Webinar – The Tools and Technologies for the Future of Revenue Cycle Management

Plano, TX and Pleasanton, CA Apr 30, 2015 – Healthcare is evolving at breakneck speed in almost every respect with no sign of slowing down anytime soon. Innovation is required to not just keep up with trends but also stay ahead.
Since our founding in 1987, we have always felt that it was our obligation to continuously make advancements to our products and stay ahead of the curve to meet not only the current but also the future needs of our healthcare provider customers.
In our next webinar, we review the technological components of revenue cycle management that will be crucial for future heathcare provider sustainability, including:
• Data Analytics & Intelligence Platforms
​• Business Office Efficiency & Productivity Tools
• Next-generation Billing & Remittance Technologies

M2S® and SonoSoft® sign licensing agreement as first EMR integration partner for new VQI® Varicose Vein Registry™

Chicago, IL and West Lebanon, NH Apr 28, 2015 – M2S, Inc., a leader and innovator in technology for quality improvement in healthcare and SonoSoft, a leader in business continuity software and services, have committed to reduce registry data entry time for the new Vascular Quality Initiative(VQI) Varicose Vein Registry. SonoSoft will provide electronic medical records (EMR) integration for the M2S PATHWAYS™ platform, allowing collection of more comprehensive data for improved patient care.
This licensing agreement will allow vein centers, hospitals and outpatient facilities who are participating in the VVR to significantly improve their data entry workflow and efficiency. SonoSoft’s EMR software will automate the data capture of over 150 data fields on the web-based PATHWAYS form for the registry, including patient demographics and history, procedure details and follow-up.
Jeff Lord, Chief Technology Officer at M2S, says “Effective EMR integration is essential for the clinical registries on the PATHWAYS platform in order to streamline the data entry process for our clients. Our work with SonoSoft on the integration for the Varicose Vein Registry will both strengthen the PATHWAYS platform and help our clients to capture the quality data they need to track outcomes.”
SonoSoft provides an automated process for uploading the data required for the M2S PATHWAYS platform and the Varicose Vein Registry. By linking the M2S PATHWAYS clinical registry functionality with SonoSoft’s EMR functionality, staff and physicians can improve both the quality of care and efficiency. Vein specialist electronic medical records can be shared with other physicians and can conform to standards for medical billing with insurance companies as well.
Dr. John Stahl, President of Empower Technologies, adds,”We have developed a nice interface with the M2S PATHWAYS platform, so that the information in our EMR will populate the 150+ data fields for the registry in a single click and can be uploaded to the website. We feel that this improves workflow as well as the desire to continue to participate in the registry without compromising data accuracy. It’s a win/win for everyone.”

Gaffey Healthcare in Machine Learning Blog

Machine Learning Blog: How ML Accelerates Claim Automation & Revenue at GAFFEY Healthcare
Plano, TX and Pleasanton, CA Apr 27, 2015 – Machine learning can help modern businesses utilize their data to become more profitable. GAFFEY Healthcare is a leading healthcare technology solution provider, and they help their customers – who include over 200 healthcare systems, hospitals and physician practices – accelerate their revenue cycle. Microsoft and GAFFEY Healthcare recently collaborated on a pilot to deploy ML in GAFFEY’s claims automation and processing engine at a couple of hospitals using Azure cloud services, and are now working to move this system into production for many more of their customers.
The cash flow at healthcare organizations is frequently slowed down by insurance companies postponing claim payments. GAFFEY now uses ML to make predictions around:
Whether a human collector is needed to accelerate the claim payment process, and
How long it will take for an insurance company to pay a claim (0-60 days, 60-90 days, or 90+ days) based on historical patient and claim payment information.
GAFFEY is now able to target workflow processes to help its customers speed up their payment collections, while keeping its labor cost lower by eliminating non value added touches.
To make predictions, a binary classification model was developed to determine whether a human collector is needed to have the insurance company pay the claim, and a multiclass classification model was developed to predict how long it will take for an insurance company to pay a claim. Azure Machine Learning was used to develop the two models, which work on the same input data composed of insurance and claim information. Boosted decision trees gave the most accurate results, both for the two-class and multi-class models. The trained models were then used in the scoring workflow shown in Figure 1 below, and deployed as a web service. The web service takes the claim and insurance information as the input, and outputs the probability of a human collector being needed and the predicted length of time for a claim to be paid.
In addition, Azure cloud services were utilized to set up an automated data pipeline for GAFFEY. Figure 2 below illustrates how the on premise data in their system is automatically pulled and aggregated into the cloud using Azure Data Factory. The ML models described above are consumed by a daily batch request to the machine learning REST API for the new claims, and the results are automatically pushed back to their data center for use in their claim processing rule engine.
By deploying this automated data movement and processing pipeline and utilizing ML, GAFFEY has been able to improve their operational efficiency through accurate predictions on which claims should be worked on and when, resulting in better cash flow management and lower costs for their customers.

Precyse Announces Case Management and Utilization Review Consulting

A new service to strengthen the critical link between clinical and financial operations
Wayne, PA Apr 22, 2015 – Precyse, the industry leader in Health Information Management (HIM) performance solutions, announces today the launch of their new consulting services for case management and utilization review (CM/UR). Case Managers and Utilization Review staff can impact quality of care, timely and
appropriate reimbursement, and patient satisfaction – all necessary focus areas for sustainability in the new era of healthcare. Precyse consultants offer CM/UR expertise to revitalize CM/UR programs, and can help provide solutions to help solve some of today’s most challenging issues.
“Case management and utilization review function as a critical link between a healthcare provider’s clinical and financial operations,” said Marion Kruse, RN, MBA, Sr. Managing Director Clinical Services at Precyse. “We are well positioned to provide the best service in the industry because of our well-rounded, seasoned consultants that not only possess expertise in CM/UR, but have experience in other areas, including clinical documentation improvement, coding, and other revenue cycle functions.”
The benefits of CM/UR Consulting Services include:
• Integrating financial and clinical operations for the new era of revenue cycle challenges
• Thriving in a Value-based Purchasing world – improve 30-day Readmission and Medicare Cost per Beneficiary
• Driving down average length of stay
• Reducing cost per case
• Lowering denials related to avoidable days
Precyse’s CM/UR Consulting Service provides a three phase approach including an independent assessment, program redesign and implementation, and on-going performance monitoring of healthcare facilities’ CM/UR program. The offering also includes on-site education provided by practicing physicians and case management experts.

Quantum Health Named #1 Large Employer Workplace By Columbus CEO

Columbus, OH Apr 13, 2015 – Quantum Health, the leader in care coordination and consumer navigation, announced today that it has been ranked as the #1 2015 Columbus CEO and WBNS10TV Top Large Employer Workplace in central Ohio.
The Top Workplace award is determined based solely on employee feedback through a survey, organized by WorkplaceDynamics, LLP, a leading research firm on organizational health and employee engagement. Some perks of employment at Quantum Health noted in the survey include unlimited access to free beverages, snacks, fresh-popped popcorn and catered lunches, access to an on-site fitness facility, and a team space equipped with massage chairs, a game room, and a serenity/meditation room.
Quantum Health has previously been highlighted in other local and national press as a rapidly growing, innovative company, as well as a great place to work. Quantum Health has been recognized as both a FORTUNE Magazine Great Place to Work® and an Entrepreneur Magazine Great Place to Work® listing as a Best Small & Medium Workplace.
“It’s wonderful to receive awards that speak to our culture and our team focus,” Trott said. “Maintaining the well-being of our team means we can better serve our members, so we really focus on making this a great place to come to work everyday—it’s great to be recognized for that effort.”

Quantum Health To Speak At Midwest Business Group On Health’s 35th Annual Conference

Columbus, OH Apr 21, 2015 – Quantum Health founder and Chief Executive Officer Kara Trott will present on the panel “Addressing Waste, Overuse & Inappropriate Care in Today’s Health Care System” alongside David Adams, Chief Executive Officer of HealthcarePays, Roger C. Merrill, MD, Chief Medical Officer at Merrill Health Strategies, and Jan Berger, MD, President & CEO, Health Intelligence Partners, Medical Director, MBGH, at the Midwest Business Group on Health’s 35th Annual Conference. The conference will be held April 29-30, 2015 at the The Mid-America Club in Chicago. The presentation will focus on waste and inappropriate care in the healthcare system, and Quantum Health will speak on lessons learned from over 16 years of coordinating care and guiding consumers toward appropriate utilization.

Precyse Healthcare Information Management Platform Resonates with Providers

The industry’s only technology platform specifically designed to integrate all functions of health information management
Wayne, PA Apr 13, 2015 — Precyse expands its footprint as healthcare providers increasingly embrace the vision of a single, integrated platform to support all aspects of health information management on an enterprise-wide basis. The Precyse platform leverages knowledge gained in delivering stellar health information management services over the past 15 years to a vast array of healthcare organizations. The platform is used today to automate clinical documentation improvement (CDI) and medical coding workflows via a single shared infrastructure. This shared infrastructure, coupled with state-of-the-art natural language processing (NLP) and enhanced cross-role communication, enables providers to optimize reimbursement, reduce audit risks, and improve quality while lowering the total cost of ownership.
The number of client go lives for the Precyse platform has doubled in the last 6 months as providers understand what is required to prepare for risk sharing and quality-based arrangements. The Precyse technology has continued to evolve to support these requirements – providers and the new healthcare landscape require more than just standalone CAC or CDI specific to inpatient or outpatient workflows, and the Precyse platform has gained in breadth and depth. Customers who were early implementers of technology are reinforcing their commitment to the single integrated approach to help break down silos and open communication among physicians, CDI specialists, coders, auditors and others.
One early adopter, Holyoke Medical Center, is delighted with the latest release from Precyse. Per Laura Piquette, Director of Health Information Management/Privacy Officer “we are experiencing vastly improved throughput and productivity with this latest release and the enhanced integration with the Meditech EMR is invaluable to our coders. In addition, the common infrastructure optimizes our coding and documentation integrity through enhanced coder to CDIS communication. The Precyse implementation team and support teams assigned to Holyoke Medical Center are wonderful to work with.”
The Precyse combined offering of CDI technology and clinical documentation improvement services also continues to see tremendous market momentum, separate from the ICD-10 transition, as clients recognize that improving clinical documentation is foundational to many of their initiatives to improve the quality and reduce the cost of healthcare.
Debra Stenner, Precyse Chief Technology and Strategy Officer, states, “With expanded use of our technology, our customers are not only reaping the benefits of more appropriate reimbursement and better public quality reporting, but many are now looking at ways to rethink their documentation and coding staff’s roles and antiquated workflows to provide even greater efficiency and return on investment.”

Quantum Health Reaches Major Milestone: Over 5 Million Consumer And Provider Connections Made Half A Billion In Savings For Employer Health Plans

Columbus, OH Apr 2, 2015 – Quantum Health, the leader in care coordination and consumer navigation, announced today that it has achieved a major business milestone, making 5,497,028 connections, helping 779,470 consumers and providers more effectively navigate the complex healthcare system. Through this high level of engagement, the company delivers a 5% to 8% reduction in healthcare costs for its self-insured employer clients, which have entrusted over $6 billion in health plan spend with Quantum Health. The company is a disruptive force in the healthcare industry, whose groundbreaking consumer-focused research led to the creation of the care coordination and consumer navigation segment, a sector that is rapidly growing in response to the rise in healthcare consumerism.
“Reaching this major milestone is a testament to the trust our clients and their members have placed in Quantum Health, and to the financial savings, increased engagement and greater employee satisfaction that we deliver,” said Kara Trott, founder and Chief Executive Officer of Quantum Health. “Our clients have found there are many advantages to having employees engaged in their own healthcare journeys. Our clients realize lower spending trend, a more maximized health plan and that their employees have a much better customer experience.”
Quantum Health was the first to define and use consumer behavior process mapping in healthcare by tracking 3,200 patients and 290 providers for two years. From this research, the company built a best-in-class model for care coordination and consumer navigation based on how people experience their healthcare journey, what they need and how best to connect with them.
Over the past 16 years, the company has earned recognition for its ability to deliver dramatic and sustainable results for large self-insured employers. Quantum Health clients experience nearly flat year one healthcare spend and a reduction in trend by year three, a reduction in health benefits related workload, allowing for a great focus on HR strategy, and 92% member satisfaction by providing true patient support and advocacy to employees.