehealth brought on by COVID-19 catalyzed an era of care distribution and decentralization powered by care delivered outside the traditional healthcare facility.Business models that

Robust Billing Software Can Maximize Reimbursements, Keep Practices Honest

Robust Billing Software Can Maximize Reimbursements, Keep Practices Honest

Billers and coders play critical roles in patient care, making sure that claims are correct and properly submitted so the practice, ambulatory care center, rehab center, hospital, or other providers

Intelligent Automation of the Revenue Cycle: How an Integrated Platform Approach …

Intelligent Automation of the Revenue Cycle: How an Integrated Platform Approach Yields Financial Results

In this rush to invest in automation and digital solutions, providers are often overlooking how a multi-layered technology approach can increase value realization. They need intelligent automation

What Does a Hybrid Telehealth Care Model Look Like?

What Does a Hybrid Telehealth Care Model Look Like?

Hybrid healthcare has been predominant during the pandemic, and telehealth has shown great promise in bringing cost-effective healthcare to regions and communities that otherwise might have had less

Key Considerations for COVID-19 Vaccine Billing and Coding

Key Considerations for COVID-19 Vaccine Billing and Coding

For many providers, the end of the pandemic is in sight with the recent emergency use authorization of a COVID-19 vaccine. And while this may be true, it is just the start of a COVID-19 vaccine

Patient Financial Experience Hinges on Patient-Centered Billing

Patient Financial Experience Hinges on Patient-Centered Billing

Currently, patients are struggling under high—and often confusing—healthcare bills. More than half of the 1,000 survey respondents said they had received a surprise medical bill, a bill a patient did

CMS Clarifies 2021 PFS Reimbursements for Remote Patient Monitoring

CMS Clarifies 2021 PFS Reimbursements for Remote Patient Monitoring

In the final rule, to qualify for reimbursement under CPT codes 99457 and 99458, CMS mandated at least 20 minutes of interactive communication time between provider and patient over a calendar month,

Hospital, Health System Financial Leaders Want Automation Tools for Revenue …

Hospital, Health System Financial Leaders Want Automation Tools for Revenue Cycle Management

A majority of chief financial officers and revenue cycle leaders at hospitals and health systems across the U.S. think automation tools should be designed specifically for healthcare revenue cycle

How Does CRM Provide Strategic Insights to Drive Business Value?

How Does CRM Provide Strategic Insights to Drive Business Value?

In an increasingly competitive environment, customers are getting spoilt for choice with a bouquet of products and services to choose from. Customers have become more discerning and demanding than

Recovering From COVID-19: How Practices Can Maintain the Revenue Cycle in 2021

Recovering From COVID-19: How Practices Can Maintain the Revenue Cycle in 2021

As a result of the COVID-19 pandemic, the American Hospital Association (AHA) estimates that hospitals and health systems have lost more than $202 billion from a drop in revenue, combined with

When Your Dots Don’t Connect: How to Bring Your Virtual Care Strategy Into Focus …

When Your Dots Don’t Connect: How to Bring Your Virtual Care Strategy Into Focus

The variety of ways healthcare practices interact with patients is now catching up with how people communicate with each other. Gone are the days of telephone reminders and snail-mail. Healthcare is

How Mayo Clinic’s Data Liquidity Strategy Succeeded Despite COVID-19

How Mayo Clinic’s Data Liquidity Strategy Succeeded Despite COVID-19

Mayo Clinic began exploring use cases for artificial intelligence in 2017. An internal work group identified more than 200 activities using AI or machine learning (ML) technology for patient care,

How to Improve Revenue Cycle Management: Five Tips

How to Improve Revenue Cycle Management: Five Tips

As the world continues to battle Covid-19, its effects on population health are just one facet of the crisis. The economic fallout is also seriously impacting both people and businesses, including

Risk-Based Agreements: Good for Business, Patients

Risk-Based Agreements: Good for Business, Patients

As the COVID-19 pandemic has deepened the financial and psychological challenges for practices, the idea of taking on the risk of a value-based care model may seem like an incredibly high hurdle in

EHR-Integrated Patient Engagement Improves Access to Care — And Generates …

EHR-Integrated Patient Engagement Improves Access to Care — And Generates Revenue

While new rules for interoperability should have an impact, providers can get ahead of the game now by implementing EHR-integrated solutions that not only help the flow of patient data between

Leveraging Multiple Data Streams to Accelerate Reimbursement and Enable Agile …

Leveraging Multiple Data Streams to Accelerate Reimbursement and Enable Agile Operations

The pre-billing process during which the hospital, EMS agency, or physicians group financially clears the patient shouldn’t require one or more full-time billing specialists submitting and re-

Best Practices for Physicians in Adopting Compliant and Efficient Data Sharing

Best Practices for Physicians in Adopting Compliant and Efficient Data Sharing

To stay relevant and survive in the industry, independent physicians must invest in compliant, data-sharing technologies to improve their practices. There are several reasons why independent

Breaking From Traditional Healthcare Budgeting During Modern Times

Breaking From Traditional Healthcare Budgeting During Modern Times

As the pandemic has underscored, healthcare is not static. Providers must be able to adapt to emerging and oftentimes complex changes in healthcare, like value-based care, competition from new players

It’s Time for Healthcare to Adopt Modern KYC (Know Your Customer) Data Practices

It’s Time for Healthcare to Adopt Modern KYC (Know Your Customer) Data Practices

‘Know Your Customer’ is a critical part of today’s financial regulatory environment to verify its consumers' identity to prevent banks from being used by criminal elements for money laundering

Striking the Right Balance Between In-Person Care and Telehealth Services

Striking the Right Balance Between In-Person Care and Telehealth Services

With the recent surge in telehealth services utilization, Chris Waugh, chief innovation officer at Sutter Health, has been facing a question that many leading health professionals are asking: how can

With Telehealth Here to Stay, Healthcare Looks to Sustain It Through Patient …

With Telehealth Here to Stay, Healthcare Looks to Sustain It Through Patient Engagement

Telehealth adoption has skyrocketed during the COVID-19 pandemic, and with good reason: Patients are hesitant to venture into brick-and-mortar care settings, yet they have health needs that must still

Automation in Health Systems and How It Can Be a Solution per Amy Dirks Stevens …

Automation in Health Systems and How It Can Be a Solution per Amy Dirks Stevens of AVIA

MHE's Briana Contreras spoke with Amy Dirks Stevens, EVP of Digital Strategy Performance and Practice Lead at AVIA health, for this week's episode of Tuning Into the C-Suite. The two talked about

How Time-Driven Costing in Healthcare Boosts Staffing, Revenue Cycle

How Time-Driven Costing in Healthcare Boosts Staffing, Revenue Cycle

Time-driven costing in healthcare is a methodology that calculates the costs of resources consumed as a patient moves through the care process. The strategy has gained popularity among hospital

Improving Coding Processes to Achieve Value-Based Care Success

Improving Coding Processes to Achieve Value-Based Care Success

Value-based care is about efficiently providing the most cost-effective yet highest quality care that improves patient outcomes. There are a number of studies showing that physicians in value-based

Turning Patient Cancellations Into Revenue

Turning Patient Cancellations Into Revenue

The internet has changed the way all industries do business. It has permitted consumers to give direct and instant online reviews on various products and services. This allows suppliers to learn and

Transitioning to Value-Based Care

Transitioning to Value-Based Care

Although risk-based care contracts have existed for many years, primary care doctors have been reluctant to embrace them. But with careful planning, these contracts can offer medical practices the

New Payment Model Will Advance Regional Value-Based Care

New Payment Model Will Advance Regional Value-Based Care

According to a news release, the Geographic Direct Contracting Model will see participants taking responsibility for the patients’ health outcomes, which will give them a direct incentive to improve

Medicare Bundled Payments

Medicare Bundled Payments

In this webinar, we discussed the Medicare bundled payment programs, specifically BPCI and CJR, and determined how these programs are influencing providers and their delivery of care. We explored the

The Future of Healthcare Reimbursement Hinges on the Aligned Incentives, …

The Future of Healthcare Reimbursement Hinges on the Aligned Incentives, Actionable Data of Value-Based Care

Over the past several years, healthcare has been slowly but surely moving toward the adoption of value-based care. As the industry enters a new decade, the transition is finally picking up speed.

How to Derive Value From the Data in Your EHR

How to Derive Value From the Data in Your EHR

Why are hospitals and health systems seeing mediocre results from their EHR analytics component? And what should they do to chart a path forward to gain the right organization-wide insights they need

In the Uncompensated Care Pandemic, AI Is a Potent Antidote

In the Uncompensated Care Pandemic, AI Is a Potent Antidote

Unfortunately, the problem of uncompensated care will only get worse as the pandemic progresses and its economic toll worsens. In the first half of 2020, 43% of Americans were uninsured, had gaps in

Predictive Healthcare Forecasting Key to Provider Survival in 2021

Predictive Healthcare Forecasting Key to Provider Survival in 2021

Nearly three-quarters of healthcare executives (74 percent) recently surveyed by the Health Research Institute said their organizations would invest in more predictive modeling in 2020, they explain

Digital Health Is Central to Value-Based Payment Strategies

Digital Health Is Central to Value-Based Payment Strategies

​Admittedly, over the past decade, the transition to value has been slower than initially projected. However, COVID-19 has made it clear the time for value is now—and payers are taking notice. CMS has

Why Providers Need Analytics to Prepare Today for the Aftermath of the …

Why Providers Need Analytics to Prepare Today for the Aftermath of the Coronavirus

The goal, if possible, is to bring healthcare back to some semblance of its pre-coronavirus activity. As my colleague, Mary Lou Mangan-Lamb wrote recently: “As providers determine how to get patients

Interoperability Breakthroughs to Advance Value-Based Care and Improve Clinical …

Interoperability Breakthroughs to Advance Value-Based Care and Improve Clinical and Financial Outcomes

Interoperability in healthcare is at an inflection point. Great progress has been made, but many challenges remain that limit stakeholders’ ability to fully optimize the delivery of quality, value-

6 Strategies for Effective Healthcare Marketing in a Post-COVID World

6 Strategies for Effective Healthcare Marketing in a Post-COVID World

The idea of returning to pre-COVID conditions is becoming less plausible by the day. Nearly every business model has had to transform seemingly overnight, and hospitals and health systems are center

The Health System of the Future Will Be Consumer-Centric, Wellness-Oriented and …

The Health System of the Future Will Be Consumer-Centric, Wellness-Oriented and Digitally Connected

While the pandemic has presented many adversities, it has also introduced growth opportunities to enhance companies' performance, leading to the acceleration of new customer engagement models and

Take Your Telehealth Program to the Next Level

Take Your Telehealth Program to the Next Level

Before COVID-19, fewer than 1 percent of Providence patients were using virtual platforms for visits — yet that number grew to more than 60 percent during the first wave of COVID-19, Vaezy said.

Real-Time Data Improves Care Coordination, Value-Based Care

Real-Time Data Improves Care Coordination, Value-Based Care

Patients can easily become lost in the healthcare system. A patient moving from the emergency department to an inpatient hospital stay then to a specialist, and finally following up with their primary

COVID-19 and the Future of Evidence-Based Medicine

COVID-19 and the Future of Evidence-Based Medicine

COVID-19 exacerbated the global need for reliable healthcare information while shrinking the timeline for creating it due to unparalleled urgency. In response, many health care publications have

Using Telehealth to Enhance Current Strategies in Alternative Payment Models

Using Telehealth to Enhance Current Strategies in Alternative Payment Models

In particular, telehealth may play an increasingly important role in alternative payment models (APMs) that are designed to improve quality and contain costs through better coordination. Telemedicine

Post-COVID Health Care - The New Normal or the Corrected Normal?

Post-COVID Health Care - The New Normal or the Corrected Normal?

The point of care has increasingly been switched from hospitals to homes or to other places the patient requires help. We have seen a quick surge in hospitals and medical centers using telehealth

Looking to 2021: Why We Need to Focus on Virtual Care

Looking to 2021: Why We Need to Focus on Virtual Care

If 2020 taught us anything, patient access to virtual healthcare is no longer a “nice to have” innovation for the future but rather a paramount necessity of the present. The worldwide outbreak of the

Four Moves to Grow Share and Capture and Deliver Value… Even During a Pandemic

Four Moves to Grow Share and Capture and Deliver Value… Even During a Pandemic

Amidst the COVID-19 crisis, the U.S. healthcare system has struggled to safeguard lives and suppress the virus while buckling under financial strains, low consumer confidence, and the burden of

Telehealth Reimbursement Just for Value-Based Providers Post-COVID?

Telehealth Reimbursement Just for Value-Based Providers Post-COVID?

Clinicians in A-APMs that include financial risk for total Medicare spending and quality of care would be able to leverage most telehealth expansions, including higher payment rates for telehealth

CMS Proposes Rule to Streamline Prior Authorization, Data Exchange

CMS Proposes Rule to Streamline Prior Authorization, Data Exchange

The Centers for Medicare & Medicaid Services (CMS) proposed a new rule aiming to boost patient data exchange and streamline prior authorization to alleviate clinician burden. Additionally, the rule

Reimagining the Healthcare Supply Chain to Bolster Resilience and Efficiency

Reimagining the Healthcare Supply Chain to Bolster Resilience and Efficiency

Supply chain leaders are reconsidering the industry-standard just-in-time inventory model, which dictates that supplies be delivered essentially on a daily basis to sites across a health system.The