Dr. John Zelem, MD, FACS, is the principal owner and CEO of Streamline Solutions Consulting, Inc., a company that offers a wide range of services, including technology-enabled physician advisor services, clinical revenue consulting, and managing Medicare and Medicaid regulatory compliance. With a robust background that spans over 26 years as a Board-certified general surgeon and 15 years in healthcare executive leadership, Dr. Zelem brings a wealth of knowledge and experience to the table.
Throughout his medical career, Dr. Zelem honed not only his surgical skills but also developed expertise in teaching, corporate sales training, product development, and motivational speaking. His transition to healthcare executive leadership allowed him to further develop competencies in compliance, contracts, utilization review, case management, and physician education. As a former executive medical director, he played a key role in managing quality assessment and improvement, as well as developing and enhancing physician advisor programs that positively impacted revenue cycles while ensuring compliance.
Dr. Zelem's career is a testament to the concept of holism, where every aspect of his journey—whether positive or challenging—has contributed to the growth and advancement of his expertise. He continues to expand on this holistic approach by focusing on breaking down silos within organizations and integrating them through structure, communication, standardization, and accountability.
Streamline Solutions Consulting offers expert consultations and educational courses, including the recently launched "Navigating Organizational Silos" and "Prevention vs. Correction (PrevCORE): How to Make Tomorrow Better." These courses are designed to help organizations improve processes, enhance compliance, and foster holistic management practices. Explore our products section to learn more or contact Dr. Zelem directly for personalized solutions.
Services
Streamline Consulting Services, Inc. helps hospitals, physicians, utilization review and physician advisors by providing a holistic solution to successfully achieving a healthy and compliant process in your revenue cycle.
Read MoreStreamline Solutions Consulting, Inc. has the unparalleled ability to step back and objectively look at your organization; open your mind to different ways of doing and improving processes through gap analysis techniques while breaking down silos. Some of the following components define your processes and culture:
- Leadership
- Community
- Physicians
- Staff
- Documentation improvement
- Compliance and existing processes
Remember this: If you want to make some changes, you need to make some changes.
Let Streamline Solutions Consulting, Inc., utilizing a holistic approach, be part of your change, be your solution, through trust and collaboration.
What does taking a holistic approach mean?
Looking at the big picture
Every little change you make affects the whole.
Utilization Management 360®
Breaking Down Silos
Holism: The Silo Integrator
At Streamline Solutions Consulting, Inc., we believe that HOLISM is the key to breaking down and rebuilding the silos that often hinder organizational efficiency. Holism is the practice of integrating all parts of a system to enhance the functionality of the whole. It acts as the "silo integrator," ensuring that once silos are dismantled, they are rebuilt or managed in a way that promotes:
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Knowledge sharing,
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Cross-functionality,
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Interoperability,
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Cross-pollination,
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Standardization, and
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Accountability.
This approach is essential not just in healthcare but across all industries.
Our holistic methodology is exemplified in our Utilization Management 360 approach, which is designed to optimize and integrate various components of healthcare operations. We specialize in breaking down the silos that exist among key functions in Clinical Revenue Cycle which are:
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Utilization Review,
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Case Management,
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Clinical Documentation Integrity,
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Physician Advisors, and
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Coding and
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Compliance.
By leveraging clinical documentation as the common denominator or the glue that connects them all, we create a cohesive team-based approach where each part influences the whole, ensuring that every aspect of the organization works together seamlessly.
Streamline Solutions Consulting, Inc. operationalizes this holistic approach through extensive data reviews, interviews with key leadership and staff, and the application of best practices. This enables us to foster an integrated, collaborative environment that yields measurable and sustainable results.
The principles of holism are also at the heart of our course, "Navigating Organizational Silos," available to businesses across all industries. This course provides strategies to manage and integrate functions effectively, ensuring that your organization can achieve its full potential.
At Streamline Solutions Consulting, Inc., we provide the solutions you need to fill in the missing pieces of your organizational puzzle, delivering a complete and functional picture. Let us help you rebuild your silos for a more efficient, collaborative, and successful operation.
Physician Advisory Services
The use of Physician Advisors has been increasing exponentially over the past years. Streamline Solutions Consulting, Inc. understands the history, development, utilization of the Physician Advisor role for more than just chart reviews for Level of Care Determinations, and can:
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- Analyze your present program for compliance, standardization, and accountability
- Ensuring that existing and new program Physician Advisors integrate with UR/Case Management, your physicians, and your leadership
- Through gap analysis techniques evaluate for efficiencies
- Help “break down silos” that may exist linking Utilization Review, Case Management, and CDI in a holistic manner
- Improving physician documentation
- Help to develop and customize new programs for your individual needs unique to your culture and community
- Assist in hiring and training competent Physician Advisors for new programs through a unique onsite training presence and mentoring afterwards
Streamline Solutions Consulting, Inc. is well positioned to help you establish a high quality program through these qualifications:
- 14 years of overall Physician Advisor experience
- 5 plus years of designing and building onsite Physician Advisor programs
- Involved in the interviewing hiring of over 20 Physician Advisors
- Implemented and provided onsite training for 14 Physician Advisors
- Assisted with PA integration with
- Case Management, Utilization Review
- Facility physicians
- Executive level
- Assisted with PA integration with
- Managed and mentored a team of 14 Physician Advisors
Helped set up a program of measurable metrics to hold Physician Advisors accountable
Case Management Repair Services
Case Management repairs often include fixing readmission programs as well as trouble-shooting discharge planning issues. Too often, too many opinions within case management hinder real process improvement. We can fix that. Working in conjunction with case management experts, here are just a few of the problems we can fix at your facility or practice:
Read More- Determining where time is being wasted
- Evaluating team members’ performance. Are they operating at the top of their license?
- Is there enough support staff?
- Problems with care transition and the progression of care
- Difficulty understanding the components of value-based purchasing
- Help with risk-assessment
- Are services being provided that can be set up in alternative settings
- Readmission reduction programs
- Reduce mortality rates
- Discharge planning
Have a problem with your case management? Contact us.
Revenue Cycle Repair Services
Repairing any of the moving parts of your revenue cycle is our specialty. We will analyze your present program for cross-functionality, knowledge-sharing, and integrated responsibilities. We will tackle documentation that is common to all components to make sure the medical necessity is present and for justification and proof that medically necessary services were provided.
Read MoreIn particular, we can help you with your clinical revenue cycle (CRC). Here are just a few of the revenue cycle and clinical revenue cycle problems we can fix:
- Revenue cycle management (RCM) programs so that everyone becomes more aware where CRC resides in RCM and its significant effect on sustainable revenue
- Broken communication bridges with finance, compliance, business operations and technology
- Inconsistent reporting structure among UR, case management, CDI, the physician advisors and coders
- Bottlenecks and constraints that are preventing your clinical revenue cycle teams from having a smooth, efficient, collaborative process through team empowerment
Have a problem with your revenue cycle or your clinical revenue cycle? Contact us.
Testimonial
August 21, 2020
Re: Testimonial for Services of Streamline Solutions Consulting, Inc.
The Sentara Revenue Cycle engaged the services of Streamline Solutions Consulting, Inc., specifically Dr. John Zelem, for an independent review of the Utilization Review processes for Sentara Healthcare. I have been acquainted with Dr. Zelem since the beginning of our business relationship in 2011 with Optum in his prior role as Regional Vice President of Provider Relations and Education.
In this time, I have come to value his experience, professionalism, and wealth of knowledge in the development of best practice programs related to utilization review, physician documentation, and regulatory compliance. We have built a trusting and collaborative relationship over the years which made the selection of John for our project an obvious choice. Read More
The scope of the project included a very comprehensive review of our Utilization Review processes, the Physician Advisor program, the roles and working knowledge of other Sentara physician and non-physician leaders in the review process (Case Management, Clinical Documentation Improvement, Utilization Review, Chief Medical Officer, etc.), policies, opportunities, and outcomes.
The goal of the engagement was to make recommendations for an integrated, collaborative, unified team approach for a what came to be known as a “Utilization Management 360” approach enveloping all intra-operational entities involved decision support for documentation and billing compliance. This was a very comprehensive project that required extensive data reviews, interviews, and best practice research. At the conclusion of the project, John formulated very well thought out recommendations for our system delivered in a thorough executive report.
If you have further questions, I would be happy to assist you.
Sincerely,
Karen A. Pelham, MSN, RN
Director, Hospital Clinical Revenue Cycle
Sentara Healthcare
kapelham@sentara.com
757-965-0372
White Papers
- July 5, 2021 11:20 PM(0) johnzelem
The clinical revenue cycle (CRC) is seldom mentioned and under-reported. The more universally recognized concept, of course, is revenue cycle management (RCM). It is the umbrella of which CRC is an integral part and a crucial revenue driver, accounting for a large portion of the direct and indirect cost of providing care. CRC needs to be recognized for this importance, and also requires improvement from its present status with a more holistic approach.
- May 26, 2021 11:47 PM(0) johnzelem
When we hear the word hospital or healthcare our thoughts automatically go to patient care which is not unreasonable. Yet, one must remember that there is also a business side to healthcare. If it is not treated as a business there will not be enough revenue to fund it for survival. Learn more…
- March 30, 2021 10:57 PM
- March 6, 2021 3:38 PM(0) johnzelem
It seems that there is now a relatively new concept or program that has come into play in healthcare and it is called “Revenue Integrity” (RI). Is it another silo or is it a solution for clinical revenue cycle? According to an HFMA Survey of 125 hospital and health system CFOs and revenue executives, only 44 percent of respondents say their organizations have established revenue integrity programs.
- December 9, 2020 5:20 PM(0) johnzelem
Team empowerment is the essential ingredient to the success of any initiative, but it cannot be engaged without thoughtful processes. Teams are composed of individuals with unique skills, personalities, backgrounds, and drive. Utilizing the ingredients provide here will help provide the cement, the glue, the structure to maintain an holistic approach where the whole is greater than the sum of its parts
- September 23, 2020 10:04 PM
- September 23, 2020 9:29 PM(0) johnzelem
Hospital revenue is declining. What kind of changes does Revenue Cycle Management need to make? What is the solution? The real question to ask is how much pain needs to be endured for RCM to be motivated to change and not just use temporary patches. What will be the precipitating factor that will cause RCM to make some changes now before significant pain. The solution is “Utilization Management 360®”