president’s message inside this issue - hfma ... · president’s message inside this issue f a l...
TRANSCRIPT
INSIDE THIS ISSUE President’s Message
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Dear HFMA NENY Members,
We have had an extremely successful and
exciting 2017 to date. Our chapter has enjoyed
a very active summer full of networking and
cultivating new relationships through our
Annual Golf Tournament, Day at Races, and
Volunteer Picnic.
On the topic of relationships, we recognize how
important collaborations with other professional
organizations in the capital region are. This is why we have recently
come together with MGMA to create a Payer Symposium Event on
November 16th. This event serves as a place for payers to provide
updates to healthcare organizations as well as a payer panel where
we will be asking panelists questions regarding industry trends. Dr.
Lawrence from IHANY will be there speaking on some of the
innovative things the ACO is currently doing. I highly encourage all
to attend but please leave your boxing gloves at home – this event
is all about collaboration.
Education and growth are also on the chapter’s radar this season.
We have two very exciting opportunities to tell you about:
HFMA NENY is working with Avadyne Health to provide three
membership scholarships for new members through May 2019!
We have sent an e-mail out regarding how to apply and are
accepting applications now until November 17th! For questions
regarding this please contact me at [email protected]
The second opportunity is that HFMA NENY is working with local
colleges to increase access to education and did you know that
HFMA's Vision Is "To Be An
Indispensable Professional
Resource For Healthcare
Financial Managers."
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Educational Events 2
Feature Article:
Determining if the
Provider Sponsored
Health Plan is
Right for You
4
HFMA Region
2+You Puerto Rico
Relief Fund
7
New & Reinstated
Members!
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Career Corner 9
Pictures: Day at the
Track and Volunteer
Picnic 2017
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Northeast Chapter
Leaders
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“Vital Signs of Northeastern New
York” is the official newsletter of
the Northeastern New York Chap-ter of the Healthcare Financial
Management Association.
EDITORIAL POLICY
Submission of material for publica-
tion is strongly encouraged. Arti-
cles should be typewritten. The
editor reserves the right to edit
material and accept or reject contri-
butions whether solicited or not. All
correspondence is assumed to be a
release for publication unless other-
wise indicated. Send all corre-
spondence, or materials for publica-
tion, to:
Diane Seeley
Saratoga Hospital 211 Church St
Saratoga Springs, NY 12866
FAX: 518-584-4108 Email: [email protected]
Opinions expressed in articles or features are those of the author and
do not necessarily reflect the views
of the Healthcare Financial Man-agement Association, Northeastern
New York Chapter or the editor.
membership is FREE for full
time college students? This
allows free admission to all
chapter events and
networking socials in
addition to access to online
HFMA resources! If you
know a college student
have them apply today -
http://www.hfma.org/apply/
As you go through this holiday
season I hope that our
chapters’ vision will resonate
with you and encourage
increased collaboration in your
own daily life. Wishing you all
the best – let’s keep in touch.
Best,
Jade Litchfield
[email protected] Jade is the Senior Project Manager of “ITWorks” at Cerner
APC/OPPS Update for 2018
Date: December 13th, 2017
Time: 1:00-2:00pm EST
Price: FREE for Members and
Non-Members!
CPE’s: 1.0 hours
Speaker: Jean Russell, MS,
RHIT, Epoch Health Solutions,
LLC
The Medicare Outpatient
Prospective Payment System
(OPPS/APCs) final rule is
published in early November each
year. This presentation will
include an overview of the
significant changes associated with
the 2018 final rule. Some of the
key changes expected this year are
as follows:
A reduction in the payment
rate for certain Medicare Part
B drugs purchased by hospitals
through the 340B program.
A two-year moratorium on
Recruit a HFMA
Member Today!
HFMA helps finance lead-
ers create and maintain
fiscally sound healthcare
organizations in order to
provide excellent patient
care.
Benefits of membership!
2
REGION 2 WEBINAR
GOLD
We Need YOU!
SILVER
We Need YOU!
BRONZE
Commerce Bank
direct supervision
requirements currently in place
at rural and critical access
hospital packaging of low-cost
drug administration services.
Further reduction of the APC
payment for services
performed in a non-excepted
off campus provider based
department.
A continuation of the increased
consolidation and packaging of
services paid under OPPS.
For more information and to
register, visit the following link:
https://register.gotowebinar.com/
register/5695997283154648066
Moving From Volume to Value
in Purchased Services-
Information Technology
Date: January 10th, 2018
Time: 1:00-2:00pm EST
Price: FREE for Members and
Non-Members!
CPE’s: 1.0 hours
Speakers: Brent Petty and Gary
Davis, Lexmark Healthcare
Healthcare is under extreme
pressure to find cost savings and
efficiencies and a ripe area for this
is in purchased services. This
webinar will guide you to a better
approach employing a value based
framework to better achieve cost
and efficiency targets.
The Value Based Framework
A Specific Application as
Applied in Managed Output
Services
The SOFTR approach for
helping make smarter
decisions for IT investments
For more information and to
register, visit the following link: https://register.gotowebinar.com/
register/5764290149999909634
3
Please remember to
support our generous
sponsors:
DIAMOND
MLMIC
Determining if the Provider-
Sponsored Health Plan Path is Right
for You
By John Tam, Executive Vice President of
Strategy, and Ken Wood, Senior Vice President
of Health Plan Development, Evolent Health
Providers have historically lacked control over
the ability to tie meaningful quality metrics to
reimbursement, and some would put this at the
top of the list of issues that hamper their
success. After all, it is the providers on the
frontlines of care delivery who can truly
manage medical costs and quality for patients,
as they have a unique set of controls only they
can execute.
Couple that desire for more control with the
industry’s continual shift toward value-based
care, and more and more providers are seeing
the true value in assuming risk. Some are even
wondering if they should launch their own
health plans.
A provider-sponsored health plan (PSHP)
represents the ultimate value-based care or risk
arrange-ment. Simply defined, a PSHP is an
organization of individual practitioners,
ancillary service providers and/or hospitals that
come together to design and run their own
health plan. These provider PSHPs are com-
pletely responsible for all aspects of costs,
quality, network configuration, benefit de-sign
and other activities associated with providing
health insurance to their members. Those
succeeding—well-known national players like
Intermountain and Kaiser Permanente, re-
gional leaders like Driscoll Children’s Health
Plan in Texas and Alliant Health Plans in
Georgia, and the more than 250 other PSHPs
currently operating in the U.S.—have
showcased the potential for upside rewards.
PSHPs can also offer some distinct advantages
over other types of health plans, such as more
effective population health management. Some
studies suggest that PSHPs are more efficient,
paving the way for lower premiums and other
incentives that benefit their members.
But let’s be frank: PSHPs are not for the faint
of heart, and many of us remember PSHPs that
failed in the 1990s. Becoming a traditional
PSHP is a massive undertaking and requires
getting to scale in a way that not all providers’
market dynamics will support. While some
groups will decide to move forward with the
creation of a full-blown PSHP, others will find
they’re left with gaps to fill and aren’t quite
ready. Yet, they still want to take on more risk.
So then what?
Evaluating Your Risk-taking Capabilities:
Nine Critical Considerations
Fortunately, advances in technology, business
intelligence and information-sharing plat-forms
are opening new opportunities for new PSHP
4
FEATURE ARTICLE
players. There are more tools available today to
help all types of health care organi-zations
aggregate the necessary capabilities to design,
build and successfully run a PSHP. The
question, then, becomes which ones you have
in house, and which ones you need to contract
for or otherwise acquire.
Having had the opportunity to work for and
alongside some successful PSHPs, we offer
nine critical business considerations your
organization needs to honestly discuss and
deeply analyze to determine if becoming PSHP
is a viable option for you.
A comprehensive feasibility analysis must
answer tough questions. Specifically, we
recommend that you:
Identify the potential network size and
types of providers you will need
Evaluate your change management
capabilities
Analyze the organization’s market position
and local competition
Assess local payer reaction
Gauge consumers’ buy-in
Investigate your specific regulatory
environment
Consider costs and financial realities
Evaluate different sales options
Assess your insurance IQ
Accurately and objectively analyzing these
considerations is crucial to gauging the po-
tential success of your risk-taking endeavor and
determine whether and how to ultimately move
forward.
For those groups who identify capability gaps
and aren’t sure how to fill them, partnering
with a third party could be a viable option.
A partnership with a traditional commercial
payer, for example, can offer the license,
capital, scaled infrastructure and expertise that
eases your own administrative burden, and can
provide advanced regulatory knowledge and
insight. Such an arrangement requires careful
consideration of the potential partner, as some
provider independence will necessarily be lost.
It’s also important to consider how any new
arrangements could impact your strategic
relationships with other payers in your local
market.
Industry Shifts Pave Way for Emergence of
Neutral Payers
Other options have emerged as the health
paradigm has shifted. While we’re conditioned
to think of payers as either state or federal
government or the historical private
commercial types, a new third category of
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Sponsor Highlight!
payer has emerged in recent years. Purpose-
built for a value-based care paradigm and for
data-driven population health initiatives, these
“neutral payers” have collectively raised $1
billion in capital to solve the unmet needs of
providers and patients. Neutral payers offer a
different approach for providers who might not
be ready to launch their own PSHP and aren’t
keen on partnering with a traditional payer.
Some key advantages and benefits to
partnering with a neutral payer include:
Innovative consumer technology
Collaborative mindset and a desire to
disrupt legacy incumbents which may lead
to more favorable deal terms for providers
Customizable approaches, such as
cobranding or white labeling insurance
plans with provider systems that have
prominent brands
Openness to exclusivity because there is no
historical relationships to maintain
Robust change management capabilities
combined with on-the-ground physician
and staff training and reinforcement
A third party’s ability to ensure incentives
align with your physicians’, staff’s, and
overall business’s needs and goals
There are also potential challenges. Most
neutral payers lack the brand recognition of
their larger counterparts. Some have less of a
track record and balance sheet, creating
uncertainty about their longevity.
The good news is that after you conduct your
feasibility study and weigh the advantages and
benefits against challenges, you will be steeped
in critical value-based care information and
ready to take on greater amounts of risk, either
on your own or with a partner. And for those
groups that decide to pursue a full-blown PSHP
or partner with a traditional or neutral payer,
you’ll have much of the information you need
to fine-tune your risk-taking appetite.
John Tam is Executive Vice President of
Strategy for Evolent Health.
Ken Wood is Senior Vice President of Health
Plan Development for Evolent Health.
You can reach them via e-mail at
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Sponsor Highlight!
Dear HFMA Region 2 Friends & Colleagues,
We have been following closely the heart
wrenching pictures and reports regarding the
extensive damage caused by Hurricanes Irma
and Maria to our HFMA friends and colleagues
in Puerto Rico, a member of Region 2. The
effects of these storms will be felt for years and
their impacts on the communities, first
responders, healthcare leaders, and
professionals will likely last a lifetime. In
times like these, community matters. Our
commitment to the communities we help and
serve is our primary focus. Because of our
strong desire to do something, we have set up a
website to raise funds for our fellow HFMA
members and their loved ones in Puerto Rico
during their time of need.
www.youcaring.com/
HFMA_Region_2_Hurricane_Maria
Please note, that donations made to the above
may not be considered tax deductible, please
consult your tax professional for determination.
You may also contribute to these fundraising
organizations:
The American Red Cross
Federal Emergency Management Association
(FEMA) (This page offers resources for you
and your community)
Government of Puerto Rico
To offer your support and help, or to obtain
additional information, please consider using
the resources provided above. Additionally,
HFMA National has dedicated a page on their
website to provide updates regarding the
effects of these storms as well as Hurricane
Harvey. Please check this page often for
updates.
HFMA sends its heartfelt thoughts and wishes
to everyone impacted by these storms and for
those who are stepping up to help during these
extraordinarily challenging times.
Kristen Zebrowski, Region 2 Regional
Executive
Kiran Batheja, Region 2 Regional-
Executive Elect
Michele Mecomonaco, Region 2 Regional
Executive Elect-Elect
Sincerely,
Jade Litchfield
President – NENY HFMA
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HFMA Region 2+You-Puerto Rico Relief Fund
8
New Members Juanita Wheeler
Heather Radliff
Colleen Gilchrist
Kristin Signor
Paul O’Brien
John Habermehl
Lori Santos
Lynette Turo
Amy Bourdeau
Nella Moran
Michael Bobersky
Stephen Beyer
Thomas Robert
Cherie Smith
Judith Joly
Peter Oldytowski
Janice Macke
Tanya Herd
Kevin Frodyma
Lisa McElheny
Melissa Inman
Lana Ayzikovich
Kevin Curtis
Sharon Prescott
Emily Rings
Cynthia Spaulding
Lindsay Portu
Eileen Smith
Stephen Miano
Rachael Mennor
Kathleen Buckley
Sasha Bliss
Karen Crevier
Ryan Smalley
Dan Kilmartin
Greg Jones
Reinstated
Rebecca Slagle
Kevin Burke
Roland Surprenant
Jeffrey Cohen
Eugene Laks
Michele Kelly
Donald Booth
Shannon Burke-Doomchin
Laura Pasco
Frances Lockrow
Ann Marie Hatch
Please contact Matt Hunt at mat-
[email protected] if you would like
more information on becoming a member or
have any questions regarding current member-
ship status.
New & Reinstated Members July-September 2017
The Have and Have Nots of Group
Disability Insurance
Provided By: Barry Rings Jr. Northwestern
Mutual
If you are one of the lucky workers covered by
an employer sponsored Group Long Term
Disability Income (LTD) insurance policy,
you are more fortunate than most. Even if you
are covered, it is extremely important to make
sure you are adequately protected.
Becoming disabled due to accident or illness is
a very real risk.
While the likelihoods vary with age, during
your income producing years, 1 in 4 of today’s
20 year olds will become disabled before
reaching the age of 67.1 Yet, few American
workers are financially prepared to weather a
disability. In fact, the Council for Disability
Awareness reports that 65% of working
Americans say they could not cover their
normal living expenses for a year if their
employment income was lost; 38% could not
pay their bills for longer than three months.2
The question to ask yourself is whether your
family could meet expenses for three or four
months if the primary wage earner lost his or
her income due to a disability. Given the
current economic conditions, now would be an
excellent time to review your assets and
consider how long your family could make
ends meet if the primary wage earner suffers
from cancer, a heart attack, an accident or
some other disabling event.
Even if you have employer provided group
LTD coverage, such coverage alone, seldom
provides families with enough benefits to meet
all their financial obligations.
Limitations of Employer-Provided LTD
policies
Here are some typical limitations of group
LTD policies provided through an employer:
Most group LTD policies only cover 60
percent of base salary, which leaves you to
meet your financial obligations on a 40
percent drop in income.
Typically, group LTD polices do not cover
incentive compensation such as profit
sharing contributions, deferred
compensation or regular incentive
bonuses.
When the employer pays the premium for
group LTD coverage, any benefits
received are considered taxable income to
the employee.
9
CAREER CORNER
10
Group LTD benefits are often reduced dollar
for dollar with any Social Security benefits,
workers compensation benefits, or auto no
fault benefits received by the disabled
employee.
Group LTD policies may have low monthly
benefit maximums which can reduce the
amount of income replaced for higher paid
employees. For example, if the group LTD
policy replaces 60% of salary with a
maximum monthly benefit of $5,000,
anyone making more than $100,000 per year
receives less than 60% when faced with a
disability.
Calculating Your Income Post Disability
Clearly, everyone who relies on a paycheck
needs to assess how long he or she could
continue to meet their financial obligations in
the event of a disability, including any ongoing
savings for education and retirement.
As a first step, it’s important to consult with an
experienced financial professional. Look for
someone who is both knowledgeable and
trustworthy. Make sure the insurance company
is reputable, and has financial strength and
stability and commitment for the future.
A financial professional can help you assess
whether you would have the financial resources
to meet your obligations in the event of a
disability and for how long. If additional
disability income coverage is needed, he or she
can advise what types of supplemental coverage
would be appropriate. Underwriting rules by
insurance companies often dictate how much
coverage is available to an individual, but the
wide variety of policies on the market today can
suit many different income levels and budget
requirements.
What’s most important is to have a solid,
complete plan in place to get you through the
“have not” periods of life.
1U.S. Social Security Administration, October 2015 2 Disability Statistics, Council for Disability Awareness,
March 2013.
Article prepared by Northwestern Mutual with
the cooperation of Barry J. Rings Jr.
Barry J. Rings Jr is an Associate Wealth
Management Advisor to William Newman with
Northwestern Mutual. Barry Rings and William
Newman are based in Albany, NY. To contact
Barry J. Rings Jr. please call 518.459.4665, e-
mail at [email protected] or visit
www.wmnewman.com.
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A fun filled day with NENY Friends and Family!
Did I just hear “First Call” for the next Race or another round of drinks?
Girls just want to have FUUUNNN... and win $$$ of course!
HFMA-NENY Day at the Track 2017
Great food and good times were had by all!
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Festive decorations...
….and most importantly the great company! An abundance of good food….
What a perfect day to celebrate our NENY Volunteers!
Volunteer Picnic 2017
hfma
Northeastern New York
Chapter
Officers
President Jade Litchfield President Elect Mike Ostrander Secretary Deb Trumbull Treasurer William Vooris
Directors
Mike Wallner, FHFMA, MSHA Rico Viscusi Diane Seeley, CRCR Bob Shwajlyk
Jim Gavin Marty Dunbar
Committee Chairs and
Members:
Certification Rico Viscusi Programming Committee Alyson Belz, Co-Chair Flora Pagan, Co-Chair Marty Dunbar, Comm Member Membership Matthew Hunt, CRCR, Chair Brianna Frisch, Comm Member Newsletter Diane Seeley, CRCR, Chair Social/Awards Committee Robert Shwajlyk Rabin Kayastha, MPA, CRCR
Dan Berryann Bill Walbridge Sponsorship Committee Mike Wallner, FHFMA, MSHA Karen Richards, FHFMA, CPA Webmaster Rabin Kayastha, MPA, CRCR Bob Shwajlyk DCMS Contact Jade Litchfield Founders Contact Jade Litchfield LINK Committee Jade Litchfield
2018-2017 Northeast Chapter Leaders
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2015 redesigned CHFP Certification Program
The new CHFP is structured into two parts:
Module I: The Business of Health Care & Module II: Operational Excellence
Earning the CHFP - The CHFP credential is awarded upon successful completion of module I end of course
assessment and successful completion of module II case study exercises. For more details, updates and FAQs
please go to the Certification area of the HFMA website. Questions? Please email [email protected].