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Readers Write: Carrot or Stick? Physician Compensation in Value-Based Cancer Care Delivery

April 27, 2017 Guest articles No Comments

Carrot or Stick? Physician Compensation in Value-based Cancer Care Delivery
By Lucy Langer, MD and Lalan Wilfong, MD

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A previous post on re-designing cancer care in the context of the Centers for Medicare and Medicaid Innovation’s (CMMI) Oncology Care Model focused on physician engagement in cancer care delivery redesign and how to create a framework to engage physicians in quality improvement and the delivery of better patient care. In this article, we will discuss considerations around physician compensation when trying to strike a balance between productivity and value in this new care model.

The OCM pilot, which began in July 2016, is an alternative payment model designed to test whether specific changes in the payment for cancer care delivery can result in better care, smarter spending, and healthier people. Under the OCM, physician practices are subject to both financial and performance accountability during episodes of care defined by active chemotherapy administration to cancer patients. Reimbursement in the OCM is fee-for-service, but also includes a per-beneficiary Monthly Enhanced Oncology Services payment. According to CMS, this $160 MEOS payment is intended to assist participating practices in effectively managing and coordinating care for oncology patients during episodes of care. The potential for a performance-based payment is designed to incentivize practices to lower the total cost of care and improve the quality of care for beneficiaries during treatment episodes.

Evolving Models

Physician engagement is an essential component for success in payment models like the OCM. Practices can change physician behavior through the compensation model. Most oncologists are compensated based on relative value unit-generation, and some contain a small, additional bonus or incentive for activities such as supporting leadership roles in the practice. But how will compensation models evolve in the era of value-based care delivery?

New compensation models ought to include:

  • Productivity measures.
  • Incentives to provide high-quality care and thresholds that are relevant to the practice.
  • Visibility and reporting once key quality metrics are included.
  • Physician buy-in and full engagement to support the quality initiative.

In the new era of value-based care, practices must determine how to recognize physicians for their contributions to the larger practice’s ability to meet quality and cost-containment targets. This means creating a financial incentive for balancing both personal productivity and practice accountability to improve the quality of care provided.

Real-World Experiences

The US Oncology Network brings together more than 1,400 independent physicians from more than 45 physician-owned practices and over 400 sites of care across the United States, including primarily medical oncologists, radiation oncologists, surgeons, and urologists. We are both part of a committee within the network that has come together to think through and provide guidance as we transition to value-based care. Collectively, this committee has put resources in place to help 14 affiliated practices successfully enroll more than 19,000 Medicare patients (to date) in the OCM. In addition to the OCM, many practices affiliated with our network are participating in similar APMs.

As a result of this level of participation and the potential impact of these programs on each practice’s financials, key questions regarding physician compensation have emerged. For instance, with more than 420 physicians, Texas Oncology is focusing efforts to use a small proportion of compensation to incentivize clinical guideline- or pathways-based treatment protocols. With the implementation of a clinical decision support tool and tying 2 percent of salary to pathways performance, we have seen pathway adherence increase from 78 percent to 90 percent over a one year time frame*. On the other hand, Compass Oncology, with over 40 practitioners, is pursuing a different model and moving towards implementation of a novel total compensation model that shifts away from RVUs to a “Balanced Scorecard.” The Balanced Scorecard emphasizes three key elements – practice growth, fiscal responsibility, and quality metrics – that identify where physician behaviors can align with practice goals, patient needs, and payer contracts.

Productivity remains an important contributor to the health of a practice, and eliminating productivity from physician compensation entirely would be unwise. By pairing productivity with value and quality goals set at the practice level, we believe that physicians will be more likely to alter behaviors towards a more team-based approach.

The transition to true patient-centric care is the essence of new payment models aimed at reducing waste, enhancing patient services, and optimizing patient outcomes. An engaged physician brings value to the practice by providing leadership as a member of a larger team focused on meeting the patient needs. While the doctor-patient relationship remains central to this care, additional services are recommended to meet the needs of the patient. These include social work and financial counseling to decrease the barriers to receiving care, survivorship and palliative care to address patient symptoms and advance care planning, and triage nursing and advanced practice providers to provide clinical services between physician visits. Physicians should be incentivized and compensated for facilitating effective teams and providing mentorship, education, and leadership to drive practice transformation and success in value-based payment policies.

Metrics, Metrics, Metrics

Practices that participate in the OCM and similar models will be held to reportable metrics that emphasize value. Payments will be made based on performance compared to historical data for our own practices as well as the performance of other practices in the model. Baseline value metric data is available to us through CMMI, and tracking performance to these value metrics is an important element when considering physician incentives.

We believe that by incentivizing performance via novel payment models to address quality metrics and improvements in patient care, we must also ensure this approach fully aligns with our practice culture, values, and goals. Metrics that are widely held to be important in oncology as indicators of ‘best practice’ and high-level care, such as days on hospice, performance to established pathways and guidelines, and patient satisfaction, are under consideration for inclusion in the model.

Carrot or Stick?

Ultimately, in considering how to incentivize and motivate physicians through enhanced compensation models, each practice will have to wrestle with some fundamental questions: Is it better to use a carrot or a stick? How can the practice ensure ‘buy in’ to any major changes in compensation? What are the underlying values and strategic goals that you are trying to achieve? How do we balance productivity and value-based care? While we do not purport to have THE answer to physician compensation in the era of value-based care, it is clear that for our practices, legacy RVU models may not truly reflect physician activities that contribute to success with non-fee-for-service contracts. Each practice will have to customize any compensation formula to fit the practice culture, demographics, and payer contract mix.

Lucy Langer, MD is president of Compass Oncology in Portland. Lalan Wilfong, MD is medical director of quality programs at Texas Oncology in Dallas. Both practices are in The US Oncology Network.


References

1J Clin Oncol 34, 2016 (suppl 7S; abstr 187)


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News 4/26/17

April 26, 2017 News No Comments

Top News

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Rumor has it CMS will notify eligible providers of their MIPS participation status next month – information that CMS had originally intended to deliver last December. MGMA put pressure on CMS Administrator Seema Verma to issue the notices last month, emphasizing that the transition to MIPS “is a challenge involving upgrades to electronic health record software, reengineering clinical workflows to meet data capture and reporting requirements, contracting with data registries, and training clinical and administrative staff. Without basic information about eligibility, physicians and medical groups are significantly disadvantaged from positioning themselves for success in the program.”


Webinars

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April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

Heads up sales reps: Microsoft will soon add LinkedIn data to its Dynamics 365 sales software. New features will include the ability to use a sales rep’s email, calendar, and LinkedIn connections to gauge a prospect’s interest, and ways to save an at-risk deal using co-worker connections. Microsoft acquired LinkedIn in a $26 billion deal last year, and is no doubt hoping to give Salesforce a run for its money when it unveils the new features this summer.


People

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David Harvey (Health Healthcare) joins Formativ Health as CTO.

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Culbert Healthcare Solutions hires Joel Szymanski (Nuance Healthcare) as senior sales executive.


Announcements and Implementations

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SimonMed Imaging signs on with Zotec Partners for RCM and PM services at its 75 locations in Arizona.

MedData develops a mobile version of its patient payment and engagement app.

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Oncology Consultants (TX) selects patient relationship management software from Navigating Cancer. The 10-location practice will add Navigating Cancer’s population health capabilities once it comes out of development later this year.

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Urgent care and occupational medicine provider Concentra adds PM capabilities from Allscripts to its use of the company’s TouchWorks EHR and FollowMyHealth patient portal.


Government and Politics

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President Trump nominates biopharmaceutical company executive Brett Giroir to HHS assistant secretary. If confirmed the Baylor College of Medicine adjunct professor would have the power to appoint a new Surgeon General; additional responsibilities would include oversight of a dozen public health offices, 11 advisory committees, and development of policy recommendations.


Telemedicine

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BumblebeeMD debuts a healthcare savings plan that offers members unlimited virtual consults from a variety of telemedicine companies, as well as medical bill advocacy and negotiation services. Individuals pay $170 a year, while families pay $200.


Research and Innovation

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Consumers turn to more consumer-friendly sites like WebMD and Google reviews over niche sites like ZocDoc when looking for a physician, according to a survey of 500 consumers. Top selection criteria also includes affordability, being in-network, and convenience. Fifty-three percent of patients seem to want secure messaging more than their physicians, who, at 34 percent, feel that it is a distraction from patient care. That stat seems counterintuitive to me. Wouldn’t care triaged via a text or portal message free up physicians to spend more time with patients who might need more in-person attention?


Other

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ChicagoInno profiles Triggr Health, a fledgling company that has developed an app that uses patterns derived from phone usage – sleep history, call logs, texting history, etc. – to predict when a person will likely relapse back into substance abuse. The company claims it can predict a relapse three days before it happens with 92-percent accuracy. When such a likelihood is established, the app will proactively reach out with actionable messages of support. The company has raised $4.2 million since launching in 2014.


Sponsor Updates

  • EClinicalWorks will exhibit at the CAMGMA 2017 Annual Conference April 27-29 in San Diego.
  • Healthwise will exhibit at ZeOmega’s client conference May 2-4 in Plano, TX.
  • Intelligent Medical Objects will exhibit during the HIMSS UK eHealth Week May 3-4 in London.

Blog Posts


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Jenn, Mr. H, Lorre

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News 4/25/17

April 25, 2017 News No Comments

Top News

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Zoom Health – the insurance arm of Portland, OR-based ZoomCare – decides to close up shop after state insurance regulators deem it financially unstable. ZoomCare clinics, which have made news over the last several years for their unwillingness to accept Medicare and Medicaid patients, remain unaffected. Zoom Health is the third payer in the state to exit the market since the ACA became law in 2010.


Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Announcements and Implementations

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Medsphere Systems adds a scheduling tool to its ChartLogic EHR for physician practices and OpenVista EHR for hospitals.

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Allscripts announces that its EChart Courier service has helped physician practices digitally exchange 10 million medical records with payers since becoming part of the company’s EHR in 2015..

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Nonprofit Cumberland County CommuniCare (NC) implements Mediware’s AlphaFlex EHR to better enable its behavioral health services.

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Square Care, a physician-owned IPA and management company based in Long Island, NY, rolls out Athenahealth technologies at its 20 locations.

EHR vendor ISalus Healthcare will offer RCM services from AXO HMS.


Telemedicine

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The American Telemedicine Association’s annual conference concludes in Orlando. Looking through the tweet stream, I’m surprised no one brought up MDLive’s class-action lawsuit related to patient privacy. As a former MDLive user, I’m wondering if I’ll get paperwork in the mail alerting me to the legal wranglings.


Acquisitions, Funding, Business, and Stock

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Philadelphia-based HealthVerity raises $10 million in a Series B round led by Flare Capital Partners and Greycroft Partners. The company will likely use the funds to further develop its new Web-based Marketplace, which aggregates de-identified health data for research and marketing purposes.


Government and Politics

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The problem with paper: The Center for Children’s Digestive Health (GA) pays HHS a $31,000 HIPAA fine, incurred after it sent PHI to document storage company FileFax without first requiring the company sign a business associate agreement. The matter came to light while OCR was investigating FileFax’s failure to properly dispose of unwanted documents (think unlocked dumpsters instead of shredders).


Research and Innovation

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A PwC report on consumer receptivity to AI finds that the majority of its 2,500 survey takers believe it will benefit mankind in a number of ways – though they scale back their enthusiasm for healthcare-related advances. Just 22 percent of respondents – the lowest percentage across 10 categories – believe AI will replace physicians in the next five years. Other findings include:

  • Over 40 percent feel AI will expand access to medical services for low-income patients
  • Fifty seven-percent would share data to further medical breakthroughs. (Sixty-two percent would so to help relieve local traffic.)
  • Seventy-seven percent, however, prefer an in-person doctor’s visit to a robotic smart kit-assisted assessment performed at home.

Other

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Independent physicians in Vermont band together to form a state chapter of the national Association of Independent Doctors. Over the past year and a half the state has seen 20 independent MDs leave Vermont, sell their practices to a health system, or opt for hospital or community health center employment. A chapter spokesperson believes the new chapter will help connect Vermont’s independent physicians “with the independent doctors across the country who are dealing with the same sorts of issues, and it really helps us get our message out more nationally about the value of independent practices.” Vermont will become the AID’s fifth chapter.


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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JennHIStalk

News 4/24/17

April 24, 2017 News No Comments

Top News

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Remote monitoring company CardioNet will pay $2.5 million to settle an HHS fine related to an unsecured, PHI-containing laptop stolen from an employee’s car in 2012 and the company’s lack of follow up in instituting corrective actions. It is the first company of its kind to incur such a fine.


Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Announcements and Implementations

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DiagnosisAI develops a medical reference skill for Amazon’s Alexa that gives users the ability to ask for and receive medical advice based on physician-curated content.

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Shin Imaging Center implements ERad’s RIS, PACS, speech recognition, communications, and patient and physician portal technology at its two centers in California. It will roll out the same functionalities at a third site expected to open later this year.

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HealthCost launches a Web-based marketplace that gives physicians the ability to set prices for their outpatient services, and patients the ability to comparison shop for those services.

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Jackson Clinics, a chain of 15 facilities in Northern Virginia, agrees to a limited roll out of Phzio home physical therapy technology from EWellness. 


Telemedicine

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Perhaps looking to take advantage of the hype cycle surrounding the American Telemedicine Association’s annual conference taking place this week in Orlando, Austin-based startup Medici announces that its secure messaging app is now available in all 50 states. Medici’s technology, which includes video-based communication, is slightly different from traditional telemedicine platforms in that it gives patients the ability to invite their providers into the Medici network – a plus if you’re looking to dive into telemedicine but don’t want to seek treatment from a total stranger.

Salus Telehealth adds 24/7 urgent care consults to its VideoMedicine service.

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The American Academy of Sleep Medicine’s virtual consult business launches AASM Sleep Select, which seems only slightly different from its flagship platform in that it offers providers simpler technology options for quicker integration into their practices.


People

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Healthcare compliance and credentialing company Symplr hires Kyle Allain (API Healthcare) to lead its new Cactus Provider Management operation. Symplr and Cactus Software merged several weeks ago.


Government and Politics

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HHS will soon create its own cybersecurity center. Based on the Dept. of Homeland Security’s National Cybersecurity and Communications Integration Center, the HHS version will look to get off the ground sometime in June and will seek to educate stakeholders about the risks of using mobile apps and sharing resultant data. “[T]here’s so much noise out there about cyber threats to security and privacy,” says HHS CISO Chris Wlaschin, who explains that the new center will “analyze those and deliver best practices and the two or three things that a small provider, a small office, a doc in a box can do to protect his patient’s privacy and information security around those systems.”


Other

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The Carter Center will work with Liberian government officials to expand access to mental healthcare for Liberians affected by the Ebola outbreak, which killed over 11,000 in West Africa between 2014 and 2016. “After the civil war, people didn’t go through enough counseling,” explains Francis Kateh, MD Liberia’s deputy health minister and CMO. “You have people already going through post-traumatic depression. Then Ebola came, and that built on what was already going on.” It seems to me that some of the money being poured into showcasing innovations at the ATA conference this week could be diverted to helping virtually care for the mental health issues of Liberia’s 4.2 million people, including 4,000 Ebola survivors.


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

JennHIStalk

Population Health Management Weekly Wrap Up 4/23/17

April 23, 2017 News No Comments

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The University of Vermont Health Network promotes Stephen Leffler, MD as chief population health and quality officer.

HealthPartners rolls out Welltok’s personalized healthcare incentive plan to individual and small group plan members this month. It will offer the technology to its commercial large group markets next year.

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Cynthia Yannias (Better Health Network) joins eQHealth as state director, Illinois, government operations.

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Allen Kemp, MD (Centura Health Physician Group) joins Erdman’s Board of Directors.

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Caradigm announces that it will reduce its workforce as part of a reorganization that it hopes will streamline operations. The company went through similar motions last fall, reorganizing product teams and its Services organization.

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Prime Healthcare ACO (CA) implements population health analytics and benchmarking from Persivia to assist its 70 practices with 2016 reporting requirements.

The University of Pennsylvania Health System partners with Independence Blue Cross in a care coordination and data sharing deal – part of the Independence Facilitated Health Networks model – that both hope will decrease costs and improve care quality. The partnership, which begins July 1, includes:

  • Shared accountability; for example, PHS will offer Independence members a 30-day no-readmissions guarantee for all inpatient services.
  • Real-time exchange of EHR and claims data for better decision-making.
  • Collaborative assessments including on-site visitations from Independence clinical teams and quarterly meetings for benchmark analyses.

Sponsor Updates

  • Intelligent Medical Objects will exhibit at the European Federation for Medical Informatics meeting April 24-26 in Manchester, England.

Blog Posts


Contacts

Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

JennHIStalk

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