Jim Dougherty

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As the nation continues to respond to the COVID-19 pandemic, Madaket wants to express its deep gratitude to the dedicated professionals on the front lines of patient care. These individuals and organizations are facing a herculean task: caring for others while putting their own health at risk.

The burden of healthcare administration should be the least of the providers’ worries during this time. Yet, it is essential to keep on track, especially during a pandemic that causes increased care services. Many other healthcare professionals, like practice managers, billing staff, clearinghouses, and payers, are working tirelessly behind the scenes to support providers by performing credentialing, enrollment, and many more administrative duties.

As third-party, outsourced administrative partners, clearinghouses, and RCM vendors, in particular, help providers ensure quality patient care remains the top priority, while they keep financial operations of practices and hospitals afloat.

However, as workforces across the nation settle into remote operations to help flatten the coronavirus curve, clearinghouses and RCM vendors are likely going to see-if they haven’t already-interruptions to workflow. Many of these organizations are stuck navigating the bureaucratic and largely paper-based systems of data exchange between payers and providers. More than 80% of attachments shared between payers and providers are still traveling via 

With paper shuffling and manual work among “the usual” way of doing business, it will be tough for organizations to maintain a normal routine. A typical work environment for many staff handling administrative paperwork includes file cabinets, fax machines, and stacks of forms. Now that they’re at home, the usual ways of working have to change.

The solution is digitization and automation. Digital technology, including automation, has been available as an option in healthcare for years, but now, it’s a necessity to keep organizations running smoothly. Even before COVID-19 rose to the forefront of healthcare, CMS Administrator, Seema Verma, said that the agency had been 

 to improve efficiency in administrative transactions.

The rest of the healthcare industry must follow suit and embrace a new normal. While going remote was not by choice, the time is now for providers, payers, and clearinghouses to standardize, automate, and digitize their processes to help remove unnecessary waste that has no place in the business of healthcare. We encourage clearinghouses and RCM partners to use this opportunity to set themselves up for success now, and in the future, by embracing and investing in digital solutions.

Who knows? Our new digital normal might not be so bad after all.

Jim Dougherty is an entrepreneur and innovator, specializing in disrupting manual administrative processes by introducing new automation in healthcare and finance. At Madaket, Dougherty leads the team toward its goal of automating healthcare’s hidden administrative transactions for frictionless payer-provider relationships.

Articles

What clearinghouses and RCM staff need to know going remote.

How Remote Healthcare Administration May Spark a New Digital Norm 

Healthcare is not only expensive, unfortunately, it’s also wasteful. In fact, 

arly $760 billion annually is spent unnecessarily in healthcare

, according to a recent study published in 

In addition to identifying the problems within healthcare, the researchers of the 

 study also suggested methods of addressing waste. One such solution is greater adoption of value-based payment programs. Primarily aimed at improving care quality and reducing costs, value-based payment programs have downstream effects on both care and business processes that can reduce administrative waste for payers and everyone they work with in delivering and financing care. 

Value-based payments are transforming the healthcare industry. Traditionally, in a fee-for-service model, payers pay providers for the individual services they provide. For example, each office visit, each medication, each MRI is a claim and a payment.  

One challenge with the fee-for-service paradigm is that it pays doctors based on activity. Additionally, each service stands alone with its own transactions, which inherently means more shuffling of papers between payers and providers, and more administrative waste on both ends.

Value-based payments, on the other hand, consolidate payments and paperwork by giving global payments to cover either an entire population or an entire episode of care. They help payer reward providers for the value of the services they deliver to patients, rather than the volume.

5 Quality Measures That Matter for Value-Based Care

Value-based payment programs come in many forms. CMS has developed models such as the Bundled Payments for Care Improvement Advanced Model for bundled, episode-based care, or the Medicare Shared Savings Program for accountable care organizations. Commercial payers are following suit, opting to pay doctors one payment for an entire population, episode, or procedure. For example, many insurance companies are contracting directly with doctors 

Adoption of these programs is rising, and the fee-for-service model is declining. A recent study from HHS revealed that more than 

Value-based payments don’t just arbitrarily cut back on waste. These programs encourage providers and payers to develop new ways of thinking, doing, and working together that help improve care.
	
	Any reduced administrative waste is a result of a few key things:

In fee-for-service models, it’s every entity for itself. Though providers and payers have the same goal of delivering the right care to the patient, much of the administrative inconvenience between them pits the two entities against each other. In value-based payments, payers and providers agree together on a lump sum to cover what the patients need, and both have skin in the game. Payers are often giving money upfront, hoping it helps providers choose the best route in advance. Providers are often on the hook for anything that exceeds the agreed-upon price. This meeting of the minds, and risk on both sides, ensure that payers and providers are working toward the same goal-better care at reduced costs.

 Naturally, the global payment aspect of value-based payments reduces administrative transactions by effectively lumping payments and paperwork together. Instead of processing separate claims and other paperwork for an office visit, MRI, surgery, and post-acute facility, providers payers can process the paperwork for one joint replacement bundled payment. This reduces the number of steps in the overall administrative process, allowing payers, providers, and everyone in between to repurpose their time toward activities that are more productive.

The goal of value-based payments is to improve care outcomes for patients, while also reducing the costs associated with that care. One way value-based programs achieve this is by increasing care coordination among providers. For example, one 

 highlighted that some ACOs in value-based payment programs added hospitalists to their care teams for patients having surgery. While a primary care physician in an ACO may be responsible for the patient, the hospitalist may be better suited to care for the patient in the hospital thereby reducing the chances of a costly and wasteful readmission after discharge. Better quality acute care may translate to less care needed down the line and less administrative hassle for that care.

As adoption of value-based payments increases, we will undoubtedly discover more ways to leverage this new method of incentivizing providers, and paying for care, that helps cut down on administrative waste. In the meantime, given the amount of money we waste each year in healthcare, it’s certainly worth a try.

Jim Dougherty is an entrepreneur and innovator, specializing in disrupting manual administrative processes by introducing new automation in healthcare and finance. At Madaket, he leads the team toward its goal of automating healthcare’s hidden administrative transactions for frictionless payer-provider relationships. 

Comparing the benefits of value-based versus volume-based.

Author | Jim Dougherty

Articles

How Remote Healthcare Administration May Spark a New Digital Norm

The Administrative Benefits of Value-Based Care