LUMINA Podcasts

As hospitals and medical groups continue to focus on financial performance, optimizing their revenue cycle through denial management drives results. To effectively reduce denial rates, revenue cycle leaders must first discover the root cause of denials. A focused approach to denial management can provide health care leaders considerable financial and operational improvements.  

In this episode of Value-Based Care Insights, Daniel J. Marino sat down with Tina Hodges and Michael Brown from RSM to discuss some of the revenue cycle challenges facing hospitals and medical groups today, as well as tactics to reduce denials and increase financial performance.

Key points include:

• Health care providers are experiencing workforce challenges; effective management of your workforce is a requirement to enhance the denial management process across the revenue cycle ecosystem 
• Timely data and information allows revenue cycle leaders to understand the root cause of denials and work productively to reduce them  
• Sharing dashboard reports with key performance indicators with stakeholders, including physicians, engages them in the denial management process  
   

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Over the past year, we have seen substantial investments in healthcare made by non-traditional health care providers such as CVS, Walgreens and Amazon and others as they position themselves as strong participants in healthcare delivery.  Last year, 2022, was one of the highest years for health care deal-making with private equity investing considerable resources into technology, physician services and analytics. How will these new deals impact the health care industry? 

In this episode of Value-Based Care Insights, Daniel J. Marino sat down with Brian Greenberg and Zach Eisenberg from Greenberg Advisors, to discuss trends and “hotspots” of investments in health care. 

Key points include:

• Understanding the motivation of private equity as structure investments in IT, analytics and revenue cycle capabilities.  
• How non-traditional healthcare providers are position themselves for growth given the economic and labor for challenges.  
• Trends in investments particularly in behavior health, revenue cycle management and analytic capabilities. 
   

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As health systems, integrated provider networks, clinically integrated networks (CINs), and accountable care organizations (ACOs) engage in population health initiatives, aligning technology with value-based contracts' performance goals is a key success factor. The lack of alignment can be attributed to a disjointed vision, fragmented operations, and misaligned information technology (IT).  

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Julie Bonello, Founder of Integrate Health, along with Brian Bentley and Nick Frenzer from Epic Health Technologies, to explore how to optimize value-based technologies and drive a higher level of population health performance.  

Key points include:

• To drive successful performance of value-based contracts, health care organizations must have an aligned vision, operations, and IT systems, including the electronic health record  
• The structure and leadership of the organization must be led through a clinical lens to achieve results in population health   
• There are critical foundational factors that provider organizations must consider as they adopt technology 
   

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Part of CMS’ journey in regulating coordinated care with providers, a value-based exception and safe harbor was enacted in early January 2021 under the Physician Self-Referral “Stark” law and Anti-kickback Statues. The new provision allows value-based enterprises eligible for safe harbor protections under the Stark and Anti-kickback statute. 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Jim Carr and Luis Argueso, cofounders of InHealth Advisors. Dan, Jim, and Luis discuss the framework of a Value Based Enterprise (VBE). 

Key points include:

• Key steps provider organizations must take to establish a VBE 
• Creating the VBE governance structure with principals  
• Timing of the VBE structure considering VBC payer contracting  
  
   

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The nursing industry has faced many challenges in recent years, including COVID-19, which has resulted in staffing shortages and clinician burnout. As the nursing workforce shifts from baby boomers to millennials, the pressure placed on nurses and clinical staff continues.  Contributing factors to the increased pressure include untimely nursing recruitment in the hospital environment, lack of leadership support and resourcing with operational improvement initiatives, and minimal focus on nurse wellness.  High-performing nursing leadership is required to steer the ship in the right direction. 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Nancy Lakier, CEO and Founder of Novia Solutions. Dan and Nancy evaluate the current state of nursing and the need for effective nursing leadership.  

Key points include:

• Addressing clinical burnout of nurses is paramount as it negatively impacts culture  

• Seeing that nurses are leaving the industry at an average age of 35-40 (the youngest the industry has ever seen), preventing burnout and supplying adequate resources needs to be explored 

• Structured leadership development programs for nurses are a key ingredient as they improve nursing retention rates and overall patient care delivery 

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With the advancement of technology in health care organizations are recieving an excessive amount of data. How can organizations manage that data to create actionable insights? 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Rick Howard, Chief Data and Products Officer for an analytics vendor and former Chief Data officer of Ascension Health. The two discuss the management of data within four categories: claims/finance, lifestyle, and social determinant data.

Key points include:

• Using retroactive and retrospective models to manage data

• Analyzing the four categories of health care data: clinical, claims/finance, lifestyle, and social determinant data.

• Building causation models

Throughout 2022, primary health care faced many challenges. Staffing shortages, high hospital costs, and the advancement of telemedicine forced health care organizations to rethink their strategic plan heading into 2023. 

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Lucy Zielinski, Managing Partner at Lumina Health Partners. Dan and Lucy analyze health care trends in 2022 and take a peek into 2023. 

Key points include:

• Health care leaders have felt continued pressure on finances. With an unstable economy and high hospital costs, organizations need to focus on operational effectiveness, reducing clinical variation deduction, and revenue cycle management.

• Staffing shortages were a major issue for hospitals in 2022, the trend is expected to continue. Health care organizations will need to center their attention on staffing recruitment and workforce well-being in 2023.

• Effective service line development will allow physicians to deliver consistent, patient-centric care.

Over the past few years, the primary care has gone through immense change. Everything from the incorporation of virtual health, to the shortage of primary care physicians to the building of new team-based models of care.  

In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Dr. Michael Hanak, a board-certified family physician working with a large academic medical center in the Chicago metropolitan area. The two discuss common trends and challenges in today’s primary care model.

Key points include:

• Exploring the challenges of the traditional patient care model and how primary care is evolving given technology and the new entrants of non-traditional providers

• Using a digital experience to help promote a team-based care model and track performance outcomes

• Incorporating technology into today’s primary care model to improve patient care and expand access.

Each year, one in five Americans visit the emergency department (ED) at least once  – and these costly ED visits are on the rise. Are they a symptom of a larger issue in our health care system? Many of emergency visits are preventable – this may be a symptom for inefficient care management, inadequate patient access, or lack of patient knowledge. As hospitals and payers transition into value-based care, interpreting ED visits may be a symptom of a larger problem. 
 
In this episode of Value-Based Care Insights, Daniel J. Marino is joined by Dr. Nicholas Dodaro, Chief Medical Officer and co-founder of Medical Life Holdings, a portfolio of companies and practices founded in 2006 to improve the value of health care delivery. The two discuss common issues with emergency room visits, why they’re so costly, and what to do about them.

Key points include:

• “Unmanaged” or “unengaged” patients seem to be a big contributor to unnecessary ED visits.
• Understanding the financial impacts of ED visits on the performance of value-based contracts.
• Reviewing ED visits can be insightful to future improvements with care delivery.

Rural health care providers often encounter barriers that limit their ability to provide the care they need. Even well before the pandemic, rural health providers faced many challenges. Today, workforce shortages and access to health care services are at an all-time high.

On this episode of Value-Based Care Insights, host Daniel J. Marino is joined by the CEO of Great Plains Health, Ivan Mitchell. The two discuss modern-day challenges that exist in today's rural health care environment.

Key points include:

• How to address rural health care challenges and deliver the right level of care while remaining economically stable
• Strategies to provide access to primary and specialty care in rural areas 
• The need for alignment between health care providers and insurance carriers within rural communities