TBS Healthcare PPT Final 4 16

Business Innovation. Smart Sourcing. Operations Management.

HEALTHCARE SERVICES COLLATERAL. © 2015.

www.transbizsolution.com/healthcare

TRANSNATIONAL BUSINESS SOLUTIONS’

Capability Presentation for

HEALTHCARE SERVICES.

TBS Strategic

Advisory

Consulting

Business Innovation. Smart Sourcing. Operations Management.Healthcare Industry

Overview of the current status of the industry.

INTRODUCTION▪ At 3 trillion dollars of annual expenditure, it accounts

for close to 20% of the nation's GDP

▪ Overuse and unnecessary care account for anywhere from one-third to one-half of all health care costs, which equal more than a trillion dollars per year

▪ Centers for Medicare & Medicaid Services (CMS) is changing the model of payment from pay for service topay for performance

▪ Both the Provider and Payer segments of healthcare are currently going through a transformation period and the critical success factor will depend on the right combination of technology and the people who will drive it.



The healthcare industry is in an unprecedented situation where success will depend on the right collaboration of technology and the people who drive it.

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Our team recognizes the complex and unprecedented challengesfacing the healthcare industry today. Be it in the area of business process management, interoperability, population health management or patient engagement, we work closely with clients in developing, what we refer to as the “TBS Healthcare Consortium”. This is a unique and highly customized business solution that TBS has created, along with its consortium of selected solutions delivery partners, that enables us to fulfill the client's exact requirements.

About TBS

TBS is a strategic advisory and operations consulting firm and has an abundance of experience and knowledge of the issues facing the business of healthcare today. Transnational's healthcare practice vertical is headed by highly experienced healthcare professionals along with veteran business executives with deep insight about the challenges and continually evolving landscape of the healthcare industry. Together our team utilizes proven business practices to identify the key issues facing an organization and works with specific subject matter partners to provide proven solutions.

WHO WE ARE

Overview of our operations.

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Our management

team has decades of

Healthcare and Business

experience and success.

We have assembled a

consortium of service

Partners that bring the best

practice solutions to the

issues facing healthcare

today.

Our process preserves

your current strengths,

and adds improved

solutions to prepare you

to meet future needs




VISION&

MISSION

What we believe inOur guiding principles.

“

“

TBS recognizes the unprecedented and complex challenges facing the healthcare industry today. Our vision is to provide holistic and integrated solutions for the emerginghealthcare system.

Our mission is to drive our client’s success through our deep domain knowledge of healthcare, along with best practice solutions with our consortium of proven solutions providers.

”

”

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Why TBSWhy Us?

WHY TBS FOR

HEALTHCARE

CONSULTING?

▪ Subject Matter Expertise (Clinical) hands on and leadership experience in provider organizations

▪ Nationwide senior level contacts within and outside of the Healthcare industry

▪ Senior Business Leadership experience both Nationally and Internationally

▪ Hands on experience in designing IT enabled business process solutions.

▪ Strong project management skills covering multiple verticals

▪ Cost saving solutions critical to stability and success

▪ Proven solutions delivered from the partnerships assembled in the TBS “Healthcare Solutium”

TBS will assist in the Project planning stages right through the implementationand review of success of the projects for each of our clients.

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TBS Service ApproachOur Approach

This Includes:

▪ Decision making tools for care planning and implementation

▪ Patient engagement

▪ Improvement of operational efficiency

▪ Coordination of care efforts of hospital and physician groups into one Integrated delivery system

Care

Provision

Care

Management

Our team recognizes the complex and unprecedented challenges facing the healthcare industry today. Our role is to transform healthcare organizations from “Care Provision” to “Care Management” in line with the trend towards performance based reimbursement.

OUR HEALTHCARE

SERVICES

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The TBS “Consortium” 01

Together with our consortium of partners we provide the following solutions to the challenges facing healthcare today!




Population Health Management with Advanced Analytics Capabilities & Solutions

TBS Advisory

▪ Project Management

▪ Change Management

▪ Innovation

▪ Human Capital Management

Financial Sustainability with

best practice Revenue Cycle Management

solutions

Business Process Improvement in

organizations including IT systems & solutions

Delivery of healthcare

content to meet the challenges of the shifting

payment model

1. Business process Integration and improvement.

2. Secure Healthcare Communications

3. Compliance and content management

4. Population health & disease management.

5. Clinical Trial/Grant Management Solutions

6. Revenue Cycle Management

Our Health Care Services Include:

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The TBS Process

Discovery Design

Implementationand Results

We work with our

clients to bring

measured results

and continued

process

improvements.


“

”

Our engagement & implementation.

After Identifying needs, we develop solutions that best address the issues.

“”

“

”

TBS



We obtain a deep understandingof clients’ immediate challenges as well as those that lie ahead.

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Business Innovation. Smart Sourcing. Operations Management.Healthcare Industry

Transition Issues of ICD-9 to ICD-10 Coding

Issues of the

ICD-10

TRANSITION

As the Healthcare Industry has transitioned to ICD-10, changes and restructuring of organizational policies and procedures are necessary. This transition has affected much more than the coding department. This transition may significantly affect your organization’s revenue flow.

Were you prepared for the Transition to ICD-10?

TBS is positioned to help develop a plan that will avoid the potential for productivity losses and other challenges that can negatively impact revenue. Auditing how this transition may have affected your Revenue Cycle Process flow will assure that this transition will not affect your continued RCM success



The healthcare industry is in an unprecedented situation where success will depend on the right collaboration of technology and the people who will drive it.

ICD-10Were you ready for ICD-10 Transition?.

TBS has the experience necessary to analyze an organization’s current as well as projected needs surrounding the transition to ICD-10 coding requirements and what could happen if not prepared.

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Coding-Denial Claims-Auditing Services

Our engagement & implementation.

TBS ICD-10

Coding & Auditing Services

Provide consultation services to assess your medical coding needs to insure you are keeping pace with the new ICD 10 regulations

1. Assess Coding Needs

2. CDI Training

3. Supplying Vetted Coders

4. Denial Claims Management

6. Secure Remote Process

5. Auditing of Coders

Administer CDI training for staff to better understand the documentation requirements for the additional information needed in ICD -10 Coding

Obtain the number of coders needed to fill any voids that the transition to ICD 10 may have created from the TBS pool of fully vetted and certified remote medical coders. TBS will contract with you to supply, manage and pay these contracted medical coders as outsourced staffing.

Supply AHIMA Certified Auditors to improve skills by auditing

the ICD 10 coding of your current coding staff..

TBS coding services are provided remotely through a secure central VDI platform that allows management to monitor, assist and

document the coding, Denial Claims Management and Auditing efforts.

Our Team at TBS will help your hospital perform at optimum levels by supplementing your coding staff with our certified coders, trainers and auditors!

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Supply certified coders experienced in identifying causes of denied claims and address problem areas in an effort to assist in reducing denied claims many of which are resulting from the transition to ICD-10.

Business Innovation. Smart Sourcing. Operations Management.Strategic Advisory Services

How we help medical practices and other healthcare organizations

Strategic Support to Healthcare

Organizations

• Expertise in anticipating rapidly changing trends in reimbursement and strategic positioning of healthcare organizations to thrive in these new payment environments.



The healthcare industry is in an unprecedented situation where success will depend on right collaboration of technology and the people who will drive it.

• Systematic evaluation and optimization of the use of new technologies (real time analytics and decision support systems).

• Accountable care shared savings preparation (for successful participation in the Medicare Shared Savings Program)

• Bundled Payment Arrangements Preparation (for retrospective

and prospective, inpatient and post-hospital care episodes)

• Other value-based payment arrangements

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Business Innovation. Smart Sourcing. Operations Management.Strategic Advisory Services

How we help medical practices and other healthcare organizations

Preparing for Risk Bearing Arrangements

• EHR optimization (evaluation of implemented EHRs to improve quality, safety, efficiency and risk management)



Source: “Why Are Bundled Payments So Attractive for Hospitals and Physician Groups?” KPMG.

Challenges of bundled payments? • Bundled Payments (concerning which types of bundled payment arrangements & for what conditions/procedures)

• Volume to Value Based reimbursement (maximizing current reimbursement to finance the most cost effective technology and infrastructure to prepare for value based reimbursement)

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Business Innovation. Smart Sourcing. Operations Management.Patient Safety

Our patient safety assessment tool

Patient Safety

Assessment Tool



Patient safety assessment customized for use to

determine how well Citrin'sclients (especially hospital

or large physician group practices) are prepared to prevent or detect medical errors, while ensuring the

delivery of high quality and efficient care.

Our other patient safety services

focused on optimizing your client’s use of

Electronic Health Records

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Business Innovation. Smart Sourcing. Operations Management.Emergency Room Management

Our ER management solutions



Maintaining the FFS business of the Emergency Room but at the same time focusing on reducing avoidable ER use.

Achieving DSRIP goals and meeting performance metrics to avoid ER visits

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Improve ER throughput, process flow and efficiency

Assure adequate revenue flow

Implement principles of Lean Six Sigma

Business Innovation. Smart Sourcing. Operations Management.Wellness Programs

For Business & Industry



• Disease Prevention• Exercise program• Diet/nutrition• Work life balance• Mind Body

Medicine,

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• Employers grappling with rising health-care costs face a new dilemma: how to avoid paying hefty taxes (Cadillac tax starting in 2018) on generous employee health-care plans.

• To avoid the tax, or lessen its bite, many companies intend to move to high-deductible health plans.

• To shield employees from these high deductibles, companies invest in wellness programs to keep patients out of the health system, while improving workforce productivity

What can be done?Introduce Wellness Programs to employees by educating them about:

• Disease prevention• Exercise programs• Diet/Nutrition• Work life balance• Mind Body medicine• Smoking cessation

Business Innovation. Smart Sourcing. Operations Management.Our Leadership Team

For the Healthcare vertical.



Sumantra Sen Founder & Managing [email protected]

Sumantra Sen is the founder and Managing Director of Transnational Business Solutions, a Strategic Advisory and Operations Consulting Firm based in New York City. In his twenty nine years of professional experience, Sumantra has served and advised a range of industries, including engineering, packaged goods, financial service, pet products , healthcare and wellness industry. Sumantra maintains a successful track record in startup management, International Business Development, process re-engineering and off shoring strategy in diverse industries.

Prior to his current role in Transnational, Sumantra has worked with Fortune 100 companies and entrepreneurial startup ventures in countries like India, Germany, UK and USA. From his senior leadership positions in Mobil Oil, Cummins Power, BTR and Lazard, he is considered an expert in start-up management, retail and distribution of packaged

goods, international M&A initiatives and capability sourcing. As a former CEO, he has a successful track record in operational innovations, marketing, team building and mentoring.

Sumantra is very active in the professional/business community. He is also a regular speaker in various international business schools, such as Logos Business School in Nigeria, Faculty of Management Solutions (F.M.S.), Delhi University, and Department of Business Management-Calcutta University, Kolkata. He spends time with the academic communities abroad.

A national scholar from India, Sumantra holds a bachelor degree in Engineering from Jadavapur University, Calcutta, India, and a MBA from the University of Delhi, India. He is also a recipient of several prestigious awards both as a corporate leader and an entrepreneur.

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Dr. Charles AswadDirector - TBS Healthcare [email protected]

Dr. Charles N. Aswad is the principal consultant for Transnational Business Solutions’ Healthcare Practice Area since 2011. Dr. Aswad is the Emeritus Executive Vice President and CEO of the Medical Society of the State of New York (MSSNY). He served as President of the MSSNY, Speaker of the American Academy of Family Physicians; Chairman of the American Medical Association’s Task Force on the Medical Workforce and was a member of the American Medical Association’s Council on Long Range Planning and Development. In addition, Dr. Aswad served as a member of the AMA’s Health Policy Agenda for the American People and was an AMA New York Delegate.

Dr. Aswad was appointed, by the New York State Commissioner of Health, to the Council of Graduate Medical Education (GME) where he was Chairman of the Subcommittee of Minority Participation in GME. He was appointed to serve on the Commission for a Healthy New York and the New York State Tobacco Control Partnership.

Dr. Aswad has been a consultant and advisor in both medical and dental fields, as well as to major corporations. He developed the Smoking Cessation Program for MSSNY, which included training programs for Physicians and patients. He was consultant to major pharmaceutical

companies in the areas of: clinical trials, communication to professions in the areas of AIDS, Hepatitis C, Influenza, Diabetes, Cancer, Childhood and Adult Obesity, physician involvement in anti-terrorism efforts, and developed a program for treatment of Biological Warfare Agents, post 9/11. He collaborated with multiple health agencies in State and Federal government, as well as NGOs, including The American Heart Association, The American Cancer Society, The Lung Association, and others in developing communication programs. Dr. Aswad served as Chairman of the Editorial Board of a major continuing medical education and communication company. He has personally worked with both the heads of FDA and the US Surgeon General’s Office and the predecessors.

Dr. Aswad is a graduate of the State University of New York at Binghamton-Harpur College and New York Medical College. He is a Charter Fellow of both the American Academy of Family Physicians and the American College of Emergency Physicians.

Dr. Aswad is the recipient of numerous honors including Distinguished Alumnus Honors from both the State University of New York and New York Medical College.

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James B. Couch, M.D., J.D., FACPEConsulting [email protected]

Dr. Couch has over 30 years of accomplishments evaluating, developing and implementing advanced electronic systems to improve the quality, safety and value of care delivery. He was the first physician in the country trained in Six Sigma in 1992, and the first to apply these process improvement methods to the healthcare and financial services industries that year.

He led a clinical trial of an advanced clinical decision support and care management fulfillment system at a leading academic health system that demonstrated a 700% ROI. He has also worked extensively in evaluating and positioning cloud-based electronic health information systems, clinical and population health analytics products for use by leading healthcare providers and payers including Aetna and Humana.

Dr. Couch has worked extensively in value based compensation systems in his roles as Chief Medical Quality and Chief Medical Officer for a leading

Academic Health System, two “Big 5” health insurers, and the American Division of the world’s largest reinsurer. He led value based compensation projects with hospital and physician leaders, insurance and employer executives in Cincinnati and San Francisco

Dr. Couch has published four books, including his latest this past year on “Achieving the Quadruple Aim in a Technology-Driven Transformed Health System: Better Care, Improved Health, Lower Costs and Decreased Medical Liability”. He contributed to the Institute of Medicine’s landmark study on “Health IT and Patient Safety”, published in 2012.

Dr. Couch’s education includes a BA in Social and Behavioral Sciences from Ohio State University; a JD (Doctor of Jurisprudence) from the Indiana University Maurer School of Law; and an MD from the University of Pennsylvania School of Medicine. He has taught health policy at Harvard, Yale, Penn and Oxford.

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Paul J. Szklarski, FACHEConsulting [email protected]

Paul Szklarski, MBA, FACHE is a senior healthcare executive with a strong history of successful product line start up and positive operating margins.

Paul’s education and background brings real world experience to the healthcare arena. At his most recent post, he increased grant funding by 30% by implementing three new service lines for a primary government client. His NIH and NIMH grants, government contracting and practice acquisitions are indicative of his skills.

Mr. Szklarski led the development of a $21 million hospital system service line at Beth Israel Medical Center in New York City that delivers vital services to the Marriott Corporation, Pitney Bowes, Xerox and the United States Postal Service. He led the initial response team with the Postal Service during the anthrax crisis. Szklarski also led the academic mission

of the School of Osteopathic Medicine at the University of Medicine and Dentistry of New Jersey.

Paul founded the Health Industry Resource Group in 2003. It continues to exert a significant influence on healthcare in the region.

He is nationally certified as a Fellow in the American College of Healthcare Executives and has spoken nationally on HIPAA, leadership, and business development.

He holds an M.B.A. from Widener University and lives in Egg Harbor Township with his wife & children.

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Manab SenPrincipal Strategic [email protected]

• 30+ years’ international experience including 23 years C level, in US, India and the Middle-east;

• 6 start-up/restructuring /turnaround situations• Hands on experience in Banking, Financial Services,

Healthcare and Information Technology,• Managed private equity investments, generating

exemplary returns using multiple exit strategies of cross border M&A, restructures, spin-offs, divestments or IPOs

• Experience runs across Fortune 500, family owned groups, absolute start-ups;

• Expertise focused on business strategies, divestments, acquisitions and value creation

After 12 initial years as a Credit analyst with American Express bank and India’s largest Banking conglomerate, Manab was selected by India’s premier Media group, to head their finance function and spearhead diversification. Setting up a diversified Financial Services organization from ground-up he ran it as President, leading to the formation of a retail Bank, public listing and being rated as one of India’s most respected organizations.

Next he implemented a diversification exercise for India’s largest domestic pharmaceutical group into financial

services, healthcare delivery and a health insurance joint venture. As CEO he completed an acquisition and took the company public within a space of 4 years from setting up.

Manab then moved to Bahrain where he set-up the Corporate Finance function of a leading Investment Bank. He managed a private equity fund with exemplary returns, led several cross-border mergers and acquisition transactions with focus on information technology.

Moving to the USA in 2000, Manab took up the role of President, Chief Strategy Officer, and Global head financial services solutions for a global, IT services company. The company’s valuation increased 17 fold in 4 years. Since 2006 Manab has invested in, coached and helped restructure a Business Process Management company, now on a profitable path from near bankruptcy.

Manab graduated from the University of Calcutta India with a degree in Finance. He has completed several programs at the Indian Institute of Management, Ahmedabad, Rutgers Business School and is also an Associate of the Indian Institute of Bankers.

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Tim KirschConsulting [email protected]

Tim Kirsch is a Consulting Partner of Transnational Business Solutions. He has a track record of achievement in delivering sales and profitability results in highly-competitive markets and product lines. He is skilled in planning and executing sales strategies encompassing channel management, distribution, merchandising and direct sales programs. He is known for his ability to motivate others and manage-by-example.

Tim is a seasoned business manager with extensive experience and accomplishments in recruiting the right people for an organization, developing their performance through coaching and mentoring and driving a business forward. He has practical experience in all aspects of business process and operations. He is a skilled problem solver who applies creativity to problems and opportunities. He has senior level experience in distribution, purchasing, technology solutions, and business process improvement. He has been highly successful in negotiating and establishing strategic relationships

focused on delivering lower cost of goods and services and higher profitability.

Most recently Tim was instrumental in the setup and move of a technology company into a new state of the art Data Center in Upstate New York. He managed the audit process for the organization to successfully attest for SSAE 16 certification. Additionally Tim developed and managed a company wide process improvement initiative in an effort to streamline to company’s internal operations.

He is a graduate of Siena College in Loudonville N.Y. where he earned a Bachelor of Science Degree in Marketing and Management. As a lifelong resident of the Capital Region of New York, Tim has developed several of his own businesses as well as participated as senior level management in the success of other regional business enterprises.

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Janet HortonMedical Billing & Coding Manager [email protected]

Janet Horton has worked in Health Information Management (HIM) since 1972. She began in a clerical position and transitioned to coding in 1989.

She has been both an inpatient and outpatient coder in a Medical Facility for 10 years. In addition, she has 20+ years experience managing and opening physician’s offices, setting up billing, coding and hiring staff.

She returned to the hospital setting in 2000 as Coding Manager and then Director of HIM in 2005 for Major Trauma Facility with over 400 beds, leading, transcription, release of information, clerical and coding areas.

She has initiated the instillation of Electronic records and a Clinical Documentation Program

and worked closely with the Revenue Cycle Team.

In 2009 she moved to remote work in the field as an ICD 9/10 Coder and Auditor, along with training for Physicians and Coders in ICD 10.

She holds her CCS and is an ICD10CM/PCS Trainer and Ambassador through AHIMA (the American Health Information Management Association).

She continues to work toward her RHIT.

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TBS Consortium Partners Capability Examples

Data Marshall

Our Consortium partners such as the two highlighted here, could be brought into large organization clients who needed to improve their fee for service revenue capture and/or their key business processes and overall operations.

BISIL

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TBS Consortium Partners

Data Marshall

Revenue cycle management services

Increasing your operational efficiency and maximizing your productivity is critical to a healthcare provider’s operations. In the current market scenario, the costs to administer claims and retain staff continue to rise and erode your profits. Data Marshall enables healthcare organizations to focus on the clinical needs area by providing revenue cycle management services which include:

Eligibility Verification Medical Billing Accounts Receivable Analysis Denial Claims Management Financial Performance Analysis Underpayment Recovery Services

Hospitals are now being required by CMS to reduce admission rates which decreases the revenue need to be certain they are collecting all funds earned through their efforts. Underpaid claims most times get written off the books. We have found that on average 5% of a hospital’s annual revenue is lost to underpayments. Data Marshall will perform an Underpayment Review Audit to identify, rebill and then collect on average 80% of those underpaid claims most times in the millions of dollars.

Reasons for Underpaid Claims

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BISIL Elements

What does BISIL provide?



✓Close fit Model the process as you need it to work for you

✓Integrate Different data sources and applications

✓Evergreen Keep the solution in sync with evolving requirements and process improvements

✓Collaborate Extensive Social and collaboration capabilities

✓Products Different products for different needs

✓No Code/Low Code

✓Extensive System Management Capabilities

✓No Code/Low Code

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TBS-BISIL SOLUTION FRAMEWORK

Core System

PPS needs

Systems of Record

Participants

Patient Discharge

EMR

ReceivingPhysicians

AncillariesPatient/Family Education

EHR PMS PMS EMR EMRPMS

Care Management System and Data

Warehouse

Reporting AnalyticsData

Visualization MPIData

Visualization

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THANK YOU!

Contact Us:45 West 34th Street

Suite #1107 New York, NY 10001

[email protected]

800-362-8691

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TBS Healthcare PPT Final 4 16

Documents

Transcript of TBS Healthcare PPT Final 4 16