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Health care is in need of innovation: new tools, devices, and processes that can improve clinical outcomes, patient experience, and the bottom line. Many large health systems are taking the lead in developing and commercializing creative ideas generated by their own clinicians and by outside inventors looking for a source of support.
Leadership talked with three innovation executives to learn more about the benefits, challenges, and transformative potential of such initiatives for health systems and for the industry in general:
Thomas J. Graham, MD, an orthopedic surgeon, is chief health strategy and innovation officer, Tavistock Group, and global chairman, Lake Nona Institute, Orlando. He is the author of Innovation the Cleveland Clinic Way: Transforming Healthcare by Putting Ideas to Work, which draws on his experience as chief innovation officer of Cleveland Clinic Innovations from 2010 through 2015.
Marc Probst is chief information officer and vice president, Intermountain Healthcare, Salt Lake City.
Michael Mirro, MD, is chief academic research officer, Parkview Health System, and director, Parkview Mirro Center for Research and Innovation, Fort Wayne, Ind.; and co-director of the Midwest Alliance for Health Education.
Graham: We launched the formal innovation function in 2000, but innovation was woven into the DNA of Cleveland Clinic from its founding in 1921, and it's given us so many firsts: from blood transfusion and kidney dialysis to cardiac valves and orthopedic implants. We've spun out 76 companies, hundreds of royalty- bearing licenses, and thousands of patent applications.
Recently, the big splash was Explorys, which we sold to IBM Watson. It's a massive database of deidentified information from across the entire healthcare ecosystem, combined with the world's most scalable performance management platform, which drives improvements in every aspect of medicine and care delivery.
Probst: Intermountain Healthcare is well-known for
best practices, and that has led to the development of what we call Care Process Models, which provide expert advice in the diagnosis and management of certain medical issues. They're not "recipes" but instead help clinicians optimize decision making. These are available, free of charge, on our website. However, we have collaborated with Cerner to develop two related services that we are in the process of commercializing now: software that automates the models and a consulting service to help people get the best possible results from their use.
We are also at the forefront of personalized cancer treatment through Intermountain Precision Genomics, which is capable of testing and providing treatment for the greatest number of actionable gene mutation types and which offers advanced next-generation sequencing.
Mirro: Historically we've focused on device and drug development, participating in multi-center trials. But we're also very committed to process improvement. For example, we received a grant from the Robert Wood Johnson Foundation to address adolescent depression and suicide, which is a major problem in Indiana, using telemedicine. We've already modeled some things we think have potential, so now we're in the process of testing them to see if adolescents will find them useful. And we are increasingly involved in medical informatics.
Probst: I think the best innovation comes from the people who actually do the work. We're finding that our clinicians are the ones who provide the most value to the industry. I can't see every hospital doing this—for some of them, it's just not part of their mission. But for those organizations that are larger, that have the resources, and, frankly, some of the most innovative and research-oriented clinicians, I think it's our responsibility.
Graham: The real advantage of conducting innovation in an academic medical center or other not-for-profit healthcare organization is that the "virtuous cycle" is at play. The crucible of ideation is the bedside or lab bench, but if there's no apparatus in place to nurture that idea, it probably gets shoved in a drawer or thrown away, so no one benefits. When the hospital is capable of seeing the idea through all the necessary stages—for example, engineering, prototyping, regulatory, legal, investment, and ultimate divestment as an external company of royalty-bearing license—that adjacency eliminates a lot of barriers. So that's why we developed a core competency in commercialization and corporate ventures.
Mirro: Our hope as a health system is that the research and testing we do will benefit our patients, that we improve their care by accelerating not only new product development and commercial ventures but also new process improvement innovations that enhance patients' experiences and outcomes in terms of health and economics.
For example, in this part of the state we have a cluster of orthopedic device companies that attracts start-ups in that field; those people come to us with their ideas to see how we can help them accelerate their success. This helps the region economically and may bring new technologies to our patients that they would not benefit from outside of an investigational setting.
Mirro: Having a clinical test environment—which includes a research center, a center for health innovation to screen and seed projects for Parkview staff, and an advanced simulation center—allows us to really accelerate the development of new products from within the health system. Compare this with a team of engineers that thinks of some innovative product but then has to look around for partners and make their invention a priority for someone else. We're focused internally on our 10,000 employees, but we have innovators from the outside come here to provide advice and referrals to community resources, because the state of Indiana is very focused on the health science space.
On the regulatory side, the key to getting approval in the shortest possible time is being able to identify regulatory barriers facing the particular type of device or product in question, and knowing how and in what order to approach those barriers. For example, a medication adherence app for either an iOS or Android platform may or may not need to get 510(k) approval, depending on how directly it influences the care of the patient. We know a lot about the [Food and Drug Administration] regulatory process because of the many device and drug studies we do, but we also use our academic partners at the Indiana University School of Medicine and their research technology center to advise us on tech transfer.
Probst: Having a champion in the C-suite is so important. At Intermountain, that's our CFO, Bert Zimmerli, who's my boss. He understands the financial benefits and risks of innovation, he really knows the industry, and he's personally made it happen. He brought in a small group of us to start the process five years ago, to develop guiding principles and an approach to spur more innovation in the organization; he brought in a vice president for innovation and growth to focus on this function exclusively; and he spearheaded the building of our Transformation Lab, which is all about inviting in new partners, sourcing new creative ideas, and bringing those ideas into the organization.
Now, Intermountain is a very conservative organization, so it wasn't like selling this idea to the rest of our leadership and board was smooth sailing. We had to do a lot of educating and discussing—Why does this make sense for us? What does it do for us as an organization?—and Zimmerli has been the leader all the way.
Graham: I'm a big evangelist for process. The difference between being creative and being innovative is putting ideas to work, and that's a nonlinear, arduous, long process. If you don't have the basic architecture or apparatus of innovation, the support system, you've got an uphill battle to move the needle. You need the basic building blocks:
You also need people who understand market needs, can identify potential investors, and know how to get a favorable deal structured.
Probst: It took Intermountain two to three years just to achieve a shift in attitude to where we will permit ourselves, as an organization, to be in a commercial venture outside of our core business and mission, which is care delivery. It wasn't so much a matter of resistance—the culture of innovation has been there all along—but we'd always given it away. We've had to work hard to build a business-oriented environment and a team that can take ideas from our busy clinicians and commercialize them.
We still believe in imparting our knowledge freely. But we've learned that for our innovators to be really successful, we need to invest money, and that we could actually do a better job of that if we charged for some of these things.
In tandem with that is building an expertise internally that allows us to identify powerful concepts, build prototypes, and find capital to move them forward. We're not experts yet, but we're making strides in the right direction. We're putting a basic foundation in place to make it possible for us to nurture ideas from inside and outside the organization.
Mirro: Sometimes we have difficulty identifying the right population to test a product or care path. Let's say we want to study a technological solution to problems facing lower-income patients with diabetes, such as sticking with a healthy diet and filling expensive prescriptions. Data mining the system for such a narrowly defined group can be challenging; for one thing, there are competing priorities for our technical and human resources. So we're working closely with our [information systems] team to come up with simpler analytic tools.
Another challenge is educating staff in what they need to do to bring an innovation to reality; most ideas come from the bedside, so we want to unleash the creativity of nurses and physicians. We provide entrepreneurial coaching—we're currently developing a more sophisticated curriculum—but it's a lot of hard work.
Graham: You know the fishing's always better in muddy water, and the seas of health care are certainly roiling now—we have to do better, help more people, and do it faster and with more fiscal responsibility. And I think innovation is going to be the margin of difference. Innovation is an amazing platform for collaboration—it can take former competitors and turn them into collaborators, it can take vendor-client relationships and turn them into partnerships—and we need to democratize it. If a hospital has invested in an innovation apparatus and a doctor working at a hospital across the street has a great idea, if they don't share, then everybody loses.
We did that very tangibly by developing the Global Healthcare Innovation Alliance, which has allowed Cleveland Clinic to share its capabilities with major universities like Notre Dame, commercial partners like Cox Media, and government- sponsored research centers like NASA.
There's also a real capital gap in innovation today. I have 50 patents, and each one cost more than $100,000 to develop and protect. It's a misconception that the venture capital or private equity community is just standing by to dole out money, especially at the pre-commercial level of funding, when you need a few thousand dollars to get something off the drawing board. Luckily, Ohio is a very forward state when it comes to business and had two funds that were very instrumental in the growth of CC Innovation: Ohio's Third Frontier Fund and Jobs Ohio gave critical capital at some of the hardest times.
Probst: I don't know that health systems or hospitals make the best vendors in the world. Our mission is health care—serving our communities and helping people live the healthiest possible lives—and vendors need to be more focused on how to generate revenue or, for those that are public, increase their stock value. We definitely add credibility to any of the products or services we might develop, but we'd rather have a vendor lead the commercialization part of innovation.
We invested in an incubator group called HealthBox, which provides a structured framework that helps employee inventors and entrepreneurs determine the commercial viability of their business concept, validate the market opportunity, identify product development or service needs, and develop a plan for growth, including go-to-market strategy and funding needs.
And we have a true collaboration with Cerner: We leverage their technology to automate our Care Process Models, and we're building pieces of that initiative specifically to fit into that technology. We will benefit from their customer base, and the software will help their customers—hopefully, both ships will rise.
Mirro: We have a very liberal intellectual property policy that ensures that Parkview inventors benefit financially—typically by licensing a new tool or idea to a commercial entity—with the health system taking a small piece of that to help renew the seed-funding process. For example, an algorithm or pathway to manage a chronic disease might have tremendous value for a large private payer, which could really put the innovation on steroids and launch it.
We look at clinical outcomes but also, particularly with process improvement, at economic outcomes. A product might not have a direct health benefit as far as reduction of mortality, but it might improve the patient and family experience and provide an economic benefit in the form of cost avoidance.
And, of course, our involvement in so many clinical trials spurs creativity among our physicians and other clinical staff.
Probst: The biggest benefit for Intermountain is not yet financial, nor is that the primary reason we got into innovation. We got into it to create an attitude and an excitement around innovating, because we believe that fostering innovation and supporting people who come up with better ways to provide care and better tools is a major part of health care—and that's the best thing we're getting out of it.
It also starts to get us into the right circles. People are approaching us now who may not have approached us in the past. New start-up organizations that have exciting solutions are coming to us and asking us to work with them. We bring them in, we pilot their inventions, we share ideas on how to improve them, and that's really helping us provide better care.
For example, there's a company called Velano Vascular that's created a needle- free device that fits into a port so you can draw blood from a patient whenever you need to and do other things that typically involve needlesticks. We tested early versions of the product, we gave them feedback, and we're piloting it now in three hospitals. My bet is we're going to be a big-time user of this device, and that's great for our patients. We won't benefit financially in a direct way but indirectly in many ways.
Another example is Sotera Wireless. We've been working on and off with them for four years on a wearable vital-signs- monitoring device. We believe this could be successful, and we could realize some financial benefit from that eventually, but, again, we got engaged with the company because we came to feel strongly that this was a good thing for patient care.
Graham: Innovation can be a great way for a hospital to augment its bottom line with nonclinical revenue—royalty-bearing licenses, sales to companies, spin-off companies. And if somebody's ideas make a difference to the bottom line, that boon should be shared. We've returned $90 million to on-campus inventors since 2000, writing seven-figure checks to some of them. That's a very powerful incentive and a very powerful recruitment and retention tool—and an amazing advantage for our organization.
The patients win, they get the newest therapy; the inventor wins, the institution wins, and chances are some jobs are created.
Lauren Phillips is president of Phillips Medical Writers, Ltd., Bellingham, Wash., and a frequent contributor to Leadership.
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
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This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
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Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
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Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
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Providers Focus Too Much On Revenue Cycle Management
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Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
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Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
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Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
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Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
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Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
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Therapy: Benefits at All Levels of Care
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