Smarter Levees, Safer Spend (Part 2 of 3) | Why Do Value Leaks Persist Across The Levees?
In part 1 of this series (link below) we share how health plans have cost control mechanisms in place but the controls of "levees" don't work in a synchronous manner, creating value leaks in MLR. In part 2, we expound upon why such value leaks persist. We show structural reasons such as siloes IT systems, lack of EMR data in care management, long term contracts with vendors and lack of analytics and AI training among care management teams that contribute to the leaks persisting. Stay tuned, as part 3 will address how to navigate these structural issues and begin to create better integration across all the "levees" or cost controls.
by Munzoor Shaikh and Scott Wilkerson
VOL. 2 NO. 7 | August 14, 2025
Smarter Levees, Safer Spend (Part 2 of 3) | Why Do Value Leaks Persist Across The Levees (pdf)
The New Physician Advisor (Part 2 of 2) | Enhanced Operating Model
In part 1 of this series (link below) we share how part-time physician advisers can’t keep pace with today’s bed and revenue pressures and thus require a foundational reset in their skillset. To build on that foundation, an enhanced OPERATING model shifts success from individual expertise to coordinated orchestration across teams. By aligning metrics, ownership, and daily flow decisions, hospitals can achieve higher throughput, stronger financial performance, and better patient outcomes without adding clinical FTEs.
by Tammy Gavin, RN, LFACHE, Munzoor Shaikh, MBA and Christopher Steel, MD
VOL. 2 NO. 6 | August 12, 2025
The New Physician Advisor (Part 2 of 2) | Enhanced Operating Model (pdf)
Smarter Levees, Safter Spend (Part 1 of 3) | How Does Value Leak from Health Plans?
With near $1 Trillion federal budget cuts to healthcare, health plans face an unprecedented level of cost pressure today. Traditional cost control mechanisms exist, but simply improving each "levee" to control the value leaks won't suffice. Rather, linking the levees together is the key. In this first part of a three part series, we explore how the value is leaking today, even prior to the federal budget cuts. Part 2 will explore why the leaks persist despite best intentions and part 3 will detail operating models to link the levees.
by Munzoor Shaikh and Scott Wilkerson
VOL. 2 NO. 5 | July 22, 2025
Smarter Levees, Safer Spend (Part 1 of 3) | How Value Leaks from Health Plans
The New Physician Advisor (Part 1 of 2) | Resetting the Foundation
Part-time physician advisers can’t keep pace with today’s bed and revenue pressures. What is required is a modern skillset including criteria mastery, data fluency and real-time peer support. A full-time adviser with a renewed foundation can cut length of stay and overturn denials, without additional investment of new capital. Read the first installment of our two-part series to see how a simple role reset can unlock millions for your hospital.
by Tammy Gavin, RN, LFACHE, Munzoor Shaikh, MBA and Christopher Steel, MD
VOL. 2 NO. 4 | July 8, 2025
The New Physician Advisor (Part 1 of 2) | Resetting the Foundation (pdf)
Purpose or Profit?
Almost every board and c-suite member of US hospitals today is challenged with trying to balance purpose with profit. In this article, we dive into the day to day realities that characterizes this dilemma and how the finance function can and should step up as a transformational agent. We share 2 pragmatic tools, a future-back planning tool and an initiative portfolio balancing tool.
by Kimberly Hodgkinson, MBA, FHFMA and Munzoor Shaikh, MBA
VOL. 2 NO. 3 | May 27, 2025
Seven Days, One Mission:
Hospital ancillary services are often staffed with reduced clinicians
on the weekend and off hours. This leads to a "monday morning havoc" -
the very desire to reduce provider burnout actually becomes worse. Read
our paper to learn how best to tackle this daunting yet possible
cultural change.
by Tammy Gavin, RN, LFACHE and Munzoor Shaikh, MBA
VOL. 2 NO. 2 | APRIL 15, 2025
Re-Membering the Member:
Federal budget cuts are coming. Current projections for such cuts
are at $880 Billion with Medicaid in the cross hairs. But such cuts could
actually help small and midsize plans stand out. We believe this can be so
by outsourcing most other functions but keeping member facing
functions internal, personalized and differentiated. Learn more by reading our
paper.
by Munzoor Shaikh and Scott Wilkerson
VOL. 2 NO. 1 | APRIL 1, 2025
The Case for Case Management:
With acute utilization remaining high in most markets,
throughput and LOS remain a challenge for health systems.
In the past, case management has often not been directly tied
to patient flow or value. But now, it can not only serve to improve
patient flow across the continuum, it can engage the patient better
and reduce provider burnout. Read more to find out.
by Munzoor Shaikh, MBA
VOL. 1 NO. 1 | AUGUST 1, 2024
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