Healthcare Consulting

accelerating the journey to risk capability


DHG Healthcare Consulting is not everything for everyone. We have designed our services portfolio to match the complex opportunities and challenges our clients face on their journey toward Risk Capability. This transformational shift is a provocative, dynamic challenge – in both complexity and importance. While grouped as Solution Sets and Capabilities, we work collaboratively with our clients to develop distinctive approaches to the unique market challenges they face.

Why

 

The healthcare industry is undergoing a radical transition, shifting from a traditional, well-defined fee-for-service economy, to a system where value is defined by outcomes rather than inputs, where new players are emerging, and former competitors align. Most importantly, the healthcare industry has become an economy where purchasers of every size will demand greater efficiency, quality, outcomes, transparency and access. They will demand risk capability.

At the highest level, achieving risk capability strikes at the powerful status quo within the U.S. healthcare system. Successfully navigating this shift will require:

  • Adept management of the physician enterprise,
  • Keen insight into an evolving revenue portfolio,
  • Skilled connection of varied payment programs to larger population health challenges,
  • Exceptional management of an increasingly complex reimbursement and regulatory environments, and
  • Sophisticated recognition of and responses to a variety of complex associated business risks.

This is truly the hard work of healthcare transformation. Successfully navigating this shift is challenging and will require courage, confidence and a guide. DHG Healthcare is here to inform, guide and support our clients so their organizations can realize their long-term potential.

How

 

Our goal at DHG Healthcare is to be your guide along every step of your organization’s unique journey toward risk capability. For that reason, our services portfolio is designed around the complex business issues our clients face every day, combining distinct approaches, informative analytics, and deep technical competencies that drive value and results.

But solution sets, approaches and playbooks are not enough. Success in the journey toward risk capability requires a guide. At DHG Healthcare, we believe that guide should be:

  • Resourceful - Quick and thoughtful in addressing challenges and defining a clear path to success;
  • Forward Looking - A powerful focus on design and innovation with an ever - progressive mindset;
  • Insightful - Brings deep understanding to form actionable perspectives; and
  • Honest - Free from bias and focused on our clients.

Since its introduction in 2013, we understood the journey toward risk capability would be difficult and require a different approach, one that would always start with conversation infused with the principles listed above. These principles characterize our 'how' and make DHG Healthcare a truly distinctive partner.

What

DHG Healthcare Consulting is not everything, for everyone. Our consulting practice provides only those services that we believe are critical to an organization’s journey toward Risk Capability via broad Solution Sets that fall into two major categories.

Management Consulting

Managing industry participants’ transformational shift to Risk Capability is a provocative, dynamic challenge - in both complexity and importance. Our Management Consulting team assists our clients in answering this challenge via Solutions Sets designed to:

  • Realize transaction value and strategic promise (Circumference)
  • Energize the Physician Enterprise (Achieve)
  • Skillfully navigate and connect Alternative Payment Model programs (ke’nekt)
  • Illuminate a purchaser’s path to a better health plan (iluminus)
  • Cleverly manage and optimize a diverse portfolio of commercial contracts (PS)
  • Power growth through Service Line clarity and optimization (GO)
  • Inform the decision makers of the Senior Living domain (Senior Living)

These are augmented by targeted offerings in the Revenue Cycle, Post-Acute, Technology Optimization, and Analytic domains. Each is intentionally chosen for the key role they play in the journey toward Risk Capability.

Reimbursement & Regulatory Compliance

Complete
Cost Reporting & General Compliance
DSH - Disproportionate Share Hospital
Bad Debt
Wage Index
Medical Residency
Provider Based Solutions
Strategic Reimbursement Services

Our team delivers both targeted offerings to meet specific organizational needs (Bad Debt, Cost Reporting, Disproportionate Share and Wage Index) and the Complete Solution Set.

As organizations advance toward Risk Capability, there are specific steps they can take to enhance their near-term performance while preparing them for the long-term sustainability. Our reimbursement and compliance teams support our clients in this work via the following targeted offerings:

  • Medicare/Medicaid Cost Reporting
  • Medicare Bad Debt
  • Medicare/Medicaid Disproportionate Share Hospital (DSH)
  • Wage Index
  • QVG Record Assessment and Improvement Planning

Beyond these targeted offerings, Complete is a distinctive solution set that delivers our full suite of reimbursement offerings in a comprehensive bundle - uniquely designed for each client situation. The power of this offering is its ability to smartly synchronize the deployment of those reimbursement levers that will drive maximum near-term operational and financial benefit while maintaining long-term alignment with strategic objectives.

Capabilities

Due to the holistic nature of our Solution Sets, and the complexity of the challenges they are meant to address, our engagements typically require the deployment of several specialty capabilities. Embedded within our engagement teams, the deployment of these capabilities is critical to long-term sustainability. These capabilities are meant to assist our Solution Set teams in:

  • Envisioning, developing and applying the analytics that will provide key insights and long-term accountability (Applied Analytics)
  • Applying the perspectives and improvement opportunities that will facilitate alignment with the clinical agenda (Clinical / CDI)
  • Developing the financial modeling tools that will be instrumental in building organizational clarity and courage (Calibrate)
  • Deploying a “Situational Change Approach” design to diagnosis, implement and sustain human performance improvement (People & Change)

Whatever the category, each Solution Set or targeted offering was deliberately chosen given the core business challenges associated with achieving Risk Capability and is continually refreshed to ensure we bring the distinct solutions you would expect from a trusted guide. A guide committed to you for the long term - on your path toward Risk Capability.

Targeted Offerings

Attached to our Solution Sets and Capabilities, there are crucial, targeted areas that warrant attention across the healthcare enterprise as these organizations follow the path to Risk Capability…areas that are crucial to a healthcare organization or institutions' success and sustainability.

Our dedicated teams are positioned to guide, deploy tools and provide extensive support to clients as they go through these processes within their organizations, whether this is a shift in their approach or regularly scheduled maintenance. With a keen eye on uncovering trends driven by our analytics and research teams, our targeted offerings group challenges and drives organizations to keep ahead of the curve as the healthcare landscape continues to evolve.

Learn more about each of our specific targeted offerings.

Clinical Documentation Integrity Services (CDI)

As healthcare organizations react to risk adjusted and/or quality-based reimbursement mechanisms (BPCI-A, VBP, MSSP, MSPB, etc) and begin to assume more risk in payor contracting, they must develop core competencies and adapt to produce claims data to accurately depict the true acuity and burden of illness for each patient and to predict future resource requirements for individual patients and entire populations.

Competencies around this include precise clinical documentation attached to clinical workflow; technology solutions that are accurate and provide the required compliance coding; regular feedback on clinical documentation quality by credentialed personnel; and a systemized process that includes training to assess and improve coding quality.

Our comprehensive and holistic approach to CDI is matched with a customized plan for every client, wherever they are on their journey to Risk Capability for their organization.

Compliance

Our Clinical Documentation and Coding Integrity team work extensively with healthcare providers in all areas including appropriate coding, clinical documentation and billing of services across the full continuum of care settings and associate payment mechanisms. We guide our clients on their path to Risk Capability with urgent challenges around Compliance.

These include general, focused and/or attorney privileged matters in support of ongoing compliance initiatives, alongside reviewing and identifying required corrective measures or defense against third party assertions; Statistical sampling, payment error quantification, payment error extrapolation and disclosures when needed and serving as the Independent Review Organization (IRO) for a number of organizations with reporting requirements under Corporate Integrity Agreements as a result of entering into settlement agreements with government agencies; and establishing, evaluating and/or implementing compliance policies and safeguards based on regulatory requirements, which covers designing compliance plans as well as providing ongoing assessment activities to verify the operationalization of the adopted policies.

Revenue Cycle

The shift to value-based care in healthcare has created revenue at risk and anticipating and managing the “revenue transition” is crucial to future enterprise sustainability. Our team is uniquely positioned to assist with the overall patient continuum of care from the point of scheduling, patient access or patient encounters through coding, billing, and account resolution.

With an approach that is balanced and insightful, we guide clients through workflow and technology challenges associated with the revenue cycle while delivering best-in-class analytics, knowledge and experience. Comprised of comprehensive services, we assist clients with improving clean claim billing rates, decreasing denials and reducing claim manual touches which are both key to bottom-line improvement and sustainability.

Post-Acute Advisory Services

With increasing complexity emerging around the post-acute healthcare space, our team not only delivers support services tied to operationalizing healthcare entities, but also serves as an advisor to clients as they work to bridge processes with actionable claims submissions data and AR collections.

Providing an industry software platform, troubleshooting support, custom reporting, analyses and training support are a handful of additional services we provide.

Healthcare Industry

The healthcare industry is undergoing a radical transition. From a traditional, well defined fee-for-service economy, to a system where value is defined by outcomes - not inputs. Successfully navigating this shift is challenging and will require courage, confidence, and a guide. The people of DHG Healthcare are here to inform, guide and support our clients so their organizations can realize their long-term potential.

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