Kristine Daynes

Compliance requires exacting skills. HIM departments are expected to make sure patient care is appropriately documented, check for medical necessity, assign codes with ICD-10 specificity, identify conditions present on admission […]

As the volume of outpatient care has grown over the past several years, so has interest in outpatient clinical documentation improvement (CDI). Yet many organizations struggle to define what exactly […]

Roughly 40 percent of healthcare financial leaders say their organizations lack in-house expertise and staffing for extremely important activities, such as managing new regulations and payment models. The gaps put […]

HHS is adapting yet again of one of its most widespread quality initiatives, called Partnership for Patients. Will it be more of the same or a whole new game? HHS […]

Gaining or losing? There are mixed messages about the profitability of healthcare delivery organizations. Earlier this year, Modern Healthcare reported that hospitals’ overall operating margins in 2016 increased to an […]

Perhaps it’s true that we tend to see what we expect to see. In my job, I work with healthcare quality measures. Given this bias, my scan of the media […]

I’ve been reading ProvenCare, which describes the Geisinger approach to health care and is filled with mottos such as “achieving extreme patient satisfaction” and “treating patients like family.” One discovery […]

Recently, I reviewed the Medicare Hospital Value-Based Purchasing (VBP) scores for three hospitals recognized nationally for outstanding care and patient safety. They didn’t look good. The ratings for clinical outcomes […]

Hierarchical Condition Categories (HCCs) have been the underlying risk adjustment for many Medicare programs for several years. But they didn’t attract wide interest until CMS began shifting more payment toward […]

Years ago, I briefly thought my calling in life might be as a bookie in Las Vegas. I was in business school and had developed a statistical model that could […]

Healthcare pundits agree this is a time of uncertainty. Depending on your media of choice, uncertainty either reigns (New York Times), looms (CNN), or trickles down (Public News Service). Given […]

Profitability for a health plan used to be a factor of actuarial skill and efficient operations. Insurers tended to invest in technology to increase the efficiency of call centers, contract […]

The digital age has created more noise than useful information. This is especially true in health care, where the quantity of electronic health information has exploded over the past decade. […]

Value-based payment models are attracting attention for risk adjustment methodologies, especially HCC risk adjustment, which is used to calculate cost benchmarks for Medicare Advantage and other CMS payment models including […]

Shifting from volume-driven to value-based healthcare wouldn’t be so difficult if value meant just one thing. But every payer and value-based program defines value to suit its own purposes—on good […]

We all know the Trump administration’s commitment to repeal and replace key components of the Affordable Care Act. What we don’t know is what that will look like or how […]

Two years ago, I blogged about my favorite websites for information on population health. Since then my inbox has become crowded with e-newsletters and alerts. Recently I found myself unsubscribing […]

What is the most effective mechanism in the U.S. to achieve the goals of health reform? Is it cutting-edge technology? Risk-based payment models? Affordable health insurance coverage for more people? […]

CMS recently announced the 2015 financial and quality results for nearly 400 Medicare ACOs. My 3M colleagues and I were eager to sift through the data for insights to help […]

So much hope is invested in health data. As technology zooms into the 21st century (wearables, predictive modeling, precision medicine), health data organizations are scrambling to keep up. The promise […]

One surprising development as health care shifts toward risk-based payment is how many health systems intend to become insurers. According to one study, half of health systems have applied or […]

At the AHIP conference last week, Bernard Tyson, CEO of Kaiser Permanente, spoke forcefully about health equity during a panel session. “We need to rethink the best way to provide […]

Hospitals and physician practices are skeptical about the real value of value-based care. A Frost & Sullivan study for 3M found fewer than half of providers agreed that value-based care […]

The 3M Client Experience Summit this year is a combination science fair and storytelling festival for healthcare professionals. In all the best ways. There is an actual science fair of […]

As CMS launches its mandatory bundled payment program, payers on the fence may be wondering if it’s time to push their providers toward bundles also. A number of commercial insurers […]

CMS released seven sets of core quality measures earlier this month. They come from a collaboration with AHIP, NQF and other stakeholders to harmonize performance measures across commercial and government […]

Connected care is a popular concept in the healthcare IT world. Commonly, it is used in conversations about interoperability, mobile applications, patient portals, wearable devices, and telehealth. These technologies will […]

This question was posed by an audience member to speakers at the 3M Value-Based Care Conference. The answers were all “yes,” but not without qualification about how data transparency changes […]

Last month, David Blumenthal, MD, director of The Commonwealth Fund, addressed a 3M conference in New York City on value-based care. He mentioned soon-to-be-released recommendations from his organization on effective […]

There is no common definition for population health. But if you ask enough healthcare executives, you’ll get a clear sense of what it means in terms of how it challenges […]

I’ve heard value-based care called “the new ICD-10.” I understand the comparison, at least in reference to regulatory disruption. But aside from the CMS willpower behind value-based care, I don’t […]

It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may […]

I love hearing about multi-source or all-payer claims databases (APCDs). I’m not a data scientist, but I know enough about analytics to appreciate the possibilities within an APCD. Each announcement […]

Anyone who has renovated a home while living in it should relate to the challenges of shifting to value-based payment. It is takes time, money and grit to redesign a […]

Although cost is a common topic in health care, it is not commonly understood. As one man’s trash is another man’s treasure, similarly, in health care, one man’s cost is […]

Thirty-eight states are developing State Innovation Models (SIM), or new models for multi-payer healthcare payment and service delivery, funded by grants from CMS. The SIM program tests ways to lower […]

There is plenty of speculation about the fate of hospitals and healthcare IT. The uncertainty could make it difficult for hospital executives to set strategies for the coming year. Yet, […]