Author: LBodnarchuk

Q&A with ProspHire’s Luke Laurin on Vendor Management

Written by LBodnarchuk on . Posted in Insights.

What is Vendor Management as a Service Solution in the Healthcare Industry?

Vendor management as a service solution is providing healthcare organizations with best-practice strategies to optimize management of third-party vendors by streamlining vendor management workflows, reducing vendor costs and improving compliance with regulatory requirements.

We offer our clients a range of vendor management services, including vendor selection, contract management strategies, performance monitoring KPI definition, risk assessments and compliance monitoring. By utilizing a collaborative partner for these functions, healthcare organizations can free up internal resources focused on these efforts, reduce costs associated with vendor contracts, and improve the quality of their vendor management processes.  

Are there industry regulations around vendor management?

Vendor management is critical to ensure ongoing patient safety, regulatory compliance and operational efficiency. In healthcare, the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG) and the Joint Commission have published guidelines regarding vendor management practices. CMS requires healthcare organizations to have written policies and procedures for selecting and managing vendors, including risk assessments and ongoing monitoring of vendor performance. OIG emphasizes the need for proper due diligence before selecting a vendor, which includes a qualitative and quantitative process that should lead to a decision that best fits the needs of the healthcare organization.

The Joint Commission includes vendor management as a standard for medical equipment and facility management. In addition to regulatory requirements, many healthcare organizations also have their own internal operating procedures for vendor management. These standard operating procedures may include requirements for vendor selection, contract management and ongoing vendor performance management.

Why is coordinating services from multiple vendors so important?

In healthcare, there are many vendors that provide products and services that need to work together to support patient care. Ensuring interoperability between these vendors will help them work better together. Coordinating services from multiple vendors can help with reducing duplicate efforts and resources, which often results in reduced costs. Improving communication between vendors leads to better outcomes for a patient and a better customer experience in the often-confusing world of consumerism in healthcare. By streamlining the vendor management process, most healthcare organizations find they can reduce the number of vendors they need and will consolidate to critical mass in order to “get it done” the right way.   

Where does innovation fit into vendor management? 

Innovation can play an important role in vendor management, especially as technology and other advancements continue to shape the way products and services are developed and delivered in the healthcare industry.

Here’s where I see recent innovation fitting into the vendor management process:

  • Identifying innovative vendors: Vendor management involves selecting and managing vendors who can provide products and services that meet the needs of the healthcare organization. Innovation can be an important factor in selecting vendors who can provide cutting-edge solutions and stay ahead of industry trends.
  • Collaborating with vendors on innovation: Healthcare organizations can collaborate with their vendors to develop new products and services that can improve patient care and drive operational efficiencies. By fostering innovation in their vendor relationships, healthcare organizations can stay at the forefront of industry trends and maintain a competitive edge.
  • Incorporating innovative solutions into vendor management processes: Healthcare organizations can leverage innovative technologies and solutions to streamline their vendor management processes, automate tasks and improve data analytics.
  • Adapting to new technologies and industry changes: As new technologies and industry trends emerge, healthcare organizations must adapt their vendor management processes to stay up-to-date. By embracing innovation and being open to new ideas, healthcare organizations can stay agile and responsive to industry changes.
Where does innovation fit into vendor management?

How Can ProspHire Help?

ProspHire’s Vendor Management Office team has extensive experience in assessing current processes, identifying the gaps and developing a centralized VMO operating model strategy. That may include identifying cost saving measures and formalizing vendor management from selection to onboarding processes. We have also helped clients in developing custom analytical dashboards to monitor critical KPIs to keep our clients compliant with regulations and monitor overall vendor spend to ensure value is achieved.

Connect with us today to start talking about how we can partner with you to improve your vendor management.

ProspHire's Vendor Management Office team has extensive experience
Andrew Bell with blurred background

Q&A with ProspHire’s Andrew Bell on Stars Performance Improvement

Written by LBodnarchuk on . Posted in Insights.

The importance of Medicare Stars Performance Ratings cannot be overstated, as they serve as a critical benchmark for evaluating the quality of care provided by Medicare Advantage Plans. These ratings play a pivotal role for both plan members and healthcare leaders alike. ProspHire’s Stars Performance Improvement Leader, Andrew Bell, talks about the challenges faced by healthcare organizations regarding Stars Performance, strategies to improve these ratings and insights into upcoming changes in the Medicare Stars landscape. 

Why are Medicare Stars Performance Ratings important?

Medicare Stars Performance Ratings are important because they provide a measurement of the quality of care offered by Medicare Advantage plans. From the perspective of the member, the Star ratings help compare the quality of different plans during enrollment periods. For Health Plan leaders, the Medicare Stars Program is important because it affects both the financial performance of their plans and their ability to attract and retain enrollees. Higher Star ratings can lead to enhanced benefit offerings, improved financial performance and more favorable reimbursement levels.

What are the biggest challenges your clients are facing regarding Stars Performance?

When we first engage with a client on a Stars project, they are typically lower performing or are at risk of falling below the 4.0 Stars QBP threshold. There are several commonalities in these circumstances. The first and biggest being a lack of organizational-wide awareness and priority in Stars. If Stars isn’t given the time and dedicated attention it requires and isn’t a priority of the leadership at your organization, you will be hard pressed to succeed. The second is data integrity and data availability. Succeeding in Stars is largely based on a health plans’ ability to aggregate data and synthesize it down into an actionable plan to improve performance ratings.

How do organizations improve their Stars Rating?

Success in Stars starts with proper governance, accountability and data-backed decision-making capabilities. When we work with clients, we seek to understand their specific plan challenges and structure. With that as a starting point, we advise implementing a cross-functional governance structure with accountability at the domain and measure-level. We have also worked with clients to onboard them onto our proprietary forecasting and projection technology. This technology enables clients to have real-time insights into contract performance and allows leaders to make informed decisions with measure-level goal setting.

How can Stars leaders gain momentum and partnership across their organization?

One of the biggest challenges that Stars leaders have within an organization is remaining a priority. Every health plan has competing priorities and strategic initiatives. As a best practice, Stars programs that remain at the forefront and an integral part of the business functions will gain leadership buy-in. It is extremely beneficial to have the backing of Senior Leadership. They will help break down barriers and ensure that the organization is aware that Stars performance is a priority to them.

What do health plans need to know about Star Year 2024 and beyond?

When I speak with clients and folks within the Stars and Medicare world, the Tukey Outlier deletion for SY2024 is what keeps them up at night. This methodological adjustment paired with the somewhat surprising proposed rules for Medicare Advantage and Stars are keeping people thinking. These changes are likely going to have quite a substantial negative impact on Star Ratings industry-wide.

Can you offer insights on what can be done now to prepare for the Tukey Outlier?

At this point, most health plans and Stars leaders are aware of the Tukey outlier deletion modifications. What leaders should be doing is conducting thorough measure-level analysis to understand what measures will be impacted by Tukey and then begin to mitigate against potential measure score drops. With so many measures simultaneously in play, strong data analytics can help enable Stars programs to target the right measures for their plan to achieve their stated contract goals and quality ratings.

What do Stars leaders need to be thinking about in the years ahead?

To stay ahead of the Medicare Stars Program changes, Health Plan leaders need to consider several innovative strategies, including:

  • Investing in technology and data analytics to better track and evaluate quality performance, including predictive analytics and intervention effectiveness
  • Focusing on customer satisfaction, including offering telehealth services and addressing social determinants of health through community engagement or enhanced benefit offerings
  • Collaborating with healthcare providers to improve the quality of care and to gather more comprehensive data on patient outcomes
  • Regularly reviewing the Medicare Stars Program and making necessary adjustments to stay ahead of the curve and to maintain a high level of quality

Is there any risk for Stars Leaders to delay their strategy implementation 6-months or a year?

As we all know, the Medicare Stars Program is a complex overlapping cycle, with two Star performance years simultaneously in play at any given moment. The truth is that the best time to start implementing a Stars improvement plan was yesterday. Any consequences of a delay in action will not be felt immediately; however, the downstream consequences of those delays in decisions will most certainly impact the health plan’s ability to achieve the quality bonus payment, performance improvement and other stated goals.

How Can ProspHire Help?

Since our inception, ProspHire has been supporting health plans in Medicare Stars. We work collaboratively with your team and seek to understand the unique circumstances of your health plan. By leveraging contract specific data and on-the-ground insights into plan operations and capabilities, our healthcare experts will deliver a Customized Contract Capability Assessment in tandem with a tailored Stars Strategic Roadmap and Playbook. This support will empower Stars leaders to take control of their Stars Program and enable them to feel confident about their math-path to success and corresponding intervention plans.  

ProspHire can help by leveraging contract specific data and more.

Medicare Stars CAHPS Cut Point Analysis

Written by LBodnarchuk on . Posted in Insights.

With the final release of Star Year (SY) 2024 data coming in October, plans should expect a slow release of data to health plans in the period leading up to that date. One of the first big data releases included Members Choosing to Leave the Plan Part C and Part D measure data. CMS has also released information to plans to indicate that potential data errors occurred for some contracts and that an investigation into performance should be conducted.

The second data release contained the publishing of contract level CAHPS data in HPMS. This CAHPS data also includes cut points for each measure. The ProspHire Medicare Stars team reviewed and analyzed the movement from Star Year 2023 to Star Year 2024.

The movement from Star Year 2023 to Star Year 2024

CMS will continue to release data to plans via HPMS: Plan Preview #1, Plan Preview #2 and the final public data release in early October. Health Plans should quickly review data as it is released to validate its accuracy. They also should utilize that data to better inform their contract’s overall SY24 projection. It would benefit Stars leaders to ensure that their senior leadership team is aware of projections in advance of the final release.

If you are not satisfied with your contracts Stars performance and require a refreshed approach to Stars performance improvement, the Medicare Stars team at ProspHire can partner with you to create a strategy moving forward and execute on your behalf. Connect with our experts today.

Operational Efficiency Tips

Tips for Improving Operational Efficiency

Written by LBodnarchuk on . Posted in Blog.

In the healthcare industry, operational efficiency is crucial for providing high-quality patient care, reducing costs and improving overall organizational performance. With healthcare costs continuing to rise, organizations must find ways to improve efficiency and reduce waste without compromising patient care.

We will explore some practical tips and strategies for improving operational efficiency in healthcare. By implementing these tips, healthcare organizations can streamline their operations, improve patient outcomes and position themselves for long-term success in a rapidly changing industry.

What Is Operational Efficiency?

Operational efficiency refers to the ability of an organization to produce goods or services with the minimum amount of resources and waste possible. In other words, it is the ratio of output to input in terms of time, money and resources.

Operational efficiency can be achieved by optimizing the processes and systems that are involved in producing a product or service. This includes:

  • Improving the efficiency of workflows
  • Minimizing waste and errors
  • Reducing costs
  • Maximizing productivity

In healthcare, operational efficiency is particularly important, as it can have a significant impact on patient outcomes. By optimizing processes, healthcare providers can improve patient flow, reduce wait times and help patients receive high-quality care in a timely manner. Overall, operational efficiency is a key factor in helping healthcare providers deliver high-quality care in a cost-effective manner.

Overview of Process Optimization in Healthcare

Process optimization is a key aspect of improving operational efficiency in healthcare. It involves identifying opportunities for improvement in the processes and workflows used in delivering patient care and making changes to optimize those processes.

The goal of process optimization is to reduce waste, improve patient outcomes and increase efficiency. By analyzing the way healthcare organizations operate, it is possible to identify areas where processes can be streamlined, standardized or automated through these methods:

  • Using technology: One key aspect of process optimization in healthcare is the use of technology. Electronic health records (EHRs), telemedicine and other digital tools can help automate processes, reduce errors, and improve communication and collaboration among healthcare providers.
  • Optimizing workflows: Another aspect of process optimization is optimizing workflows. This involves identifying the steps involved in a particular process and determining how those steps can be streamlined or eliminated to improve efficiency. For example, by standardizing processes for admitting patients, hospitals can reduce the time it takes to get patients into a room and receiving care.
  • Reducing administrative burdens: Administrative burdens can also be reduced through process optimization. By simplifying administrative tasks, such as billing and insurance claims, healthcare providers can reduce the time and resources needed for these tasks, freeing up more time to focus on patient care.

Why Process Optimization in Healthcare Is Important

Key reasons why process optimization is important in healthcare

Process optimization is essential in healthcare for a variety of reasons. Here are some key reasons why:

  • Improved patient outcomes: Process optimization can lead to improved patient outcomes. By streamlining processes and reducing errors, healthcare providers can help patients receive the best possible care.
  • Increased efficiency: By optimizing processes, healthcare providers can increase efficiency, reducing wait times and improving patient flow. This can lead to better patient experiences and improved outcomes.
  • Cost savings: Process optimization can also result in cost savings for healthcare organizations. By reducing waste and increasing efficiency, healthcare providers can save money on staffing, supplies and other resources.
  • Better resource allocation: Process optimization can help healthcare organizations allocate their resources more effectively. By identifying areas where resources are being underutilized or overutilized, healthcare providers can allocate resources more efficiently.
  • Improved compliance: By optimizing processes, healthcare organizations can work to be in compliance with regulations and standards. This can help to avoid fines and penalties and protect the reputation of the organization.

Process optimization is essential in healthcare to offer patients high-quality care, use resources effectively and maintain efficient and effective operations.

Tips on How to Increase Operational Efficiency

Here are some ways to increase operational efficiency:

  • Standardize processes: Standardizing processes can help reduce variation and improve efficiency. By creating standard workflows, procedures and guidelines, healthcare providers can reduce errors and improve patient outcomes.
  • Use technology: Leveraging technology can help automate processes and reduce administrative burdens. EHRs, telemedicine and other digital tools can help healthcare providers communicate and collaborate more effectively, leading to increased efficiency.
  • Optimize workflows: Analyzing and optimizing workflows can show areas where processes can be streamlined, automated or eliminated. These changes can help reduce wait times, improve patient flow and increase efficiency.
  • Improve communication and collaboration: Effective communication and collaboration among healthcare providers can help to reduce errors, improve patient outcomes and increase efficiency. By using digital tools and other communication methods, healthcare providers can work more efficiently and effectively.
  • Continuously monitor and improve: Continuously monitoring and analyzing operational processes can help identify areas where further improvements can be made. By regularly evaluating and optimizing processes, healthcare providers can operate at peak efficiency.

Strategies for Healthcare Process Improvement

There are several strategies healthcare organizations can employ to improve their processes and drive better care at lower costs:

  • Implement evidence-based practices: Evidence-based practices are medical interventions that have been proven to be effective through rigorous scientific research. By implementing these practices, healthcare organizations can improve patient outcomes while reducing costs by avoiding unnecessary tests, procedures and treatments.
  • Focus on prevention: Preventive care can help address health issues early before they become more serious and require more expensive treatments. Healthcare organizations can encourage patients to adopt healthy lifestyles and provide preventive services, such as screenings and vaccinations.
  • Reduce waste and inefficiency: Healthcare organizations can reduce waste and inefficiency by improving processes such as inventory management, reducing wait times and eliminating unnecessary tests or procedures.
  • Collaborate with other providers: Collaborating with other healthcare providers, such as hospitals and primary care providers, can improve care coordination and reduce duplication of services, which can lead to lower costs.
  • Engage patients: Engaging patients in their own care can improve outcomes and reduce costs. Healthcare organizations can provide education and resources to help patients manage their conditions and make informed decisions about their care.

How ProspHire Can Help

ProspHire is a healthcare management consulting firm that specializes in helping healthcare organizations optimize their operations and improve performance. Here are some ways we can help improve operational efficiency in healthcare:

  • Process optimization: We can help healthcare organizations identify opportunities for process optimization and implement changes to streamline workflows, reduce waste and increase efficiency.
  • Technology optimization: We can help healthcare organizations optimize their technology infrastructure, including EHRs, telemedicine and other digital tools, to improve communication, automate processes and reduce administrative burdens.
  • Performance improvement: We can help healthcare organizations improve their performance by setting performance goals, tracking progress and making changes to improve performance over time.
  • Change management: We can help healthcare organizations manage change effectively by communicating changes to staff, training staff on new processes and technologies and supporting staff through the change process.
  • Interim management: We can provide interim management services to help healthcare organizations maintain continuity of operations during times of transition or change.
Leverage ProspHire's expertise to optimize your operations

By leveraging our expertise, your healthcare organization can optimize your operations, reduce waste and improve patient outcomes. Connect with us today to learn more about how we can help.

Soaring to New Health

Soaring to New Health Episode 2: Ask the Next Generation Pharmacist

Written by LBodnarchuk on . Posted in Blog.

Welcome to Season 1, Episode 2 of the Soaring to New Health Podcast.

This episode is Ask the Next Generation Pharmacist. We talk with ProspHire’s Mark Thomas, an experienced pharmacist and consultant in the healthcare industry and Chris Antypas, a seasoned pharmacist, executive owner and innovator, about the pharmacist’s rapidly change role, the new ways to deliver patient care and the evolvement of medication management.  

Today, pharmacy is at the forefront of many conversations. Drug costs are rising at an unprecedented rate. Employers and employer sponsored plans are trying to navigate and tackle pharmacy costs; and health plans are trying to zero in on how to contain costs while also ensuring access to innovative therapies.

On the innovation side, drug manufacturers continue to bring novel and rare disease therapies to the market. This, while the payer side is addressing rising drug costs and trying to navigate how to continue to afford to pay for medications and ensure access. Plus, billionaire business owner Mark Cuban is on a mission to “disrupt” the pharmaceutical Industry and sell low-cost prescription drugs directly to Americans.

Antypas says, “We spend a lot of time talking about healthcare costs and unfortunately what I’m seeing is there’s really not been enough attention put on the role that medications play in managing total cost of care”. His personal journey in trying to disrupt healthcare and improve healthcare is focused on the relationship with his patients – knowing who they are, understanding their personal situation and providing them with meaningful solutions to access or afford a medication. You’ll find that relationship-based care blended with a custom pharmacy experience at Antypas’s Asti Pharmacy in Pittsburgh’s South Hills area. Adherence packaging is an example of this care model, where the patient receives a customized blister pack containing all their daily medications.

In the digital heath and technology space, Antypas’s Perigon Pharmacy, umbrellaed under Perigon Health 360, a 50-state licensed, dual accredited specialty pharmacy that is creating tools for patients to help them take their medications more accurately and effectively. One such device sits on a countertop in the patients’ home and intelligently dispenses medication. This intersection of healthcare and innovation optimizes the care team’s ability to track and monitor whether the patient appears to have missed a dosage and then sends reminder notifications via text message or phone call. It’s at that point the pharmacist can connect with the patient to determine the cause and a solution.

The opportunity for health plans is to view pharmacy as a strategy to address any healthcare gaps and help manage member health. Thomas talks about the opportunity for the next generation pharmacist to think differently and outside of the box when it comes to drug delivery models. Antypas says those new ideas and pathways to success are built from being brave and having the courage to advocate and make a difference in a patient’s life.   To hear more about today’s pharmacy trends and what some pharmacists are doing to push the boundaries of the traditional pharmacy practice, download Soaring to New Health’s episode two, Ask the Next Generation Pharmacist here.

Soaring to New Health Blog-Episode 1, Don’t Be a Pain in the ACA

Written by LBodnarchuk on . Posted in Blog.

Welcome to Season 1, Episode 1 of the Soaring to New Health Podcast.

This episode is Don’t be a Pain in the ACA. ProspHire’s Affordable Care Act (ACA) experts, Caitlin Nicklow and Matt Dauffenbach, talk about what it is, why it’s important, the timeline for launching a plan, how to get started and the impact on health plans.

When we’re talking about ACA, we’re normally talking about the individual exchange. This is an insurance marketplace for those who don’t have employer sponsored health care and don’t qualify for Medicaid or Medicare.  To obtain coverage, individuals log on to their state or federal exchange and you shop for health care. It’s as simple as that.

The ACA has benefitted both members and Health Plans. The biggest advantage for members is the essential health benefits that each plan must include. It’s a safeguard for members. When you shop for a plan, you know that each one has, at minimum, the same core benefits, including preventative care and emergency services. Health Plans benefit from launching ACA plans because it’s an opportunity to stay with a member through all the phases of their life. When health plans launch an ACA plan, it keeps that revenue stream within the organization. Those health plans also immediately benefited from the Medicaid Redetermination because those members could move from Medicaid to their ACA plan. If your health plan doesn’t have an ACA plan, there is still an opportunity to launch one because the Medicaid Regermination process is going to take a year to unwind. Open Enrollment for Plan Year 2024 will be key for members who shop around for plans and want to make a switch.

Health plans shouldn’t underestimate the time it takes to set up an ACA Plan. The timeline varies and it depends on whether you are a brand-new plan or a mature plan that has already obtained NCQA or URAC accreditation. That could mean the difference between 12 months and 18 to 24 months. At ProspHire, we tell our clients not to rush… plan out those processes, make sure you have the infrastructure to support the potential number of member growth.

Demographics and competition are important. You could have a plan that launches with 5,000 members and quickly grows to 50,000. Realistic short term and long-term goals are all a part of planning conversations. It’s important to understand what your strengths as a plan are, how strong your brand is and what differentiators will attract members.

Staying on top of ACA compliance and regulations can be a full-time job. At the foundation, the biggest requirement is Qualified Health Plan (QHP) certification. Any plan in the marketplace in any U.S. state must have this certification and you must renew it annually. The process looks at the bones of the operation of the plan, starting in May and wrapping up in September. In addition, every state will have their own specific requirements to operate in that state. Third is a must have – accreditation. That looks at the inside of the plan, the policies and procedures. Beware that NCQA or URAC is very time intensive and involves more than 100 requirements for the plan to be in compliance.

Prioritization is key when launching an ACA plan. During the assessment phase, we talk with you about competing projects and resources. We look for ways to align your priorities and leverage existing projects and resources in your organization to avoid duplication of efforts across multiple programs.

For more details on the challenges and solutions once the plan is established and enrollment period begins, download Soaring to New Health’s episode one, Don’t be a Pain in the ACA here.

Leveraging Evidence-Based Interventions to Address Population Health

Written by LBodnarchuk on . Posted in Insights.

As payers and providers continue to manage the impact of COVID-19 on their populations, social determinants of health (SDOH) remain a focus for improving population health. Addressing SDOH has become even more vital as the pandemic had a disproportionate effect on the most vulnerable populations who are also greatly impacted by SDOH-related issues. While it remains at the forefront of strategy across the healthcare industry, it is imperative that interventions targeting SDOH are measurable and evidence-based to draw insights into conclusive results. In doing so, organizations will be better equipped to implement successful SDOH initiatives driving improved health outcomes.

SDOH describe the conditions in which people are born, live, learn and play, among other things and impact a wide range of health, functioning and quality of life concerns.[1] The Centers for Disease Control has identified five key areas of focus including healthcare access and quality, economic stability, education access and quality, neighborhood and built environment, and social and community context.[2] There is consensus regarding the need for consideration of these factors when measuring health; however, success has been varied with decision makers often crafting solutions from afar and without local and member-level input or data to support their efforts. While traditional healthcare services remain vital to measuring health, it is only one piece in a complex web of factors that impact health costs and outcomes. Studies show that social determinants can have a greater impact than healthcare or lifestyle choices in influencing a person’s health with some showing that they can account for as much as 80% of health outcomes.[3] This includes food insecurity, job security, education, among others; however, efforts to address these issues have largely been unsuccessful. There are programs across the country targeting these various issues and it is important that they be measured for impact and success.

SDOH - social determinants of health - vector infographic illustration

A common SDOH highlighting this issue is food security, defined as a household-level economic and social condition of limited or uncertain access to adequate food.[1] Food security can be temporary or long term and is influenced by various social factors including job security, disability and income, among others. When crafting interventions to target food security, it’s important to think broadly about the surrounding factors that influence it. Access to food is crucial, but so is consideration of the transportation needed to acquire that food (or lack thereof) and an intervention that targets food distribution without consideration of the related factors is doomed to fail. One organization working to address food security is Feeding America, which manages a nationwide network of food banks and other community-based agencies to feed more than 46 million people yearly.[2] The organization has developed a Framework to mitigate the implementation of unhelpful or unsuccessful interventions targeting food security[3]

Framework to mitigate the implementation of unhelpful interventions

Feeding America highlights the Supplemental Nutrition Assistance Program (SNAP) as an example of a ‘proven’ SDOH framework – one that has demonstrated consistent positive improvement to accessing healthy food through multiple studies. It has accomplished this through local networks of food banks, despite being a national program. This local approach allows for tailored outreach activities, utilizing community networks and unique language and cultural needs to deliver services that are useful for the communities needing it the most.[1]  

Despite this, it is important to note that while the intervention itself may be evidence-based in its implementation, it is not immune to external factors that could limit its effectiveness. The framework also takes into account those conditions that could impact an intervention’s success such as the high cost of food. Considering the rising food prices in 2022, approximately 10% higher according to the USDA, this would have a direct impact on a program like SNAP’s success, as the benefits are not regularly adjusted to reflect variation in food costs or cost-of-living. Therefore, when evaluating an intervention on its effectiveness in addressing SDOH, it is imperative to remember that they don’t exist in isolation and are continuously impacted by our changing world.

There is a growing recognition that building strategies that incorporate SDOH are beneficial for both providers and payors. These initiatives provide opportunities to address population health needs in communities across the country, which can improve care for members while reducing costs, if done correctly. To accomplish this, it is essential that SDOH interventions be evidence-based and both collaborative and customized to local communities, enabling organizations to increase the effectiveness of their initiatives while improving care for the most vulnerable populations.  

How can ProspHire help?

At ProspHire, we want to ensure your programs have the greatest impact on members and patients, while simultaneously addressing the disparities that exist across our communities. Our team’s extensive knowledge in this topic can help your organization optimize strategies and deliver effective programs that support the most vulnerable populations. We understand the challenges and solutions to drive change through social determinants with a focus on your unique member and patient needs. Reach out today for more information to partner in this important work.

References

  1. https://health.gov/healthypeople/priority-areas/social-determinants-health
  2. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved [May 18, 2023], from https://health.gov/healthypeople/objectives-and-data/social-determinants-health
  3. https://www.rwjf.org/en/insights/our-research/2019/02/medicaid-s-role-in-addressing-social-determinants-of health
  4. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/food-insecurity
  5. [1] https://www.feedingamerica.org/sites/default/files/research/hunger-in-america/hia-2014-executive-summary.pdf
  6. https://www.feedingamerica.org/sites
  7. https://www.feedingamerica.org/sites/default/files/2018-10/snap-outreach-evaluation.PDF

Social Determinants of Health Screening Tool Implementation Challenges

Written by LBodnarchuk on . Posted in Insights.

Social determinants of health (SDOH) are conditions in the environment that affect individuals’ wellbeing, quality of life and health outcomes. They are commonly grouped into domains that include economic stability, education access, healthcare access, living environment and social support. It is important to screen for these determinants in clinical settings because research shows that social determinants of health are linked to negative health outcomes. Standardizing screening tools and providing appropriate community-based resources to patients will help decrease negative health outcomes (Sokol, 2020).

The Institute of Medicine (IOM) recommends that screening tools include common domains such as educational attainment, financial status, social isolation and median income levels as social stability domains (National Academies of Sciences, Engineering, and Medicine, 2016). A review of the literature found that 70% of screening tools measure at least 8 out of the 15 recommended domains and that only 66% of the tools that were reviewed were commonly used in clinical practices (Meon et al., 2020). Although payers and providers recognize social determinants of health as a problem, organizations still struggle to implement and accurately report SDOH data. How can implementation be improved? What makes screening programs successful?

Commonly Assessed Domains of Health Related Social Conditions
Source: Meon et al., (2020). A review of tools to screen for social determinants of health in the United States: A practice brief. Population health management, 23(6), 422-429.

Screening Tools and Barriers to Implementation

There are a wide range of screening tools being used in clinical settings to identify at-risk members. Common screening tools such as Health Leads and PRAPARE are used to assess and address patients’ social determinants of health.

Health Leads screens an individual for adverse social determinants across 13 social needs domains (Health Leads, 2019). The questionnaire is evidence-based and is used in clinical settings. PRAPARE is also a nationally standardized tool used to assess patients’ risks and experiences (PRAPARE, 2022). The standardization of both tools allows them to be easily used by practitioners and integrated into EHR platforms. Despite having standardized tools, without a standardized approach, providers struggle to accurately capture, report and provide appropriate community-based resources for their most vulnerable patients (Fitzhugh et al., 2021; Meon et al., 2020). Standardization is a challenge because tools screen across different domains and lack a common approach to measure duration of time that patients experience social determinants of health. Although these challenges exist, providers have found success by utilizing evidence-based screening tools and developing a community-based approach to provide patients with needed resources (Bleacher et al., 2019).

Health Plans Combatting Social Determinants of Health

University of Pennsylvania Medical Center (UPMC) implemented “Cultivating Health for Success”, a program that partners with community organizations to provide permanent housing to members (Sokol, 2020). The program saw a savings of $6,384 for each of their participating members. UPMC was able to identify their at-risk population and provide them with a permanent solution to better control their social environment and health outcomes. Since the initiation of this program, several other programs at UPMC have been implemented to combat social determinants of health.

The success of the initiatives at UPMC was driven by practitioners recognizing that social determinants of health are interconnected and the importance of screening and identifying at-risk members. By providing members with the necessary community-based resources, UPMC saw significant cost savings because members were better able to manage their health. UPMC also recognized that data collection is paramount to understanding the “full picture” of a member to drive change.

How can ProspHire help?

How ProspHire Can Help

The first step to addressing health disparities in your community and across patient or member populations is to understand the underlying drivers of health in your population. That understanding will allow you to execute targeted programming that positively impacts your patients and their health outcomes, driving cost savings related to these disparities. At ProspHire, we have the experience and skillset to help you take that first step. We can partner with your teams to help you implement strategies that drive health equity forward. Connect with us today to learn more.

Resources:

Bleacher, H., Lyon, C., Mims, L., Cebuhar, K., & Begum, A. (2019). The feasibility of screening for social determinants of health: seven lessons learned. Family Practice Management, 26(5), 13-19.

Health Leads Screening Toolkit. Health Leads. (2019). Retrieved April 20, 2022, from https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/

Fitzhugh, C. D., Pearsall, M. S., Tully, K. P., & Stuebe, A. M. (2021). Social Determinants of Health in Maternity Care: A Quality Improvement Project for Food Insecurity Screening and Health Care Provider Referral. Health Equity, 5(1), 606-611.

Meon, M., Storr, C., German, D., Friedmann, E., & Johantgen, M. (2020). A review of tools to screen for social determinants of health in the United States: A practice brief. Population health management, 23(6), 422-429.

Sokol, E. (2020, January 29). How UPMC coordinates compounding social determinants of health. HealthPayerIntelligence. https://healthpayerintelligence.com/news/how-upmc-coordinates-compounding-social-determinants-of-health

Chris Miladinovich with blurred background

ProspHire Co-Founder and Principal Named New Chief Strategy Officer

Written by LBodnarchuk on . Posted in News.

PITTSBURGH, PA – ProspHire, a national healthcare consulting firm, is pleased to announce Co-founder and Principal, Chris Miladinovich, has been named the Firm’s first Chief Strategy Officer. In this new role, he is responsible for overseeing business development, client relationships, strategic partnerships and the Firm’s long-term strategic plan. Prior to this, Chris was ProspHire’s Chief Operating Officer in charge of the operational business units, including Finance, IT and Administrative Operations.

“I am ecstatic for the opportunity to take on this new role. ProspHire has an incredible culture that has led to tremendous growth all with an eye on improving the client experience,” said Chris Miladinovich. “My passion has and always will be to help our people and our clients succeed. Today our clients are searching for innovative solutions for their complex healthcare problems and we are focused on helping them improve their organizations in order to help their healthcare members.”

Chris brings over 20 years of experience leading large-scale, complex business transformation programs from a billion dollar, Big 4, consulting organization to an emerging business. His leadership has been focused on developing and delivering technology-driven business services and solutions in the healthcare industry and he has been responsible for managing over $20 million in annual revenue, providing outstanding client experiences and driving profitable growth.

“We are excited to have Chris take on this new role as he brings an invaluable blend of industry experience and execution,” said Lauren Miladinovich, ProspHire’s Co-founder, Managing Principal and Chief Executive Officer. “With his extensive knowledge, industry partnerships and strategic vision, Chris has stood by my side leading and growing ProspHire since 2015. We look forward to achieving that same level of success as he executes on ProspHire’s long-term strategy in the years ahead.”

Chris and Lauren have recently been named Entrepreneur of the Year® 2023 East Central Finalists.

benefits optimization in healthcare

Benefits Optimization in Healthcare: Application and Timeline

Written by LBodnarchuk on . Posted in Blog.

Healthcare organizations today are under pressure to deliver quality care while managing costs. Benefits optimization in healthcare is one strategy that can help achieve these goals. By evaluating and optimizing product benefits, organizations can provide their members with favorable core and supplemental benefits based on market trends while also managing costs.

One of the key drivers of increased enrollment for healthcare organizations is the benefits optimization cycle. The application of benefits optimization in healthcare can lead to significant increases in enrollment, improvements in operational efficiency and financial improvements over time.

In this blog post, we’ll explore the concept of benefits optimization in healthcare, including its definition, examples of its applications and the timeline for its implementation. Understanding the benefits optimization cycle can help you make informed decisions about your product benefits.

What Is Benefits Optimization in Healthcare?

Benefits optimization refers to the process of maximizing the value of plan benefits an organization offers to their members. It aims to strike the balance between offering competitive benefits while keeping costs manageable.

Through data analysis, healthcare companies can identify areas where they can reduce costs while still providing valuable benefits by examining an organization’s enrollment and benefit utilization data. For example, an organization can identify trends based on what plans are receiving greater enrollment or which benefits are the most utilized by plan. Additionally, healthcare consulting firms can help organizations assess and optimize their product benefits to ensure they align with their short and long-term business goals.

Overall, benefits optimization in healthcare is all about finding the right balance between member need, member satisfaction, and cost control. By leveraging data analysis and expert guidance from healthcare consulting firms, organizations can ensure they’re providing competitive benefits while keeping costs manageable.

Examples of Benefits Optimization Applications

Examples of how healthcare providers can apply benefits optimization

Benefits optimization is a vital aspect of healthcare management that can help organizations maximize the value of their product benefits while reducing costs. Here are a few examples of how healthcare providers can apply benefits optimization:

1. Cost Analysis and Benchmarking

Organizations can use cost analysis and benchmarking techniques to identify areas of high healthcare spending and compare their product benefits to industry standards. This helps them understand where their healthcare dollars are being spent and identify opportunities to reduce costs while still providing high-quality benefits to members.

2. Plan Design and Strategy

Benefits optimization also applies to plan design and strategy. By analyzing healthcare data and member utilization patterns, organizations can tailor their benefits programs to meet the specific needs of their enrollees. This can include offering more flexible benefits options, such as telemedicine or wellness programs, to encourage healthier lifestyles and reduce healthcare costs.

3. Vendor Management

Optimizing vendor management is another way to reduce healthcare costs while still providing high-quality benefits. By negotiating better contracts with vendors, organizations can save money on healthcare expenses and offer more comprehensive benefits to their members.

4. Compliance and Reporting

Compliance and reporting are critical components of benefits optimization in healthcare. Organizations must comply with state and federal regulations and report accurate data to regulatory agencies. Benefits optimization consultants can help organizations navigate these requirements and ensure they comply with all applicable regulations.

Overall, benefits optimization can provide significant benefits to healthcare organizations. By analyzing data, tailoring benefits programs to member needs and negotiating better vendor contracts, organizations can save money while still offering high-quality benefits to their members.

What is the Benefits Optimization Cycle?

The healthcare benefits optimization cycle is a systematic approach to improving healthcare benefits programs, encompassing various stages from assessment to measurement. By following this cycle, healthcare organizations can effectively analyze, strategize and optimize their benefits offerings.

Let’s explore each stage of the benefits optimization cycle and understand how it aligns with the Centers for Medicare and Medicaid Services (CMS) deadlines.

Assessment

The first step in the cycle is conducting a comprehensive assessment of current and emerging market benefits. This involves analyzing data on healthcare costs, member utilization patterns and satisfaction levels. Leveraging publically available data, one can quickly and efficiently have a strong grasp of the current marketplace. By understanding the existing program’s strengths and weaknesses, organizations can identify areas for improvement.

Strategic Planning

Based on the assessment, organizations develop a strategic plan to design new plan benefits or modify existing ones. This includes setting clear goals, defining strategies to achieve those goals and outlining the necessary steps for implementation.

Also, organizations might develop new products, expand their provider network or implement new healthcare technologies. Strategic planning also involves considering CMS deadlines, such as the Initial Enrollment Period, Annual Enrollment Period, Open Enrollment Period and Special Enrollment Period.

Implementation

In the implementation stage, healthcare organizations roll out their new or modified benefits programs to members. This step may include communicating with members to explain changes to their benefits packages, training healthcare providers on new processes or technologies or implementing new member engagement programs. Timely execution is crucial to meet CMS deadlines and ensure a seamless transition for members.

Measurement

The final stage of the benefits optimization cycle is measuring the outcomes and effectiveness of the implemented strategies. Organizations track key metrics such as cost savings, member satisfaction and healthcare utilization to assess the success of the optimized benefits program. This data-driven evaluation enables continuous improvement and helps organizations refine their strategies for future optimization cycles.

By following this cycle, healthcare organizations can optimize their benefits programs to increase enrollment, operational efficiency and financial performance.

The Benefits Optimization Cycle Timeline

The benefits optimization cycle timeline can vary depending on the healthcare organization and the specific benefits program the organization is optimizing. However, most benefits optimization cycles follow some general timelines: 

  • Assessment: The assessment stage of the cycle typically takes place at the beginning of the year and typically takes one to two months to complete.
  • Strategic planning: The design stage typically follows the assessment stage and may take anywhere from two to four months to complete. 
  • Implementation: The implementation stage typically takes place in the latter half of the year and generally takes one to three months to complete. 
  • Measurement: The measurement stage typically takes place at the end of the year and can take one to two months to complete. 

Here’s an example of the CMS application and bid submission timeline to understand how it aligns with the benefits optimization cycle:

  • November to February (Q4 to Q1): During this period, organizations submit a notice of intent to apply and complete the CMS application by mid-February.
  • March (Q1): The bid kickoff takes place, initiating the bidding process.
  • End of March (Q1): The first draft of benefits is completed, outlining the proposed benefits, coverage options, and associated costs.
  • April (Q2): Value-Based Insurance Design applications and the second draft of benefits are due.
  • Before May (Q2): The third draft of benefits is finalized.
  • May (Q2): The final proposed benefit review and assumptions finalization takes place.
  • June (Q2): The bid submission deadline arrives, and organizations submit their finalized bid packages to the CMS.

By aligning the benefits optimization cycle with the CMS application and bid submission timeline, healthcare organizations can ensure a comprehensive and compliant approach to optimizing their benefits programs in order to achieve strategic institutional goals.

Remember, the specific timeline may vary based on organizational needs, CMS requirements and other factors. However, following a structured timeline is key to achieving successful benefit optimizations in healthcare. 

Maximize Your Healthcare Benefits With ProspHire

Maximize your healthcare benefits with ProspHire

Benefits optimization in healthcare can help organizations maximize their benefits, reduce costs and increase member satisfaction. By following the benefits optimization cycle, organizations can continuously evaluate their product benefits, identify opportunities for improvement and implement changes to achieve their desired outcomes.

ProspHire offers expert benefits optimization services to help organizations navigate the complexities of healthcare benefits and achieve their goals. If you’re interested in learning more about how ProspHire can help your organization optimize its benefits, fill out our contact form today.