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About Children’s Hospital Colorado

Private, not-for-profit pediatric healthcare network Obtained Magnet status in 2006 In addition to one main campus facility

2 hospital locations within community hospitals 2 urgent care sites 1 urgent care site within another hospital 1 free standing surgery center 9 satellite specialty care centers

Level I trauma center Maternal fetal medicine program opened in March 2011 Ranked among top 10 children’s hospitals for over a decade Statistics

318 licensed beds 517,873 outpatient clinic visits (2011)

Celebrating over 100 years of commitment to pediatric care!3

What is RAVE?

R- ReferralA- AuthorizationV-VerificationE-Eligibility

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Structure of Patient Access

• Prior to RAVE go-live Patient access included:

• Admissions (Main and ED)• Financial Counseling• IV staff (6 FTE)

Inpatient, Ambulatory Surgery, and Observation patient populations

• Both scheduled and non-scheduled cases

• Function as a safety net • Accounts worked via Ontrac tool

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Elements in Space

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Org Chart Pre RAVE

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Scattered Across the Universe

• Where did everyone live??? Outpatient clinics

• Each reported to outpatient floor specific manager• Team included scheduling, check-in/out, IV staff• Worked floor specific accounts

Administrative Pavilion• In charge of obtaining authorizations for range of

procedures Radiology procedure authorizations Radiology required authorization prior to scheduling

• Surgical initiation • Cardiac DME • Infusions

Network of Care locations 8

Planet Deficiencies

• Processes were sub-par workflows

• No dedicated back-up for these staff members

• No dedicated management structure for IV staff

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As the Planets Start to Align…

• Concept born 4 years prior VP of Ambulatory Services VP of Finance PFS PAS Managed Care

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Project Goal Statement• Goal Statement

The goal of centralization is to reduce the overall number of patient eligibility, no

referral/authorization, non-covered services, late/no notification, wrong insurance billed and medically

necessary denials The Children’s Hospital receives, and better align resources, training, education, and information to a single point of accountability within

the organization.

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Project Objectives• Increase secured at admit rate across the organization to

exceed 95% by the time the patient arrives for their scheduled appointment or admission. Currently, this rate is at 90% (per 4-week average as reported on week ending 8/27/10 IV Summary)

• Maintain staff productivity to consistently work 45 accounts per day per rep. Currently, this rate is at 50 across the organization (per weekly productivity rate week ending 8/27/10).  

• Increase ‘days out’ in authorization rate (per 4-week average as reported on week ending 8/27/10 IV Summary):

• Goal: 0-3 days = 99% 4 days = 95%5 days = 90%.  

• Reduce overall denied dollars and final write offs by 50%. 12

The Jurassic Age….

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Early Phases

• On-boarding outpatient clinics to Ontrac (2008-2010) Rolled out in phases

• Over 2 years • Main campus and network locations

• On-going meetings with management (2008-2010) To discuss centralization of IV

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Early Phases continued

• HR Meetings (Oct 2010) Employee transfer Job descriptions Reporting Structure Career Ladder

• Promotion Ladder Insurance Verification.doc Work from home model

• Ongoing Management Meetings (Oct 2010)

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Early Phases continued

• Blending the “Families” Monthly PSC meetings (Oct 2010)

• HR Involvement Communication Tool for staff

• SBI (Situation, Behavior and Impact) Training Team life cycle (Forming, Storming, Norming,

Performing)• Team building• Learning process flows• Naming department• Committee creation• Management Structure• IT Resources

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Neanderthal Stage

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“How centralize IV, Gorg want know”

RAVE go-live structure

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Our New Home…

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Gorg like!Me too!

RAVE Begins

• Go live 4/6/11 (27 employees) (Phase 1) Gained Efficiencies

• Merging worklist• Cross training

High Volume High Dollar Radiology Auth

• Scheduling prior to authorization allowed• Back-filling for absences• Installed robust QR process• “Working Smarter not Harder”

Electronic Eligibility Verification Restructure Creation of iRAVE (NOT TO BE CONFUSED WITH RAVE!!)

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iRAVE (NOT TO BE CONFUSED WITH RAVE!!!)

• What is iRAVE? Online resource

• Insurance reference• Available to all staff• Documents payer specific requirements

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iRAVE continued

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iRAVE continued

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• What is iRAVE not to be confused with?

A prize winning pony

A planet

Gorg

RAVE

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The Next Planned Phases

• Phase 2 – July 2011 (OT/PT, 3 FTE’s)

• Phase 3 – August 2011 (Psych/CDU, ST, 4 FTE’s)

Why did we stagger these?

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Growth• Expanding RAVE scope

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Date Clinic Monthly VolumesAdditional FTE to RAVE

Jun-11 MFM- Clinic & Auth Pool 40 No

Jul-11Pain Clinic- Clinic & Auth

Pool 460 No

Sep-11SIE Downs- Clinic & Auth

Pool 70 No

Oct-11 Neurology Auth Pool Unsure at this timeYes- moved 1FTE from

Neuro Dept

Dec-11Plastics, Urology, ENT, Ped

Surg-Auth Pool 675 No

Dec-11 North Campus-Auth Pool Unsure at this timeYes – Moved 0.8 FTE

to RAVE

TBDSouth Campus and CO

Springs 2600 Yes – 1 to be hired

Maintaining Communication• Employees bringing issues they otherwise would not

have Now employees have a ‘voice’

• Monthly meetings with clinic management• Close working relationship with Patient Financial

Services Work to decrease denials

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Current state (36 FTE)• Restructure of Radiology authorization workflow

Upgrade of Epic EMR for how workflow viewed• Allows for better reporting

• Continued work to document process flows Team and workflow specific

• Anticipating efficiencies• Network of Care site addition to centralization• Medicaid PAR’s for Radiology services• Promotion of two employees to Rep III status

Multiple duties• Modular training

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Current state RAVE structure

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The Jetson’s Era

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Future State

• Move from safety net to initiation For Inpatient, Amb Surg & Obs cases

• Benchmark our existing pilot person from Orthopedics

• Standardizing Psych processes• Adding more clinics

Create a RAVE services ‘Application process’ • Service level agreement

• Creation of Registration Accuracy Task Force

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Carbon Dating

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So How Did We Do?

Secure at AdmitPre RAVE= 90%GOAL= 95%Actual 2011 EOY= 94%

Staff ProductivityPre RAVE =50 accts per dayGoal= Maintain 45 acct per dayActual 2011 EOY= 68 accts per day

Write-offs for No AuthorizationGoal= Decrease by 50%Actual 2011 EOY= Increase by 235%

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So How Did We Do? Continued…

Increase “Days Out”Pre RAVE=

0-3 days = 81%4 days = 60%

5 days = 41%. Goal=

0-3 days = 99% 4 days = 95%5 days = 90%

Actual 2011 EOY=0-3 days = 94% 4 days = 75%5 days = 60%

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More Data……

• Quality Reviews• Diligent monthly QR Process

Increased Team Average from 2.68 to 2.9 (out of 3)

• Dashboard – SAVE RECENT COPY

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Lessons Learned• Employee Satisfaction

Dynamics of a large department• What exactly are we taking on?

Responsibilities transferred with employees• Some tasks are out of scope of Insurance Verification Rep level

Roles and Responsibilities – Saw a need once RAVE went live.• Cleaner registrations• Clearly defined roles

• Work From Home Re-evaluate current structure to help maintain relationships

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Contact Information

Tobi Knight – 720-777-5688

Tobi.Knight@ChildrensColorado.orgBerj Ermoyan – 720-777-

5690Berj.Ermoyan@ChildrensColorado.org

Questions?

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