0

David White Ryan O’Hara Tiffany Ferguson Chris Lininger

Chief Nursing Executive Director Director of Community Manager ofInformatics Officer Revenue Cycle Care Management Business Intelligence

November 16, 2016

Optimizing population healthand revenue management

2

Objectives

• Learn about Northern Arizona's approach to managing the health of their community

• Understand how Northern Arizona is optimizing and standardizing revenue cycle processes for performance improvement

• Understand how Northern Arizona leverages their Cerner partnership for current project execution and future planning

3

2012

2002

2009

2016Our Cerner automation history

Live

with

Cerner 2011

CPOE

Live with

EMAR

Cerner EMR

standardization

and

optimization

RHO and

AMS

4

FMC and VVMC…Who we are, who we serve

50,000

square

miles!

700,000

lives!

5

NAH…circa 2015

Workflow

MngmtScanning

QA

Co-Pay &

Deductible

Patient

PaymentArrange

Coding &

Charge Capture

HIM

Chart

Abstracting

Chart

Deficiency

Grouper

Coder

Pt. Acct

Workflow

Scrubbing

Contract

Mngmt

Family

Billing

RVU’s

Remittance

Posting

Denial

Mngmt

Statements

Collections

Reporting Letters

EFT/ERA

Processing

Appeals &

Resolution

Transition

ToCollections

Refunds

Post Acute

Placement

Discharge

Planning

Utilization

Review

Pre-Visit Acute CM Transaction Processing & AR Mngmt

EDI/ERA

Enrollment

Provider

Credentialing

Fee

Schedule

Contract

Negotiations

Banking

Set-Up

Pre-Claim Visit

EMPI

Pre-Reg

Eligibility

Auto

Messaging

Referrals

Bill

Estimation

Address

Verify

Workflow

Mngmt

Self

Service

Scheduling

Front-End Care Mngmt Backend

Life of a Claim

Ambulatory

CAC

Medical

Necessity

Credit

Check

Registration

& Check-in

Bed

Mngmt

Patient

TrackingSelf

Service

CDI

278 N

Notifications

ROI

Acute

CAC

On-line

Bill Pay

Accel

2nd billing

Cerner 3M Athena Others AbsentManualePremisEmbedded

partner

6

NAH…2016 and beyond

Registration

& Check-In

Workflow

MngmtScanning

Patient

Tracking

Bed

MngmtQA

Self

Service

278

Notification

Co-Pay &

Deductible

Patient

PaymentArrange

Coding &

Charge Capture

Acute

CAC

HIM

Chart

Abstracting

ROI

Chart

Deficiency

Grouper

Coder

Information

Request

Pt. Acct

Workflow

Embedded

Scrubbing

Contract

Mngmt

Accel

2ndbilling

Family

Billing

RVU’s

Remittance

Posting

Denial

Mngmt

Statements

Collections

Reporting

On-Line

Bill Pay

Letters

EFT/ERA

Processing

Appeals &

Resolution

Transition

ToCollections

Refunds

Post Acute

Placement

Discharge

Planning

CDI

Utilization

Review

Pre-Visit Acute CM Transaction Processing & AR Mngmt

EDI/ERA

Enrollment

Provider

Credentialing

Fee

Schedule

Contract

Negotiations

Banking

Set-Up

Pre-Claim Visit

EMPI

Pre-Reg

Eligibility

Medical

Necessity

Auto

Messaging

Credit

Check

Referrals

Bill

Estimation

Address

Verify

Workflow

Mngmt

Self

Service

Scheduling

Front-End Care Mngmt Backend

Life of a Claim

Ambulatory

CAC

CernerEmbedded

partnerOthers

7

Goals and strategic alignment (internally)

A Clinically Driven Revenue Cycle built on EMR integrity

• Record integrity = revenue integrity

A more data-driven business unit

A thorough eval of our processes, technology, and partners

A tighter, more accountable partnership with Cerner

• Cash

• Volumes

• Quality

• Patient satisfaction

• Net revenue

• Lower cost

• Price transparency

• Integration

• Cost of ownership (labor and non-labor)

• Who’s the customer?

• Dashboarding

• Co-management

• Roadmapping

• No victim mentality

8

Scoreboard

Cash-to-goal

• FMC CY16 cash – 101.1%

• VVMC CY16 cash – 103.9%

• Consolidated – 101.9%

Post out-sourced trends • Monthly cash: $1.7M improvement

• $42.2M avg monthly cash (Jan-Dec, 2015)

• $43.9M avg monthly cash (Jan-Oct, 2016)

• Monthly cost: ~$400k improvement

• $17.8M (3.5% of NR) vs. $13M (2.6% of NR)

9

Community EMR and business office services

Ambulatoryand specialty

providers

CernerNorthern Arizona

Healthcare

Achieving the

Triple Aim:• Outcomes

• Experience

• CostPatients

Pop Health

10

Our care management journey

• Population health strategy

• ACO partnership

• Ambulatory and preventative management

• Holistic care

• BOOST integration

• Expansion of OP care management

• Utilization management

• Discharge planning

• CDI Acute Care Management

Readmission Prevention

HealtheCare

11

Care management and volume-to-value

Inpatient and ED

strategy

Outpatient

strategy

Community and

population

involvement

C o n t i n u u m o f C a r e

• Identify and triage risk

• Initiate interdisciplinary care plans

• Care management oversight of high risk patients

• Transitional care post discharge

• Post discharge call for all patients in ED and from the hospital

• Risk stratification and care plan development for outpatient self management of chronic diseases

• Community paramedicine

• Collaborative with post acute services

• Assessing gaps in care

• Partnership in our communities

• ACO partnership and care management strategy/support

12

Our engine…HealtheIntent

13

Data sources roadmap

Current state

EHR

> Cerner

ACO

> BCBS claims

> Optum claims

> Athena Health (EHR)

EHR

> Cerner

> Cerner Ambulatory

ACO

> BCBS Claims

> Optum Claims

> Private practice EHRs

Supply chain

> Lawson

Patient experience

> Press Ganey

Cost accounting

> Kaufman Hall

Human resources

> Lawson

State HIE

> AZ Health-e Connection

Future state

14

Governance

Data governance council

Enterprise analytics decision making body

SLT

Executive team

CFO

Executive sponsor

BI managerReports to the CFO

Sr BI analystFrom quality

CCL developerFrom IT

Sr BI analystFrom finance

Sr BI analystFrom strategic planning

Data management committee

Enterprise analytics implementation body

Business intelligence team

Dedicated analytics body Distributed analytics

teamPartial FTEs residing in

different departments,

providing for specific business

needs

Service Now(Service management system)

15

Our journey to value-based care

Impossible obstacle…or…inflection point

16

Enabling our NAH vision

18

Questions?

19

Education sessions: Complete a post-session survey for each session in Cerner Events app

Continuing education: Complete the attestation survey, available Nov.16 - Dec. 16

General reminders