HRS provides healthcare executive relationship services and solution assessments focused on improving the patient experience and addressing challenges caused by ACA mandates. There are several challenges impacting the patient-provider relationship, including patient experience metrics that impact reimbursement, an increasing number of uninsured patients, constraints on caregiver capacity, becoming a data-driven organization, delivering integrated care throughout the patient lifecycle, accurate ordering and revenue cycle management, quickly implementing ACA requirements, transitioning to a value-based and patient-centric model with price transparency, and accelerating accurate claims cycles. HRS' solutions aim to address these challenges through approaches like accelerated learning, virtual offices, data analytics platforms, communication and workflow solutions, performance management, and improving order accuracy

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HealthCare Relationship Services provides solution assessmentand healthcareexecutive relationship
development focused on the patient experience and care provider challenges caused by ACA mandates. Our edict
is takingbest in class customer experience / CEM models and resulting performance improvements into the realm
of patient experience management / PEM.
There are several challenges impactingthepatient – care provider relationship for your consideration:
Challenge 1: Patient Experience Metrics impact on revenue and quality outcomes.
Requirement: Outcome and quality based compensation rate adjustments require patient experience score
performance. This is known as CAHP scoring(HC = Hospital,CG = Caregiver, ED= Emergency Dept., HH=Home
Health). An organization mustrapidly and efficiently develop skills of each staff member from front officeto
physician and acrosstheentire organization of those who interact with the patient. Doing so efficiently is a
challenge.(faster, less costly,and more effective). This requires a well-designed method to train organizationson
improvingpatient experience metrics. There arealready many trainingdepartments and companies focused on
this requirement as itdirectly impacts compensation rates and patient satisfaction scores arepublished for all to
see in an ever more competitive environment.
Solution/Differentiation: An Accelerated Learning Dynamics (XLD) approach applies learningscience,human
factors,and automation in both the curriculum design and importantly how it is delivered to educate and train a
wide array of professionalsacrossa largeorganization very quickly. The core difference is providingitat the
individual'sstartinglevel of proficiency rather than one sizefits all. Itmust also be deployed across an entire
hospital staff ata fraction of typical trainingapproaches. Results areless cost,in less timeto deploy and maintain,
and improved CAHP scoring. Resourceutilization and theattention of highly skilled staff areexpensive and
distracting. XLD makes it easier,less time consuming,and less distractingto improve scores. Thought leading
Healthcareexecutives now work with an XLD approach and many more are signingup. Given revenue is tied to
periodically measured snapshotsof performance, ensuringstaff is prepared for high scores without negative
impacton resource utilization will provecritical for maximumrevenue capture and revenue loss mitigation.
Challenge 2: More Patients in an Insurance Gap. As the number of those without an ability to pay for services
while also ineligible for Medicaid increases, there will be a negative impact on provider revenue, universal
access, and the patient experience. This issue is due to grow as Federal subsidies drop across state exchange
early adopters.
Requirement: Greater access to care requires greater access to payment options. Programs designed to enable
patients with more options as they enroll for services can ensure an ability to pay at the point of orderingthe
servicerather than increasingbad receivables by way of a costly and often confusingreconciliation process. This
is especially truein states that have not expanded Medicaid and will growas the federal government reduces
current subsidies.
Solution/Differentiation: Cleveland Clinic established a patientconcierge programto providespecialistinsurance
acquisition services to patients at their pointof enrollment. This is done as an augmentation to the existing
enrollment procedures. When a patient presents and is ineligiblefor Medicaid or Medicare,the patient is guided
through selection and provisioningof insurance.This positively impacts revenue and can also improvepatient
experience scores by providingadditional capacity and expertisefor the hospitalsenrollmentstaff.
Note the University PittsburgMedical Center’s internally operated health insurancemodel. It is anticipated as a
resultof transformation mandates and greater industry consolidation,morehospital systems and a ffiliates will
work toward greater vertical integration with payers and suppliers.

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Challenge 3: Right Sizing Service Delivery Capacity as Patient Demand Grows, Caregiver Supply is Constrained,
and Compensation Drops
Requirement: IncreaseServices Delivery Capacity to a broader baseof patients utilizingexistingstaffinglevels,
optimizingresourceutilization,and providing caremore universally.
Solution/Differentiation: Virtual Officesolutionsenablecareproviders the ability to deliver more to more
patients while utilizingexistingresources. The caregiver (physician,nurse, or psychologist) gains theability to
deliver carein a face to face modality utilizingHIPAAcompliant communication and officefunctions.Note a key
differentiator is a solution which goes beyond video conferencing as a Virtual Officeintegrates office functions
within the solution.
Virtual Officetime and costsavings stemfrom accuratescheduling,mitigated waittime, and anytime/anywhere
delivery to a greater population compared to facilities based delivery. Best in classmodels augment the traditional
approach with the virtual officeoption. Rural facilities and overloaded physician groups arein a position to take
advantage of these solutions. Virtual officesolutionsgo beyond Tele-health by integrating office functions of
scheduling,payment, serviceordering,and patient followup workflow. In addition, Patient Experience scoringis
provingto be as good as if not better than on premises based experiences.
Virtual Officesolutions enablecareproviders theability to deliver more serviceto more patients with existing
resources. The caregiver gains the ability to deliver carein a face to face modality utilizingHIPAAcompliant
communication and most importantly integrated office functions.Note a key differentiator is a solution which goes
beyond video conferencing. A Virtual Officeintegrates officefunctions and workflow within the solution.
Challenge 4: Becoming a Data Driven Organization in a system with highly fragmented data architectures and
where the application of internal and external data is required.
Requirement: Rapidly and accurately assemble,analyze,interpret, and present internal and external data to
identify trends and understand root causes from which one can make quantitativebased decisions in a proactive
way.
Solution/Differentiation: InfraRed Big Data is an ecosystem of best in classdata assembly,analysis,and graphical
presentation solutions. Acore differentiator is the low cost and speed to answer it offers. Another difference is
the ability to work in conjunction with existinginternal data solutions while addingexternal data on which a full
analysis depends. These capabilities includeinternal and external data analysisaswell as omni -channel social
media sources analysis, simulation,and forecastingof trend impacts. Organizations which master the analysisand
application of data in any format and from any sourcewill bethe leaders in healthcaretransformation.
Challenge 5: Deliver Integrated Care throughout the Patient Life Cycle. This challenge will grow as more care is
provided after facilities discharge and delivered to off hospital premises clinics and patient homes.
Requirement: Deploy an ability to integrate the view and workflows of traditionally fragmented careprovider
teams with the patient. To do so an organization and its patients need a common, clear focus on patient status
and need a full lifecycleunderstandingof the patient relationship before,during, and after discharge.
To do so a provider needs a holistic,integrated careview of patient status atevery patient touch pointand for
every caregiver across thecare continuum and importantly must engage the patient as a partof the team. Full life
cyclecarerequires clearer understandingof patient status and the integration of off premises patient support
Solution/Differentiation: The solution provides communication and workflowsolutions focused on these
challenges. The coredifference is a patient-careprovider full lifecyclecommunication capability,an integrated
modules approach providingtheflexibility to deliver an integrated careview as a whole or incrementally acrossthe
careexperience in conjunction with existingsystems and processes. The modules address caregiver to patient
time management; integrated team care planningand delivery;dischargeinstruction; and postdischargefollowup
status monitoringwith patient, homecare professional,and family caregiver alerts and reminders.

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Challenge 6: Accurate Ordering and Revenue Cycle Management Flow-Through
Requirement: The ACA mandates and subsidized investment in electronic records capabilities and requires the
adoption of updated diagnostic codingused for classification,ordering,and invoicingfromICD-9-CM (circa1979
with 13,000 codes) to ICD-10-CM (circa 1999 with 68,000+ codes). Getting the order right the firsttime is critical.
Note a benchmark of quote to cash systems lawis: Bad ordering always = Bad Invoicing = Revenue leakage, Poor
DSO, Increased A/R, Reconciliation cost increase, & Negative customer experiences.
Solution/Differentiation: The ICD-10 compliancemandate though delayed is coming. The key to success in this
area is not in the technology as ICD-9 solution vendors arefollowingthe upgrade path. The difference will bein
organizational development and staff trainingfor proficientcoding atthe point of a clinical event. Also,simulation
platforms areavailableto predictthe level of operational impactatvarious levels of proficiency. Providers should
understand their exposure and plan for increased denials and revenue leakagedue to codingerrors as the changes
are implemented. Proficiency is also a key requirement for Challenge8.2 below: Accelerating Claims Cycles
Challenge 7: Implement ACA mandated and Competitive market transformation requirements quickly and
effectively throughout the organization.
Requirement: Align human capital expectation setting,performance measurement, and development with
organization strategy and mission across theentire chain of command.
Solution/Differentiation: Talent Management Inc.utilizes skillsetand job description research to accurately
define the characteristics required for job performance. It goes further than traditional performance
measurement solutions by linkingeach of these definitions to other roles in the organization as well as provides
performance improvement trainingcontent specifically designed for the role in question drivingperformance
toward the organization’s mission fromthe CEO to the front linestaff deliveringservices and interfacingwith
customers.
Challenge 8 .1: Transformation to a Value Based, Patient Centric Model with Price Transparency
Requirement. There are several other challenges and solution requirements caused by ACA mandates we are
analyzing with healthcareexecutives across thecountry. One is a keystone for the industry to achieve a patient
centric,value based system: PriceTransparency to the individual patientlevel.
The mandated publication of pricelistingacrossa menu of services is a start,yet it falls shortof providingan
understandingof pricefor a patient and the caregiver makingvaluebased decisions atthe point of ordering.
Knowing the priceis a lynchpin capability to make valueand quality outcome based decisions atthe patient –
caregiver level. Once this information is provided to the people who need itwhen they need it, there will be
positiveimpacton receivables performanceand reduce operational costs caused by re-work, redundant
reconciliation workflow,patientfrustration,caregiver frustration,and staff utilization spenton addressing an
avoidableissue.
Solution/Differentiation: There are multipleefforts underway to providea solution of providing pricedata to the
caregiver and the patient atthe time of diagnosisand orderingrather than waitingfor invoicing,reconciliation,and
collections to providethe patient an understandingof the cost of care. HRS is assessingthem now and believes
there will be a viablesolution only after those who control the data are required to provideit across thesupply
chain. This is nota technical issuerather a procedural and policy one. Recognizing this issue,several U.S. House
Bills mandatingfull pricetransparency havedied at the committee level, though this is likely to be a partof ACA
amendments in the coming Congress. Public and privateorganizationsworkingon the issueinclude:
Aetna/GoodRx; American Board of Internal Medicine/ Choosing Wisely; CA Health Care Foundation ; CastlightHealth; Catalystfor Payment
Reform; Clear Health Costs;ChangeHealthcare; Costs of Care; Councilfor Affordable Health Insurance ; EmergencyCare Research Institute ;
FAIR Health; HealthAdvocate/West; Healthcare Bluebook; Health CareCost Institute ; Health CareIncentives ImprovementInstitute; Health
Care FinancialManagementAssociation –PriceTransparency Task Force; Healthsparq; HealthinReach; Medlio; PockitDoc; United Healthcare.

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Challenge 8.2 Transformation to a Value Based, Patient Centric Model with Accurate, Accelerated Claim Cycles
Requirement. When takinga quote to cash systems and process view of the Patient Experience, one sees the
condition precedent and concurrent dependency between the accuracy and efficiency of each step of the proc ess.
The dependencies in each step of the process areso coupled the challengecan be considered challenge8.2 rather
than challenge9.
At a high level of process decomposition the functions are:
1. Service ChoiceConsideration / Quote
2. Service Selection / Order & Fufillment
3. Service Invoicing/ Claims & Reconciliation with Payers and/ or Patients
4. Service Payment / Collections & Cash
Upon this The Law of Quote to Cash is founded:
A Bad Quote = Bad Order = Bad Invoice= Bad Revenue Cycle& Bad CustomerExperiences.
Solution/Differentiation: Any solution designed to address Customer Experience and Revenue Cyclechallenges
must start with Accurate & Efficient Quoting& Ordering. Most often in Healthcare the Order is derived by care
provider diagnosisand recommendations to the patient. Unfortunately in the vastmajority of cases the patient
and care provider have limited awareness of the quote information needed to make a valuebased decision aka
PriceTransparency addingto downstream inefficiency as described in challenge8.1. Until true PriceTransparency
is availablewhatcan one do? One answer is to get the Order rightbefore kickingoff the claim& invoicingprocess.
The Order creation process begins by careprovider clinical assessmentand is set for invoicingby the selection of
the associated codes (ICD 9 / ICD 10) for claimsubmission to the payer. Given the Law of Quote to Cash,the
accuracy of this Order is critical for all downstreamprocesses and experiences thereby deriving exponential benefit
by getting the Order right the firsttime. There are several solutionsattempting to address this issuewith the aim
of reducing the amount of time and effort required to enter data while increasingthe accuracy of the order which
has proved to be a zero sum approach and thereby a solution constraintas volumedemands ri se. These include
premises based physician assistantscribes who record and enter the data manually,outsourced transcription
serviceproviders,and attempts at automation with speech to text technology. Some EMR vendors and a handful
of point solution vendors haverecognized this challengeand are extending their functionality to address the Order
accuracy issue. These includeproactive,issueprevention solutions which enabledress rehearsal claims testing
and error correction prior to submission thus improving denial events,reconciliation cycles,and collection
intervals.Providers should consider conductinga total costof quote to cash process error analysis asa way to
quantify the issueand raiseOrder accuracy capabilities as a priority for their EMR solution roadmaps.