LUMINA Podcasts

Many hospitals are experiencing increasing workflow challenges due to high inflation rates. As a result, government and commercial payers are responding in unique ways.

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses economic challenges in health care, particularly hospitals and physicians. We’re joined by commercial insurance and government reimbursement expert, Cliff Frank.

Key points include:

• Hospitals and other health care facilities are facing a number of challenges, and inflation is a key component to internal issues. It’s essential that providers have an understanding on how to navigate an ever-changing infrastructure.

• Risk contracting has been a common issue for hospitals as payers are making money on empty hospitals and slower ORs. This obviously increases the need for better contracts between payers and providers.

• The ACO module has changed drastically, impacting how care is coordinated for Medicare patients.

Healthcare industry leaders across the country are all facing the same challenges with their workforce. We are seeing record high turnover rates and record low job satisfaction. Now is the time to prioritize proactively listening to employees and making changes that will stabilize the workforce after a tumultuous couple of years.

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses how to create positive change while facing the current healthcare workforce challenges with Lumina Principal, John Malone and national expert and industry leader in workforce management, Kristi Roe.

Key points include:

• COVID was an accelerant to an already existing problem with employee experience in our healthcare workforce. The idea of organizational listening at scale, and really deeply understanding the experience of caregivers, has been amiss. COVID lifted this issue up and we're all talking about it. 

• Healthcare providers have gone through a lot of change in the past two years. When going through significant changes, thoughtful communication and listening are necessary components to successfully managing change. Stakeholders must be engaged, and everyone needs to understand their role in implementing good quality change management.

• Organizational leaders need to organize around improving the employee experience in a more deliberate way. A “retention” goal should be on strategic scorecards and a priority for leaders.

Over the past few years, the shift to value-based care has slowed down as organizations struggle with leadership alignment around care delivery advancements. However, lessons can be learned from organizations that have successfully advanced value-based care – including how to position the organization for value-based success, how to build performance based contracts, and how to create strong physician incentives.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Christopher Crow, CEO and Co-Founder of Catalyst Health Group, discuss how to make changes in an organization’s culture, finances, and operations to successfully transition to value-based care.

Key points include:

• Building a solid culture on trust is critical; it is all about physician alignment, performance outcomes, and transparency. A good trusting relationship makes it easier to align incentives over time.
• Understanding the infrastructure requirements to support value-based contracts allows for timely recruitment and effective operational change management. Focus must be on team development, operational and clinical workflows, and technology to achieve high-performance and desired outcomes.
• The cornerstone should be the physician-patient relationship - and these relationships take time and compound over time.

When switching to value-based care contracts, alignment with the providers, physicians, payers, employers, and patients must exist through a model that benefits all. Health care providers must be strategic in selecting quality measures to track that identify areas to improve efficiencies and create real value.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Jon Burroughs, President and CEO of Burroughs Healthcare Consulting Network, discuss where to start on tracking quality outcomes and how to align a provider organization around value.

Key points include:

• There are preliminary steps that are required; first, the organization must create alignment across its leadership team so that everyone is excited about the direction.
• Measure selection is key. Finding the right measures will carry the greatest weight, for example, they will lead to lower expenditures and increased revenue. 
• To support the strategy, the financial impact must be quantitated  to understand earnings. Additionally, resources necessary to reach the goals must be considered.

Social determinant of health (SDoH) factors have a great influence on the quality and care management of a population’s health. As technology advances to better capture SDoH factors, clinicians can explore new ways to integrate this data into clinical workflows to proactively identify patients at high risk for adverse outcomes – resulting in better quality care.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Amy Valley, Vice President of Clinical Strategy and Technology Solutions at Cardinal Health, discuss the importance of incorporating social determinants into care management.

Key Takeaways:

• There are five main categories of SDoH: medical, environmental, physical, behavioral and social. These factors create a proliferation of data that can be difficult for clinicians to manage, however, new technology aims to identify the signals of a potentially high-risk situation for a patient.
• SDoH provide a perspective into health conditions - and incorporating these factors into clinical workflows help to proactively identify patients at risk for adverse outcomes.
• The recent staffing shortages are forcing organizations to re-evaluate their approach to navigating care. Analytic platforms are a necessity to support care delivery. These tools have been proven to increase efficiencies and improve clinical outcomes.

Telehealth is poised to see continued growth as the health care industry experiences the benefits of telehealth models, specifically supporting patient care delivery and closing care gaps.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Dr. Alan Kumar, Senior Vice President of Medical Affairs and Chief Medical Officer at Community Healthcare System, discuss the key factors for a successful rollout and how to increase adoption during the ongoing evolution of telehealth.

As the health care industry shifts from fee-for-service to value-based arrangements, providers are facing a lot of challenges. A provider's relationship with payers is often strained by the new business model, and a provider's ability to collaborate with payers has never been more important.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Hal Katz, an industry leader in health care law, discuss how providers can successfully navigate value-based contracting with payers in a mutually beneficial way.

Revenue cycle performance is a hot topic across the country as organizations work to rebound from the difficult past couple of years caused by COVID. There are many things that impact and contribute to the complexity of the revenue cycle, but they boil down to three categories: people, process, and technology.

On this episode of Value-Based Care insights, host Daniel J. Marino discusses ways to identify areas of opportunity and increase the revenue cycle performance with revenue cycle leaders, Cecilia Gonzalez and Rachel Greenspan.

Many challenges can arise when trying to implement standardized processes in complex surgical settings. Reviewing the data and performing prioritization exercises will help leaders identify inefficiencies and assist them with understanding where to begin to operate effectively. By utilizing data and engaging surgical staff, hospitals and ASCs will see tangible benefits to the financial bottom line and to staff and patients.

On this episode of Value-Based Care insights, host Daniel J. Marino has an informative discussion with Kate Geick on the benefits of implementing operational effectiveness tools in surgical services. 

• The COVID-19 pandemic created a large shift in the site-of-care from the inpatient to the outpatient setting. This caused payers to make changes to their reimbursement structure.

• Reimbursement pressures are tremendous right now, with payers making frequent adjustments to policies and denying claims that previously would have been approved. This creates additional friction costs for providers, who are working hard to keep up with the shifting landscape.

• Payers want providers to assume more risk, and in order for a provider to do so, they need to be able to contain and even reduce costs. If providers are going to enter into risk-based contracts, they have to reduce their cost structure internally and reduce friction costs with payers.