The Transformation of Health Care in 2014

Laptop And Stethoscope Health Care in 2014Did 2013 leave you wondering about health care in 2014? There’s no doubt about it: the health care industry is being transformed even as I type. While I don’t have a crystal ball, there are trends we can see – and much of what is happening is because of technology. Cornerstone Alliance exists to ensure that current and future residents in our Primary Service Area are able to receive health care locally, with good access, competence and affordability.

As we look forward to what lies ahead, we want to share some of the transformation in health care that we see unfolding before us.

The Transformation Consumers Will See

Mitch Rothschild, CEO of Vitals, shared in a recent blog post, “Over the past decade, the internet has transferred power from the buyer to the seller in several different consumer sectors. We’re helping shape that transition in health care. Other patients’ feedback on doctors has become a critical part of the process of selecting a doctor.” He outlined five key changes he predicts health care consumers will see in the coming year:

        1. Wait Times Will Go Up- Over a million new people enrolled in the health care system in 2013, and many millions more are estimated to begin participating in 2014
        2. Patients Will Continue to Love Their Doctors- Health care consumers are becoming more savvy about choosing a doctor with whom they can build a lasting relationship
        3. Urgent Care and Alternate Care Center Use Will Continue To Grow- Consumers have more options to choose from than just their primary care physician when they want or need to receive care
        4. More Online Appointments- In 2013, about 20 percent of practices allowed online appointment requests either through patient portals or online scheduling services
        5. Increase in the Power of Online Patient Reviews- In 2014, more will turn to online reviews for comparing doctors, just like we do for other purchase decisions

The Transformation Technology is Creating

Forbes magazine outlined 5 ways technology is transforming the health care industry to help keep people healthy. Because of this, venture capitalists are pouring funds into Health IT, simply because technology will enable health care to be more efficient and effective through:

        1. Crunching data to offer a better diagnosis and treatment
        2. Helping doctors communicate with patients
        3. Linking doctors with other doctors
        4. Connecting doctors and patients
        5. Helping patients stay healthy

The Transformation We Need to Know About

The transformation of health care has far-reaching effects. Because of this, insurance providers must stay on top of the changing health care landscape. Consumer needs and the opportunities offered by technology are transforming health care in a variety of ways, including these 6 outlined in a recent article by Mark Roberts:

        1. Guaranteed issue- In 2014, health insurance companies cannot deny health insurance coverage to an individual based on a pre-existing condition. They must give coverage to anyone who applies
        2. Taxation, with representation- The penalty is $95 per uninsured adult, in 2014 there’s a $325 cap for a family or 1 percent of taxable household income, whichever is greater
        3. Boomer sooner- The 50+ population is the fastest growing segment worldwide and predicted life expectancies are at a historical high
        4. Designer teeth and eyes- More people are retiring earlier than ever before, these men and women have been used to keeping up appearances and having access to aesthetic benefits like dental and vision
        5. Clinical review- Americans are seeking access to less expensive health care options including clinics and urgent care centers rather than going to typical private physician offices
        6. Doc talk- There’s a huge opportunity for mobile applications and customized, purpose-built devices. There are already roughly 100,000 health applications available in major app stores

What lies ahead for health care in 2014?

Cornerstone Alliance Lima OH Transformation of Health Care in 2014

New opportunities.

The transformation of health care in 2014 will bring new ways of providing access, competence, and affordability to support healthier communities. Contact us for more information about how Cornerstone Alliance can support your organization through our network of providers.

New Associate Member Program from Cornerstone Alliance, Inc.

Cornerstone Alliance Inc Lima Ohio PHO healthcare reformSPECIAL ANNOUNCEMENT!!

Cornerstone Alliance PHO is pleased to announce that we have contracted with Provider Services of America to develop a range of services that are private labeled for Cornerstone member practices.

Provider Services of America (PSA) has successfully launched similar programs with other physician networks throughout the United States.

The New Associate Member Program will offer programs, products and services to our member practices that are designed to do the following:

      • Increase Practice Profitability
      • Lower Costs
      • Increase Practice Efficiencies
      • Develop New Revenue Streams For The Practice
      • Improve Patient Relations

PSA will be sending out information to you via fax or email each month that will highlight the value proposition associated with these offerings.

These programs are offered to you on an ala carte basis and the decision to use these programs, products and services is strictly voluntary.  Again, these offerings are designed to increase your revenues and, in some cases, substantially lower your costs. If you feel that any one of these offerings may be of benefit to your practice, you can simply fill out the contact section found at the bottom of the fliers to be faxed or emailed to your practice. Then send these forms back to PSA who will follow up with your practice and answer any questions you might have about the program(s) of which you have an interest.  There is no cost to your practice to enroll in this program.

Please make sure that you review the information in these faxes and /or emails as these offerings could make a significant contribution to your practice goals in 2014.

Please call Jim Skognes at: (770) 390-9183 if you should have any questions about this new program.

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

Keeping up with the NEW this Happy New Year

Should old acquaintance be forgot,
and never brought to mind?
Should old acquaintance be forgot,
and old lang syne?

For auld lang syne, my dear,
for auld lang syne,
we’ll take a cup of kindness yet,
For auld lang syne!

 Out with the old… in with the new! Even as the last words to the traditional Auld Lang Syne were sung, cheers and tinsel were flying through the air. Let the celebration begin – the new year is here!

Happy New Year from all of us at Cornerstone Alliance. This promises to be a very exciting year in the healthcare industry as we move forward with ICD-10, Value-Based Care, and many new opportunities to serve the ones we exist for: our patients.

Cornerstonepho.com website happy new year

The past year was one of moving forward in many ways for Cornerstone. We moved into the realm of social media and updated our website to make it more user-friendly and consistently up-to-date. Our goal is to provide our members with a value-added service and a portal for information. We know you are busy, so we hope to save you time by having information you need readily available at your fingertips.

new this month cornerstonepho.com Our new “New This Month” tab will be the place where we will provide information as we receive it to keep everyone “in the know” as we receive updates. Instead of providing information quarterly or even monthly, we’ll add documents that we know you’ll need as soon as possible. Bookmark this tab – and make it a favorite!

credentialing cornerstonepho.com newAnother tab you’ll want to check is our “Credentialing” tab. Not only do we offer information about what credentialing is and why it’s important, we’ll provide our list of new providers in an easy-to-follow format. At the bottom of our “New Providers” page is a link where you can access full contact information for each new provider so you’ll have it available to use anytime.

cornerstonepho.com about us newBe sure and check out our “About Us” tab. Of course it gives you information about us and what we do, along with our history and mission statement. We also share a couple of testimonials that you can click on to view, along with resources to keep you updated with recall news, recent FDA updates, drug interactions, and current developments in the medical field.

Each of our staff members is ready to support you as we bring on 2014 with anticipation and excitement. Don’t hesitate to contact us, and be sure to let us know if there’s something we can add to our website that will be of help to you. Happy New Year!

happy new year

Exploring your practice’s health insurance options for 2014?

healthcare optionsWondering what to do about your medical practice’s health insurance for the new year? Confused about what to look for and how to get the coverage you need for your team? Exploring healthcare choices for the new year for your medical office staff and need some expert insights?

Cornerstone Alliance is here to help.

We want to share an exciting idea for our members that could be a valuable opportunity and to gauge your interest in pursuing it. And there’s more! We’re here to provide information you can use from an expert who can help you understand your options.

New for Cornerstone PHO members

As you know, Cornerstone PHO is contracted with HealthSpan, an experienced healthcare company affiliated with Catholic Health Partners, which is now offering insurance plans in the greater Lima area. These insurance plans feature Cornerstone health providers in a focused, high-value provider panel.

Cornerstone and HealthSpan are evaluating offering an association plan exclusively for members of the Cornerstone PHO, effective July 1, 2014. This large group program could be open to you, your staff and their families.  If this association plan is of interest to you, please fax this letter to Cornerstone by January 15th.  

Exploring your health insurance options?

Consider HealthSpan. You’ll find exceptional benefits at some of the most competitive prices in the area for individuals and groups, both on and off the Federal marketplace. Cornerstone PHO contracted providers serve as the network for HealthSpan’s HMO plans. You can rely on Cornerstone to work hard to represent our Member practices to provide and arrange the services that you need. You can get more details on this HealthSpan offering from your broker or the HealthSpan representatives at the meeting on  December 30.th 

Learn more about HealthSpan healthcare options

You’re invited to an informational meeting at the Auxiliary Conference Center at St. Rita’s Medical Center on December 30, 2013, from 2pm to 4pm to meet with HealthSpan representatives. Plan to attend for:

  • An introduction to HealthSpan, Inc.
  • A review of HealthSpan plans for individuals and small groups
  • What to expect when seeing HealthSpan members
  • What to expect when seeing employees of St. Rita’s Regional Medical Center and Catholic Health Partners
    We hope to see you there!

Healthcare options

Navigating healthcare as a medical provider can be overwhelming. 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!

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.

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