Heather O'Sullivan MS, APRN

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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❓What happens to healthcare when the government fixes prices for a private business? I think we’re about to find out. Watch Closely 👀 🚨Massachusetts will start requiring urgent cares to accept all patients, even if out of network, to offload the overburdened Emergency Department (thanks to the collapse of Stewart Healthcare - another story) While I have my gripes about the urgent care model, especially when it’s used to replace primary care, one of the things that allows it to work better and be more efficient, is the pricing structure. Urgent care can turn patients away based on inability to pay or require payment upfront for services. This allows them to control their revenue to match the service they deliver. A healthcare business needs to be able to make enough money to pay for adequate staffing in order to give a quality experience. If an external body is setting the pricing structure, this could be a recipe for insolvency. Massachusetts will pay urgent cares at 135% of the Medicare rate. This is much lower than what most commercial plans will reimburse for urgent care fees. The urgent cares will NOT be able to balance bill (I.e. they cannot collect any additional payments to cover what insurance refuses to cover)📉 ⚕️Urgent care has been a reasonable back up for our failed healthcare system. If we start forcing urgent, cares to operate like the rest of the failed healthcare system, I see them collapsing pretty quickly. Let’s be vigilant.👀 Thank you Dr David Weinstock for sharing this important article. Please share your thoughts and predictions on what’s going to happen. #urgentcare #healthcarereform #healthcareshortages https://lnkd.in/eaTXrhJ9

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💡Are you including trust as a component in your care model for complex patients? 💡Great insights from Ryan Thompson to kick off the New England Life Care 7th Annual Population Health & Value Management Symposium talking about how trust affects patient outcomes. Trust and continuity have positive effects on patient outcomes — resulting in fewer 30-day readmissions — and positively affect your care team’s performance too.  🙌 Are you here today? Find Kathy Oliveri (or message her if you’re not) to talk about how MyndYou helps you provide continuity of patient engagement.

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I’m a big fan of Hartford HealthCare. I’ve personally been treated there, had surgeries there and recommended their services to many friends and family members. In the last couple of years HHC has made incredible strides to achieve A level quality grades from Leapfrog and they’ve integrated lots of state of the art innovation. Unfortunately, because there is no functional marketplace for health services here in Connecticut; HHC continues to charge the prices that purchasers will pay. There hasn’t been anything to change that trajectory. Employer purchasers have sat on the side-line for decades. Ask an employer what they pay for specific health services and they are basically clueless. Things are changing here in Connecticut and nationwide. Employers are waking up to their fiduciary duty to act (contract for services) only in the best interests of their plan beneficiaries. They need to know what services cost, what they should cost and what they COULD cost or run the risk of being fined or sued by their plan members. Here, a union is suing HHC for price fixing and monopolization. In other states, employers themselves are being sued for breaching their duty to plan members. Employers, because of CAA are FINALLY securing their data on their populations and actually seeing what they’re paying and once they see it, in many cases, are horrified at the prices they’re paying. In other states, competing health systems are tactically establishing direct to employer functionality to take advantage of this new opportunity; they’re going at risk with employers on their populations. Effectively, they’re furnishing a marketplace solution designed to align their supply of services with the SPECIFIC population based needs of the employer. Perhaps, the largest employer in the state of CT, aka The State of CT Employee Health Plan, will assert itself to demand accountability for health services costs. That would certainly send a signal to all health systems that accountability is now a real thing. My guess is that health systems will react when and if the largest purchasers demand that they do so. This is a story that is and will continue to play out nationally. #hospital #healthcosts #monopoly #healthcare #healthleadership #paymentreform #caretransformation #CAA #fiduciaryduty #healthmarketplace Christine Arnold John Rodis, MD Lisa Trumble Moving to Value Alliance Chris Deacon Peter Hayes Patrick Long Al Lewis 🇺🇦 Brian Klepper Cora Opsahl Stacey Richter Julie Selesnick Jamie Greenleaf AIF, CBFA, C(k)P Justin Leader Stuart Sutley Michael Brouthers Derek Moore A. J. Loiacono Doug Aldeen Scott Haas Darren Fogarty Elizabeth Mitchell Dave Chase, Health Rosetta-discovering archaeologist 🎙Spencer Smith, CSFS® Raju Kattumenu Tim Denman Les Wilkinson Christopher Gormley Dean Jargo Wyatt Bosworth Kerry Wood Steve Schutzer, MD

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Jeff Hogan does a great job explaining how hospital and health care spending can start to decrease, or at least not increase at double the rate of inflation, as it has for 20 years! As long as there is someone willing to pay the price, prices will rise. Employers (and their employees) must begin to leverage their purchasing power in the marketplace. We must all understand that Cigna, Aetna, United, Kaiser and Blue Cross/Anthem (now Elevance) are not “payers”. Employees, employers and taxpayers are the true payers through premiums, copays, deductibles, coinsurance and State (for Medicaid) and Federal (for Medicare) taxes.

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We know that physicians need insights, time, tools, and capital to effectively implement #ValueBasedCare and have the greatest impact on their patients and communities. Here are 6 common challenges #PrimaryCare #physicians face when implementing value-based care and learn how our partnership is helping providers overcome them: 

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Behavioral healthcare has many facets. Can your #EHR handle your complex needs? Core's recent blog post shares valid food for thought. 

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“It is not just about the numbers. Whether opening a facility or adding a service, we pay strict attention to ensuring we deliver quality, evidence-based care in a safe environment with expertly trained staff.” Read more from Stephanie Eken, Chief Medical Officer, and Navdeep Kang, PsyD, Chief Quality Officer, Inpatient Services, about the clinical priorities that are in place that will allow Acadia Healthcare to continue to set the standard for patient care. #QualityCare #Healthcare #Commitment.

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