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Optimal Financial Outcomes

q_iconQualVal brings experience and expertise to the transition to value-driven health care, now empowered with the analytics of QualOptima. As organized medicine prepares for performance-based payment with precise clinical performance metrics, providers face the strategic imperative to engage in the cost and quality relationship – in operations, clinical processes, and their impact on financial outcomes. The economic consequences of the cost of health care are forcing America to change dramatically and with more velocity, creating the urgent need of providers to adopt new strategies relying on the technology of QualOptima.

Value-Driven Quality-Cost Data Analytics

QualVal is a pioneer in relating clinical performance to financial performance, consulting on value as the relationship between quality (including patient safety) and cost. Hospitals and physicians have focused on optimizing billing; but now the emphasis rapidly shifts to value-based purchasing of medical services. Analytics of the QualOptima system are designed with this expertise embedded to provide value-based actionable insight.

Gains from increased patient volume based on the healthcare organization’s quality brand and patient-factored care, increased efficiency and productivity, maximized payer relationships, and reduction of unnecessary costs, as well as optimized billing are achieved with QualOptima.

Transitioning to Performance-Based Payment Metrics

In anticipation of performance-based payment, organized medicine is rapidly defining clinical performance metrics with precise definitions of numerators and denominators. QualVal experts are actively engaged from every medical specialty in these metrics embedded in QualOptima. Implementing these measures of performance as they relate to outcomes is critical to optimal clinical processes and ultimately to value-driven income.

Intelligent Systems to Reduce Patient-Care Costs

Predictive modeling from the QualOptima system provides patient management strategies to reduce patient-care costs. For example, the success story from the Clinical Trial at the University of Miami demonstrates how identifying patients at risk from intra-operative body temperature variation and post-operative nausea & vomiting (PONV) are identified for specific care protocols. Equally dramatic are the savings from reducing costs of managing patients vomiting in PACU recovery. These savings opportunities built into optimal clinical processes of care with insight from data, including individualized patient risk factors, and predictive patient modeling are expert consulting opportunities for QualVal with our clients. Coming upgrades and applications focused on real-time patient management will advance the intelligent financial outcomes tools of QualOptima for consulting and implementation.

Optimizing Revenue from New Patient-Care Models

QualOptima goes far beyond the limitations of clinical integration analytics processes to the next frontiers of outcomes in relation to clinical performance, patient management across the longitudinal spectrum of care (both inpatient & outpatient) and patient-centered personalized/individualized care integrating patient-generated health data (PGHD). As physician payment changes from telemedicine and entities such as accountable care organizations proliferate, QualVal expertise is innovative both for tools and strategies to leverage these revenue opportunities.

Merged Market Segments: healthcare providers & insurers

As hospital systems acquire health insurance companies and incorporate payer entities into the business strategies, QualVal consulting with QualOptima is the obvious choice. QualOptima is the kind of technology described by Robert Wah, MD, President of the American Medical Association at HIMSS 2014 when he said: “In many ways, we expected the electronic record to be our enterprise system, and that’s not quite going to happen in the current environment, I believe there will be a layer that sits on top of the EHR system that will pull data from multiple sources and make it available. The information from those sources will help us with analytics and the administrative mechanics of running our healthcare delivery system.”

As the lines become blurred between payers and providers, the value-driven focus of optimal clinical processes and patient management become logically related to new formulas for retained revenue and profit from optimal operational and financial outcomes of these merged enterprise revenue models.