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Category Archives: Uncategorized

ACO – The Basic Concept

Posted on April 23, 2012 by Kathleen Rand

Under the healthcare reform law, an Accountable Care Organizations (ACO) is a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve with Medicare. The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries.  The ACO is like a patient-centered medical home where the patient and providers are true partners in care decisions.

The Affordable Care Act specifies that an ACO may include the following types of groups of providers and suppliers of Medicare-covered services:

  • Networks of individual practices of ACO professionals,
  • Partnerships or joint ventures arrangements between hospitals and ACO professionals, or
  • Hospitals employing ACO professionals, and
  • Other Medicare providers and suppliers as determined by the Secretary.

The law requires each ACO to include health care providers, suppliers, and Medicare beneficiaries on its governing board. The ACO must take responsibility for at least 5,000 beneficiaries for a period of three years, also suggested in the law.

The law links the amount of shared savings an ACO may receive to its performance on quality standards.  The rule proposes quality measures in five key areas that affect patient care: patient/caregiver experience of care; care coordination; patient safety; preventive health; and at-risk population/frail elderly health.

The ACA sets out proposed performance standards for these measures and a proposed scoring methodology, including proposals to prevent providers in ACOs from being penalized for treating patients with more complex conditions.

Furthermore, any patient who has multiple doctors probably understands the frustration of fragmented and disconnected care:, duplicated medical procedures, lost or unavailable medical charts or having to share the same information over and over with different doctors.  Accountable Care Organizations , like patient-centered medical homes, are designed to lift this burden from patients, while improving the partnership between patients and doctors.  Doctors can provide better care because they will have better information about their patients’ medical history and can communicate with a patient’s other doctors.  Medicare beneficiaries whose doctors participate in an ACO will still have a full choice of providers and can still choose to see doctors outside of the ACO. Patients choosing to receive care from providers participating in ACOs will have access to information about how well their doctors, hospitals, or other caregivers are meeting quality standards.

 


Posted in Uncategorized | Tagged affordable care act, BHM Healthcare Solutions, health care consulting, healthcare compliance, Healthcare consulting firm, Healthcare management, healthcare reform, Patient-Centered Medical Home, top ten healthcare consulting firms, URAC Medical Home Accreditation, URAC Patient Centered Medical Home Accreditation | Leave a comment

A Happy New Year Wish from BHM!

Posted on December 31, 2011 by Kathleen Rand

A happy New Year! Grant that I

May bring no tear to any eye

When this New Year in time shall end

Let it be said I’ve played the friend,

Have lived and loved and labored here,

And made of it a happy year.

~Edgar Guest

 

BHM Healthcare Solutions wishes you and yours a very happy and healthy new year! May it be filled with abundance, unequivocal joy, and countless treasured moments. Make it your own, and take some time to enjoy. Be well!

Our blog posts will resume in the middle of next week. Again, the best in 2012!


Posted in Uncategorized | Tagged BHM Healthcare Solutions, Healthcare consulting firm | Leave a comment

The Cost of Healthcare Fraud and Abuse

Posted on September 6, 2011 by Danyell Jones

With a tight economy, budgetary cutbacks, and lawmakers looking for ever increasing ways to recoup money, healthcare fraud and abuse has become an issue of singular focus lately.

Back in 2010 CNN ran an excellent article on the cost of fraud and abuse (for article click here).  Little has changed since then and healthcare fraud and abuse is still having a staggering impact on the country’s bottom line.  In the upcoming week we will take a look at some of the key healthcare fraud related issues including;

  • The Qui Tam provisions of the False Claims Act
  • Reverse false claims and Medicare RAC audits
  • The Billion dollar cost of Fraud
  • What fraud initiatives are on the horizon

Here is a video from NBC Nightly News…..this story focuses on Florida, a state identified as one of the most egregious offenders when it comes to Medicaid/Medicare fraud.

Visit msnbc.com for breaking news, world news, and news about the economy


Posted in Compliance, Health Care Reform, Healthcare Fraud and Abuse, Uncategorized | Tagged fraud and abuse awareness, fraud and abuse prevention, healthcare abuse, healthcare compliance, healthcare fraud, healthcare fraud and abuse awareness, healthcare reform, high cost of healthcare fraud | 6 Comments

Healthcare Reform- The Basics

Posted on August 8, 2011 by Danyell Jones

Hello everyone,

I recently found this great video that gives a very broad overview of healthcare reform, and a fairly….(mind you I say fairly), unbiased look at healthcare reform in a “big picture” sense.  I hope that you enjoy it as a bit of an intro into our healthcare reform series, and as a means to get acquainted with the topic before we look at it from the granular level!

For questions on healthcare reform, healthcare compliance, accreditation, or financial improvement please email us at results@bhmpc.com.


Posted in Uncategorized | Tagged compliance healthcare, compliance in healthcare, health care reform, healthcare compliance, healthcare compliance association, healthcare financiam management, healthcare reform | 11 Comments

Where 1/3 of Every Healthcare Dollar is Going

Posted on July 15, 2011 by Danyell Jones

When you discuss compliance in healthcare, it is essential that you address cost.  According to the Institute of Medicine, “HIPAA compliance cost 33 cents of every health care dollar that was spent between 1996 and 2002.”

HIPAA, or the U.S. Health Insurance Portability and Accountability Act, provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information, and all organizations are expected to be held accountable by healthcare compliance associations.

Gartner identified “security for privacy compliance as one of the top 10 issues within healthcare, and an area that is misunderstood and the cause of significant spending by healthcare.”

But healthcare compliance does not have to be such a burdensome financial weight to bear.  Many healthcare organizations are now seeking expert consulting firms to assist them with reigning in HIPAA related spending, and a heavy emphasis has been placed on new and innovative IT Solutions that are lowering the cost of compliance.  In fact, according to Net IQ “70% of healthcare organizations with annual budgets greater than US$100 million are using HIPAA compliance claims and remittance advice, and more than half of these organizations seek outside help.”

The bottom line to reigning in healthcare costs is often calling in experts in the respective area to bring alignment to healthcare compliance and financial goals of an organization.  As healthcare, and already extensively regulated industry, becomes even more regulated, and as the number of healthcare services purchased through government continues to grow (currently 53% of services are purchased through the government and this rate is expected to grow by 15% per year for the next 5 years) it will become increasingly important for healthcare organizations to look to outside help to remain fiscally strong.

 


Posted in Accreditation, Learning Series, Uncategorized | Tagged Accreditation Due Diligence, compliance in healthcare, health care accreditation, healthcare compliance, healthcare compliance association, Healthcare consulting firm, reducing cost, reducing healthcare cost | 54 Comments

It’s Not About You…

Posted on July 5, 2011 by Kathleen Rand

Welcome to the final installment of the proposal writing series in which I will attempt to tie everything together. A quick summary: proposals need to be written to close business, and they need to be structured around your clients’ needs.
There are four categories of content that proposals must contain to increase your chances of success:
1. Proof that you understand the client’s business problem. Any decision that involves spending money creates some anxiety. Clients do not want their time or their money wasted. One way to ease their anxiety is to assure them that you clearly understand their issues, needs, objectives, or values. Whatever is driving the client’s interest, you must demonstrate that you have based your solution on it.
2. A specific approach to solve the problem and produce positive results that is clearly stated. You must spell out what you will do for the client, not just describe your products or services. What you recommend should undeniably link what you can do with what the client needs to get positive results.
3. A convincing reason for the client to choose your solution over any others. This is your value proposition. Without a clear statement that specifies how your approach will offer a higher return on investment, faster payback, or something similar that matters to the client, you may not win the proposal.
4. Demonstrate your ability to deliver on time and on budget. You want to show evidence that you can really do what you say you can. Effective proof includes case studies, testimonials, references and resumes of key personnel. You may also include project plans, management plans, company expertise, and other forms of substantiation like white papers, awards, or third-party recognition. Avoid throwing in everything. Again, focus on what the client cares about and pick the items to include accordingly.

Finally, language within your proposal is paramount. And again it is pretty straightforward. Be clear and direct, not passive or elusive. Sentences should be short and informative, not complicated. Put the most important item upfront: your client. Speak to them, about them, and make it obvious how you can help them.

Good luck, be well and be good to yourselves and your words…


Posted in Learning Series, Uncategorized | Tagged Behavioral Health Management, BHM, BHM Healthcare Solutions, closing business, grant writing, Healthcare consulting firm, healthcare managment, Improving Health Care Profitability | 6 Comments

Do You Know What I Mean?

Posted on June 2, 2011 by Kathleen Rand

“The difficulty … is not to write but to write what you mean…” Robert Louis Stevenson
Hi, my name is Kathleen Rand, a Senior Proposal Writer with BHM Healthcare Solutions. I am new to the BHM team but not to writing. After I graduated from college, it was common for people to ask me: ‘What are you going to do with an English degree?’ Well, what I did was write…a lot. For over fifteen years and for various organizations, I wrote just about everything from marketing materials to technical manuals, from educational curriculums and student catalogs to policies and procedures, from training documentation to government grant submissions.
It turns out communicating effectively – writing what you mean – is a marketable skill. Even in today’s digital age of texting and smart phones, a well-written presentation or proposal, one that is clear, concise and accurate, cannot be underestimated. It can translate into the close of a deal, the addition of a new client, the reward of state or government monies.
I plan to present a three part series discussing the impact of writing in the business world, more specifically the significance of solid business proposals. I will share tips on how to create a persuasive value statement that will truly differentiate your organization. Further, I will examine the elements essential to successful proposals, and those that aren’t. Finally, I will evaluate the writing process in whole: from defining the basic steps necessary to organize a proposal to assessing the importance of word choice and sentence structure.
I am excited to jump into the BHM blogosphere and look forward to the journey with you.


Posted in Quality Improvement Programs, Services, Uncategorized | Tagged Behavioral Health Management, grant writing, health care accreditation, health care consulting, Healthcare consulting firm, healthcare managment, proposal writing | 12 Comments

BHM- Jumping into the Blogosphere

Posted on May 24, 2011 by Danyell Jones

Hello and welcome to the official relaunch of BHMs “Healthcare Insider” blog.  This is a place where you will find the latest up to date information about healthcare related topics- everything from how to make your organization more profitable, to the latest political news, to how cutting edge technology is shaping the healthcare world today.

Additionally, we will be conducting interviews with some of the ultra-talented associates populating the halls of BHM, and hosting a number of guest contributors who are among the most talented leaders out there in the healthcare and technology fields.  Along the way we will try to make this blog a bit more interesting to read than your average toaster user manual, and will be poking and prodding our way into the depths of the healthcare realm to get to the heart of relevant topics, and bring insightful and valuable information, tips, and perspectives to you- the reader.

So…..bookmark this blog, email it to a friend or colleague, and be sure to add our RSS feed as we begin our journey into the blogosphere and explore the topic of healthcare.  Of course we would love to get your feedback on what topics most interest you, and what you would like to see discussed and showcased in the future.

Until next time…..

Danyell

 

 


Posted in Uncategorized | Tagged Behavioral Health Management, BHM, BHM Healthcare Solutions, cost effective, Healthcare consulting firm, Improving Health Care Profitability, reducing healthcare cost | 4 Comments

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email: results@bhmpc.com

 


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