WINTER 2018/2019 Newsletter
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President’s Message
FEATURED ARTICLE
Dana Y. Lujan 5
HFMA Certification Pete Sabal
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Member Spotlight Holly Gavin
7. Addressing Social Determinants of Health: How Health Care Organizations Can Act
Professional Medical Consultants, Inc.
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Joint Fall Conference Report Marcus Armstrong
By: Andrew Snyder, Chief Medical Officer and Anita Cattrell, Chief Innovation Officer at Evolent Health.
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Thanks for the Memories! 2018 Nevada Health Care Forum
THANK YOU! HFMA NEVADA CHAPTER BUSINESS PARTNERS The companies listed here help to make it possible for the chapter to deliver events, programs and other resources to members.
Change Healthcare Xtend Healthcare Advanced Revenue Solutions ProAssurance
Editor-in-Chief
Bonnie Barnett
Contributing Editor
Richard Bennett
Contributing Writers
Andrew Snyder & Anita Cattrell
Advertising/Subscriptions
admin@hfma-nv.org
Questions and Comments
admin@hfma-nv.org
Board of Directors Holly Gavin Professional Medical Consultants
2018/2019 Board Chapter Officers President
President-Elect
Vice President
Bonnie R Barnett PlusFour, Inc. Dana Y. Lujan, MBA DYL Consulting Group David J. Schweer, FACHE Dignity Health Central CA Service Area Joe Herman Fallon Paiute Shoshone Comm HC
Secretary
Timothy Myers Clark County Collections
Treasurer
Lawrence M. Preston, MBA, FHFMA Professional Medical Consultants, Inc
Immediate Past-President
Marcus A. Armstrong, FHFMA WipFli, LLP
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Richard Bennett PlusFour, Inc. Karla Gebo Leidos Health Peter Sabal Anthem Blue Cross Blue Shield
President’s Message
Dana Y. Lujan 2018/2019 President
Hello Nevada HFMA Community!
As college football is in full effect and I settle into my role of President for the Nevada Healthcare Financial Management Association (HFMA) chapter, I am reminded of the value that HFMA has brought to me both personally and professionally. While residing in Texas, I was a HFMA member but did not become engaged with HFMA until I relocated to Nevada. That is when my story started to change, and I saw the value of my membership. During this time, as I have become more involved with HFMA, I realized that the true value was in the opportunities the association was providing to me. Through HFMA I have been able to expand my professional network and develop relationships that have become invaluable. HFMA has also provided opportunities to further develop my communication and leadership skills through participation in committees and programs. Did I mention the various certification programs HFMA offers? I am currently embarking on completing the Certified Financial Healthcare Professional (CFHP) certification, but we do offer additional certification to fit your needs. So, as President I encourage everyone to consider how you can get more involved with the Chapter, whether through a committee, activity or networking event. Please keep in mind that our chapter is led by volunteers. Which mean we need the input and support from all our members to ensure we give you the information and benefits you want and deserve. If you have ideas on new programs or events, please feel free to contact any of our Chapter leaders with questions or how to get more involved. You can find our contact information on our website at: www.hfma-nv.org. Looking back over the past few months, your Nevada chapter continues to build on its success. We introduced our Revenue Cycle Management Sessions for students and early careerists and have received tremendous positive feedback. If you were unable to attend the first two sessions, our last session will be November 29th, 2018. Please register to attend and we look forward to seeing you there! HFMA participated in the Nevada Healthcare Forum with a booth, where we introduced HFMA to other healthcare professionals and encouraged them to become members. We introduced the Region 11 webinars with NorCal hosting the first “kick-off” webinar beginning in July. Each chapter in Region 11 will be hosting at least two webinars for the Region so we hope you will attend at least one. Also, back by popular demand, mark your calendars for our third Women’s Leadership Breakfast on March 8th at UMC. The committee is hard at work planning for this event and additional information will be coming out soon.
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Looking forward, we will start planning a Spring Roadshow and introducing networking bingo at a couple of our events to get the conversation flowing. Don’t forget to register for the 2018 Holiday Mixers on December 6th (South) and on December 12th (North). Please see our list of upcoming events at www.hfma-nv.org for more information. Last, but most importantly, thank you to our dedicated volunteers and our sponsoring Business Partners. Without you, the Nevada chapter would not be what it is today. Thank you for your dedication and support. So, let’s “Imagine Tomorrow” and continue to build, support and work together to make HFMA-Nevada Chapter have another successful year! Cheers,
Dana Y. Lujan, MBA 2018/2019 President
2018/2019 SILVER BUSINESS PARTNER
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What’s Missing Next to Your Name? Becoming HFMA certified distinguishes you as a leader and a high-level professional in the healthcare finance industry. HFMA’s strategic vision characterizes the current healthcare business environment as the transformation of care to achieve value. Providers, physicians, and payers are all confronted with new business challenges. Earning a HFMA certification is a designation of your knowledge, achievement and professionalism. My name is Pete Sabal and I am the certification chair for the Pete Sabal, CHFP, FHFMA, MBA Nevada Chapter of HFMA. After many years of contemplation, Certification I finally made the decision to get my certification in 2016 and was excited to have the opportunity to lead our Chapter’s Program. I decided to take (and passed! ☺) the Certified Healthcare Financial Professional (CHFP) exam, but there are other certifications that may better suit your needs. HFMA has three certification programs including Certified Healthcare Financial Professional (CHFP), Certified Inpatient Coding Auditor (CICA) and the Certified Revenue Cycle Representative (CRCR) which I outlined below. HFMA's Certified Healthcare Financial Professional (CHFP) The CHFP is geared toward financial professionals, clinical and nonclinical leaders, and payers—all those whose jobs require a deep understanding of the new financial realities of health care. The CHFP credential is awarded upon successful completion of module I end of course assessment and successful completion of module II assessment (case study exercises). HFMA membership is required. HFMA Certified Inpatient Coding Auditor (CICA) certification validates and acknowledges the expertise of the inpatient coding auditor professional. Certified inpatient coding auditors can help your organization ensure coding accuracy, increase reimbursements, and improve overall revenue cycle performance. Certified Revenue Cycle Representative (CRCR) Certification Program With HFMA’s CRCR certification, you will be better prepared to increase receivables, reduce denials, and work more efficiently – all while earning your organization high patient satisfaction scores. The Certified Revenue Cycle Representative (CRCR) program is ideal for individuals and organizations, the CRCR gives you the information you need to succeed in today’s revenue cycle environment in a convenient and informational format.
You can get more information at www.hfma.org/certification. Please feel free to contact me at peter.sabal@anthem.com with any questions. Good luck!
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Nevada Chapter Membership Spotlight Holly Gavin Director of Operations Professional Medical Consultants
As Director of Operations for Professional Medical Consultants, Inc., (PMC) I oversee the financial aspects of our physician clients. Our services include Human Resources, Payroll, Credentialing, Accounts Payable and accounts receivable review and audits. We also assist practices in the recruitment of new providers, opening offices and the expansion of services to include ancillary revenue and diagnostic equipment as needed. The most important issue in healthcare for our providers is to maintain independence and autonomy of their practice. A significant pressure being put on physicians in order to remain competitive and stay on various insurance plans is to join larger groups, or to take less reimbursement as driven down by the larger groups. In order to combat this trend, we consistently seek additional opportunities for our practices to generate additional revenue. I have worked with HFMA for years through PMC and became a member three years ago. Joining HFMA has given me the confidence to speak to people with whom I deal on a daily or weekly basis, but rarely get to see face to face. HFMA has also given me the opportunity to build relationships with others within the healthcare industry. The educational opportunities are wonderful, and I am involved with the planning committee for the Women’s Leadership conference in Las Vegas in the Spring. My key advice to early careerists is to take on as many roles in your organization as possible and strive to be flexible and highly knowledgeable. You never know what will happen in your career. To be best prepared and best positioned when ‘opportunity knocks’ it is best to be involved in as many aspects of your organization as you can be. The most important thing in my life is spending time with my two children and my husband, Mark, the man of my dreams whom I recently married and with whom I plan to spend my lifetime. Something that people do not know about me is that I love restoring and refinishing vintage furniture, and I have recently taken up sky diving with my BFF, Geno.
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Holly & Geno
Addressing Social Determinants of Health: How Health Care Organizations Can Act By: Andrew Snyder, Chief Medical Officer, and Anita Cattrell, Chief Innovation Officer - Evolent Health
Years of research and data have shown that social determinants of health have a significant impact on the profitability and sustainability of the health care industry. In fact, when considered broadly across racial disparities, education, social support, transportation, healthy food and poverty, social determinants of health have been shown to account for more than a third of total deaths annually in the United States, and up to 60 percent of health care costs, eclipsing actual direct medical expense. This is most likely attributed to the imbalance of medical and social spending in the U.S. On average, nations that are members of the Organization for Economic Cooperation and Development (OECD) spend about $1.70 on social services for every $1 on health services; the U.S. spends just 56 cents. To correct this imbalance, we need to shift a portion of our current health care expenditures to investments that address upstream social factors that heavily influence downstream outcomes. Evidence suggests that addressing social determinants of health is not only important for improving overall health, but also for reducing health disparities that are often rooted in social and economic disadvantages. For example, in addition to lower body mass index and fewer risk factors for chronic disease, early childhood education has been associated with higher levels of education attainment and income and lower rates of violent crime and incarceration. Given the far-reaching impact of these efforts, the return on investments addressing social determinants accrues not only to the health system in the form of reduced health care expense, but also to the broader community. However, current financing structures make it challenging for public sectors to pool resources together and measure the “full” return of these investments, which consist of capital infusion, tools and community-level mechanisms to deliver services. Most provider organizations don’t have the means to make these investments on their own, and those that have the means will likely find it difficult to see a near-term monetary ROI, as downstream efforts take time to take effect and may be extended beyond the health care system.
Pushing Forward by Working Backward Until broader community impact can be measured, such that other sectors are helping fund these services, health systems will need to be thoughtful and targeted on where and how they invest in social determinants of health to ensure a positive ROI. By developing approaches that work backward from the outcome they’re trying to change, health systems can take progressive steps toward targeting the underlying causes of these issues, rather than siloed steps that treat only symptoms. Some of the cursory discussions of social determinants of health suggest that addressing single factors can have a large impact on outcomes. Analysis shows this not to be true, yet most organizations are still tackling these issues in a silo. For example, we’ve seen evidence that providing free transportation services to Medicaid patients does not decrease missed primary care visits, and that building grocery stores in food deserts does not alter dietary habits. 7
One big reason why these interventions are not showing impact is because they are not targeted at those who would benefit most, and another is that they frequently lack an agreed-upon point of accountability for integrating these social services into the broader health care planning for these individuals. For example, through our own analysis, we know that for a specific set of individuals, having a transportation barrier is associated with a 63 percent increase in risk of readmission. However, providing just a ride for those patients isn’t enough. This needs to be coordinated with a medical professional visiting the home and ensuring that the conditions are conducive to a successful recovery. This includes making sure the patient has a follow-up visit with his or her physician; conducting a comprehensive medication review; and ensuring the individual has the support they need to obtain and adhere to the prescribed regimen to avoid a readmission. But without someone taking accountability for coordinating this transportation service with all the other services needed, the chances of avoiding that readmission are low. It’s the diffuse responsibility that’s led to symptom-focused and ineffective solutions, and that’s what needs to change to see widespread impact and an actual ROI on these types of investments. When accountability is present, however, a chain of connections answering to one another can help identify overall goals that can be approached in a concerted way. The team can work backward from there to drive forward progressive steps toward bigger goals and address social determinants of health in ways that show marked impact on health outcomes. To help ensure that social determinants of health efforts are accountable and productive, health care organizations can use these three action steps as a guide: 1. Define accountability. As a care team comes online, they’ll need a leader—one who is not necessarily responsible for addressing individual social determinants, but who is accountable to the patient for the results. Primary care physicians—already the “quarterbacks” for their patients’ care and accountable for total cost of care in new payment models—are perfectly positioned for this role. To succeed, though, these quarterbacks must have a strong team behind them, consisting of dedicated clinicians who are integrated into a care delivery team and who themselves are empowered to advocate for change, act on data-informed recommendations and coordinate or monitor interventions within and without the health care provider. 2. Use AI and machine learning to create and follow a comprehensive map. To change a patient’s health status and trajectory, one needs a clear understanding of where the patient is headed, what’s pushing them in that direction and any roadblocks to better paths. Can they easily access a store that sells food appropriate to their recommended diet? If told to come in for a follow-up, can they make time during the day, or are they a sole caregiver to a disabled relative? Disparate data sets can shed light on neighborhood food and public transit access, household type, education and financial history, clinical notes from the electronic medical record and other variables. When these data sets are aggregated, artificial intelligence and machine learning can flag variables that, when viewed together, can pinpoint both clinical and social risk factors and flag opportunities for either physician or community intervention. Such machine-learning resources can be designed to provide pushnotifications and other interactive support tools that convert data sets into actionable insights while minimizing any additions to administrative time.
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3. Redefine your measurement strategy by collaborating across stakeholders on shared goals. Realizing an ROI is muddy business when the investments made affect patients from multiple touchpoints. Metric definition and metric measurement, like interventions themselves, need to extend beyond a care provider’s four walls. Work that has traditionally been done purely at the social level should now be married with health and outcomes data to more robustly predict areas of need and define success. Considerable barriers remain, as clinicians who answer to their own facility’s balance sheets must answer to financial overseers who may not be willing to count a community benefit as a realized return. We may need to see new public discussion on tax exemption and definitions of community benefit here, but there’s strong potential, if we get it right, to truly redefine managed care and community health if we can redefine the metrics of care outcomes. Andrew Snyder is the Chief Medical Officer and Anita Cattrell is the Chief Innovation Officer at Evolent Health. They can be reached at: AMSnyder@evolenthealth.com ACattrell@evolenthealth.com
Andrew Snyder
Anita Cattrell
HFMA members are welcome and encouraged to attend events hosted by ACHE, MGMA, HIMSS and others as listed here … we are all working together for the benefit of the Nevada healthcare leadership community! FOR EVENTS, EVENT DETAILS AND REGISTRATION INFORMATION GO TO: WWW.HFMA-NV.ORG WWW.NVMGMA.ORG WWW.NEVADA.ACHE.ORG WWW.NEVADA.HIMSSCHAPTER.ORG
WWW.NEVADAHEALTHCAREFORUM.ORG
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2018 Northern California & Nevada Joint Fall Conference By Marc Armstrong
NVHFMA Chapter Immediate Past President
informative Keynote Sessions including “Who Are You Becoming?” by Jonathan Fanning and Healthcare Blockchain Primer by Ed Page, there were four General Sessions including an ACHE Executive Panel on health systems and population health, a Revenue Cycle Panel, Payer Panel and a CFO Panel. There were also four time slots on Monday devoted to breakout sessions in four educational tracks including Compliance, Rural Health & CAH, Finance and Revenue Cycle. A special emphasis was placed on innovation at this conference and a few sessions had this element interwoven into the curriculum. On Monday night, the Intergalactic Gala social event was enjoyed by many with special appearances by Obi-Wan Kenobi, Buzz Lightyear and other cosmic and futuristic celebrities. This social event and the entire conference were truly out of this world!
Marc Armstrong
TAKE ME TO YOUR LEADER … Oh, wait! I AM the leader! I recently had the pleasure of representing the Nevada HFMA Chapter Board of Directors at the second annual Northern California & Nevada Joint Fall Conference. The 3-day conference was themed “HEALTHCARE: A Brave New World”, which was held at the Resort at Squaw Creek up at Lake Tahoe from September 16-18, 2018. Helping kickoff the conference was the 7th Annual Vincent Acquisto Memorial Golf Tournament at the Squaw Creek course on Sunday, September 16th, followed by the Welcome Reception later that evening. A full 15 hours of quality educational sessions were offered, beginning on Monday and concluding in the early afternoon on Tuesday. In addition to highly entertaining and
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Hosted by HFMA, NVMGMA, ACHE & HIMSS Nevada Chapters
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