Healthcare Transformation and Value-Based Care

Harold Bischoff Healthcare Transformation Value-Added Care

From the desk of Harold Bischoff:

For each of us and all of us in the industry, healthcare transformation is top of mind and priority on our list. The goal: The delivery of value-based care. During the first week of November I had the pleasure to attend the Leadership Development Institute held by Catholic Health Partners (CHP) in Mason, OH.  At the session I got to hear presentations by the top leaders of CHP on how they are restructuring all the hospitals and organizations composing the entity.  The goals for CHP are to:

  • Develop clinically integrated networks in all markets served by the organization and to re-design the care delivery process;
  • Change the payment model from being paid for the volume of services to being paid for quality/outcomes/total costs;
  • Re-structure and align how support services within CHP, such as IT, legal services, HR, etc., are provided and attain cost efficiencies.

The message of the meeting was that we—whatever our role in the delivery process—have been called to transform with confidence, competence, and servant-hearts.  Over the next year each CHP employee will be able to make a promise to make lives better, to promise to be of service and to promise to make healthcare easier.

One week later I attended The Advisory Board Company’s  National Meeting in Washington, DC.  Over the course of two days I got to hear up-to-the-minute research on what leading-edge health delivery organizations are dealing with in healthcare transformation and doing to restructure their delivery systems.

These experiences have flooded my mind with all the changes that are happening in healthcare delivery and the financing of care.  While many believe that the Patient Protection and Accountable Care Act (the Health Reform Act) was the motivation for all the changes happening, I know that PPACA doesn’t deal directly with healthcare costs.  Many leaders within healthcare organizations have concluded that our society simply cannot afford to deliver healthcare in the manner that we have.  True leaders are attempting to change their delivery processes in order to ensure that they can continue to serve their communities.

Cornerstone Alliance Lima OHSt Ritas Medical Center Lima OHCornerstone Alliance, Inc. is working closely with St. Rita’s Medical Center in the structuring of a clinically integrated network to deliver value-based care.  Since I have been working on this effort since early 2007, I welcome the changes that are afoot within CHP and St. Rita’s and believe that our Cornerstone Member Physicians and Providers will benefit, as well as the population at large in the Lima community from this effort.

Stay with us in this adventure called healthcare transformation as we seek the best ways to deliver value-based care for the good of our people and our community.  I look forward to the journey ahead.

Harold L. Bischoff, FACHE
Executive Director
Cornerstone Alliance, Inc.

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5 Ways to Help Ensure Medical Claims Can Be Processed

ensure medical claims can be processedHealthcare providers are facing more challenges than ever when it comes to making sure medical claims are paid. Medical offices are not only implementing healthcare reform provisions, payers are constantly updating policies for reimbursement and pre-certification, along with making coding changes.

Add to that the October 1st, 2014, ICD-10 deadline. With ICD-10 increasing the number of CM and PCS codes from ICD-9’s 17,000 to a formidable 141,000, it’s enough to make any medical office staff member a bit nervous.

The challenge?
Potentially lower reimbursements.

It’s simple. If the correct code is not submitted for the service provided, the claim cannot be processed and it won’t be paid accordingly. But with more than nine times as many codes coming, mistakes are bound to increase – at least temporarily.

The plan?
Stay on top of changes to ensure medical claims can be processed.

Need to ease the transition to ICD-10? Here are 5 things to check to ensure medical claims can be processed and paid as promptly as possible:

1. Check payer’s websites monthly for updates

It is important that office staff check payer’s websites monthly for updates. Many times a claim isn’t processed or paid correctly due to a change in a policy by a payer. Some offices send payer updates, but many do not.

2. Check alpha and numeric coding

Coders often confuse the number “0” (zero) with the letter “O” and the number “1” (one) with the letter “l.” Good news: The letters O and I excluded in the ICD-10 system to avoid confusion with the numbers 0 and 1.

3. Check diagnosis and procedure codes needed to process the claim

It is imperative that both the diagnosis and the procedure are coded. Another must: Check accuracy and ensure complete coding of records and medical records. Functional errors, including records that coded incompletely or codes associated with the wrong medical test, will result in an unprocessed claim.

4. Check medical records

With the implementation of ICD-10, it is important to check specifics found in medical records to ensure prompt claims processing. For example, the coder must specify specific type of chest pains, which may mean looking at the information in the medical record that differentiates them from atypical pains.

5. Check codebooks for accuracy and don’t rely completely on coding software

To cut down on errors, practice management software prepared for the ICD-10 transition may be implemented. This can be a time- and sanity-saving means of moving into ICD-10. However, it’s important for coders to continue referencing codebooks and not develop an over-reliance on coding software.

Taking time to check a few simple areas can help ensure that medical claims can be processed quickly and paid as promptly as possible. As medical providers prepare for moving to ICD-10, taking time to check now can result in a smoother transition. Cornerstone Alliance serves Allen, Auglaize, Hancock, Hardin, Logan, Mercer, Paulding, Putnam, Shelby and Van Wert counties in Ohio. Please contact us if we can be of service to you!

November Updates from Cornerstone

Welcome to November!

November Cornerstone

Don’t forget to turn your clocks back an hour at 2am on Sunday the 3rd!

It’s that time again – Don’t forget to turn your clocks back an hour this weekend as we shift from Daylight Saving Time to Eastern Standard Time.
Enjoy your extra hour!

It’s a busy time at Cornerstone Alliance as we do our utmost to stay on top of healthcare updates. There are no events planned for November as we gear up for our quarterly Credentialing Committee meeting on December 5th and our quarterly Board meeting on December 10th. We are planning an Annual Meeting for our members on Tuesday, December 3, 2013 from 6:00-8:00 p.m. at the UNOH Event Center. We plan to focus on Marketplace/Exchange plans that will be offered in our service area via the Federally-Facilitated Marketplace/Exchange effective January 1, 2014. An important update was forwarded to our members about these plans and how they will affect our members. We will do our utmost to keep everyone informed and – as always – please contact us if you have any questions.

CLICK HERE for October updates at Cornerstone, including information about the Ohio Exchange/Marketplace:
Ohio Exchange Carriers

We have learned that Molina Healthcare will not be offering an “Exchange Product” in Region 2 of the State of Ohio. Therefore, Cornerstone will not pursue an “Exchange Agreement” with Molina Healthcare.  If you have questions regarding this or any information about Cornerstone, please contact Harold Bischoff, Executive Director of Cornerstone, at 419-996-5317 or hlbischoff@health-partners.org

Update: Ohio’s Marketplace/Exchange Plans

October 11, 2013

Re:  Update on Ohio’s Federally-Facilitated Marketplace/Exchange

Dear Cornerstone Alliance, Inc. Providers

This note is to provide basic information about the Marketplace/Exchange plans which will be offered in our service area via the Federally-Facilitated Marketplace/Exchange effective January 1, 2014.  In addition to this letter, we are planning an Annual Meeting for later this year to bring speakers to Lima to answer your questions on this matter.  We have two slide presentations to describe the role of the Marketplaces and how they are structured: one from Mary Wachtel (HPIO) and another from Jocelyn Guyer (Manatt Health Solutions).  Once arrangements for the Annual Meeting are finalized a notice will be sent to all Member offices.

Briefly, here are the most important facts for you:

  • The entire Cornerstone primary service area (Allen, Auglaize and Putnam counties) are located in Region #2 of the Ohio Geographic Rating Areas;
  • The Health Policy Institute of Ohio estimates that 160,000 persons statewide will enroll in the Marketplace/Exchange products.  That would mean that there will probably be fewer than 10,000 covered persons in Region 2 over the entire year.
  • Member offices participating with HealthSpan and MMO through Cornerstone will be providers to patients enrolling via the Marketplace in those carrier’s plans.  No additional action by providers participating with HealthSpan and MMO via Cornerstone are needed (A letter will be posted on our website in the near future from HealthSpan informing Cornerstone participating providers that by being contracted with HealthSpan that you are also included in the HealthSpan Select network.  The HealthSpan Select network will be used for their Marketplace product).
  • Many of the bronze plans in the Exchange will have out-of-pocket maximums of $6,350 and $12,700 for individual and family coverages.  Another item to mention is that the out-of-pocket maximums in the Marketplace/Exchange products for both the individual and small group plans have ALL out-of-pocket expenses accumulating to the out-of-pocket.  This may different than what the providers may have encountered in some current PPO plans.
  • Cornerstone may offer a solicitation with at least one other carrier in order for our Members to participate in an additional Marketplace carrier.  This solicitation may be mailed to our Members within the next few weeks.
  • Finally, it is vital that Cornerstone providers understand that the Anthem Marketplace product –Community—Anthem is not contracted via Cornerstone Alliance, Inc.  Catholic Health Partners –the parent organization to St. Rita’s Medical Center—and Anthem could not agree upon mutually acceptable terms and consequently, Cornerstone Alliance is not contracted with Anthem for their Marketplace product nor is St. Rita’s Medical Center.

Please review the slides in the two presentations (first paragraph f this letter) for much more detailed information on the Marketplace offerings.  If you still have any questions on Cornerstone plans offering products on the Marketplace, please email my office at:  hlbischoff@health-partners.org

Sincerely,

Harold L. Bischoff, FACHE

Executive Director
Ohio Exchange Carriers

October 29, 2013 UPDATE

We have learned that Molina Healthcare will not be offering an “Exchange Product” in Region 2 of the State of Ohio.  Therefore, Cornerstone will not pursue an “Exchange Agreement” with Molina Healthcare.  If you have questions regarding this information, please contact Harold Bischoff, Executive Director of Cornerstone at 419-996-5317 or hlbischoff@health-partners.org

San Salvador 3000: Cornerstone Partners to Impact the World

October 1, 2013

Three thousand miles away, yet part of our world. Leaders of tomorrow are growing up in a dangerous environment and Cornerstone Alliance, in partnership with the Lima Rotary, wants to make a positive impact.

El Salvador map

Escuela Mizata is a small school located in the town of La Libertad, El Salvador. It is located in an area that is filled with gang members. To prevent students from becoming part of these gangs, the Lima Rotary Club wants to improve the school’s facilities by encouraging students to play sports and improving their educational experience by providing food and proper facilities.

Our goal is to add (CLICK HERE for the first report, including pictures):

  • A soccer/basketball court
  • A basketball court
  • A kitchen and mess hall
  • Restrooms

Lima Rotary LogoPlans are being finalized for the San Salvador 3000 event to be held in the Center Court of the Lima Mall on Saturday, October 26th, from 10:00 a.m. until 3:00 p.m. This event is meant to increase public awareness of the Lima Rotary International Service activities. Rotary International is the oldest and largest service club in the world with more than 32,000 clubs worldwide. The Lima Rotary Club was formed in 1915 and international service has been a key focus for Rotary since its founding.

San Salvador projectLima Rotary was recently informed that $14,680.00 was being forwarded to the Club Rotario San Salvador Maquilishuat to fully fund the rehabilitation of the kitchen and restrooms at the Mizata School in La Libertad, El Salvador. The growth of gangs is causing issues throughout El Salvador. The rehabilitation of the school, along with the construction of boundary walls to enclose a playground, will allow the students to attend classes and minimize their contact with gang elements. Each Rotary International project is a cooperative effort between a host club – in this case, the Club Rotario San Salvador Maquilishuat – and an International Partner Club: the Lima Rotary Club.

Lima to San Salvador mapThe Lima Mall event is an opportunity to share the many international service activities in which the Lima Rotary is involved with the Lima community. In cooperation with the Lima YMCA, four stationary bikes will be set up in the Center Court of the Mall. The Club hopes to pedal a total of 3,000 miles – the distance from Lima, OH to San Salvador, El Salvador – in a series of competitions between businesses and organizations to be held throughout the day. In addition to the two-person teams representing various organizations for bragging rights about who can pedal farther in ten minutes on a stationary bike, the general public will have the opportunity to participate in the world’s largest advertisement.

Polio this closeFor many years the number one priority for Rotary International has been to eradicate polio. If we would put a measurement to this endeavor, the world is “within inches” of successfully eradicating a disease that – only a few decades ago – crippled the lives of many. During the San Salvador 3000 event on October 26th, YOU can be part of the “We Are This Close…” initiative to END POLIO NOW for only a dollar. Plan to join others in walking the red carpet, going in front of the lights, and showing the world that you care about how close we are to eradicating polio – and you want to be involved.

Plan to join us!
We look forward to seeing you at the Lima Mall on October 26th.