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Why Payers Care About Accreditation and How to Strategically Incorporate Accreditation Readiness into Your Day-to-Day Care Coordination Operations

Hospital specialty service lines have many accreditations available to them - Joint Commission Disease Specific Certification, ACoS Commission on Cancer, Blue Distinction Center designation, NCQA Disease Management, etc - how do you know which ones are right for you? How do you calculate the ROI for them? How will they affect your reimbursement? Felicia's presentation will discuss how to start accreditation planning for your service line (spine, oncology, bariatrics, etc) and how to incorporate accreditation readiness into your day-to-day care coordination activities. Planning includes deciding why you need accreditations that payers target (commercial and CMS). Then, gathering the outcomes that the accreditations require (e.g. CoC standards, surgery outcomes for spine, long-term outcomes for bariatrics, etc); and finally, planning for how to shepherd those outcomes to fruition through strategic operations and specialty care coordination.

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Felicia Nicholson

The Claro Group

Felicia Nicholson is a registered nurse with over 25 years’ experience within healthcare. She has dedicated most of those years building effective care management teams and designing care management programs. She possesses a broad and comprehensive knowledge across the health care industry, having partnered with providers, hospitals, payers, employers, and health systems. Currently, she is a senior manager with The Claro Group, one of the associates of the performance improvement team.

Prior to joining The Claro Group, she was an independent healthcare consultant after a period of time with FTI Consulting. In which, she was a Director within their HealthCare Solutions segment. She worked with health systems towards clinical integration, redesigned care management operations and customization processes and workflows to maximize positive results and outcomes. She has held several leadership roles with providers and payer organizations, including Director of Clinical Operations for Optum Health, a business segment at United Health Care, she turned around the clinical team performance to become one of the top performing teams across the business segment; and Director of Care Management at Blue Cross and Blue Shield of IL/Health Care Service Corporation, she partnered with national employers to design and implement custom care programs improving clinical outcomes resulting in cost savings. She is adept in improving care coordination across multiple platforms. She was Manager of Network Development and External Relations at Blue Cross and Blue Shield Association (BCBSA) where she managed project teams that launched Blue Distinction Centers and partnered with physician organizations across the country.

She holds B.S.N and M.B.A. from Olivet Nazarene University. She is a member of American Society for Quality and volunteer District Leader with the Humane Society of the United States.