lasix without prescription Clomid without prescription celexa Levitra without prescription buy Zyvox online Diflucan no prescription cipro without prescription Cialis Professional no prescription Fluoxetine Buy Citalopram No Prescription Flomax buy jelly Cialis online Buy Doxycycline Online


  Home | Contact Us | Login | Register

Share This...Share on FacebookTweet about this on TwitterShare on Google+Share on LinkedIn

Value-Driven Revenue

Value-Driven Revenue

q_iconQ’s first-to-market solution to meet the strategic imperative for healthcare providers to transform from fee-for-service and optimized billing strategies and software to a value-based revenue model empowered by QualOptima is pivotal for all value-driven revenue strategies. Healthcare decision makers are challenged by new strategic imperatives from rapid changes in both the delivery of care and payment for services models. At the same time, competitive challenges from new forces in the healthcare market are coinciding with lines blurring between providers and insurers. The technology challenges with electronic medical records, hospitals again purchasing physician practices, and physician specialty groups needing connectivity and interoperability add complexity to an already complex business environment. Challenges to dramatically move to patient-centered care, more personalized and individualized, with consumers more involved in their health and care and especially more involved in purchasing decisions about their insurance and providers with larger deductibles and more choices from employer plans. Q’s interoperable and connected health technology links all data, applications and processes to provide access to electronic, comprehensive EMR patient records, disparate vendor databases and real-time analytics.


Value-Based Purchasing Imperative for a Value-Driven Revenue Model


Value-based purchasing (VBP) refers to a broad array of performance-based payment strategies linking financial incentives and penalties to provider performance across all healthcare settings. VBP is central to efforts of Medicare to drive improvements in quality and slow health care spending using a set of defined measures to achieve better value. The Accountable Care Act (ACA) focuses on bad outcome, no outcome, no income.

Until 2015, pay-for-performance (P4P) payments were limited to relatively small incentives. Now physicians and hospitals are waiting to see if their payments will be reduced by penalties or increased by P4P incentives. As these payment programs are implemented and subject to change, QualOptima metrics and analytics are the solution not only for enhanced revenue but for optimal clinical processes and outcomes that will have significant impact using data-driven solutions for results-driven success. Q’s embedded analytics tools focus on the total array of performance measures, not only P4P but for organized medicines performance measures sets as well as target performance metrics, for example to identify and decrease low-value services to achieve cost-conscious care published for internal medicine.


Strategic Imperatives Demand Clinical Performance & Outcomes Measurement


The challenges facing healthcare decision-makers are extraordinarily based on the need for performance and outcomes measurement. The care delivery and payment models need to focus on the simple imperative in the Accountable Care Act (ACA):

Bad Outcome | No Outcome | No Income

Q’s first-to-market clinical intelligence software is the complete solution for healthcare providers, payers, employers, and insurance companies seeking to achieve optimal financial and operational efficiencies. Q is the proven and experienced clinical performance and outcome analytics and solutions company in American health care. QualOptima was developed by Q from insight into the urgent needs of our customers.


Array of Financial Drivers for QualOptima


Some of the more dramatic new drivers of revenue and the compelling logic for the QualOptima clinical intelligence system include:

  • Increasing patient volume with branding strategies targeted to patient-centered care and knowledge of the patient, developing loyalty
  • Implementing true efficiencies of care around optimal clinical processes and real-time patient management
  • Transforming evidence-based clinical processes with provider-specific experienced based optimal clinical practices
  • Mitigating against pay-for-performance penalties and recovering P4P incentive payments
  • Eliminating denials for readmissions, hospital-acquired conditions (HAC’s), and reducing exposure to RAC audits and qui tam claims
  • Mitigating against negligent credentialing claims and reducing professional liability premiums
  • Facing new public reporting of low-performing providers with specific complication rates and publication of high profile medical errors

Strategies to increase revenue simply from optimizing billing, by any name, are over, just as the software products that are designed with that purpose central to their technology.

analytics-connectivity-platform


Overuse, Underuse & Misuse Framework of QualOptima


Most experts agree that while the political climate in 2008 centered on access to health care, the coming pressures will focus on cost! The impacts of value-based care and payment and care remain unclear. However, the uncontrollable costs from wide variations in care are, in fact, controllable and are largely responsible for spiraling costs of health care in America. Analytics embedded in QualOptima focus on variance, not only from rates but with the technology to identify and manage the causes. This is true both for overuse, where unnecessary costs are incurred for care not needed or even beneficial to the patient, exposing the patient to all the financial, emotional and physical risks, but for underuse, where delays in care may result in far more expensive treatment modalities.

Q’s experience, expertise and technology with QualOptima in identifying and managing challenges of misuse are nationally recognized for results and solutions.


Competitive Advantages with Value-Based Performance Measurement


Healthcare organizations are rapidly facing the pressures of competing on performance with significant financial incentives based on value (quality + cost). The competitive advantage balance sheet has two sides, negative and positive. On the positive side of the ledger, QualOptima is the ideal choice for healthcare providers and payers whose strategy is to market on performance and outcomes. High-performing organizations are marketing demonstrating their quality, not just organizationally but by service and specialty-type.

The days of gimmicks and contracting with companies to “evaluate” their performance are over. The negative side of the competitive advantage balance sheet results from highly- publicized bad outcomes; next it will come from publication of outcomes data identifying specific complication rates for hospitals and physicians. Transparency and public reporting of performance and outcomes-specific data is rapidly becoming available to patients and payers as health data analytics tools for identifying low-performing performers become widespread.


QualOptima Essential for Strategic Planning of Provider Revenue Models


Thought leaders in health care are beginning to consider the immediate strategic necessity to reconsider the “all things to all consumers” health care revenue model. This becomes extraordinarily important to accountable care organizations (ACO’s) forming and operating. The challenge is to build a solid brand, but branding the core competence that the healthcare organization intends to be rather than being known as a brand with excellent performance in nothing.

As healthcare becomes more consumer-driven, individual patients may select tailored, ultra-narrow provider networks through private exchanges or even domestic or foreign “medical tourism” specialists based on outcomes and cost. The traditional convenience selection factor could become less significant. Providers can define a “best-in-class” healthcare service or remain a full-service healthcare provider organization. For rural hospitals or where one provider dominates a large geographic market, traditional revenue models are the only logical business decision.

Whether demonstrating optimal clinical and financial outcomes as a full-service healthcare provider or narrowing the focus to be a center of excellence, QualOptima is the logical technology product, whether licensed or bundled with QualVal consulting services.


Pay-for-Performance Metrics and Analytics


QualOptima is laser focused on the 26 measures that will be used in 2015 by CMS for value-based purchasing (VBP). They include 12 clinical process-of-care measures (for example, whether surgical patients received venous thromboembolism preventative care), eight patient-experience dimensions (such as doctor & nurse communication), five outcome measures (including 30-day mortality rates for heart failure, pneumonia and heart attack); and one efficiency measure on spending/beneficiary. QualOptima’s unique technology using patient-specific risk factors solves many of the concerns from limitations of “risk adjustment” in complex healthcare value analytics.

Value-based purchasing (VBP) refers to a broad array of performance-based payment strategies linking financial incentives and penalties to provider performance across all healthcare settings. VBP is central to efforts of Medicare to drive improvements in quality and slow health care spending using a set of defined measures to achieve better value. The Accountable Care Act (ACA) focuses on bad outcome, no outcome, no income.

Until 2015, pay-for-performance (P4P) payments were limited to relatively small incentives. Now physicians and hospitals are waiting to see if their payments will be reduced by penalties or increased by P4P incentives. As these payment programs are implemented and subject to change, QualOptima metrics and analytics are the solution not only for enhanced revenue but for optimal clinical processes and outcomes that will have significant impact using data-driven solutions for results-driven success. Q’s embedded analytics tools focus on the total array of performance measures, not only P4P but for organized medicines performance measures sets as well as target performance metrics, for example to identify and decrease low-value services to achieve cost-conscious care published for internal medicine.


Malpractice Premiums/Self-Insured Systems Must Mitigate New Liability Exposure from Failure to Adequately Measure Clinical Performance


Performance measurement is required, and organized medicine recognizing impending value-based payment is rapidly publishing numerator/denominator specifications in hundreds of performance measurement sets. These metrics are significantly different than measures hospitals and physicians are using in their processes for clinical integration and other optimized billing initiatives with software products.

The structure of embedded clinical content and metrics for these performance measures sets, and the technology captures and integrates not only the structured clinical data of less than 15% of essential data, machine reading and learning tools of QualOptima are unique for all elements of required data. And the data is patient-specific with individualized risk factors. Impending liability exposures for failure to measure clinical performance will result in even more aggressive negligent credentialing claims and litigation. Opportunities from joining multiple plaintiffs with the commonality of failure to measure performance in credentialing, especially in states with vigorous capitation limitations, will further serve to foster liability exposure.