Cypress Healthcare Consultants

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Value-Based Care Strategies for Skilled Nursing & Rehabilitation Facilities Value-based care (VBC) is shifting the landscape for skilled nursing and rehab facilities. Payers demand better outcomes, hospitals want lower readmissions, and patients expect quality care. To thrive, facilities must adapt—quickly. Here’s how to win in a VBC world: 1. Reduce Readmissions – Your #1 KPI CMS penalties for readmissions hurt. Track and address the top causes—sepsis, falls, UTIs, respiratory infections. Partner with hospitals for better discharge planning. Use telehealth to follow up. 2. Optimize Length of Stay (LOS) Too short, and patients boomerang back. Too long, and margins shrink. AI-driven predictive analytics can pinpoint the ideal LOS for each patient, balancing cost and care quality. 3. Master Your Quality Metrics Your Five-Star Rating, QMs, and rehospitalization rates dictate payer and referral relationships. Invest in staff training, infection control, and early intervention programs. 4. Nail Your Post-Discharge Follow-Up Patients discharged without a plan = readmissions waiting to happen. Establish a 30-day post-acute care model with home health, pharmacies, and virtual check-ins. 5. Leverage Value-Based Contracts Payers are looking for partners, not vendors. Negotiate for shared savings or per-member-per-month (PMPM) care coordination fees. If you can prove cost savings, you will get paid. 6. Invest in AI & Predictive Analytics AI can flag high-risk patients before they deteriorate. Predictive tools help manage staffing, prevent falls, and improve clinical decision-making. Early intervention = fewer crises. 7. Build Stronger Referral Networks Hospitals favor SNFs with data-backed results. Market your success rates, low rehospitalization metrics, and specialty programs. Be the go-to facility for complex rehab cases. Bottom Line: Value-based care isn’t optional—it’s survival. Optimize outcomes, reduce costs, and own your data. The future belongs to SNFs that prove their value. Are you ready to make VBC work for your facility? Let’s connect. https://lnkd.in/gb2jt9NE

The Case for In-Home & In-Facility Dialysis: Better Outcomes, Lower Costs When it comes to dialysis, one size doesn’t fit all. For patients with end-stage renal disease (ESRD), choosing between in-home and in-facility dialysis can significantly impact their health, quality of life, and overall costs. Let’s break it down--starting with what matters most: patients, outcomes, efficacy, and cost savings. ?? Patients First: Control & Comfort In-home dialysis offers flexibility, greater independence, and improved quality of life. Studies show patients dialyzing at home report higher satisfaction, better energy levels, and greater adherence to treatment. In-facility dialysis ensures structured medical oversight for patients needing higher-touch care, reducing hospitalizations from complications. ?? Outcomes & Efficacy: The Numbers Don’t Lie A Harvard Medical School study found home dialysis patients had a 13% lower mortality rate and 33% fewer hospitalizations compared to facility-based counterparts. If it's true that hospitalizations can be reduced by more than 30%, this is a massive win for everyone! In-facility dialysis can still be optimal for patients requiring more intensive monitoring, reducing infection risks and ensuring continuity of care with nephrologists. ?? Cost Savings: Who Wins? The average cost per patient per year for home dialysis is ~$70,000, compared to $90,000+ for in-facility dialysis (CMS data). Home dialysis reduces ER visits and hospital stays, generating an estimated 25-30% cost savings for payers and providers. ?? Case Study: A Real-World Example A Chicago-based health system implemented a hybrid dialysis model, shifting 40% of eligible patients to at-home treatment while maintaining high-touch in-facility care for complex cases. The result? A 28% reduction in hospitalizations, $12M in annual savings, and improved patient-reported quality scores. ?? The Future of Dialysis: Hybrid Models Win As healthcare moves toward value-based care, expect to see more payers incentivizing home dialysis while facilities evolve into specialized care hubs. The key is giving patients options that improve outcomes while lowering costs. What’s your take—should more patients transition to home dialysis, or do we need a better balance? Let’s discuss! ?? #Dialysis #HealthcareInnovation #ValueBasedCare #healthcareissues #managedcare #dialysis #infacilitydialysis #inhomedialysis #ESRD #healthoutcomes #treatmentefficacy

Breaking Through Closed Managed Care Networks: A Lifeline for Home Health & Hospice Providers If you’re a home health or hospice provider, you may have hit the "closed network wall." It sucks, honestly. You have patients, hospitals, physicians, and post-acute partners who would like to refer to you. Closed networks block access to your patients and referrals! The result? Delays and disruption to continuity of care, patient and caregiver stress and confusion, and financial uncertainty for your agency. Here's the truth: Closed networks aren’t always closed. ??If you know how to play the game and have a knowledgable managed care advocate, you can often break through the barriers and secure those all-important contracts! Let's look at your options: ?? 1. Exploit “Network Adequacy” Rules Payers are required to maintain adequate provider access—and they often fail. If a plan can’t prove they have enough home health or hospice providers within reasonable distances, they must contract with out-of-network providers to ensure patient access. ?? Action Step: File a network adequacy complaint with state regulators or CMS if you see long wait times, travel burdens, or care delays. ?? 2. Use Continuity of Care Protections Even in a closed network, patients have rights. Many states have continuity of care laws that require payers to cover services with an existing provider for a set period if a network change disrupts care. ?? Winning Strategy: If a patient has an established care relationship, request a Continuity of Care Exception under Medicare Advantage or state Medicaid rules. ?? 3. Negotiate “Single Case Agreements” Even if a plan says “we’re closed,” exceptions happen every day. If a patient has a unique clinical need, a Single Case Agreement (SCA) allows an out-of-network provider to be paid at negotiated rates. ?? Pro Tip: Use patient advocacy—help families and doctors push the health plan for an SCA based on continuity of care. Plans fear regulatory scrutiny when denying necessary care. ?? 4. Leverage Patient & Physician Pressure Plans listen when patients and referring physicians push back. If a closed network is causing delays, encourage: ? Physicians to submit medical necessity letters demanding access to specific home health or hospice services. ? Patients to contact their plan’s grievance department (and file a complaint with CMS if needed). More pressure = more flexibility. ?? Bottom Line: Stop Accepting “No” as an Answer Closed networks aren’t the end of the road. Use network adequacy laws, continuity of care exceptions, SCAs, and patient pressure to ensure your patients get the care they deserve—and your agency stays financially secure. ?? Home health & hospice leaders—what’s working for you in managed care negotiations? What isn't working? Let's schedule a 15-min call to evaluate your options!

Managed Care Contracts for Radiology & Imaging: Are You Leaving Money on the Table? Radiology and imaging services are at the frontlines of reimbursement battles, facing shrinking margins and new capitated payment models. If you’re in the industry, here’s what you need to know right now to stay ahead. ?? Reimbursement: CMS vs. Commercial Payers Medicare reimbursements rarely cover the full cost of imaging services. Many providers rely on commercial contracts to stay profitable. But here’s the kicker—CMS is pushing site-neutral payments, meaning hospitals may only get 40% of the traditional outpatient reimbursement rate. ?? Translation? If you’re not aggressively renegotiating commercial contracts, you’re losing money. ?? Capitation: A Risk or a Goldmine? More payers are pushing capitated models—flat-rate payments per patient, no matter how many scans they need. Sounds good for predictable revenue, right? Except when high-utilization patients destroy your margins. If you go this route, make sure the numbers work! ?? Winning strategy: Leverage predictive analytics to assess risk before signing capitation deals. Some radiology groups have doubled profitability by negotiating risk-adjusted rates. ?? Regulations Are Changing the Game CMS's value-based shift is real. MACRA and state capitation models are rewriting the rules. If you’re not tracking regulatory shifts, you could be stuck in contracts that bleed revenue. ?? Final Takeaway Radiology groups need aggressive managed care strategies—benchmark against CMS, renegotiate contracts, and assess capitation risks. If you’re not doing this, you’re already behind. ?? What is your experience with payer negotiations? Need help? Drop a comment below or reach out directly!

The Financial Game Changer You Can’t Ignore Managed care contracting isn’t just paperwork—it’s the financial heartbeat of healthcare organizations. Get it right? You maximize revenue, cut costs, and elevate patient care. Get it wrong? Expect shrinking margins, denied claims, and frustrated staff. So, how do you ensure you’re on the winning side? ?? Let’s break it down. Understanding Managed Care Contracts Think of them as playbooks between providers and payers—commercial insurers, Medicare Advantage, and Medicaid. These contracts dictate your revenue, service coverage, and financial risk. Key Contract Components You Can’t Ignore ? Reimbursement Models: Fee-for-service, capitation, bundled payments, shared savings. ? Network Participation: In-network vs. out-of-network—your patient volume depends on this. ? Risk-Sharing Arrangements: Stop-loss provisions, shared-risk pools—protect yourself. ? Quality Metrics & Incentives: Get paid for patient outcomes and efficiency. ? Utilization Management: Preauthorization, credentialing—avoid reimbursement delays. ? Contract Terms: Rate escalations, dispute resolution—know your leverage. How to Maximize Financial Performance ?? 1. Negotiate Smarter ?? Benchmark reimbursement rates nationally. ?? Push for inflation-adjusted increases. ?? Use claims data to quantify financial impact before signing. ? 2. Optimize Revenue Cycle ?? Automate claims and prior auth workflows. ?? Monitor underpayments and resolve them FAST. ?? Train billing teams on contract-specific rules. ?? 3. Leverage Data & Tech ?? Predictive analytics to forecast patient risk. ?? AI-driven automation to cut denials. ?? Real-time dashboards for contract performance tracking. ?? 4. Align Workflows to Contracts ?? Train staff on billing and compliance rules. ?? Automate preauthorization alerts. ?? Conduct quarterly contract reviews to stay ahead. The Bottom Line If you’re not optimizing your managed care contracts, you’re leaving money on the table. The Cypress team is here to help. Let’s talk. https://lnkd.in/gb2jt9NE

When is it time to get help with your managed care contracts? If you’re running a hospital or post-acute facility, you’re juggling patient care, physician relations, staffing challenges, and financial performance—all while handling managed care agreements off the side of your desk. Here’s the hard truth: Payer agreements are not designed with your best interests in mind. Payers have entire teams dedicated to reducing what they pay you, using complex contract language and shifting reimbursement models to their advantage. They ASSUME you won't read the fine print...and very often, you DON'T! If you’re not actively negotiating, you’re leaving money on the table—possibly millions. That’s where outside expertise comes in. ?? Contract Language Can Hide Costly Loopholes Small clauses = big revenue losses. Hidden terms impact denial rates, carve-outs, and outlier payments—and you might not even realize it. ?? Benchmarking Matters How do your rates compare to industry standards? Without data-driven insights, you might be underpaid compared to peer facilities. ?? Negotiation is a Game of Leverage Payers negotiate hundreds of contracts a year. You negotiate a few. Outside experts bring market intelligence, payer tactics, and strategic leverage to get you the best possible terms. ?? Time is Money Your team is focused on operations and patient care—not spending months in contract negotiations. Bringing in specialists ensures faster contract turnaround and better financial outcomes. ?? Value-Based Care is Changing the Rules With the shift to value-based reimbursement, contracts are more complex than ever. Experts help ensure you maximize incentives and avoid pitfalls. ?? The Bottom Line: Payers have professionals working to protect their profits—shouldn’t you have professionals working to protect yours? If you're ready to optimize your contracts, improve reimbursement, and take control of your managed care strategy, let’s connect. ?? Reach out here https://lnkd.in/gb2jt9NE to schedule a quick chat. I'll listen, and then I'll let you know how we can help!

What If Doctors Actually Focused on Health? Here’s the deal: primary care today is a prescription factory. You walk in with a problem, and you walk out with a pill. High blood pressure? Take this. Stomach issues? Try that. Stressed out? Here’s something to take the edge off. And guess what? You’re still sick. Now, imagine a world where your doctor is open to promoting good health habits—not just keeping you on meds for life. Dr. Emily Carter was one of those overbooked, overworked physicians who could barely spend 10 minutes per patient before slapping a prescription on the problem and moving on. One night, staring at yet another prediabetes case, something clicked. “This guy doesn’t need another pill. He needs someone to tell him how to fix his body.” So she did something radical—she stopped defaulting to prescriptions and started looking at real health solutions. The Experiment Enter Mark. Mid-40s, tired, overweight, blood sugar creeping up. He was next in line for diabetes meds. Instead of reaching for her trusty prescription pad, Dr. Carter told him: ?? Ditch the processed junk. Eat like your great-grandparents. ?? Take magnesium and B vitamins to stop feeling like a zombie. ?? Walk every day—nothing crazy, just move. ?? Get outside. Vitamin D isn’t just for fun; it keeps you alive. Mark wasn’t thrilled. He wanted the easy fix. But he gave it a shot. The Results? CHECK THIS OUT! Six months later: ?? His blood sugar? Normal. ?? His energy? Through the roof. ?? His stress? Managed—without a prescription. All without adding a single new drug to his life. The problem isn’t doctors—it’s the system. Insurance pays for quick visits and pills, not nutrition counseling. Most physicians aren’t trained in how to actually heal people—just how to manage disease. But the ones who break free? They’re changing lives. Imagine if every doctor: ? Checked for nutrient deficiencies before writing a prescription. ? Focused on gut health, inflammation, and lifestyle before meds. ? Actually helped patients get off medication instead of stacking more on. But only with doctors who are done playing the game and ready to actually help people get well. So, what now? You have a choice: 1?? Keep treating your body like a science experiment for Big Pharma. 2?? Find a doctor who is open to wholistic medicine and supplementation. Doctors can do better. Patients deserve better. I was one of those patients! My doctor did not change her 'prescription' for my health, but she didn't stand in the way of me making the changes either. The biggest change for me? Whole food, walking daily, and clean, non-toxic health supplements...starting with Magnesium, Vitamin D, Super Reds and Super Greens. I found a wholesale source for clean, premium quality supplements about 2 years ago. Since then I am down more than 70 lbs and my labs are all excellent! Are you ready to take control of your health? Start here https://lnkd.in/guNy8c2T

The Power of Physician Leadership in Independent Practice Associations Independent physicians are at a crossroads. As healthcare shifts toward value-based care, private practices face mounting pressure to coordinate care, control costs, and improve patient outcomes—all while navigating complex payer contracts. The question is: Who will lead this transformation? We are looking for a few good men and women to blaze the trails of care transformation! The Role of Physician Leaders Physician leadership is the driving force behind Independent Practice Associations (IPAs). These leaders don’t just practice medicine; they shape strategy, operations, and financial sustainability for independent physicians. Their impact is felt in: ? Strategic Direction – Aligning practices with value-based care models and smart payer negotiations. ? Clinical Integration – Implementing best practices for better outcomes and lower costs. ? Advocacy & Negotiation – Representing physicians in policy and payer discussions. ? Operational Efficiency – Streamlining administration and enhancing care coordination. Success Stories in Physician Leadership Physician-led IPAs are proving that strong leadership transforms healthcare. Here’s how three major networks are winning: ?? Advantage Care Physicians (ACP) – Team-Based Success ACP’s physician-led model achieved: ? 15% fewer hospital admissions through preventive care. ? 10% boost in patient satisfaction with improved coordination. ?? Monarch Healthcare – AI-Powered Value-Based Care With 2,500+ independent physicians, Monarch leveraged AI-driven initiatives to: ? Cut ER visits by 20% using predictive analytics. ? Improve chronic disease management, reducing readmissions. Heritage Provider Network – Population Health at Scale By leading one of the largest risk-based contracts in the U.S., Heritage’s physicians delivered: ? $1B+ in savings through proactive population health strategies. ? 15% fewer preventable hospitalizations with coordinated care. Why Physician Leadership Matters Physician-led IPAs aren’t just surviving—they’re thriving. Their leadership ensures: ?? Seamless Care Coordination – Integrating specialists, primary care, and hospitals. ?? Financial Strength – Negotiating stronger payer contracts and maximizing shared savings. ?? Technology & Innovation – Driving EHR adoption, AI analytics, and telehealth for efficiency. Physician leadership isn’t optional—it’s essential. ACP, Monarch, and Heritage prove that when doctors lead, patients win, costs drop, and practices thrive. As healthcare evolves, the next generation of physician leaders will define its future. Will you be one of them? We would love to have you join us as we support our IPA leadership in the transformation of health care delivery! ?? Let’s build a stronger, physician-led future together.

Overcoming Closed Provider Networks in Post-Acute Care The Problem? Payers and hospital systems lock post-acute care facilities out of referral pipelines. The result? Limited contracts, fewer patients, lost revenue, and care disruptions. Want to break through the barriers? Let's break it down: 1. Build Referral Relationships That Bypass Roadblocks Hospitals and physician groups control referrals—get in their circle. ? Partner with IPAs and independent PCPs. ? Align with hospital case managers for smoother discharge planning. ? Use outcomes data to prove your facility delivers better recovery rates. 2. Tap Into Value-Based Care to Unlock Contracts Payers want cost savings + quality outcomes. Give them both. ?? Join ACOs for access to broader networks. ?? Use data-sharing agreements to prove care coordination works. ?? Embrace alternative payment models (APMs) that reward efficiency. 3. Expand with Telehealth & Remote Monitoring Keep patients engaged after discharge—payers will take notice. ?? Virtual follow-ups reduce complications and readmissions. ?? AI-driven analytics flag high-risk patients early. 4. Fight for Policy Reform Closed networks limit patient choice—push for change. ?? Join industry groups advocating for inclusive policies. ?? Use data-driven case studies to show access gaps. ??? Engage lawmakers to support legislation expanding provider networks. 5. Diversify Payer Mix & Service Offerings Single-payer reliance = high risk. Expand options. ?? Contract with MA plans, Medicaid Managed Care, and private insurers. ?? Offer home-based care, outpatient therapy, or palliative services. ?? Introduce direct-pay options for out-of-network patients. Bottom Line: Adapt, Innovate, Win. Post-acute providers who strengthen referrals, leverage value-based care, embrace telehealth, fight for reform, and diversify revenue will thrive—despite closed networks. At Cypress Healthcare Consultants we specialize in supporting post-acute health care facilities. We'd love to work with you! #postacutecare #IRFs #rehabilitationhospitals #managedcare #facilitycontracting #managedcarestrategy