Post on 20-Aug-2015
Achieving Revenue Cycle ExcellenceTo Prepare for Health Reform
Jim Morrison, VP and General ManagerRevenue Cycle Solutions, McKesson
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Agenda
Healthcare Reform: The Environment
Provider Impact
Enhancing Payer Relations
Reimbursement Management
Driving out Cost
Case Studies in High Performance
Summary and Q/A
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Healthcare Reform:The Environment
Healthcare reform legislation set things moving.
The next steps are less clear …
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Audience Survey
Which of the areas listed below is your organization most prepared to address?
A. Accountable care/shared savings strategy
B. Value-based purchasing
C. Readmissions and hospital-acquired conditions
D. Bundled payments
E. Strategy to address newly insured patient populations
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HFMA ANI 2011 Conference Survey
Bundled payments
Accountable care/shared savings strategy
Strategy to address newly insured patient populations
Value-based purchasing
Readmissions and hospital-acquired conditions
1%
6%
6%
12%
16%
Percent Indicating "Very Prepared" To Address
Sample size = 84
Please indicate your organization’s preparedness to address the areas listed below.
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Four Building Blocks of ACOs
► Leverage evidence based decisions in delivering programmatic care
► Support integrated/holistic approach to managing patients across the continuum of care
► Support integrated workflow in managing cost/quality
Care Management
► Manage multiple payment models at the POC including traditional FFS
► Leverage analytics to define/ support care bundles and prepare for bundled payments
► Tools to manage contracts and payment distribution logic
Payment Mechanics
► Actively engage patients in their care process► Provide patients with access to their pertinent
information► Enable care coordination and connectivity► Enable a range of personal health management
and health information tools
Connectivity, Engagement, Medical Home
PCMH ACO
► Stratify populations for management.► Identity opportunities to manage cost and
quality► Report and act up care gaps► Understand and optimize provider performance► Support internal/external reporting demands
Analytics
ACO Strategic Competencies
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Payment Mechanics
Connectivity, Engagement, Medical Home
Connectivity► Interoperability► Data Exchange► Care Coordination Communication► Messaging ► Notifications► Results► Referrals / Orders
Engagement► PHR► Multi Modal Comm.► Education► Online Programs► Decision Support► Marketing
Transformational Services
Financial Management► Eligibility► Medical Necessity► Auto-authorization
Payment Mechanics► Contract Repository► Medical Policy► Payment Policy► Distribution Logic
Analytics
Performance Analytics► Operational Efficiency► Service Line Analysis► Cost Trend Population Analytics► ID & Stratification► Care Gaps► Intervention Outreach
Network Analytics► Cost & Quality► PMPM Spend► Efficiency Profiles► Attribution Logic► Benchmarking► Incentive ModelingOutcomes Reporting► HEDIS. NQF, PQRI, IQR
Care Management
Holistic Management►UM / DM / CM►ID & Stratification►Medical Necessity►Decision Support►Readmission Mgmt.
EBM► Assessments► Care Plans► Care Guidelines► Education► Campaign Mgmt
PCMH ACO
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Bundled PaymentRequired Capabilities
Efficiency Profiles
Episode RegistrationEvidenced-Based
Guidelines
Distribution Logic
Care Management Tools
Analytics Engine
Clinical& ClaimsData
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Bundles PaymentsSuccess Requirements
Analytics
• Operational analytics to identify service line opportunities
• Network analytics to determine and track provider efficiency in support of bundled contracts
• Analytics to track associated claims activity
Advanced Tools
• Utilization management tools to reduce variation in resources supporting bundled payment
• Integrated analysis of operational & network performance against contracts
• Care management tools to ensure integrity of bundle
• Tools to register and trigger bundle
• Payment distribution logic
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Healthcare ReformWhat’s Next?
The world will include a mixed environment: Capitation/fee for service, risk sharing
The world will be a heterogeneous one: Medical homes, legacy systems and significant investments, clinics, labs, doctors’ offices, unique payer relationships, unique employer relationships, consumer driven healthcare, regulatory reform, analytics to drive down cost, population management, increased demands and shrinking reimbursement … all coming by 2014
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Healthcare ReformWhat’s Next?
Population Management
• Analytics supporting the ID and risk-adjusted stratification of a population of patients
• Integrated analysis of clinical and claims data
• Tools to intervene to address gaps in care
• Reporting tools to define and report on metrics
• Profiling tools to assess provider efficiency and optimize performance
Changes in Care Settings
• Hospitals expanding footprint to non-traditional settings
• Connectivity between all care settings – clinical & financial – is essential
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Agenda
Healthcare Reform: The Environment
Provider Impact
Enhancing Payer Relations
Reimbursement Management
Driving out Cost
Case Studies in High Performance
Summary and Q/A
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Provider ImpactThe Changing Landscape
Reduced Reimbursement
• Fee-for-service payments cut
• Commercial payers driving to Medicare levels
Payment Reform & Evolution
• Pay for performance
• Bundled payments
• Capitation• Shared savings
Quality Improvement
• Pay for performance
• Public reporting measures
• Meaningful use• Enterprise care
management
ICD-10 Transition
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Agenda
Healthcare Reform: The Environment
Provider Impact
Enhancing Payer Relations
Reimbursement Management
Driving out Cost
Case Studies in High Performance
Summary and Q/A
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Audience Survey
Are you talking with any of your payers about how the health reform changes will affect your relationship?
A. Yes, we’re meeting regularly
B. Yes, we’re in the early stages of discussion
C. No, but we have plans to meet
D. No, with no plans to meet
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Enhancing Payer Relations
• Holistic view of the patient• Match clinical & claims data• Reduce administrative costs with
automation• Regular educational updates from payers
Collaboration & Information
Sharing
• 5010 allows more information sharing between provider and payer
• Cleaner claims results in fewer denials • Collaborate with your payers on contract
reviews prior to ICD-10 transition
5010 & ICD-10 Transition
Advantages
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Agenda
Healthcare Reform: The Environment
Provider Impact
Enhancing Payer Relations
Reimbursement Management
Driving out Cost
Case Studies in High Performance
Summary and Q/A
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Reimbursement ManagementComplexities and Mechanics
Contracting and Understanding Cost
Analytics to understand performance
Provider-based Physicians
•Single source to track and manage patients
•Historical view of payments
Disparate information management systems
•Acute and Ambulatory billing integration
•Case Management/Length of stay control
•Medicare 72-hour window•Underpayment management
• Cost of care, quality of care, spend per-member per-patient
• Provider efficiency• Benchmarking & Incentive Modeling
• Reporting to regulatory bodies
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Agenda
Healthcare Reform: The Environment
Provider Impact
Enhancing Payer Relations
Reimbursement Management
Driving out Cost
Case Studies in High Performance
Summary and Q/A
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Driving Out CostsStrategies and Opportunities
Big focus on clinical IT comes from ARRA
Strengthen your revenue cycle processes by using your IT system to the full extent
─ Process flow improvements
─ Organizational changes and improvements
─ Technology plan to improve results
Optimize to drive to the best practice for each area
Reduce total cost of ownership for IT
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Audience Survey
What process do you use today to confirm patient identity?
A. Photo ID
B. Photo ID and insurance card
C. Biometrics
D. Other
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Driving Out Costs Patient Identification Management
Medical Identity Theft is one of the fastest growing crimes in the U.S.
An estimated 1.4 million adults, approximately 5.8% of the U.S population, were victims of medical identity theft in 2009.
Biometrics identity confirmation can ensure the right patient receives the right care
* According to the National Survey on Medical Identity Theft prepared by Ponemon Institute in 2010
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Agenda
Healthcare Reform: The Environment
Provider Impact
Enhancing Payer Relations
Reimbursement Management
Driving out Cost
Case Studies in High Performance
Summary and Q/A
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Audience Survey
What are your current net accounts receivable days?
.A 40 days
B. 41 – 45 days
C. 46 – 50 days
D. 51 – 55 days
.E 56 days
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Case Study Mississippi Baptist Health System
Staff education on IT and processes
HIS table updates to align with best practices
Process improvement for point of service collectionsKey Statistics and Accomplishments
Net Cash collection increase of $10,237,193
Denial write-offs decreased by 45%
Point of Service cash collections increased by 15%
A/R days decreased from 36 to 34 (well below HFMA target)
Failed claims decreased by 24%
Adjustments decreased by 1.37%
Staff HIS education test results improved from 59% to 87%
550 licensed beds. Project statistics run from November 2009 - December 2010.
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Audience Survey
What is your average time for patient registration to be completed?
.A 10 minutes
B. 11-15 minutes
.C 16 minutes
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Case Study Spartanburg Regional Medical Center
Streamlined insurance master tables
Established electronic remittance advice for each payer
Standardized graphical user interface for registration staff
Key Statistics and Accomplishments
Decreased A/R days by 8 days
Record breaking cash collections – more than $30M
Reduced unbilled accounts from $58 million to $30 million
Reduced failed claims by $6M
Increased admission speed 30% and improved admissions accuracy 50%
Three facilities included: Spartanburg Hospital: 568 licensed beds; Village Hospital: 48 licensed beds; Restorative Care: 84 licensed beds
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Agenda
Healthcare Reform: The Environment
Provider Impact
Enhancing Payer Relations
Reimbursement Management
Driving out Cost
Case Studies in High Performance
Summary and Q/A
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Connectivity & Engagement
► Interoperability with identity management
► Patient communication► Engagement Model
Analytics / Data Aggregation
► Performance evaluation► Population analysis► Network analysis► Outcomes reporting
Care Management
► Cross-continuum, patient centric care plan
► Quality and Evidence► Holistic disease management
Financial Management
► Eligibility► Payment mechanics► Disbursement Management
Financial Management
►Eligibility►Payment mechanics►Disbursement Management
Analytics / Data Aggregation
►Performance evaluation►Population analysis►Network analysis►Outcomes reporting
Care Management
►Cross-continuum, patient centric care plan
►Quality and Evidence►Holistic disease
management
What’s Next?Managing Populations and Risk Under Health Reform
Connectivity & Engagement
►Interoperability with identity management
►Patient communication►Engagement Model
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What’s Next?Managing Populations and Risk Under Health Reform
Connectivity & Engagement
► Interoperability with identity management
► Patient communication► Engagement Model
Analytics / Data Aggregation
► Performance evaluation► Population analysis► Network analysis► Outcomes reporting
Care Management
► Cross-continuum, patient centric care plan
► Quality and Evidence► Holistic disease management
Financial Management
► Eligibility► Payment mechanics► Disbursement Management
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Extra Resources
sites.mckesson.com/AchieveHIT/reform.asp
More Information on Revenue Cycle Management
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Questions