Wendy Horton, FACHE

The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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Full Medicaid expansion needed to retain Georgia’s physicians Georgia was ranked 5th worst place to practice in a recent Medscape article (“Best and Worst Places to Practice 2024”), using five criteria: physician compensation, cost of living, malpractice premiums, the health of the state’s residents, and physician burnout levels. As current and future physicians and health advocates, this column will add context by detailing our experiences practicing in Georgia. It is no surprise that three of the five worst-ranked states for practicing are among those that have not expanded Medicaid. In Georgia, refusal to expand Medicaid means that nearly 12 percent of residents (well over a million people) are uninsured, significantly limiting their access to healthcare. Only in Texas is coverage worse. Due solely to political concerns, Georgia chose to submit a Medicaid waiver and develop its own Medicaid expansion program, Pathways to Coverage. The governor’s office projected that the program would cover an additional 100,000 Georgians in its first year. But it has been an utter failure, with fewer than 3,500 covered at a cost to taxpayers of $26 million. Full Medicaid expansion would have added over 350,000 Georgians while cutting state spending by $710 million. These three states that refused to expand Medicaid are not surprisingly red. It is also unsurprising that the states with the greatest percentage of unhealthy residents are red. Hopefully, Georgia who thought they had a better way of expanding access to care with their own plan that squandered $26 million to cover 3,500 residents will realize that retaining physicians requires a more sensible approach to expanding access to care. #expandinghealthacess, #accesstocare, #limitingcoveragetoresidents https://lnkd.in/eefqH-9Y

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Thank you to our wonderful participants this afternoon in the HCT Consulting Group Healthcare Transformation Executive Roundtable. Brian D. Washburn, DHA, MHA, FACHE, FACMPE, CHFP, PMP Chris Saxman Elizabeth Crawford Restat Elya Prystowsky, MS, PhD Mark Korth. I was encouraged by several insights from this amazing group: 👉 #Transformation - we know it when we see it! 👉 #Valuebasedcare - we know it when we don't! 👉 #Valuebasedcare means different things to #patients and #providers but we should not lose sight that like or not, we have to play by the language and definitions being proposed by the Centers for Medicare & Medicaid Services 👉 #Transformation towards #VBC should be keeping healthcare simple, local and well-coordinated - what 99% of people are trying to do today. Organizing to stop the despicable 1% is adding 30% of costs to everyone - especially #ruralhealth 👉 #EMR Transformation has put some hospitals out of business and in some communities, when the hospital closes, the whole community shuts down 👉 #Transformation this group sees on the horizon includes demand for change only intensifying, doing more with fewer providers, addressing #documentation challenges, #AI should focus on removing the hassle of the little things 👉 MAJOR RISK AHEAD - Will #transformation defined by CMS + #BigTech lead to a loss of simplifying the provider-patient experience? Will documentation to meet #VBC demands only escalate due to the 'potential' of what technology offers? And therefore, will health disparities only expand due to the inability of #ruralhealth to keep up? Ultimately - will we eventually have to unwind many of the current technology investments to one day return to a simpler provider-to-patient connection? Thanks again to our amazing participants. DM me if you'd like to be on our roster to participate in the next one!

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I'm thrilled to share a recent article from the Spring 2024 Winship Magazine highlighting the incredible efforts of our team in addressing oncology drug shortages. This challenge is a critical aspect of patient care that often goes unnoticed but requires immense hard work, coordination, and planning. A huge shoutout to our exceptional pharmacy department, especially our pharmacy technicians, buyers, and inventory teams. Your dedication ensures that our patients have uninterrupted access to the vital medications they need for their unique cancer treatments. Kudos to our Medical Director, Dr. Jonathan Kaufman for his leadership and unwavering commitment to overcoming these challenges. Throughout this process the integration between our physician and pharmacy leadership has been outstanding. The relentless efforts behind the scenes by our Winship Cancer Institute of Emory University teams are pivotal in providing top-notch care to our patients. It's a humble reminder of the intricate work that goes into each patient's journey, making a significant difference in their fight against cancer. To everyone involved in making this possible—thank you for your remarkable work! Read the full article to learn more about how our teams are making strides in mitigating oncology drug shortages: https://lnkd.in/exrXHFQ9 #PatientCare #Oncology #PharmacyHeroes #TeamWork #CancerCare #EmoryHealthcare #Winship #Cancer #Healthcare #Drugshortages #shortages #Medicationshortages #LifeSciences

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My next Signal takes a closer look at the latest antitrust probe into large dialysis companies and the shifting role of non-competes in kidney care. A recent POLITICO article provides helpful background around topics like NCAs in dialysis and impacts on the adoption of home dialysis technologies. This is an important discussion, so I'd love to hear from you. If you have something you'd like to share, whether it's an anecdote, comment or question for other readers, please leave a comment or send me a message. H/t to Tom Mueller for sharing the article last week. https://lnkd.in/e95a23JF

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Today marks an important milestone with Emory Healthcare’s announcement of their statewide PHC and collaboration with Guidehealth. We began our commercial relationship with Emory Healthcare Network earlier this year on an interim basis and quickly progressed by fully integrating our technology and capabilities. In a short time, our joint efforts have created “speed to value”, demonstrating considerable traction and early wins on quality, patient care and overall performance. There are many people to thank - - and I'll start by acknowledging the network and service line leadership of Patrick Hammond, Tina-Ann Kerr Thompson, MD, MBA and their teams including Dan Salinas, MD and Susan Helton, Adam Tribbett and many others. Unless they saw the merits of us working together, we wouldn’t be here. We as a company have grown through inspiring engagement with Emory’s digital health leadership led by Alistair Erskine MD MBA and his team including Nitu Kashyap. The data science architecture, our use of AI and integration into Emory’s digital health strategy has transformed our business in many ways including accuracy and risk prediction, clinical prioritization, outreach and access, and scalable interventions. A shout out to Guidehealth's technology partners who have led us to unprecedented success and first mover advantage of our platform. I want to personally acknowledge Joon S Lee MD, Emory Healthcare CEO for his vision and personal attention to our collaboration. As also Chris Augostini, EVP and Emory University CFO. Their teams have been working closely with us to make today’s announcement a reality. Finally, to our leadership, at every level beginning with MARK SELNA, McKay Crowley, MD, MBA, FACP, CHCQM, Robert Alterman, Michael Gleeson, Roger Ou, Jeanne Wisniewski, ACC and their teams who’ve been working tirelessly to integrate technology and people into partner workflows, I want you to know that none of this would have been possible without your creativity, dedication and higher purpose that you bring to bear for patients and physicians every day. With today’s announcement, we now support six health systems in four states across a variety of contracts. With Emory, our collaboration extends across all patients and payers and is by far the most comprehensive and clinically integrated expansion of our model. And with it, we are honored to firmly plant our flag in the Peach State! https://lnkd.in/eARfUMnG

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It's time to rethink how we think about #340B. At the request of the committee, I had the privilege of writing a statement for the record for yesterday's House Committee on Energy and Commerce Oversight subcommittee hearing on 340B: (https://lnkd.in/eTZXZKzp). My goal was to help explain to the committee and other stakeholders how the unprecedented growth of (and flagrant abuse of) a well-intentioned program is harming employers, purchasers, and working families. AND that the most significant victims of this abuse are employers and workers - not the pharmaceutical industry, which is the program's most vocal critic. As I note in the testimony, "At its core, the 340B drug pricing program represents a government-regulated price arbitrage program in which certain healthcare providers can purchase prescription drugs at a steep statutory discount and sell those drugs at the prevailing market rate." First, on the pharmaceutical industry: Drug makers have an obvious gripe about a program that requires them to provide very large discounts (often exceeding 50%) on a significant portion of their products. But despite the rapid growth in 340B, drug makers remain highly profitable. And there is evidence (cited in my testimony) that manufacturers are effectively "pricing in" the 340B hit to them by raising their prices on commercial payers. In fact, it would be shocking if drug makers didn't consider 340B - the second largest drug purchasing program in the country, after Medicare Part D - in their pricing calculations. But there are three other ways - all cited by significant evidence in the testimony - that employers, purchasers, and consumers are paying more for drugs AND other medical care, uniquely #Becauseof340B. 1) Supercharged consolidation: It is an unambiguous fact that hospital system consolidation has significantly increased health care prices over the past 20 years. 340B is a significant driver of that consolidation. Independent practices cannot participate in 340B. But more than 50% of hospitals can and do. And they can reap huge profits by buying physician practices, converting them to outpatient clinics and watching the arbitrage dollars role in. 2) Distorted prescribing and pricing patterns. 340B clinics are demonstrably more likely to prescribe higher cost drugs than non-340B clinics. Again, so they can maximize arbitrage on the differential. 3) Lost discounts. I'm a vocal critic of PBMs, but at least SOME rebates get passed back to employers. Not in 340B. There are no PBM rebates, only the big statutory one for hospitals. Every time a prescription is filled in the 340B channel, employers lose the discount. I don't have a single figure (because of 340B, we all pay $XXX more), but for the employer market, the number would easily be in the several billions, if not tens of billions per year. And growing. I hope #Congress is paying attention.

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Sharing key takeaways on the CMS Hospital Inpatient Quality Reporting program for FY2025. - Seven new measures are added (which are welcome, with the caveat of let's see how they work out) -> Patient Safety Structural Measure beginning CY 2025 with payment determination in FY 2027 -> Age Friendly Hospital CY 2025/FY 2027 -> Catheter-Associated Urinary Tract Infection Standardized Infection Ratio Stratified for Oncology Locations (CAUTI- Onc) CY 2026/FY 2028 -> Central Line-Associated Bloodstream Infection Standardized Infection Ratio Stratified for Oncology Locations (CLABSI-Onc) CY 2026/FY 2028 -> Hospital Harm – Falls with Injury (eCQM) CY 2026/FY 2028 -> Hospital Harm – Postoperative Respiratory Failure (eCQM) CY 2026/FY 2028 -> Thirty-day Risk-Standardized Death Rate Among Surgical Inpatients with Complications July 1, 2023–June 30, 2025/ FY 2027 - Five existing measures are removed (which is a breath of fresh air) - the unpopular PSI-04, and measures related to 30-day episode payments for acute myocardial infarction, pneumonia, total hip/ knee arthroplasty, heart failure - Two existing measures are modified (Global malnutrition composite score expanded from seniors over 65 to anyone older than 18 - this is very positive; and Refined HCAHPS measure - will post details on this next week.)

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For those looking to understand how data analytics and targeted provider education can transform documentation practices, this article is for you.

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I’m thankful that I could share my thoughts at that very hearing. There is so much misinformation about 340B. For me, it comes down to two main points: 1- if hospitals need that money as a subsidy to fund everyday activities, they should just ask for a subsidy. Let’s open up the books of these institutions, which already get a huge subsidy with their non-profit status, and see why they are running in the red. Are they really losing money on Medicaid patients or are they just bloated and inefficient? 2- let the subsidy follow the patient. This is a drug benefit program. Why does the funding go to an institution? Imagine if we did that with SNAP, giving a bunch of money to large restaurant chains in exchange for their promise to use the revenue to provide food for poor people (with no oversight to ensure that’s done). We don’t do that; instead we give the benefit to the person who needs it. Let’s change 340B to match that model. Adam J. Bruggeman, MD, MHA, FAAOS, FAOA Daniel Choi Colin Yokanovich John Strom Peter Stein Adam Fein Deborah Williams Lisa Grabert Maya Babu, MD, MBA Katie Orrico Larry Bucshon, M.D. Ann M. Richardson, MBA

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With decreased bed availability, thinned hospital margins and increased demand for care that exceeds the hospital supply — improving patient flow has become a focus for health system C-suite executives. I shared with Fierce Healthcare this broader strategy that could improve hospital throughput performance: 1. Use data to create a network of high-performing post-acute options 2. Measure and manage performance across that ecosystem with agreed-upon targets 3. Create alignment with post-acute providers to help with transfers 4. Make protocols that guide readmissions after initial discharge This strategy has allowed Allina Health to achieve high performance in our hospitals for throughput and capacity management. In less than a year, we have saved 24,808 inpatient days, reduced discharge to skilled nursing facilities length of stay by 1.61 days and decreased discharge to home health length of stay by 0.89 days. To read more about this strategy for improved hospital throughput performance, click the link in the comments below.

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Do you know or are you one of the Healthcare Financial Management Association (HFMA) members who earned a certification in Q2 to validate expertise and demonstrate commitment to the profession? Some 2,115 individuals were honored in Q2 with HFMA certifications, with 101 people earning multiple certifications. Check out the story to see a list of all honorees.

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Championing Integrity in CDI Cesar M. Limjoco, M.D., Faisal Chawla, and I joined forces to produce the first of a series of podcasts titled Championing Integrity in CDI. While the profession updated its name to reflect "Integrity' versus "Improvement," in reality current CDI processes have yet to reflect and achieve measurable sustainable meaningful integrity in the documentation. We invited Dr. Chawla as our first guest to share his vision and ideas on how the CDI profession should focus on recognizing and treating the medical record as a communication tool versus a reimbursement tool. Take a listen and hopefully realize the immediate need for updating and reengineering current CDI processes, strengthening the vision and mission of CDI to collaborate with physicians as collaborators and facilitators for more effective documentation and communication of patient care. #CDI, #transformationCDI, #transformingCDI, #properrepsectforCDIsofttware, #roleofCDI, #movingintherightdirection https://lnkd.in/e6aDaCub

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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Trends to watch at #HLTH2024. Healthcare executives share what's on their agenda

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