945 dyke and mendenhall

© 2/25/2015 RelayHealth and/or its affiliates. All Rights Reserved. Proprietary and Confidential.
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Help Increase Patient Collections and Improve Patient Satisfaction
Best Practices for Keeping Patients
Financially Engaged

2
Our Speakers Today
Travis Mendenhall,
FHFMA, MFA
Sr. Systems Analyst,
Gwinnett Hospital System
David Dyke
Vice President, Revenue Cycle
RelayHealth

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Part 1: Market Dynamics
• Patient
• Market
• Quality
Part 2: Case Study: Gwinnett Hospital System
• About Gwinnett Hospital System
• Strategies for Change
• Results & Best Practices
Discussion & Questions
Agenda: Doing the Impossible

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Part 1: Market Dynamics
• The Patient’s World View
• The Market is Shifting at an Alarming Rate
• Qulaity Madters

Concept
% of People who
THINK they
understand the
concept
% of those that
THINK they do,
and ACTUALLY
understand
% of People
(Total) who
ACTUALLY
understand
Co-Pay 100% 72% 72%
Deductible 97% 81% 78%
Coinsurance 57% 59% 34%
Max Out Of
Pocket
93% 59% 55%
Training: Patients
Source: Consumers Misunderstanding of Health Insurance, Journal of Health Economics & Washington Post, August 2013
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/08/08/do-you-understand-health-insurance-most-people-dont/

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Broad Consumer Mobile Internet Access
Trending
Americans
90% Have Cell
Phones
58% Have
Smart Phones
• 83% : Age 18-29
• 49% : Age 50-64
• 47% : In < $30k
Households
• 81% : > $75k+
Activities
• 82% : Pictures
• 81% : Texting
• 50% : Email
• 49% : Location
• 31% : Health
• 29% : Banking
& Payments
Source: Pew Internet & American Life, January 2014

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Technology Adoption and Usage
0% 25% 50% 75% 100%
Cell Phone
Internet
Broadband
Internet & Mobile Phone
Adoption
All Adults Adults +65
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
18-29 30-49 50-64 64+
Internet Use Frequency:
By Age
Daily 3-5x Week
Source: Pew Internet Project, Older Adults and Technology Use Report 4/3/2014

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• Seniors with annual household income of $75,000 or more, 90%
go online and 82% have broadband
• Seniors with annual household income $30,000 or less,
39% go online and 25% have broadband
• 27% of Seniors own a tablet, e-book reader or both
• 18% of Seniors own a Smart Phone
On the Topic of Seniors and Technology
Source: Pew Internet Project, Older Adults and Technology Use Report 4/3/2014

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Online account
management is
growing across all
demographics for all
markets
Online Account Management
Source: Pew Internet & American Life Project, Generations 2010, 12/2010
0%
10%
20%
30%
40%
50%
60%
70%
18-33 34-45 45-55 55-64 65-73 74+
Regularly Paying Bills Online
By Age Group
Growing 10-14% per year
Continued steady usage

1 in 5 Employer Sponsored
Patients in HDHP
10
0% 20% 40% 60% 80% 100%
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0%
4%
5%
8%
8%
13%
17%
19%
20%
29%
Conventional HMO PPO POS HDHP
30% Growth
62% Growth
12% Growth
Source: Kaiser Francis Family Foundation, 2013 HEBS
5% Growth
ACA Impact?

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Collecting Critical Financial Information
• Helps improve efficiency
• Helps reduce risk
• Assists in increasing
Patient Satisfaction
See Patient
Here
Take Payment
Here
Take Payment
Here

Your Past, Present and Future
2011 2012 2013 2014 2015 2016 2017
Standard: 5010
Operating Rules: Claims
Operating Rules: Remittance
Operating Rules: Eligibility
Operating Rules: Claim Status
Operating Rules: EFT
Op. Rule: Referral/Auth.
Standard: EFT
Standard: Claim Attachment
Standard: ICD10Standard: ICD10

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Operating Rules
• Operating rules included in the ACA
• Defines common USAGE and CONTENT for
HIPAA transactions
• Most obligations on health plans provide specific data
• If ANSI 4010/5010 defined HOW to communicate
• Then operating rules define WHAT to communicate

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Operating Rules for Eligibility
CMS Adopted CAQH CORE Phase 1 & 2
Rule Areas Goals
System
Up Time
• 86% availability per week (24 hours of down time per month)
• Publish scheduled maintenance
• 1 week advance notice for non-routine maintenance
• 1 hour notice of emergency downtime
System
Response Time
• Real Time - Maximum 20 second “round trip”
• Batch - In by 9PM, out by 7AM
• 90% adherence
Benefit Response
• Support 48 Service Types
• Example: Medical, Physician , Hospital, Urgent Care, Mental Health
Static
Financial
• Co-Pay, Co-Insurance, Base Deductible for most service types
• Return In & Out-of-Network when different
Variable Financials
• Return “accumulators” (Year to date)
• Remaining Deductible, Out-of-Pocket

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Alerts Drive Action and Quality
•Alerts
• Quick Confirmation
• Other coverage alerts
• Real-time alerts
within the HIS
•Registration Quality
• Drive process
accountability
Patient has
Medicare but it’s
actually an HMO!
The HMO is
“Super Duper
Health”
DO SOMETHING

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Monitoring the Team
Team – 74%
Registration QA Scorecard
•Alice91% (A)
•Brett77% (C)
•David45% (F)
•Chris82% (B)

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Coaching the Individual
David
Registration QA Scorecard
•Pre-Admit88%
•Lab24%
•ER45%
•Clinic31%

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Part 2:
• Strategies for Change: New Processes
• Strategies for Change: New Technologies
• Questions & Discussion

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Process and Technology
Using process and
technology to empower
staff to collect payments
earlier and more often
while ensuring patient
satisfaction

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About Gwinnett Hospital System
Lawrenceville Campus
• Acute Care
• 89 Bed Extended Care Center
• Outpatient Centers
• Neuroscience/Stroke Center
• Open Heart
• Trauma – Level 2
• Pain Management
• Clinics
• FY14
Duluth Campus
• Acute Care
• Inpatient Rehab Center
• Outpatient Centers
• Bariatrics
• Orthopedics
• Orthopedic ASC
• Concussion Institute
• Clinics
553
Beds

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About Gwinnett Hospital System
• Employees 4964
• Affiliated Physicians 850
• Discharges 28570
• ER Visits 140,308
• Ambulatory Surgery 25,505
• OP Diagnostics 217,057
• Gross Revenue $2 Billion
• Net Revenue $624 Million
FY 2014

22

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Our Challenges
• A need to increase overall POS collections
- High deductibles are the new normal
• Lost revenue/difficulty estimating patient bills
• Confusing patient statements
• High call center volume
• Manual posting of credit card payments
• Web savvy population expects consumer-friendly
payment options

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Our Goals
• Break down barriers to payment
- Inform patients of financial responsibility upfront
- Help patients understand their bills
- Provide convenient ways to pay
- Collect at multiple points during care process
• Reduce call center volume
• Increase cash posting efficiency
• Increase patient satisfaction and loyalty

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Strategies for Change
New
Technology
New
Processes
Staff is
empowered to
collect
payments
earlier and
more often

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Process Strategies
Patient Loyalty
Program
Pre-Visit Calls
with Estimates
FC Visits for All Self-Pay
Scheduled Patients
Presumptive
Charity Screening
Increase
Collections
and Patient
Satisfaction

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Patient Loyalty Program

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Process Metrics
Financial Counselor
Bedside Visits: 1673
Patients who made a payment: 23%
Patients who declined to pay: 58%
Requests for a payment plan: 17%
Requests for financial assistance: 2%
January 1 – June 30, 2013
*With 2 financial counselors
23%
58%
17%
2%

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Process Metrics
•Average collection per patient
at the bedside$722
•Average collection per month
from these same patients after
insurance pays
$100k
•Financial Advocate: average payment
arrangements per month$350k

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Patient Satisfaction: Measuring the Impact
Did this new process give you a better billing experience than you’ve
had with us before OR with another hospital system?
•Yes86%
•No11%
•Not Sure3%

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Agenda

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Technology Solution Strategies
Bill Estimation
Automated POS
Collections
Online
Payment Portal
Patient Friendly
Statements
Increase
Collections
and Patient
Satisfaction

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Automated Insurance Verification

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Automated Bill Estimation

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Automated Bedside Collections

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Online Portal Enrollment and Pay Now

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Adding Pay Now
• Adding Pay without enrolling feature brought:
- 15% Drop in enrollment
- 23% Increase in patient portal payments
• Reflects growing alarm over online security
• Desire to keep personal information off-line
Pay Now

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Online Patient Portal/Enrolled Patient or Guarantor

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Pay by Account/Save CC Profiles

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Payment Plan Requests

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Printable Payment Coupon

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Online Provider Portal

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Provider Portal

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Patient View

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Account Details

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Processing Payments

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Processing Payments

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Processing Payments- Swipe Card and
Real-Time Alerts

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Re-enabling Account/Disable Email Notification

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Provider Portal Reports

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Provider Payment Report

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Online Portal Enrollments
22,254 Total Enrollments (May 2010-Nov 2014)
$10,334,106Collected

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Total Portal Collections
• $39,507,735 Total
• $8.4 million in the Last 12 Months
• Average Payments Per Month: $718,322
• Average Payment Amount: $200

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Online Portal Payments ̶̶ Since Go-Live May 2010
Pay Now
$7 Million
$18%
Enrolled
Patients
$10.3
Million
26%
WebPay
$22.2
Million
56%

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Patient Friendly Statements
Helping patients
understand what they owe
Clear and easy to read
Drive patients to online
account management
Targeted messages by financial class

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Thinking Ahead…

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Ramping Up Adoption

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Agenda

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Our Top 5 Best Practices
 Implement Solutions to Automate
Estimation/Eligibility/Presumptive Charity
 Implement a Patient Loyalty Program
 Implement/Optimize Patient Payment Portal
 Implement/Optimize Provider Payment Portal
 Automate All Patient Payment Cash Posting
P
P
P
P
P
Questions and Comments

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• Reduce A/R days
• Maximize claim and
remittance processing
efficiency
• Reduce claim errors
and denials
• Reduce Medicare
rejections by more
than 95%
• Reduce IT expense
• Increase revenue and
reduce bad debt
• Increase patient
satisfaction
• Decrease patient
phone calls
• Reduce postage expense
by 20-30%
• Improve patient
experience
RelayAccount™ RelayAssurance™ RelayAnalytics™
• Assess operational and
financial performance
• Increase financial visibility
• Isolate root cause of issues
• Accelerate positive
organizational change
Clears the path with patient
financial visibility to help:
Efficiently manage patient accounts
and make payments to help:
Assure the fastest route to
remittance to help:
Analyze opportunities to determine
action to help:
• Determine propensity
to pay
• Increase self-pay
collections and reduce
bad debt
• Improve work flow
efficiency and staff
productivity
• Identify patients eligible
for Medicare, Medicaid
and charity programs
Revenue Cycle Solution Leadership
RelayClearance™
Improve Registration QA and Patient
flow management to help:
• Increase patient
registration data
accuracy
• Reduce claim denials
and rework
• Monitor patient flow
throughout the visit
• Report on team
performance and
productivity
AhiQa and Ahi Lobby
End-to-End Revenue Cycle Solutions

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Thank You for Your Time and Attention!
Please contact us for further information or to request a
copy of this presentation
RelayHealth
800-752-4143
rhfinancial@relayhealth.com

945 dyke and mendenhall

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