Gleneagles Hospital Hong Kong’s Post

In the ever-evolving landscape of #healthcare, providers face an ongoing challenge: keeping up with the stringent policies and processes set forth by payers. Ashley Brown, our senior director for RCM, joins HomeCare Magazine to share 5 ways to expertly navigate the changing landscape of healthcare payer policies: https://shorturl.at/qPYXM 

The latest from AHA Market Scan: Payer Denial Tactics — How to Confront a $20 Billion Problem The high cost to health care providers to obtain reimbursement from insurers shows no signs of abating. A recent report from the group purchasing and consulting organization Premier highlights the long-standing problem. The Premier findings track with the AHA's most recent survey that was conducted between December 2021 and February 2022. In that survey, 78% of hospitals reported that their experience with commercial payers was getting worse. https://lnkd.in/grXwTfa9

What cardiologists should expect as U.S. healthcare payment models evolve - “By 2030, we’re looking at a landscape where two-thirds or more of our patient population as cardiologists will be engaged in ACO relationships, either through privatized Medicare or traditional Medicare,” explained Dan Blumenthal, MD, MBA, chief quality officer at Cardiovascular Associates of America and a cardiologist at Massachusetts General Hospital. #healthcareinnovation #healthcare #valuebasedcare #valuebasedhealthcare #vbc #managedcare #employeehealth #employeebenefits #payor #providercredentialing #providercontracting #providerrecruitment #providers #directprimarycare #cigna #cignahealthcare #evernorth #evernorthaccountablecare #WeAreTheCignaGroup #StrongerTogether #zulahealth #healthininsurance #healthcare #managedcare #coordinatedcare #alternativepaymentmodels #insurance #revenuecycle #healthcarenew #ACO #VBC

Regional and rural hospitals face a harsh set of circumstances different from major metropolitan areas. Among them is their typically geographically widespread patient base, who travel from other areas seeking care. In the complex landscape of healthcare billing, regional hospitals must navigate intricate coding, insurance requirements, and evolving reimbursement rules. With adequate training, these challenges can be overcome, and the health of the organization improved. Learn more about billing training for rural hospitals: https://bit.ly/47kNq3X #FQHC #MedicalBilling #Healthcare #RegionalHospital #RuralHospital #MedicalBilling #Training

Patient engagement with healthcare is a strong predictor of health outcomes and care satisfaction. This is an important target for all healthcare providers, but especially for rural healthcare providers where access to care is scarce. Ensuring quality healthcare means assessing how patients engage with their care and areas for improvement. This is a great example of how technology can reach patients at home to improve their care in-person! At Sparta Community Hospital in rural Illinois, “the hospital’s average no-show rate was nearly 15%, about 25% higher than the average in the field.” Through a one-way messaging platform the hospital was able to share reminders and information with patients at home. The AHA reports that “since implementation, the hospital has reduced no-show rates from 15% to 9%, the hospital reports. In addition, it has seen a 50% reduction in the burden on clinical staff since launching the platform.” Digital healthcare can be a powerful tool — when it’s coupled with an equally powerful purpose. By boosting patient engagement, especially in areas of healthcare need, patients can receive better quality care. #RuralHealthcare #PatientEngagement #DigitalHealthcare

Prior authorizations and denials delay care delivery and frustrate clinicians within the fee-for-service model. But within value-based models, the payers and providers have the opportunity to create a new method for healthcare delivery with the same incentives.

Direct primary care (#DPC) has made healthcare --> SIMPLE for patients. 🏥✨ The way it should be... S-traightforward 🛣️ Direct Primary Care (DPC) offers a straightforward approach to healthcare. Patients pay a fixed monthly fee directly to their primary care provider, eliminating the complexities of insurance claims, co-pays, and hidden fees. This transparency fosters trust and allows patients to focus on their health without worrying about unexpected costs. I-ndividualized 👤 DPC provides individualized care tailored to each patient’s unique needs. Physicians in DPC practices have more time to spend with each patient, allowing for comprehensive and personalized treatment plans. This individualized attention ensures that patients receive the best possible care for their specific health concerns. M-inimal Bureaucracy 🗂️ By cutting out the middleman, DPC significantly reduces the administrative burden on healthcare providers. This minimal bureaucracy means doctors can spend more time with patients and less time on paperwork. The streamlined process leads to a more efficient and satisfying healthcare experience for both patients and providers. P-reventive Focus 🩺 DPC emphasizes preventive care, aiming to keep patients healthy rather than just treating illnesses as they arise. Regular check-ups, wellness plans, and proactive management of chronic conditions are integral parts of the DPC model. This preventive focus helps patients maintain optimal health and reduces the likelihood of serious health issues in the future. L-ong-term Relationships 🤝 DPC fosters long-term relationships between patients and their primary care physicians. These relationships are built on trust, familiarity, and ongoing communication. A continuous doctor-patient relationship leads to better understanding, improved health outcomes, and a more personalized care experience over time. E-fficient Care ⚡ DPC ensures efficient care by reducing wait times and providing easier access to healthcare services. Patients can typically get same-day or next-day appointments, communicate directly with their doctors via phone or email, and receive timely care when they need it most. This efficiency reduces stress and ensures that patients' health needs are promptly addressed. Thank you all DPC providers for taking the path less travelled. #directprimarycare #directsurgicalcare #directspecialtycare #healthcare

As payers continue to remove prior authorization requirements for specific procedures, it's crucial for #healthcare providers to stay ahead. Discover how #Experian Health can help providers stay updated with ever-evolving payer requirements and streamline prior authorization processes. #Experian

Provider appeals are a critical challenge for hospitals, with many facing difficulties in recovering rightful reimbursements. A recent Becker's Healthcare article shed light on this issue, highlighting the financial strain ($43.84 per denial) it places on healthcare institutions. At Crosby Health, we've responded to this challenge by developing an operating system specifically designed for the complexities of provider appeals. Our system leverages data from hundreds of thousands of medical records and direct submission to major insurance companies, streamlining the process and improving success rates. For those interested in learning more about our approach and how it can benefit your hospital, we're here to provide insights and discuss potential solutions. #RevenueCycleManagement, #Healthcare, #ProviderAppeals, #MedicalBilling, #HealthTech, #CrosbyHealth, #InsuranceClaims

"Addressing Overutilization: Challenges in Healthcare Efficiency" The challenge of overutilization of health services is a significant issue in healthcare systems worldwide, leading to unnecessary costs, resource strain, and potential harm to patients. Here’s a breakdown of the key aspects of this challenge: ### 1. **Increased Costs** - Overutilization leads to increased healthcare spending without corresponding improvements in patient outcomes. This includes unnecessary tests, procedures, and hospital stays that inflate healthcare costs and burden insurance systems and patients financially. ### 2. **Resource Allocation** - Unnecessary use of medical resources diverts them from patients who need them more critically. This can lead to shortages and reduced access to essential healthcare services for other patients, impacting the overall efficiency and equity of the healthcare system. ### 3. **Patient Safety and Quality of Care** - Overutilization can expose patients to unnecessary risks, including side effects from medications, complications from surgeries or procedures, and exposure to infections in a hospital setting. Each unnecessary intervention carries a risk of harm that might outweigh potential benefits. ### 4. **Diagnostic Cascade** - Unnecessary tests can lead to more unnecessary tests, a phenomenon known as the "diagnostic cascade." False positives or incidental findings can lead to further investigations that compound the risks and costs without improving patient outcomes. ### 5. **Insurance Premiums and Coverage Limits** - Overutilization can drive up insurance premiums as providers attempt to cover higher costs. This can make healthcare less affordable and accessible, especially for underinsured or uninsured populations. ### 6. **Provider Burnout** - Increased demand for unnecessary procedures and tests can contribute to healthcare provider burnout. This is due to increased workload and the moral distress associated with providing care that may not be medically justified. ### 7. **Patient Expectations and Education** - Patient demand and expectations for thorough and immediate interventions, often influenced by a lack of understanding of medical processes or by information from unreliable sources, can pressure physicians to order more services than medically necessary. ### 8. **Regulatory and Legal Pressures** - Healthcare providers may practice defensive medicine by ordering additional diagnostics or treatments to protect against potential malpractice lawsuits, rather than because they are clinically indicated.