November 4, 2013 Navigating Your Roadmapfirstillinoishfma.org/...Navigating-Your-Roadmap.pdf ·...

Results Delivered. Bottom Line.

November 4, 2013

Navigating Your Roadmap:Maximizing Margin in a Changing Environment

© 2013 MultiCare Consulting Services; Proprietary and Confidential 1

MultiCare Consulting ServicesFirst Illinois Fall Summit 2013

Objective & Agenda

Objective of Today’s Session

During this time of rapid change in the healthcare industry, developing along term strategic “roadmap” focusing on increasing patient satisfactionand maximizing reimbursement while keeping costs low has never beenmore important. The goal of today’s session is to provide the framework tocreate a sustainable roadmap to achieve defined performance metrics

Agenda

MultiCare Consulting Services (MCS) Introduction (5 min)


MultiCare Consulting Services (MCS) Introduction (5 min)

Program Overview (25 min)

o Industry Trends & Revenue Cycle Risk Points

o Defining the Revenue Cycle Roadmap

– Phase I – Developing the Strategy

– Phase II – Executing Defined Initiatives

– Phase III – Valuing Successes & Failures

Small Group Breakout (45 min)

o Developing your own Roadmap

Objective & Agenda

Learning Objective(s) for Session

Showcase the ability to understand the impact of the various environmentalpressures facing each and every provider (i.e. exchange rollout, higher deductibleplans, decreasing managed care reimbursement, etc)

Develop a strategy and describe a detailed plan to enhance Revenue Cycleperformance over the course of a defined timeline

o Increase Yield

o Revenue Protection

o Increase Cash


o Increase Cash

o Expense Reduction

Outline a plan to measure the effectiveness of each initiative


Program Overview – Navigating Your Roadmap


As of September 30, 26 states have opted not toexpand the Medicaid program

This will leave roughly 5 million poor orunderinsured adults in the ‘coverage gap’

To save costs on benefits, many employers have beenoffering ‘defined contribution plans’ rather than‘defined benefit plans’

Many consumers are purchasing high-deductible

Navigating Your RoadmapCurrent Healthcare Trends


Many consumers are purchasing high-deductiblehealth plans, leaving them with increasing out-of-pocket costs

The PPACA has accelerated ‘shared risk’ paymentmodels, CMS is now running ACO, PCMH, andbundled-care payment demonstration projects

Commercial insurers have also been shifting to thismodel, increasing the number of ACO-typeorganizations they run

Below are Revenue Cycle specific Risk Points as identified by MCS to keep inconsideration while charting your Roadmap

EMR Implementation – Planning for Success

o Comprehensive Testing (Charge, G/L, Claims, etc)

o Workflow Redesign (Policies & Procedures)

EMR Optimization – Realizing the ROI

o Fully Leveraging System (You Paid for It!)

o Reaching “Stable State” Metrics

o Training and Education (Learning Management System)

Navigating Your RoadmapMCS Revenue Cycle Risks Points


o Training and Education (Learning Management System)

Patient Access

o Point of Service Collections / Patient Liability Estimation - Transparency

o Financial Counseling – Helping Patient Navigate Options

o Minimum Data Set – Efficiently Capturing Information

Mid Revenue Cycle (HIM and Case Management)

o Coding – CAC, ICD-10, Driving Performance

o Medical Necessity (IP vs OBS) – Tightening Regulations

Below are Revenue Cycle specific Risk Points as identified by MCS to keep inconsideration while charting your Roadmap

Billing, Collections, & Follow Up

o Clean Claims – Eliminate Rework

o Specialty Account Management

Revenue Integrity – Capturing the Whole Pie

o Denial / Avoidable Write Off Management

o Payment Variance Resolution

o Strategic / Transparent / Defensible Pricing

Navigating Your RoadmapMCS Revenue Cycle Risks Points


o Strategic / Transparent / Defensible Pricing

o CDM Management

o Charge Capture / Reconciliation

Reporting/Communication – Key Performance Indicators | Productivity | Quality

o Providing Role Specific Data – It’s All Available!

o Breaking Down Barriers - Everyone Rowing in One Direction

o Workforce Optimization – Define Productivity

Navigating Your RoadmapOverview

1. Phase I – Developing the Strategy

I. Long Term (3-5 years)

II. Short Term (< 12 months)

2. Phase II – Executing Defined Initiatives

I. Resource Allocation

II. Workplan Development

III. System Configuration

IV. Risk Mitigation

GoalSetting

Execution


IV. Risk Mitigation

3. Phase III – Valuing Successes & Failures

I. Define operational performance benchmarks

II. Determine ROI estimates and methodology

III. Set timing intervals to evaluate initiative success

Valuation

Long Term Goals (3-5 Year Plan)

Identify the strategic vision of the organization and developincremental plan(s) for meeting the defined mission

Key Players: CFO & VP Revenue Cycle

Short Term Goals (less than 12 months)

Immediate action steps towards meeting defined long termgoals; Directly related to long term vision

Key Players: CFO, VP Revenue Cycle, Departmental Managers

Navigating Your RoadmapPhase I – Goal Setting


MCS Recommendation

In many cases, it can be beneficial to have an outside reviewof your operations to validate internal assumptions

Executing Defined Initiatives

Determine Resource Allocation

o Outline of Investment Required to Achieve Goals

Create Initiative Workplan

o Guide of Actions Steps with Clear Accountability

System Configuration

o Systems Updates Needed to Meet Evolution

Risk Mitigation

o Identification and Scoring of Risk Factors

Navigating Your RoadmapPhase II – Execution


o Identification and Scoring of Risk Factors

MCS Recommendation

Realistically estimate resource needs; underfunded projects are a waste ofcapital

Interdepartmental alignment (Clinicians, IT, Finance, Revenue Cycle) is crucial

Clearly communicate and address risks early and often

Executing Defined Initiatives

Set Initiative Evaluation Criteria

o Define Operational Performance Benchmarks

– 3 to 5 Data Elements Tracking Performance

o Establish ROI Estimates and Methodology

– How and When ROI will be Evaluated

MCS Recommendation

Keep focus on clear set of core operational metrics (3-5 per initiative)

Navigating Your RoadmapPhase III – Valuation


Keep focus on clear set of core operational metrics (3-5 per initiative)

Track and Trend metrics at defined intervals (weekly / monthly / quarterly)

Perform Cost / Benefit analysis in relation to initiate investment

Utilize industry benchmarks to relationally track success

Implement defined vendor management criteria (if applicable)


Small Group Breakout


Please split into small, diverse groups

The goal of the exercise is to collaboratively examine your current state in regards toinitiative planning, execution success, and performance valuation

Please take 30 minutes to focus on:

1. Goal Setting: Identification of Highest Priority initiatives

o Agree on 1-3 initiatives per group

2. Execution: Resources, Technology, Structure Needed to Achieve

o What are the key factors needed to be successful?

Navigating Your RoadmapSmall Group Breakout


3. Valuation: Develop Key Performance Indicators

o How will you determine success (3-5 metrics)?

To close, groups will take 15 minutes to discuss key takeaways

Example Areas of Focus – MCS Risk Points

System Adoption | PAS | Mid Rev Cycle | Billing & Collections | Revenue Integrity |Reporting & Communication

Below are some example questions to discuss as a group:

Phase I - Goal Setting

o What criteria did you use to prioritize your goals?

o How do you ensure you budget appropriately to meet your goals?

o How do you turn your goal into a strategy?

Phase II - Execution

Navigating Your RoadmapSmall Group Breakout


o How do you define the tactics to implement your strategy

o What are the most common operational barriers that you have faced?

o Have you invested appropriately?

Phase III - Valuation

o How have you historically tracked project success and how was this communicated?

o Have do you monitor risk points?

o Have you been able to track ROI to your bottom line?

Thank you!



Tim KinneyManaging Director630 - 267 - 3738 (c)


Kent RitterAssessment Director317 - 366 - 2722 (c)

MultiCare Consulting Services, LLC1102 Broadway, Suite 510

Tacoma, WA 98402

MultiCare Consulting Services, LLC430 West Erie, Suite 200

Chicago, IL 60654

http://www.multicareconsulting.com

Brad BennettAssessment Manager708 - 297 - 1612 (c)

Executive Biography

Mr. Kinney is a Consulting Services Managing Director for MultiCare Consulting Services.He is responsible for overall project management and internal practice development. Tim hassignificant experience leading engagements focused on cash acceleration, denial management,vendor management, physician documentation improvement, electronic medical record preand post live risk mitigation, and system implementation.

Background & AffiliationsMr. Kinney earned his Bachelor of Business Administration from the University of Wisconsin,Madison. Mr. Kinney is a member of both the HFMA’s First Illinois Chapter and theAmerican College of Healthcare Executives (ACHE). Prior to MultiCare, Tim worked at bothStockamp & Associates and Huron Healthcare, which acquired Wellspring Partners in 2007

Tim KinneyMCS Consulting Services Managing Director


Stockamp & Associates and Huron Healthcare, which acquired Wellspring Partners in 2007and Stockamp & Associates in 2008.

Professional ExperienceMr. Kinney has worked with multiple academic medical centers, health systems, andcommunity hospitals over the course of his career. He has successfully managed numerousnet revenue improvement projects with scopes that include; patient throughput analysis,patient status improvements, enhanced billing functions, and enhanced reimbursementstrategies. The results of Tim’s engagements have yielded his clients significant net revenueimprovement. Tim has managed various large scale process redesign engagements thatencompass all revenue cycle functions. Additionally, Tim has served as an interim revenuecycle leader for a multi-hospital health system based in California.

Contact InformationPhone: 630-267-3738Email: [email protected]

Executive Biography

Mr. Ritter is an Assessment Director with MultiCare Consulting Services. Kent isresponsible for oversight, strategy, and quality control related to all MCS client opportunityassessments. Kent’s unique mix of operational and technical expertise allows him tothoroughly understand each clients unique situation and key pain points in order to develop aspecialized plan based on the opportunities available through technological and operationaloptimization.

Background & AffiliationsMr. Ritter earned his Bachelor of Science in Business with a concentration in Finance atIndiana University’s Kelley School of Business. He is certified in Epic’s Resolute Hospital

Kent RitterMCS Assessment Director


Indiana University’s Kelley School of Business. He is certified in Epic’s Resolute HospitalBilling application and is trained in several other Epic revenue cycle applications including:ADT/Prelude and Resolute Professional Billing. Kent is a member of the First Illinois HFMAchapter in Chicago. Prior to joining MultiCare Consulting Services, Kent was a consultantwith Huron Healthcare, which acquired Wellspring Partners in 2007 and Stockamp &Associates in 2008.

Professional ExperienceMr. Ritter has worked with numerous large health systems, academic medical centers, andcommunity hospitals, utilizing many major health information systems in his revenue cycleconsulting career. Kent has led projects focused on net revenue improvement, cost reduction,HIS implementation, post-live system optimization, and operational and financial processimprovement throughout the entire revenue cycle.


Brad BennettMCS Assessment Manager

Mr. Bennett is an Assessment Manager with MultiCare Consulting Services. He isresponsible for project delivery and internal methodology/tool development. Mr. Bennett hasexperience in system implementation, clinical operations, labor optimization, and healthcarevaluation initiatives. Mr. Bennett specializes in net revenue methodology improvement andbusiness process transformation solutions in all areas of the revenue cycle.

Background & AffiliationsMr. Bennett earned his Bachelors degree in Economics from the University of Illinois atUrbana-Champaign. Currently, he is working to obtain his MBA from the Booth School ofBusiness at The University of Chicago. Mr. Bennett has certifications in Epic Systems’

Executive Biography


Hospital Billing module as well as the HFMA’s Certified Revenue Cycle Representativeprogram. Mr. Bennett is a member of the First Illinois HFMA chapter. Prior to his work atMultiCare, Mr. Bennett worked as a consultant for Wellspring Partners, which was acquiredby Huron Healthcare in 2007.

Professional ExperienceMr. Bennett has experience working with healthcare organizations ranging from communityhospitals to large multi-facility healthcare systems. Mr. Bennett has successfully implementednet revenue improvement initiatives and revenue cycle process improvements ranging fromself pay strategy, vendor management, denials management, strategic pricing, charge capture,patient status classification, electronic medical record pre and post live risk mitigation, andsystem implementation.


MultiCare Health SystemLeading Health Organization with National Recognition

MultiCare is a leading-edge, integrated health organization made up of fivehospitals including Allenmore Hospital, Auburn Medical Center, Good


hospitals including Allenmore Hospital, Auburn Medical Center, GoodSamaritan Hospital, Mary Bridge Children’s Hospital and Tacoma GeneralHospital, numerous primary care and urgent care clinics, multi-specialty

centers, Hospice and Home Health service, and many other services

HFMA Map Award for HighPerformance in Revenue Cycle (2012)

8th on SDI top 100 list (2011)Winner of Hospitals and Health

Network’s Most Wired Award (2012)HIMSS Davies Enterprise

Achievement Award (2009)

MultiCareConsulting

Services (MCS)was born from an

idea in 2008

Leveraged clientsuccess to continue

to offer refinedproducts andservices to a

growing customerbase

Expanded servicesin 2010

Expanded Servicesin 2011

Grown to a teamof over 55

professionals in2013

MultiCare Consulting ServicesMCS Overview


base

Initially offering Epic RiskMitigation services based onthe success at MHS

Expanded to offer RevenueCycle Net RevenueImprovement offerings

Initially offering Epic RiskMitigation services based onthe success at MHS

Expanded to offer RevenueCycle Net RevenueImprovement offerings

Each engagement continuesto produce better outcomesand improved metrics

MCS Tools have progressedto be a key differentiation inthe market

Each engagement continuesto produce better outcomesand improved metrics

MCS Tools have progressedto be a key differentiation inthe market

Interim Management Services;Revenue Cycle Leadership

Post live Epic ProcessOptimization support

Consolidation and Integrationservices associated with mergersand affiliations

Opened office in Chicago, IL

Interim Management Services;Revenue Cycle Leadership

Post live Epic ProcessOptimization support

Consolidation and Integrationservices associated with mergersand affiliations

Opened office in Chicago, IL

Executive Level InterimManagement services; C-Suite

Full Financial Sustainabilityservices; Labor & Non-Labor

Educational Offerings viaeLearn & eCompetency formatwith a focus on Epic pre-live,go-live and post-live refreshereducation delivery

Executive Level InterimManagement services; C-Suite

Full Financial Sustainabilityservices; Labor & Non-Labor

Educational Offerings viaeLearn & eCompetency formatwith a focus on Epic pre-live,go-live and post-live refreshereducation delivery

Expanding into Epic Clinicalservice optimization

Service offerings includeimplementation support aroundNet Revenue Optimization,Process Improvement, EMRRisk Mitigation, EMROptimization, Training andEducation, and Mergers andIntegration

Expanding into Epic Clinicalservice optimization

Service offerings includeimplementation support aroundNet Revenue Optimization,Process Improvement, EMRRisk Mitigation, EMROptimization, Training andEducation, and Mergers andIntegration

“Results Delivered. Bottom Line”

November 4, 2013 Navigating Your Roadmapfirstillinoishfma.org/...Navigating-Your-Roadmap.pdf ·...

Documents

Transcript of November 4, 2013 Navigating Your Roadmapfirstillinoishfma.org/...Navigating-Your-Roadmap.pdf ·...