The document summarizes a presentation by Phoenix Medical Management, a consulting firm that designs and implements hospital case management programs. The presentation discusses Phoenix's services and methodology, best practice principles for case management, and expected outcomes of their engagement. Phoenix aims to clearly define roles, improve productivity and outcomes, and reduce costs through their collaborative approach.

1. The Hospital Case Management Company 1401 S Ocean Blvd Suite 402 Pompano Beach, FL 33062 www.phoenixmed.net 1.888.671.6505 Celebrating almost 15 Years of Service to Hospital Case Managers PHOENIX Medical Management, Inc.

2. TODAY’S AGENDA Phoenix overview Strategy session Best practice case management principles for sustainable success Deliverables Questions © Phoenix Medical Management, Inc. Slide

3. © Phoenix Medical Management, Inc. Slide WHO WE ARE… Phoenix Medical Management, Inc. A national consulting firm exclusively dedicated to the design, implementation and management of hospital-based case management programs. In business since 1994 with continuous financial strength and stability through quality business management Innovators of Case Management University featuring a broad selection of on-site educational programs for case managers, medical staff, Board of Directors, & hospital associates A team of experienced consultants and associates with executive and firing-line experience in hospitals

4. © Phoenix Medical Management, Inc. Slide CORPORATE CAPABILITIES… Recognized leader in the field of Hospital Case Management. Range of clients from large teaching facilities to small rural community hospitals coast to coast. Variety of engagements from enterprise-wide transformation to one-day on-site workshops . We wrote the book, the only book, on hospital case management

5. © Phoenix Medical Management, Inc. Slide OUR PHILOSOPHY OF BUSINESS… Greater results are achieved through collaboration Service excellence through people, processes and information enable us to exceed client expectations We seek to evolve with our customers by understanding their needs over time Our goal is to become a strategic partner not a vendor of consulting services

6. WHAT WE DO… …work with you to: Define intent of future program Design a responsive infrastructure Develop an operating plan Identify priorities and timelines Facilitate execution of your plan Educate case management staff Support hospital wide preparation for ‘go-live’ Mentor, reinforce, and strengthen performance expectations © Phoenix Medical Management, Inc. Slide

7. HOW WE DO IT…methodology: 1. GET EVERYONE ON THE SAME PAGE Convene hospital and medical leadership to present components of hospital case management, to promote understanding of basic principles, and to secure consensus that the basic principles are in harmony with organization’s vision, goals and values. 2. ORGANIZATIONAL ASSESSMENT/READINESS EVALUATION Interviews, focus groups, observations and review of performance outcome reports © Phoenix Medical Management, Inc. Slide

8. HOW WE DO IT…methodology: 3. PRELIMINARY PLAN/RECOMMENDATIONS Based on assessment and serves as basic foundation for the design of a strategic plan 4. IMPLEMENTATION PLAN Collaborative endeavor with design team to identify and prioritize design elements 5. EXECUTION, EDUCATION AND TRAINING Hospital wide preparation and case manager orientation © Phoenix Medical Management, Inc. Slide

9. EXPECTED OUTCOMES © Phoenix Medical Management, Inc. Slide Clearer lines of communication and role definitions More satisfied workforce with greater productivity Reduced consumption of clinical resources Lower severity adjusted costs per case Improved operating margins Effective progression-of-care Improved patient through-put Reduced length-of-stay Higher CMI per physician Reduction of payer denials

10. Strategy session © Phoenix Medical Management, Inc. Slide

11. BUILDING AN ENTERPRISE-WIDE VISION OF HOSPITAL CASE MANAGEMENT What organizational values/goals are driving this engagement? What was the intent of the current hospital case management program? What are the strengths and weaknesses of the current program? What is your vision of a reinvented case management program? What outcomes do you anticipate using to evaluate the “goodness” of what the hospital case management program achieves? © Phoenix Medical Management, Inc. Slide

12. Best practice principles, concepts and assumptions © Phoenix Medical Management, Inc. Slide

13. JUST WHAT IS CASE MANAGEMENT ANYWAY? Acute care case management is a dynamic and collaborative practice of business, interpersonal, and clinical strategies which, when successfully applied, effects more efficient delivery of care, reduces variation in the consumption of clinical resources, and produces improvements in clinical and financial outcomes. © Phoenix Medical Management, Inc. Slide

14. Continued decreases in reimbursement Value Based Purchasing POA/HACs RACs and the MACs Grassley proposal: Community benefit or taxes Medical Staff Relationships H-CAHPS Regulatory Compliance Public Reporting, Transparency & Value © Phoenix Medical Management, Inc. Slide CHALLENGES DRIVING THE EVOLUTION OF HOSPITAL CASE MANAGEMENT

15. IN THE RECENT PAST…. Hospital case management practice defined by tasks to be done: Chart review for Utilization review Audits for Performance/Safety/Core Measures Documentation Improvement initiatives Post acute placement plan Complete arrangements to implement DCP ‘ Hunting, phoning, forming faxing, filing’

16. TODAY…. Practice is defined by goals to be achieved: Appropriate level of care Improved patient navigation Improve delivery of care processes Orchestrate team support for safety and quality Promote swift and safe transition Influence responsible use of resources Reduce risk, fragmentation and inefficiencies Advocate for stakeholders Case managers today manage Margin and Mission

17. BEST PRACTICE BUILDING BLOCKS: 1. Case management spans the entire episode of acute care….and beyond © Phoenix Medical Management, Inc. Slide ACCESS PROGRESSION OF CARE DISPOSITION Gatekeeping processes: ED/Direct admits/Transfers Bed tracking and mgmt w/ regionalization Central scheduling w/ decision trees for correct placement Admission & discharge criteria for specialty units Observation patients (CDU); SPU patients; etc. Care Mgmt >Patient throughput Care coordination EBM protocols Critical care/Telemetry criteria Safety and quality compliance System obstacles Practice behaviors Discharge or transition: Early and ongoing post acute evaluation Expectation mgmt Resource center support Transition to LOC Patient and family readiness

18. BEST PRACTICE BUILDING BLOCKS: 2. “ The avoidable day is the most expensive item commonly provided by a hospital” © Phoenix Medical Management, Inc. Slide

19. BEST PRACTICE BUILDING BLOCKS: 3. “Every process is perfectly designed to achieve exactly the results it gets” © Phoenix Medical Management, Inc. Slide

20. BEST PRACTICE BUILDING BLOCKS: 4. Prospective resource management prevents unwanted events from occurring in the first place © Phoenix Medical Management, Inc. Slide

21. BEST PRACTICE BUILDING BLOCKS: 5 . “When doctors are provided an opportunity to understand their own data and its relevance to benchmarks, these innately competitive professionals actually relish the chance to improve.” © Phoenix Medical Management, Inc. Slide

22. BEST PRACTICE BUILDING BLOCKS: 5. LOS and operating margin are products of system barriers and physician practice decisions © Phoenix Medical Management, Inc. Slide Dr. Smith Dr. Brown MS-DRG 179 Respiratory Infection without CC/MCC MSDRG 179 Respiratory Infection without CC/MCC Relative Weight GMLOS Actual LOS Charges Cost [40% C:CR] Reimbursement Margin 1.2754 4.36 5.4 $15,000 $6,000 $6,377 $377 1.2754 4.36 4.8 $20,500 $8,200 $6,377 ($1,823)

23. BEST PRACTICE BUILDING BLOCKS: 6. The case manager works in partnership with the physician at the point-of-service to influence practice decisions. © Phoenix Medical Management, Inc. Slide

24. BEST PRACTICE BUILDING BLOCKS: 7. Support activities are best delegated to trained support staff © Phoenix Medical Management, Inc. Slide

25. BEST PRACTICE BUILDING BLOCKS: 8. The case manager is often the only consistent resource for the physician and the patient © Phoenix Medical Management, Inc. Slide The patient Navigator!

26. BEST PRACTICE BUILDING BLOCKS: 9. “ The idealistic model of caring only about the patient is gone. Case managers are forced to prove their value with numbers not feelings.” © Phoenix Medical Management, Inc. Slide Objective Indicator Source Goal Cost reduction Severity adjusted cost per case Targeted MS-DRGs from Solucient 5% reduction in costs/case Customer Satisfaction Satisfaction with CM interventions Post-acute phone surveys > % satisfaction rate Resource Utilization Pneumonia Days in ICU Canopy < 1 day in ICU Post acute services ED visits by chronic CHF patients Monthly readmission stats < frequency of ED visits Margin Revenue Actual reimbursement vs. actual costs for targeted physicians < financial losses - Gap between revenue & costs

27. BEST PRACTICE BUILDING BLOCKS: 10. Advocacy is the hospital case manager’s primary ethical obligation. © Phoenix Medical Management, Inc. Slide Seekers of continuity in a field noted for fragmentation

28. DELIVERABLES Organization assessment Campus visits Corporate transition team Preliminary vision of structure and operations Will incorporate today’s expressions with the organizational culture and practice environments Realistic and achievable recommendations Practical implementation plan Priorities and timelines Preparations Case management teams, hospital associates and medical staff © Phoenix Medical Management, Inc. Slide

29. CRITICAL SUCCESS FACTORS Support of senior management and medical leadership Active two-way communication Clear goals and measurement of progress Commitment to provide adequate resources Understanding internal readiness & barriers A culture that includes accountability © Phoenix Medical Management, Inc. Slide

30. “ An invasion of armies can be resisted, but not an idea whose time has come” Victor Hugo, 1852 © Phoenix Medical Management, Inc. Slide