Healthcare

Our Audience

Who We Serve

The Healthcare Delivery Systems iLab and our for profit division, Healthcare Innovation Solutions, work with many of the healthcare industry’s major stakeholders.

Through our non-profit iLab we provide technology and consulting services funded by state and federal agencies that enable innovation, transformation, continuous quality improvement and interoperability. Through our for-profit subsidiary, HCIS, we make some of these same solutions available commercially.

Many of our clients practice in New Jersey or have vested interest in the local healthcare community, but we also work with practices and companies doing business outside the state, as well as federal agencies and organizations.

Read on to see how we work with the various members of the healthcare industry.

+Accountable Care Organizations (ACOs)

Medicare has encouraged ACOs networks of doctors and hospitals that try to limit unnecessary spending by sharing financial and medical responsibility for providing coordinated care to patients ever since the Affordable Health Care Act was enacted in 2010. There are hundreds across the United States, both within the Medicare Program and organized by private payers.

NJII works with many of the ACOs from New Jersey and beyond, providing them access to our statewide health information exchange, the NJHIN, and helping them report on their performance against specific quality measures required of them.

If you are an ACO, any one of these programs or solutions may interest you: 

+Behavioral Health and Substance Use Disorder Organizations

Behavioral Health Organizations focus on improving the mental well-being of their patients. For those suffering from a Substance Use Disorder (SUD), the treatment services in New Jersey range from detoxification services and outpatient care, to short- and long-term residential treatment. Many behavioral health organizations accept Medicare and Medicaid and are thus eligible for specific programs designed to provide them incentives for improving their interoperability. If they reach certain thresholds of services provided, they are also required to report on their quality measures and ability to move to a value-based program model as opposed to being paid fees for services delivered.

If you are from a behavioral health organization or SUD provider, you may be interested in the following programs:

+Clinically Integrated Networks (CINS)

There are more than 500 CINS across the United States. These groups are primarily legal entities that enable physicians to work together under the same umbrella and negotiate shared contracts with various payers and vendors. The goal is to increase their operating efficiency while improving quality of care by sharing best practices and facilitating interoperability among their offices.

NJII often works with CINS to help them meet their target objectives, specifically in terms of quality metrics, reporting required of them for Medicare and Medicaid reimbursement, and connection to the NJHIN.

If you are from a CIN you may be interested in learning more about the following:

+Clinicians

Individual clinicians work with NJII in several ways, all of them focused on meeting government requirements, addressing advantage of alternative payment models, transforming the way they operate, or improving their interoperability. 

If you are a clinician, current programs that may interest you include the following:

+ Electronic Health Record (EHR) and Electronic Medical Record (EMR) Providers

At NJII we have a strong knowledge of EHR and EMR systems. Why? Because we work with our providers to help them with the data abstraction and reporting required of them by their payers, both public and private.

Our experts understand how to get the data needed to report on MIPS and DSRIP and many other incentive payment programs focused on reducing costs while improving quality. 

In addition, although we are vendor agnostic and will never recommend one software provider over another, we are also tasked with helping providers understand the benefits of adopting or upgrading their EHR.

If you are an EHR or EMR provider and want to understand more about the program and solutions offered by NJII, please contact us. 

+Federally Qualified Health Centers (FQHC)

FQHCs are organizations that have qualified for additional funding under Section 330 of the Public Health Service Act (PHS). They qualify for enhanced reimbursement from Medicare and Medicaid, and typically receive other benefits as well. They are designed to benefit underserved areas and populations, offering a sliding fee scale, providing comprehensive services (either on-site or by working with another provider) and offer transportation services necessary for patient care. They are also required to implement an ongoing quality assurance program.

We work with FQHCs to help them report on their quality measures and take advantage of additional programs for which they are eligible, specifically around support and incentives for improving their interoperability. 

If you are with an FQHC you may be interested in the following:

+Health Information Networks (HINs)

As of 2020, there are six regional health information networks in New Jersey.  NJII works closely with these organizations to ensure that their members have access to the statewide health information exchange, the NJHIN. In addition, NJII may also work with a regional health information network to make sure its members can extract the information they need to successfully report MIPS, DSRIP, or to meet other payer requirements. 

If you are with a health information network and have questions about how you can work with NJII, please contact Shelby Klein, Senior Director, Program Development at shelby.klein@njii.com.

+Hospitals

There are more than 70 hospitals in New Jersey and NJII works with all of them. As with ambulatory health care service providers and nursing and residential care facilities, NJII helps hospitals with their innovation, quality improvement, transformation and interoperability programs.

Interoperability: As of 2020, all 71 hospitals in the state are sending data about patient admissions, discharges and transfers to the NJHIN.  For each patient, they provide the basic demographic data for that patient and a diagnosis code.

Quality Improvement: NJII also works with many hospitals in the state by providing the tools and support they need to successfully report against the Delivery System Reform Incentive Payment (DSRIP) Program

The goal of this program, as approved by the Centers for Medicare and Medicaid Services (CMS), is to encourage better health for the overall population and lower costs. 

DSRIP represents a new funding model for hospitals, where payment is based solely on reaching or surpassing set health-improvement target goals.

Transformation/Cost Savings: HCIS, NJII’s for-profit subsidiary, offers a solution called Realytics, which is a systematic approach to helping hospitals return millions of dollars to their bottom line. The team provides methodologies, processes, systems, training and data that helps uncover opportunities for savings by focusing on a Cost Per Unit of Service. Learn more

Innovation: Over the past few years, NJII has worked with several leading hospitals to help them implement Innovation programs that allow them to successfully gather and qualify innovative ideas, move them from concept to prototype, conduct the research necessary to understand market potential and create a solid business plan, and then ultimately commercialize the solution for adoption or diffusion to market. 

If you are a hospital, any one of these programs or solutions may interest you: 

+Integrated Delivery Networks (IDNs)

An IDN is formed when a group of physicians work with their local hospital(s) to create a healthcare ecosystem and brand that patients can use to receive any type of care they need from emergent or acute care, to physical therapy, to preventative services, and everything in between.  

Often, an IDN will also work with a payer or directly with employers to form their own value-based program, and many of those programs will be risk-bearing. This mean the IDN and the providers within it share the risk of achieving the financial targets of the plan, while also meeting the requirements in terms of quality and patient outcomes. 

NJII works with IDNs in several ways. We help them improve their interoperability and access to statewide health information by connecting to the NJHIN. We also help them meet their reporting requirements for public payers like Medicare and Medicaid. Lastly, we can help them create and support their own value-based programs and undergo the transformation required to prepare for those programs. 

An IDN is set of physicians working with hospitals to form a healthcare ecosystem where a person can receive any type of care it needs from one single ‘brand’ of healthcare provider. Ultimately, the goal is holistic care; as a patient, you can receive preventable care, physical therapy, and everything in between. Through electronic health records (EHRs,) patient information can be stored, tracked and shared within the network providing comprehensive view of a patient’s health.

If you are with an IDN chances are you will be interested in some or all of the following:

+Long-Term and Post-Acute Care Facilities (LTPAC)

The need for long-term and post-acute care (LTPAC) services has been growing in our state and country because of aging populations. These facilities also serve younger persons with disabilities. Services are provided in specialty hospitals and nursing homes, as well as residential and community settings. 

Transitions between acute, post-acute, and long-term care settings are a key driver of cost and improved communication and care coordination during these transitions has been proven to reduce costs and hospital readmissions. Better care coordination also leads to shorter lengths of stay, decreased costs and improved health outcomes. NJII supports several programs that improve care coordination and patient outcomes in LTPACs. 

If you are with an LTPAC the following programs may be of interest to you:

+Patients

Patients are the target beneficiaries of all our work, and improving patient outcomes and experience is what drives us. There are even a few instances where we work directly with patients. 

In our HCIS division, we have built an app called MiQlave which empowers patients to retain and control their own medical records. MiQlave has been made available to a limited population of users on both Android and Apple devices. To learn more contact us at hello@healthcareinnovationsolutions.com.

+Payers

NJII works with both private payers (insurance companies) and public payers (state and federal government). The primary way we work with payers is by helping them establish value-based programs. We then work with our network of providers, clinicians, practices, hospitals, ACOs, etc. to help them understand the requirements of the value-based programs or alternative payment models (APMs) and abstract and prepare their data for reporting.

If you are a payer interested in working with NJII to create a value-based program or APM, or if you would like NJII to work with providers on your behalf, please contact us.

+Practices

Our client roster includes thousands of medical practices. Some are small, with one or two providers, others are very large with dozens of providers. In smaller practices, we often work with the clinicians themselves. In larger practices, our main point of contact is often an administrator, office managers or even an EHR manager.

Healthcare practices also work with us to meet government requirements, transform the way they operate, move to value-based care and alternative payment models, and improve their interoperability. 

If you are with a practice either primary care or a specialty you may be interested in the following: 

+State & Federal Government

Since 2014, we have received almost $64 million from the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services’ (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), plus $60 million in funding via grants from the New Jersey Department of Human Services (DHS) and the New Jersey Department of Health (DOH)

Our track record meeting and exceeding the requirements and milestones set out in grants related to healthcare transformation, quality improvement, innovation and interoperability make us a compelling partner for driving change in the Garden State. If you have a program or initiative you want to initiate to help revolutionize healthcare in New Jersey, NJII would make an excellent partner — one with with hands-on-experience, a strong network of physicians and partners, proven ability to build technology solutions, and deep expertise in data analytics and reporting. 

For more information on how we work with our partners, please contact Shelby Klein, Senior Director, Program Development at shelby.klein@njii.com

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