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.

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