Cost

Executive Papers & Reports

Health Catalyst Editors

Healthcare Price Transparency: Understanding the Cost-Pricing Relationship (White Paper)

Healthcare consumers are demanding the same level of price transparency for medical care they have in other transactions—particularly as healthcare moves away from a fee-for-service model and patients are responsible for larger portions of their medical bills. Meanwhile, as of January 2021, federal regulation requires health systems to make their service charges publicly available. The healthcare industry, however, hasn’t historically succeeded with consumer-grade price transparency. Organizations must now figure out how to bridge the gap between their costs and patient charges. Doing so requires comprehensive understanding of all the costs behind a service and consumer-friendly explanation of how these expenses translate into prices.

Marlowe Dazley

Predicting Denials to Improve the Healthcare Revenue Cycle and Maximize Operating Margins

Healthcare financial leaders are constantly brainstorming ways to increase operating margins through better revenue cycle performance. These efforts often lead revenue cycle leaders to denied claims—when a payer doesn’t reimburse a health system for a service rendered. Although denials are a common reason for lost revenue, experts deem nearly 90 percent avoidable.
Effective denials management starts with prevention. Organizations can use revenue cycle performance data, combined with artificial intelligence, to predict areas within each claim’s lifecycle that are likely to result in a denial. With denial insight, health systems can optimize revenue cycle processes to prevent denials and increase operating margins.

Farhana Nakhooda
Larry Lofgreen

2021 Asia-Pacific Healthcare Trends: Growing Digitization, Universal Health Coverage, and More (White Paper)

Along with the rest of the globe, 2021 healthcare trends across Asia-Pacific (APAC) countries will center on COVID-19 recovery and resuming the healthcare improvement journey. In the APAC region, however, a mix of developed and developing countries poses unique challenges, as healthcare access and basic infrastructure vary widely between urban and rural populations and economic levels. To shepherd healthcare out of the pandemic and enhance delivery overall in 2021, APAC nations will focus on increasing investment in digital health (including virtual care, machine learning, and EMR adoption), achieving universal health coverage, shifting more towards value, and improving payer-provider relationships.

Daniel Orenstein, JD
Stephen Grossbart, PhD

2021 Healthcare Trends: What Leaders Need to Know from COVID-19 to New Administration Policies (White Paper)

While much of the healthcare industry was eager to put 2020 behind it, the new year brings its own challenges, concerns, and promises. Trends in the three main categories of new Biden administration policy, care delivery, and healthcare technology will shape 2021, with key issues including the long-term effects of COVID-19, future emergency preparedness, and the outlook for the Affordable Care Act (ACA). Healthcare leaders can prepare for this pivotal year by understanding critical areas to watch within these categories and how events, activities, and political appointments will affect the healthcare ecosystem.

Health Catalyst Editors

Healthcare Price Transparency: Understanding the Cost-Pricing Relationship

Healthcare consumers are demanding the same level of price transparency for medical care they have in other transactions—particularly as healthcare moves away from a fee-for-service model and patients are responsible for larger portions of their medical bills. Meanwhile, as of January 2021, federal regulation requires health systems to make their service charges publicly available. The healthcare industry, however, hasn’t historically succeeded with consumer-grade price transparency. Organizations must now figure out how to bridge the gap between their costs and patient charges. Doing so requires comprehensive understanding of all the costs behind a service and consumer-friendly explanation of how these expenses translate into prices.

Pat Rocap
Deb Gordon

Healthcare Consumerism and Cost: Dispelling the Myth of Price Transparency

Join Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, as they examine the importance of understanding the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat will provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.

Health Catalyst Editors

Improving Sepsis Care: Three Paths to Better Outcomes

Sepsis affects at least 1.7 million U.S. adults per year, making it a pivotal improvement opportunity for healthcare organizations. The condition, however, has proven problematic for health systems. Common challenges including differentiating between sepsis and a patient’s acute illness and data access. In response, organizations must have comprehensive, timely data and advanced analytics capabilities to understand sepsis within their populations and monitor care programs. These tools can help organizations identify sepsis, intervene early, save lives, and sustain improvements over time.

Health Catalyst Editors

Deliver Data to Decision Makers: Two Important Strategies for Success

Surviving on thin operating margins underscores the need for all end users at a health system to make decisions based on comprehensive data sets. This data-centered approach to decision making allows team members to take the right course of action the first time and avoid making decisions based on fragmented data that exclude key pieces of information.
To promote data-driven decision making and a data-centric culture, healthcare organizations should increase data access and availability across the institution. With easy access to complete data, end users rely on the same data to make decisions, no matter where they work within the health system.
Two strategies can help organizations integrate and deliver data to end users when they need it:

Select infrastructure that fits most people’s needs.
Ask the right questions.

Farhana Nakhooda
Larry Lofgreen

2021 Asia-Pacific Healthcare Trends: Growing Digitization, Universal Health Coverage, and More

Along with the rest of the globe, 2021 healthcare trends across Asia-Pacific (APAC) countries will center on COVID-19 recovery and resuming the healthcare improvement journey. In the APAC region, however, a mix of developed and developing countries poses unique challenges, as healthcare access and basic infrastructure vary widely between urban and rural populations and economic levels. To shepherd healthcare out of the pandemic and enhance delivery overall in 2021, APAC nations will focus on increasing investment in digital health (including virtual care, machine learning, and EMR adoption), achieving universal health coverage, shifting more towards value, and improving payer-provider relationships.

Health Catalyst Editors

The Right Way to Build Predictive Models for the Most Vulnerable Patient Populations

Predictive artificial intelligence (AI) models can help health systems manage population health initiatives by identifying the organization’s most vulnerable patient populations. With these patients identified, organizations can perform outreach and interventions to maximize the quality of patient care and further enhance the AI model’s effectiveness.
The most successful models leverage a mix of technology, data, and human intervention. However, assembling the appropriate resources can be challenging. Barriers include multiple technology solutions that don’t share information, hundreds of possible, often disparate, data points, and the need to appropriately allocate resources and plan the correct interventions. When it comes to predictive AI for population health, simple models may harness the most predictive power, which allows for more informed risk stratification and identifies opportunities for patient engagement.

Health Catalyst Editors

Three Cost-Saving Strategies to Reduce Healthcare Spending

Health systems continue to face fiscal challenges and burdens due to changing reimbursement rates, COVID-19, and managing the aftermath of care disruptions from the pandemic. Operating on thin margins with limited resources means health systems need to adopt alternative cost-saving measures to maximize limited resources.
Comprehensive, reliable data increases visibility into expenses across the care continuum so that leaders can leverage new methods to save money, generate income, and accelerate cashflow to keep patients healthy and hospital doors open. With access to recent data, health systems can focus on three cost-saving strategies:

Increase physician engagement.
Predict propensity to pay.
Implement evidence-based standards of care.

Health Catalyst Editors

Charge Capture Optimization: Target Five Hotspots to Boost the Bottom Line

As health systems continue to adapt to the pandemic healthcare landscape, certain challenges remain—including generating revenue on thin operating margins. Poor charge capture is a common reason behind lost revenue that healthcare leaders often fail to address. Because charge capture is the process of getting paid for services rendered at a hospital, poor charge capture processes mean the hospital does not get paid in full for a service, resulting in lost revenue that is typically unrecoverable.
Health systems can avoid financial leakage and increase profits by focusing on five problem areas within charge capture practice:

Emergency services.
Operating room services.
Pharmacy services.
Supply chain and devices.
CDM mapping.

Health Catalyst

Transforming Care Saves Millions and Improves Patient Outcomes

Thibodaux Regional Health System wanted to further improve the level of physician engagement required for successful healthcare transformation, prompting the organization to launch a targeted initiative. Guided by insights delivered through its data platform and analytics, the newly formed steering team analyzes past performance and determines which care processes require the focus of the care transformation team. Thibodaux Regional’s care transformation initiative has effectively engaged stakeholders to achieve patient-centered excellence. In only three years, the organization has achieved significant results.

Health Catalyst

Smartsourcing Clinical Data Abstraction Improves Quality, Reduces Costs, and Optimizes Team Member Engagement

Health Catalyst smartsourced two of its clients’ clinical chart abstraction efforts to significantly reduce costs, improve value, and optimize team member engagement. Banner Health and Community Health Network (CHNw) were collectively spending more than $10 million annually to manually abstract clinical measures for submission to CMS, NSQIP, tumor registries, and more than a dozen cardiovascular registries. The smartsourced relationship, leveraging the Health Catalyst® Data Operating System™ platform and a robust suite of analytics applications and improvement services has reduced costs, enhanced data quality, and improved the team member experience for these organizations.

Health Catalyst

Denials Management Analytics Reduces Denials by Nearly $5M

On average, claim denials cost each healthcare provider $5 million every year. This loss of revenue resulting from claim denials is a concern for healthcare providers. Billings Clinic sought to determine the cause of claim denials and realized that it needed an analytics solution that could integrate data from multiple sources. The health system leveraged its data platform and analytics applications to pinpoint the sources of the denials, allowing the organization to implement prevention plans and procedures for recovering the denials. Billings Clinic achieved significant results, including:

Health Catalyst

Analytics and Provider Operations Support Generates Nearly $2M in Shared Savings

Acuitas Health was challenged to identify opportunities for shared savings, reducing cost while also improving quality outcomes. Using Acuitas Health’s advanced analytics, providers and payers can now connect, communicate, and share insights that enable the organizations to identify opportunities to decrease costs for all partners, and increase outcomes that yield benefits in several areas, including quality improvement, claims optimization, and risk adjustment.

Kyle Salyers

Innovative Healthcare Partnerships: Making the Most of Merging Resources and Capabilities

Healthcare mergers and acquisitions performed solidly in 2020, despite the downturn in the U.S. economy and healthcare in general. Organizations responded to new challenges by partnering with each other to build core business strengths, address gaps in care delivery the pandemic exposed, and enhance their resources to navigate current and future crises.
Realizing the potential of emerging healthcare partnerships requires an open and scalable analytics infrastructure plus a cultural and contractual openness to allow innovation to flourish. Organizations that have adopted an open analytics platform have the data operating advantage to form partnerships, efficiently and smoothly bring best-of-breed solutions to market, and enable the innovative potential of collaborations.

Daniel Orenstein, JD
Stephen Grossbart, PhD

2021 Healthcare Trends: What Leaders Need to Know from COVID-19 to New Administration Policies

While much of the healthcare industry was eager to put 2020 behind it, the new year brings its own challenges, concerns, and promises. Trends in the three main categories of new Biden administration policy, care delivery, and healthcare technology will shape 2021, with key issues including the long-term effects of COVID-19, future emergency preparedness, and the outlook for the Affordable Care Act (ACA). Healthcare leaders can prepare for this pivotal year by understanding critical areas to watch within these categories and how events, activities, and political appointments will affect the healthcare ecosystem.

Health Catalyst

Analytics Enables Value-Based Care Transformation

UC San Diego Health sought to transform its organization, expanding beyond fee-for-service, transitioning to value-based care, and improving the health of its patient population—forming its Medicare Shared Savings Program (MSSP) ACO. It realized it needed a better understanding of its organizational strengths, opportunities for improvement, and needed actionable, timely data that would enable it to improve outcomes, reduce waste, and succeed in value-based care. The organization leveraged an analytics platform to give insight into performance and improvement opportunities, educating and engaging ACO providers.

Health Catalyst Editors

Shifting to Value-Based Care: Four Strategies Emphasize Agility

As the healthcare payment shift from fee-for-service (FFS) to value-based reimbursement takes longer than expected, health systems must balance existing volume-based models with a growing emphasis on value. Organizations are in different phases of the journey from volume to value, and policies continue to evolve. In response, the industry’s best stance is to sustain FFS revenue while following guidelines and strategies to be increasingly ready for value.
Organizations can use four methods to remain agile as they navigate the limbo between volume and value:

Understand the first ten years of value-based care and prepare for what’s next.
Identify essential strategies for shifting from volume to value.
Leverage the Medicare Shared Savings Program.
Use population health management as a path to value.

Bobbi Brown, MBA

The 2021 Healthcare Financial Forecast: What to Expect, How to Prepare

As healthcare financial leaders plan for 2021, they can expect COVID-19 to shape their strategies. Pandemic response and recovery will continue to dominate the industry, inform new perspectives on existing issues (e.g., the shift to value-based care and health equity), and shape priorities. Meanwhile, the Biden administration will start to puts its stamp on U.S. healthcare, further making 2021 a pivotal year for the industry.
Healthcare finance teams can best navigate 2021 by monitoring and preparing to take action in five prominent areas:

Election impact.
Price transparency.
Financial forecasting.
Value-based care.
Health equity.

Health Catalyst

Analytics Driven Improvement Efforts Reduces Surgical Supply Costs by $3.2M

Banner Health identified considerable variation in surgical supply use across its facilities. The health system desired a collaborative, data-driven strategy that would allow it to maintain high-quality outcomes while simultaneously decreasing costs across all procedures systemwide. To standardize supply use, Banner Health implemented an analytics application to help identify high-volume, high-cost surgical procedures that varied across the system. It then built standardized surgical preference cards for the high-volume procedures.

Bob Alexander
Mike Andrews
Robert DeMichiei

The 100-Percent Solution to Improving Healthcare’s Operating Margins

Healthcare organizations face unparalleled pressure to increase operating margins as they adapt to the revenue compression from COVID-19 and growing competition from insurers and digital disrupters. Yet, many health systems rely on outdated, revenue-centric cost accounting solutions that are ill equipped for strategic financial decision making. As a methodology for today’s complex healthcare environment, activity-based costing (ABC) can capture healthcare resource use at a granular level. With this service-level insight into clinical cost, ABC provides actionable intelligence to help organizations improve profitability and make strategic cost-reduction decisions. These comprehensive costing solutions give health systems a full understanding of cost across the care continuum—the only level of insight that will enable strategic cost transformation in the industry’s new normal.