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Achieving Revenue Cycle ExcellenceTo Prepare for Health ReformJim Morrison, VP and General ManagerRevenue Cycle Solutions,...
Agenda  Healthcare Reform: The Environment  Provider Impact  Enhancing Payer Relations  Reimbursement Management  Driving ...
Healthcare Reform:The EnvironmentHealthcare reform legislation set things moving.The next steps are less clear …        ...
Audience SurveyWhich of the areas listed below is yourorganization most prepared to address?    A. Accountable care/shared...
HFMA ANI 2011 Conference SurveyPlease indicate your organization’s preparedness toaddress the areas listed below.         ...
Four Building Blocks of ACOsConnectivity, Engagement, Medical Home                                    Analytics►   Activel...
ACO Strategic CompetenciesConnectivity, Engagement, Medical Home                                AnalyticsConnectivity     ...
Bundled Payment   Required CapabilitiesClinical& ClaimsData                       Episode Registration                    ...
Bundles PaymentsSuccess Requirements           Analytics                  Advanced Tools• Operational analytics to     • U...
Healthcare ReformWhat’s Next? The world will include a mixed environment:  Capitation/fee for service, risk sharing The ...
Healthcare Reform  What’s Next?    Population Management               Changes in Care Settings• Analytics supporting the ...
Agenda  Healthcare Reform: The Environment  Provider Impact  Enhancing Payer Relations  Reimbursement Management  Driving ...
Provider Impact The Changing Landscape    Reduced         Payment Reform          Quality Reimbursement        & Evolution...
Agenda  Healthcare Reform: The Environment  Provider Impact  Enhancing Payer Relations  Reimbursement Management  Driving ...
Audience SurveyAre you talking with any of your payers about  how the health reform changes will affect  your relationship...
Enhancing Payer Relations                  • Holistic view of the patientCollaboration &   • Match clinical & claims data ...
Agenda  Healthcare Reform: The Environment  Provider Impact  Enhancing Payer Relations  Reimbursement Management  Driving ...
Reimbursement ManagementComplexities and Mechanics   Provider-based Physicians           Contracting and                  ...
Agenda  Healthcare Reform: The Environment  Provider Impact  Enhancing Payer Relations  Reimbursement Management  Driving ...
Driving Out CostsStrategies and OpportunitiesBig focus on clinical IT comes from ARRAStrengthen your revenue cycle proce...
Audience Survey What process do you use today to confirm  patient identity? A. Photo ID B. Photo ID and insurance card C. ...
Driving Out CostsPatient Identification ManagementMedical Identity Theft is one of the fastest growing crimes in the U.S....
Agenda  Healthcare Reform: The Environment  Provider Impact  Enhancing Payer Relations  Reimbursement Management  Driving ...
Audience SurveyWhat are your current net accounts receivable days?A.   40 daysB. 41 – 45 daysC. 46 – 50 daysD. 51 – 55 day...
Case StudyMississippi Baptist Health System Staff education on IT and processes HIS table updates to align with best pra...
Audience SurveyWhat is your average time for patient registration to be completed?A.   10 minutesB. 11-15 minutesC.   16 m...
Case StudySpartanburg Regional Medical Center Streamlined insurance master tables Established electronic remittance advi...
Agenda  Healthcare Reform: The Environment  Provider Impact  Enhancing Payer Relations  Reimbursement Management  Driving ...
What’s Next?    Managing Populations and Risk Under Health ReformConnectivity & Engagement                     Care Manage...
What’s Next?    Managing Populations and Risk Under Health ReformConnectivity & Engagement          Care Management► Inter...
Extra Resources sites.mckesson.com/AchieveHIT/reform.asp      More Information on Revenue Cycle Management                ...
Questions            32
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Prepare For Health Reform With Revenue Cycle Management Insight From McKesson

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Ensure your revenue cycle management processes help you improve payer relations, reduce costs and maximize reimbursement - in an environment of health care reform - with insight provided by McKesson in this webinar.

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Prepare For Health Reform With Revenue Cycle Management Insight From McKesson

  1. 1. Achieving Revenue Cycle ExcellenceTo Prepare for Health ReformJim Morrison, VP and General ManagerRevenue Cycle Solutions, McKesson
  2. 2. Agenda Healthcare Reform: The Environment Provider Impact Enhancing Payer Relations Reimbursement Management Driving out Cost Case Studies in High Performance Summary and Q/A 2
  3. 3. Healthcare Reform:The EnvironmentHealthcare reform legislation set things moving.The next steps are less clear … 3
  4. 4. Audience SurveyWhich of the areas listed below is yourorganization 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 4
  5. 5. HFMA ANI 2011 Conference SurveyPlease indicate your organization’s preparedness toaddress the areas listed below. Percent Indicating "Very Prepared" To AddressReadmissions and hospital-acquired 16% conditions Value-based purchasing 12% Strategy to address newly insured 6% patient populations Accountable care/shared savings 6% strategy Bundled payments 1% 5 Sample size = 84
  6. 6. Four Building Blocks of ACOsConnectivity, Engagement, Medical Home Analytics► Actively engage patients in their care process ► Stratify populations for management.► Provide patients with access to their pertinent ► Identity opportunities to manage cost and quality information ► Report and act up care gaps► Enable care coordination and connectivity ► Understand and optimize provider performance► Enable a range of personal health management and health information tools ► Support internal/external reporting demands Care Management Payment Mechanics► Leverage evidence based decisions in delivering ► Manage multiple payment models at the POC programmatic care including traditional FFS► Support integrated/holistic approach to ► Leverage analytics to define/ support care managing patients across the continuum of care bundles and prepare for bundled payments► Support integrated workflow in managing ► Tools to manage contracts and payment cost/quality distribution logic PCMH ACO 6
  7. 7. ACO Strategic CompetenciesConnectivity, Engagement, Medical Home AnalyticsConnectivity Engagement Performance Analytics Network Analytics► Interoperability ► PHR ► Operational Efficiency ► Cost & Quality► Data Exchange ► Multi Modal Comm. ► Service Line Analysis ► PMPM Spend► Care Coordination ► Education ► Cost Trend ► Efficiency ProfilesCommunication ► Online Programs ► Attribution Logic► Messaging ► Decision Support Population Analytics ► Benchmarking► Notifications ► Marketing ► ID & Stratification ► Incentive Modeling► Results ► Care Gaps Outcomes Reporting► Referrals / Orders Transformational Services ► Intervention Outreach ► HEDIS. NQF, PQRI, IQR Care Management Payment MechanicsHolistic Management EBM Financial Management Payment Mechanics►UM / DM / CM ► Assessments ► Eligibility ► Contract Repository ► Care Plans ► Medical Necessity ► Medical Policy►ID & Stratification ► Care Guidelines ► Auto-authorization ► Payment Policy►Medical Necessity ► Education ► Distribution Logic►Decision Support ► Campaign Mgmt►Readmission Mgmt. PCMH ACO 7
  8. 8. Bundled Payment Required CapabilitiesClinical& ClaimsData Episode Registration Evidenced-Based GuidelinesAnalytics Engine Care Management Efficiency Profiles Tools Distribution Logic 8
  9. 9. Bundles PaymentsSuccess Requirements Analytics Advanced Tools• Operational analytics to • Utilization management tools identify service line to reduce variation in opportunities resources supporting bundled payment• Network analytics to • Integrated analysis of operational & network determine and track performance against provider efficiency in contracts support of bundled contracts • Care management tools to ensure integrity of bundle • Tools to register and trigger• Analytics to track bundle associated claims activity • Payment distribution logic 9
  10. 10. 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 10
  11. 11. Healthcare Reform What’s Next? Population Management Changes in Care Settings• Analytics supporting the ID • Hospitals expanding footprint and risk-adjusted stratification to non-traditional settings of a population of patients • Connectivity between all care• Integrated analysis of clinical settings – clinical & financial and claims data – is essential• 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 11
  12. 12. Agenda Healthcare Reform: The Environment Provider Impact Enhancing Payer Relations Reimbursement Management Driving out Cost Case Studies in High Performance Summary and Q/A 12
  13. 13. Provider Impact The Changing Landscape Reduced Payment Reform Quality Reimbursement & Evolution Improvement• Fee-for-service • Pay for • Pay for payments cut performance performance• Commercial • Bundled • Public reporting payers driving payments measures to Medicare • Capitation • Meaningful use levels • Shared savings • Enterprise care management ICD-10 Transition 13
  14. 14. Agenda Healthcare Reform: The Environment Provider Impact Enhancing Payer Relations Reimbursement Management Driving out Cost Case Studies in High Performance Summary and Q/A 14
  15. 15. Audience SurveyAre you talking with any of your payers about how the health reform changes will affect your relationship?A. Yes, we’re meeting regularlyB. Yes, we’re in the early stages of discussionC. No, but we have plans to meetD. No, with no plans to meet 15
  16. 16. Enhancing Payer Relations • Holistic view of the patientCollaboration & • Match clinical & claims data Information • Reduce administrative costs with Sharing automation • Regular educational updates from payers • 5010 allows more information sharing5010 & ICD-10 between provider and payer Transition • Cleaner claims results in fewer denials Advantages • Collaborate with your payers on contract reviews prior to ICD-10 transition 16
  17. 17. Agenda Healthcare Reform: The Environment Provider Impact Enhancing Payer Relations Reimbursement Management Driving out Cost Case Studies in High Performance Summary and Q/A 17
  18. 18. Reimbursement ManagementComplexities and Mechanics Provider-based Physicians Contracting and Understanding Cost•Single source to track and •Medicare 72-hour window manage patients •Underpayment management•Historical view of payments Disparate information Analytics to understand management systems performance•Acute and Ambulatory billing • Cost of care, quality of integration care, spend per-member per-•Case Management/Length of patient stay control • Provider efficiency • Benchmarking & Incentive Modeling • Reporting to regulatory bodies 18
  19. 19. Agenda Healthcare Reform: The Environment Provider Impact Enhancing Payer Relations Reimbursement Management Driving out Cost Case Studies in High Performance Summary and Q/A 19
  20. 20. 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 20
  21. 21. 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 21
  22. 22. Driving Out CostsPatient 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 22 * According to the National Survey on Medical Identity Theft prepared by Ponemon Institute in 2010
  23. 23. Agenda Healthcare Reform: The Environment Provider Impact Enhancing Payer Relations Reimbursement Management Driving out Cost Case Studies in High Performance Summary and Q/A 23
  24. 24. Audience SurveyWhat are your current net accounts receivable days?A. 40 daysB. 41 – 45 daysC. 46 – 50 daysD. 51 – 55 daysE. 56 days 24
  25. 25. Case StudyMississippi Baptist Health System Staff education on IT and processes HIS table updates to align with best practices Process improvement for point of service collections Key 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. 25
  26. 26. Audience SurveyWhat is your average time for patient registration to be completed?A. 10 minutesB. 11-15 minutesC. 16 minutes 26
  27. 27. Case StudySpartanburg 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 27
  28. 28. Agenda Healthcare Reform: The Environment Provider Impact Enhancing Payer Relations Reimbursement Management Driving out Cost Case Studies in High Performance Summary and Q/A 28
  29. 29. What’s Next? Managing Populations and Risk Under Health ReformConnectivity & Engagement Care Management► Interoperability with identity ► Cross-continuum, patient management centric care plan Care Management► Patient communicationFinancial Management► Quality and Evidence Connectivity & Aggregation Analytics / DataEngagement► Engagement Model ► Holistic disease management ► Cross-continuum, patient ► Eligibility Interoperability with identity Performance evaluation centric care plan ► Payment mechanics management Population analysis ► Quality and Evidence ► Disbursement Management Patient communication Network analysis ► Holistic disease Engagement Model ► Outcomes reporting Financial ManagementAnalytics / Data Aggregation management► Performance evaluation ► Eligibility► Population analysis ► Payment mechanics► Network analysis ► Disbursement Management► Outcomes reporting 29
  30. 30. What’s Next? Managing Populations and Risk Under Health ReformConnectivity & Engagement Care Management► Interoperability with identity ► Cross-continuum, patient management centric care plan► Patient communication ► Quality and Evidence► Engagement Model ► Holistic disease managementAnalytics / Data Aggregation Financial Management► Performance evaluation ► Eligibility► Population analysis ► Payment mechanics► Network analysis ► Disbursement Management► Outcomes reporting 30
  31. 31. Extra Resources sites.mckesson.com/AchieveHIT/reform.asp More Information on Revenue Cycle Management 31
  32. 32. Questions 32

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