Health Catalyst Recommends

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HealthCatalyst Recommends

The Best Solution for Declining Medicare Reimbursements

I am one of the brave souls who takes the time to read the report issued each spring by the Medicare Payment Advisory Commission (Medpac). The report shows the numbers of Medicare beneficiaries and claims are growing; healthcare organizations are increasingly losing money on Medicare; payment increases certainly will not keep pace with declining margins; and Medicare policies will continue to incentivize quality and push providers to assume more risk. But the report also reveals that some healthcare organizations—referred to as “relatively efficient”—are making money from Medicare with an average 2 percent margin. How do you become one of these organizations? And how do you target and counter Medicare trends that impact your business?

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Five Data-driven Patient Empowerment Strategies

Data plays a big role toward empowering patients to become more involved in their care. With data, digital tools, and education, patient empowerment can act like a blockbuster drug to produce exceptional outcomes.

Data empowers patients five ways:

  1. Promotes patient engagement.
  2. Produces patient-centered outcomes.
  3. Helps patients practice self-care.
  4. Improves communication with clinicians.
  5. Leads to faster healing and independence.

Clinicians using creative, innovative care strategies, and patients with access to the right tools and technology, can produce remarkable results in terms of cost, health outcomes, and experience.

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A Health Catalyst Overview: Learn How a Data-first Strategy Can Drive Increased Outcomes Improvements

Without the pressure of a one-on-one demo, you can join a crowd of peers to ‘kick the tires’ if you will, as you listen to Jared Crapo—a sought-after healthcare strategist—talk through the strategic components to a data-first strategy employing a data operating system, a breakthrough engineering approach that combines the features of data warehousing, clinical data repositories, and health information exchanges in a single, common-sense technology platform that turns data into actionable assets used for all types of financial, clinical or operational outcome improvements.

Lest you worry about too much ‘pie in the sky’ strategy talk with few results to show, Sam Turman, Senior Solution Architect, will provide tangible solution demonstrations that are driving material results. Even if you aren’t in the market for Health Catalyst solutions and services, you will be able to:

  1. Think with more clarity through your approach to overcoming the current market challenges.
  2. Reconsider the strategy you are employing to build cross-organizational awareness and support to put a data-first plan at the center of your plan.
  3. Define action you can take today to assess your gaps, understand your options, and accelerate your progress to drive outcomes improvements.
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How to Achieve the Competencies of Successful Value-Based Contracting Delivery Systems

This webinar will review the evolution of the value-based contracting world, identifying key insights into impactable contract levers, and delineating systematic steps that lead to sustainable value-based contracting success.

Health Catalyst team members Bobbi Brown, SVP, a healthcare finance executive with over 40 years’ experience, and Jonas Varnum, a population health and value-based care strategic consultant expert, will present on many of their battle-scarred experiences working with the financial, clinical, analytical, and operational components of value-based contracting delivery models, including:

  1. Shared qualities of successful value-based contracting delivery systems.
  2. The intensifying need for robust data to drive success.
  3. Refining and optimizing core competencies.
  4. Increasing sustainability by impacting key contract levers.
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Data-Driven Practice Intelligence Increases Provider Engagement and Strengthens Improvement Efforts

Physicians are under increasing cost pressure from commercial health insurers and government payers. Physician groups that wish to remain independent must embrace the changes associated with the shift to value-based care, adopt new technologies to reduce and streamline costs, and demonstrate ongoing quality improvement.

Acuitas Health is a population health services organization that empowers physicians to make a successful transition to a value-based care delivery system. While the organization has the requisite expertise to provide these services to providers of care, Acuitas Health lacked the timely, actionable data required to effectively engage providers in improvement efforts.

Acuitas Health implemented the Health Catalyst® Data Operating System (DOS™) to support the development of practice intelligence profiles—comprehensive views of partner practices used by the practice intelligence team to increase provider engagement and strengthen improvement efforts.

As a result of the DOS implementation, Acuitas Health improved overall data quality to achieve significant results:

  • Substantial increase in provider engagement.
  • 90 percent improvement in using data to identify improvement opportunities.
  • Provider- and practice-specific data, which would have previously taken months to compile, is now available daily.


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Improving Accuracy of Clinical Documentation Positively Impacts Risk Adjustment Factor and HCC Coding

The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare beneficiaries, and the results directly impact the reimbursement healthcare organizations receive for patients enrolled in a Medicare Advantage plan. CMS requires that all qualifying conditions be identified each year by provider organizations. Documentation that is linked to a non-specific diagnosis, as well as incomplete documentation, negatively affects reimbursement.

Allina Health, a not-for-profit integrated healthcare delivery system serving Minnesota and western Wisconsin, needed to improve its HCC coding and clinical documentation in order to ensure the correct risk adjustment factor (RAF) was applied to its patients, since failing to do so would jeopardize its reimbursement and result in lower than expected compensation. After identifying opportunities for improvement by comparing its HCC risk adjustment coding data to other organizations and vendor metrics, Allina Health improved clinical documentation precision, medical diagnoses accuracy, and ensured eligible patients are seen each calendar year.


  • 10 percent increase in RAF for the target population in one year.
  • 72 percent relative improvement in four key problem list diagnoses.
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