Clinical Excellence

Clinical, Financial, and Administrative Leadership

In supporting healthcare providers, Value-Based Strategies (VBS) offers the basics and far more:

First, we help you master the essentials:

• Billing and Collections
• Revenue Cycle Management
• Clinical Management, Practice Management, and Service Portfolio Management

We roll up our sleeves and help you:

• Improve coding, billing, claims mangement, appeals, and collections
• Increase revenue under fee-for-service (FFS) and value-based payment (VBP) models; manage third-party payer (TPP) and out-of-pocket (OOP) receivables; and reduce days sales outstanding (DSO, the time between service delivery and receipt of payment)
• Become clinical leaders, volume-leaders, and value-leaders in their regions

Second, we ensure our clients participate in—and secure incremental revenue, earnings growth, and competitiveness from—breakthroughs, best practices, and benchmarks originating both domestically and abroad.

We monitor:

• Global advances in health and medicine
• Global advances in education
• Global advances in social-services and social determinants of health (SDOH)

This positions us to identify, evaluate, and get clients access to groundbreaking and disruptive innovations sure to become The Next Big Thing.

We do the hard work of ensuring each disruptive innovation has been carefully evaluated using the Academy of Managed Care Pharmacy (AMCP), Institute for Clinical and Economic Review (ICER), and other frameworks to achieve proof of value (POV).

For example, we may:

• Consider key stakeholder perspectives from across the healthcare continuum, including patients, providers, payers and other health care decision makers, and pharmaceutical manufacturers.
• Use validated and publicly available analytic methodologies and economic models (e.g., patient activation measures [PAM, activities of daily living [ADL], and quality of life [QOL] assessment from PROQOLID and/or cost-minimization, cost-benefit, cost-effectiveness, and cost-utility models described in HealthEconomics.com).
• Incorporate scientifically valid evidence (aka real-world evidence [RWE]) from multiple sources (e.g., real-world data [RWD] such as post-market surveillance data, clinical outcome assessments [COAs], and patient-reported outcomes [PRO]).
• Create value calculators, value frameworks, and plain language summaries (PLS) of value studies that enable clinical, financial, and administrative decision-makers to make value-based policy and value-based therapeutic decisions by applying their own assumptions and better interpret study findings.
• Evaluate the knowledge, skills, and impartiality of researchers (e.g., by conducting background checks, verifying credentials, and reviewing Sunshine Act data on monies received from industry).
• Update value frameworks based on state-of-the-art evaluation and cross-channel communication techniques.

Patient-Centered, Practice-Based Innovation

Protect and Enhance Your Reputation for Clinical Excellence

We ensure your organization, healthcare professionals (HCPs), and patients have three (3) interoperable technologies now essential to preemptive market leadership in the healthcare, education, and social-service sectors:

1. A SaaS-tethered mobile app (e.g., mHealth app)
2. A digital dashboard for population health management (PHM), case management, and care management
3. A data science backend for early warnings, case escalation, and discovery (e.g., clinical, administrative, and financial insights that can drive innovation)

In combination, these solutions create a Living Lab that enables your organization, HCPs, and patients to get revenue or other measurable benefits in:

1. real-world data (RWD) and real-world data (RWD) collaborations;
2. value-based contracting (VBC) and outcomes-based compensation (OBC) agreements; and
3. individual, organizational, and community impact initiatives.

Protect and Enhance Your Reputation for Clinical Excellence

Focus on the Health of Your Patients

You need help with…

1. medical billing and collections,
2. practice development and management, and
3. revenue cycle management.

For more than three decades, we have worked with some of U.S. healthcare’s most innovative healthcare professionals (HCPs) and healthcare provider organizations (HPOs)–making strategic use of healthcare’s volume-to-value (V2V) transition to improve clients’ clinical, financial, and administrative performance, outcomes, and impacts.

To improve your revenues, earnings growth, and competitiveness, we…

1. analyze your market, organization, and service lines;
2. help you design and implement winning strategies around the efficient and effective prevention, diagnosis, and treatment of targeted conditions with unduly high incidence and prevalence; and
3. ensure you generate better economic, clinical, and humanistic outcomes (ECHOs) than the competition.

Our team has a broad and deep understanding of strategic coding, medical recordkeeping, letters of medical necessity (LMN), step-therapy requirements, prior authorizations, predeterminations, evidence-based billing, electronic claims management, evidence-based appeals to reverse denials and/or win coverage exceptions, value-based payment (VBP) negotiations, real-world data (RWD) collection, real-world evidence (RWE) building, and proof-of-value (POV) reporting under value-based contracting (VBC) and outcomes-based compensation (OBC) agreements or community-impact initiatives.

Offering analytic, strategic, and hands-on support, we serve clients large and small, in…

1. primary care practices (PCPs), advanced clinical specialties, and onsite/near-site clinics supporting major employers;
2. community hospitals, regional health systems, and multi-state integrated delivery networks (IDNs); and
3. primary care super clinics (PCSCs), patient-centered medical homes (PCMHs), and accountable care organizations (ACOs).

Whether your market is dominated by fee-for-service (FFS) payment models or value-based payment (VBP) models, we understand the clinical, financial, and administrative imperatives and can help you outperform the competition.

We do that by…

1. researching population health trends, evaluating the healthcare cost challenges facing health plan sponsors and healthcare purchasers in your region (e.g., fully insured and self-insured employers and unions), and studying the competitive landscape;
2. focusing on the most critical community health risks, mapping out benefit plan design and the patient journey, and helping you rethink, reorient, and reengineer your organization to align with the pain points, needs, and aspirations of the populations you serve; and
3. enabling you to realize peak clinical, financial, and administrative performance, outcomes, and impacts by focusing on the metrics that matter most.
   

While maximizing the quality of patient care, patient-reported outcomes (PROs), and net promoter scores (NPSs); our clients experience a 20% to 35% increase in revenue during the first 90 days of partnering with us.

Count on us to help you offer the individuals, organizations, and communities you serve consistent and measurable improvements in their wellbeing, productive capacity, and socioeconomic status…so you get the results you want and need.

Medical Billing & Collections

Improve the Financial Health of Your Clinical Practice or Health System

We are medical coding, billing, claims management, denial management, and collections experts focused on improving your cash flow while you focus on improving the health of your patients.

We work with all leading software platforms and have decades of experience improving the financial health of primary care practices, specialty medical groups, hospitals, health systems, integrated delivery networks (IDNs), accountable care organizations (ACOs), and more.

1.  helping you rethink your superbills or charge masters for the volume-to-value (V2V) transition:
2. creating a portfolio of evidence—what we call evidence assets—to support your fee-for-service (FFS) payment or value-based payment (VBP) contracts; and
3. streamlining your coding, billing, claims management, appeals, and collections to improve your top and bottom lines.

We don’t promote any particular medical practice management (MPM) or billing software.

We don’t push for long-term engagements.

Instead, we let our results speak for themselves. We win long-term clients by helping them realize a greater return on investment (ROI) day in and day out.

Let us take a look at your situation, and count on us to make at least three easily implemented, revenue-driving recommendations within 10 business days.

After that, we can serve you (1) on a percent of revenue, (2) under a monthly retainer fee, or (3) in a hybrid agreement.

We’ll (1) use defensible, evidence-based coding; (2) submit your claims promptly and (wherever possible) electronically; (3) free up your staff by posting remittances and assuming responsibility for other painstaking processes; (4) handle prior authorizations, predeterminations, and denials; and (5) oversee claims-related communications including drafting and submitting letters of medical necessity (LMNs), step therapy rationales, coverage exception requests, appeal letters, and patient updates.

Revenue Cycle Management

Count on our strategic revenue cycle management (RCM) professionals to rethink, reengineer, or refine the clinical, financial, and administrative functions that contribute to the capture, management, and collection of payments associated with care delivery.

We look at every step in your revenue cycle, starting as high as possible in the healthcare value chain, so no value-driver is overlooked or underutilized.

Our RCM activities include but are not limited to the following.

• Review the incidence and prevalence of adverse health conditions in your community and cohort
• Reposition your organization to address the highest-value needs
• Build evidence-asset portfolios (e.g., templates for letters of medical necessity [LMNs], step therapy plans, and summaries of supporting peer-reviewed journal articles)
• Generate awareness, interest, and demand
• Schedule appointments
• Document medical/pharmacy benefit information, medical histories, and reasons for visits
• Complete patient intakes
• Manage care, take thorough SOAP notes, and create audit-ready medical records
• Diagnose patients and develop treatment plans
• Use evidence assets to secure prior authorizations, preauthorizations, or predeterminations
• Negotiate value-based coverage (VBC) and outcomes-based compensation (OBC) where applicable
• Measure real-world results (RWRs) using PROQOLID clinical outcome assessment (COA) instruments and patient-reported outcomes (PROs) surveys
• Use evidence-based coding and billing strategies
• Manage claims and denials to reduce days sales outstanding (DSO, the time span between delivery of service and receipt of payment)
• Implement a data-centric continuous improvement system (aka clinical, financial, and administrative learning system) to highlight and escalate outlier events
• Troubleshoot and eliminate practice patterns associated with unexpected failures
• Study and replicate unexpected successes

Count on us to help you improve the clinical, financial, and administrative performance, outcomes, and impacts of your organization.

Practice Management Consulting

Our visionary, practical, and highly effective consulting experts can guide you in practice development, practice management, and practice-based research (PBR) so you can protect and enhance your revenues, operating efficiencies, and earnings growth as U.S. healthcare makes the volume-to-value (V2V) transition.

We’ll help you design and implement winning clinical, financial, and administrative strategies across your organization…and ensure your teams are onboard, as well.

We will…

1. analyze the populations, healthcare purchasers (e.g., employers), and third-party payers (TPPs) you serve to improve alignment between your practice areas or services lines and what your customers most want and need;
   
2. evaluate the numbers behind your business (e.g., key performance indicators [KPIs]), implement the right dashboards and scorecards to keep you on top of the essentials, and support you in continuously improving your business policies, structures, systems, processes, and standards so your operations are more efficient and effective; and
   
3. measure your economic, clinical, and humanistic outcomes (ECHOs) across multiple metrics (e.g., patient, provider, payer, prescribed product, plan of care) so you have leverage in getting the payment you deserve (e.g., via statements of medical necessity [SMNs], step therapy plans, prior authorizations and predeterminations, evidence-based billing and denial management, appeals and value-based payment (VBP) negotiations, value-based contracting (VBC) and outcomes-based compensation (OBC) agreements, and more.

We’ll look at everything…

1. from the incidence and prevalence of conditions in your community or cohort to your practice portfolio or service lines;
2. from patient and specialist relationships to purchaser and payer relationships; and
3. from market insights and practice implications to financial imperatives.

Count on our interdisciplinary team of practice development, practice management, and practice-based research (PBR) veterans to help you maximize the potential of your enterprise, prepare for exponential growth, and become a leading niche or general service provider in your markets.