PHYSICIAN & CLINICAL ADVISORY

Developing a strong physician enterprise requires the help of knowledgeable physicians that can lead change in your organization. Our Physician Advisors work with your team to provide one-on-one assistance in developing physician partnerships and collaboration models to support growing enterprises. Their focus on provider engagement and leadership helps grow the organization and establish strong clinical goals and objectives.

The complexities of the CMS and private payor risk-based reimbursements require one-on-one learning experiences for your physicians. Our Physician Advisors work with care delivery providers to understand the complex arrangements that drive risk capability. The physicians provide education, communication networks and a deep understanding of how advanced payment models can improve and diversify revenue.

Responsibility for managing the health of your designated populations requires that your physicians are prepared with the information and tools to deliver care in the most efficient and effective way. Our Physician Advisors work with clients to develop strong population health management strategies that are improving care delivery across the continuum. Their focus is to help physicians build reliable and repeatable methods of care delivery in the growing population health perspective.

Physicians require quick, informative and thought-provoking knowledge content that will help them in their day-to-day care management. Our Physician Advisors are developing timely and knowledgeable advice on working to improve clinical enterprise care delivery models. These articles, videos and presentations provide physicians and hospitals the information they need to advance their risk capability.

With changes in reimbursement models, clinical and operational workflows must also change to meet the needs of patients. Our Physician Advisors focus on the people, processes and technology needed to improve operational performance and drive a strong network of clinical care management.

Patient quality and safety metrics are found in all performance improvement projects, including CMS, commercial payors and external ratings organizations. Risk capable organizations are focused on targeted clinical transformation that improves patient outcomes, reduce the cost of care and improve patient satisfaction. In addition, a focus on the quality of clinical documentation assures that the “expected” ratio of claims-based measures is accurate based upon proper depiction of patient acuity. DHG quality and safety subject matter experts assist clients in not only understanding their current performance and reporting requirements, but help providers target those areas that will have the most impact on overall performance.

Changes in the reimbursement landscape are now calling for new and different structural and governance models that impact the delivery and oversight of care and strategically position hospitals for success in the marketplace. Hospitals are focused on ensuring that models, such as shared governance in nursing, reporting structures of nurse leaders in larger health systems and organization of quality departments and functions can meet the needs of our changing delivery model.

Hospitals are also focusing on implementing evidence-based guidelines and practice recommendations to drive improvement in care delivery. Becoming proficient in clinical pathways and reducing variation in care will allow hospitals to improve performance in key quality metrics in mandatory and voluntary risk-based programs.

The rapid growth of health care costs across the past decade has resulted in the passing of the Affordable Care Act, which launched several value-based programs. This transition from traditional, fee-for-service reimbursement to a system in which value is defined by outcomes has forced healthcare providers to consider new models of care delivery that provide improved clinical care at a lower cost across the care continuum. Providers must build key competencies supporting a full-scale, transformational care management program that integrates and supports success in value-based programs and fee for service programs simultaneously.

As organizations begin to assume more risk in contracting, they must develop core competencies in risk-adjustment for patient populations. Maintaining the status quo or a legacy approach to clinical documentation and coding can have impacts that are financially detrimental to organizational success. Key impacts of clinical documentation and coding performance in the risk-capable organization include proper depiction of patient acuity through risk adjustment, accurate and complete coding for fee-for-service and alternative payment models and leveraging technology investments in EHRs to assist clinicians achieve precision and efficiency in clinical documentation.