Revenue Enhancement

Success Stories

Denial Managements Improvement Effort Produces $14.99M Reduction in Denials

At MultiCare Health System, the processes for denial management were not as effective as they could be, negatively impacting net patient revenue and financial performance through millions of dollars in adjustments. While only two-thirds of denials are recoverable, nearly 90 percent are preventable. MultiCare looked at improving denial management as an opportunity to improve appropriate revenue capture for services provided. Through targeted improvement efforts that included standardized workflows and increased data visibility, the health system is improving the root cause of denials.
Results:

$14.99M reduction in denials and avoidable write-offs.

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How Allina and Minnesota Perinatal Physicians Lowered Stress and Raised Satisfaction for High Risk Maternal Patients

Assuring patient satisfaction can be challenging, particularly when providing care to pregnant women with high-risk pregnancy conditions. As one of the foremost perinatal practices in the country, Minnesota Perinatal Physicians (MPP) acted swiftly to end a significant delay in scheduling ultrasound appointments, and reduced wait times for other visits.
With an aim to improve patient care and experience, the maternal fetal medicine (MFM) specialists at MPP, employees of Allina Health, leveraged Allina’s “Improving Clinical Value” Program—an initiative that has elevated the patient care experience for numerous other patient populations while simultaneously lowering the per capita cost of care for each one.
Results:

$210,000 in increased revenue because of improved access, projected to be $280,000 within 12 months.
20.8 percent relative improvement in no-show rate.
20 percent increase in available ultrasound appointments and an 18.2 percent increase in utilization.

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Data-Driven Clinical Documentation Improvement Program Increases Revenue and Improves Accuracy of Risk Adjusted Quality Metrics

Allina Health, an integrated delivery system throughout Minnesota and western Wisconsin, has long understood the value of clinical documentation improvement (CDI), and its growing importance in recent years. With the implementation of ICD-10, the specificity needed for accurate coding has increased, and reimbursement shifts have occurred as well, creating sizeable payment disparity for some clinical conditions. Leaders at Allina wanted to understand where their CDI program would have the greatest return on investment. However, data from the EHR was not sufficient to inform their strategy. CDI specialists still lacked the ability to perform a comprehensive assessment of the accuracy of clinical documentation, and were unable to confidently target improvement efforts in areas that would generate the greatest return on investment. To take a more data-driven approach, team members leveraged the Health Catalyst Analytics Platform, including their Late-Binding™ Data Warehouse and broad suite of analytics applications to develop a CDI analytics application. With the application, the team identified opportunities and thoroughly vetted them, before collaborating with physicians and service line leaders to educate providers on documentation improvements.
They achieved the following results:

12.1 percent improvement in CV surgical cardiology CC/MCC capture rate.
6.3 percent increase in medical cardiology CC/MCC capture rate.
Increased accuracy in publically reported risk adjusted quality metrics
Revenue capture improvement across the system – resulting in millions of dollars of additional reimbursements.

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Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement.  The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.
Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract.  The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.
Results:

Achieved 100 percent of all at risk dollars.
100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.

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Data-Driven Approach to Improving Cardiovascular Care and Operations Leads to $75M in Improvements

Health spending in the United States is greater than the gross domestic product of most nations, and the costs for cardiovascular disease (CVD) and stroke care alone total $193.1 billion. CVD accounts for approximately one out of every three deaths in the U.S. and contributes to the shorter life expectancy of Americans. Thirty-five percent of CVD related deaths occur before the age of 75 years, and 19 percent before the age of 65.
Allina Health is a large integrated healthcare delivery network operating in Minnesota and western Wisconsin that includes three large cardiac centers. Due to the prevalence and mortality rate of CVD, leaders at Allina Health recognized that they needed to focus on cardiovascular health in order to truly impact the population health and patient outcomes of the communities they serve.
By leveraging real-time data from its enterprise data warehouse (EDW), Allina Health effectively identified and addressed clinical practice variation and operational issues affecting cardiovascular care and costs. In doing so, the health system realized more than $75 million in performance enhancement savings and revenue increase over a four-year period by focusing on supply chain, lab test and blood utilization, clinical practice changes and clinical documentation improvement.
 

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How an IDS Standardized Care for Women While Increasing Market Share

One in three pregnant women give birth via cesarean section in the United States, which is more than double the rate the World Health Organization (WHO) recommends. And instead of decreasing, the overall C-section rate in Washington State increased 73 percent from 1996 to 2009. C-section rates are just one area of maternal care where our practice in the U.S. lags behind the science and knowledge of best practice. MultiCare Health System believes that all of its female patients should experience the same high-quality care across its integrated delivery system. The health of the next generation depends on it.
MultiCare recognized that it had to standardize care across its system to meet quality standards, improve its patients’ experiences and outcomes, and maintain its market share. The health system launched a Women’s Collaborative, the sole purpose of which was to improve clinical care and patient outcomes for women’s services systemwide.
By working with clinicians to implement standards of care, and using analytics to measure performance, the Women’s Collaborative achieved the following:

NTSV (low-risk, rst-time mother) C-section rate 9 percent less than the national average and already below the 2022 national goal of 23.9 percent
Six-point increase in market share for inpatient OB/GYN services
Improvements in care delivery:

63 percent reduction in episiotomy rate

11 percent reduction in SSI rate for C-sections
14 percent reduction in 3rd or 4th degree perineal laceration rate
Non medically indicated induction rate consistently less than a quarter of one percent
6.7 percent reduction in the percentage of abdominal hysterectomies

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Allina Health’s Dedication to Quality Improvement Delivers On the Triple Aim

Improving clinical outcomes is good for patients and good for health systems. In fact, Allina Health’s focus on data-driven outcomes improvement realized a total financial improvement of $125 million in a single year.
Allina embraced the mandate of achieving the Triple Aim: improving the quality and cost of care, as well as the patient experience. To achieve this goal, Allina’s leaders recognized that they would need to realign their strategies, organizational structures, and management practices. Confident that data would help the health system improve the quality of patient care and reduce costs, they implemented a data-driven performance improvement strategy.
The results are astounding. This strategy has achieved financial improvements for the health system of $100+ million per year, four years running, while also advancing Allina Health’s Triple Aim goals of improved clinical outcomes and a better patient experience through dozens of improvement initiatives.

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How to Avoid PQRS Penalties and Earn Potential Incentives with Accurate Submission of Quality Measures

CMS has recently transitioned its Physician Quality Reporting System (PQRS) program from a pay-for-reporting program to a program that will now apply a negative payment adjustment to providers who do not satisfactorily report data on quality measures. Memorial Hospital faced a significant problem when its PQRS reporting process was hampered by its transition to a new EHR system. They needed a solution. Learn how Memorial successfully used their enterprise data warehouse to submit the necessary data to a certified registry, avoiding a four percent Medicare reimbursement adjustment, and providing them with the potential to earn an incentive payment. They also now have several patient registries that can be used for quality improvement initiatives in clinical care, patient safety, and care coordination.

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How to Reduce Unnecessary Elective Deliveries: A Powerful Case Study

Studies have shown that elective deliveries before 39 weeks increase the risk of newborn respiratory distress as well as increase the rates of C-sections where there is a higher rate of postpartum anemia and longer lengths of stay for both mothers and babies. Payers are partnering with healthcare organizations to lower elective delivery rates. Learn how this healthcare organization reduced their elective deliveries by 75 percent in just six months and received a six-figure payer partner bonus.

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How to Increase Professional Billing Charge Capture with Healthcare Analytics

The demand on hospital coders continues to rise – and even more so with the ICD-10 rollout. At the same time, health systems want to make sure professional billing charge captures are accurate. Learn how North Memorial Health System leveraged their hospital enterprise data warehouse – and the Health Catalyst Professional Billing Module – to: a) increase the number of provider notes with sufficient clinical data for billing, b) increase their monthly net income and c) improve their hospital coding staff productivity by 25%.

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Streamlining Radiology Operations and Care Delivery through Analytics

Texas Children’s Hospital radiology practice administrators used to dedicate several hours each week performing manual report reviews for weekly reporting — interfering with time they could be spending on streamlining their operations and delivering patient care. They are improving their operations and increasing patient satisfaction through health analytics while reducing costs by an estimated $400K. Texas Children’s established an analytics platform that enables near-real time reporting to track key performance measures such as average procedure duration, results turnaround time to providers, anesthesia utilization, patient flow cycle times and more.

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