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Awakening the Sleeping Giant: Technology and Patient Access

Discover how technology can revolutionize patient access by increasing effectiveness, visibility, and efficiency. Learn how to adapt to the changing healthcare landscape and drive positive change.

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Awakening the Sleeping Giant: Technology and Patient Access

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  1. Awakening the Sleeping GiantHow Technology will Elevate the Effectiveness and Visibility of Patient Access Paul Shorrosh, MSW, MBA, CHAM Founder & CEO, AccuReg Patient Access Solutions NAHAM Board Member and Southeast Regional Delegate

  2. Ever feel like this in Patient Access?

  3. Time to Wake Up!…to our potential

  4. Change Drivers • Increased patient responsibility • 48 million uninsured • More Medicaid-eligible population than ever • 2-4% avg US hospital operating margin • 30% of hospitals with <0% operating margins • ACO’s and VPB (Value Based Purchasing) • Complexity of registration and billing = more required of Patient Access?

  5. What More Might We Do? • Order/Referral Mgmt • Demographic Verification • Insurance Verification • Medical Necessity • Service Authorizations • Quality Assurance • Price Transparency • Payment Estimation • Collect current & past due balances • Financial Clearance • Credit & Payment History • Charity or Medicaid • Discounts & Pmt Plans …At POS and Pre-Arrival

  6. Multi-Step Process

  7. Specialization

  8. Centralized/System Approach

  9. Evolution of Quality Assurance • QA Central HUB • Insurance Verification • Address/ID Verification Payment Estimation & Collection Service Authorization • Medical Necessity • Financial Assistance Qualification & Clearance • Price Transparency • Comprehensive Reporting • SaaS & Mobile Devices • Auto QA, Management & Education Tools • Training • Testing • Scoring • Immediate Coaching & Guidance • Auto QA & Management Tools • Productivity • Accuracy • Performance • Volume Staffing • Wait/Reg Times • Automated QA • 1% in 2005 • 19% in 2008 • 35% in 2011 • Manual QADifficultIneffectiveCostly

  10. Person-Centered QA Environment • Identity Verification • Payment Estimation & Collection Demonstrated Value of Work Key Performance Indicators and Best Practices Continuous Coaching & Training Education & Testing s Accountability to Standards Performance Metrics & Reporting dddddddddd Trusted Reminder System • Financial Assistance Qualification Quality Assurance Queue • Address Verification Real-Time Interaction Intelligent Alerts • Medical Necessity • Insurance Verification • Service Auth/Cert

  11. Exhibit A: Insurance VerificationShift from Analysis to Resolution • Initiate Request • Open Response • Read Response • Find Relevant Info • Interpret Relevant Info • Identify Variances • Correct Variances • Verification Rate KPI • Initiate Request • Open Response • Read Response • Find Relevant Info • Interpret Relevant Info • Identify Variances • Correct Variances • Resolution Rate KPI

  12. Exhibit B: Pre-RegistrationShift from Activation to Completion Past Pre-Reg Process: Future Pre-Reg Process: Account activation ID & Address Verification Insurance Verification Authorizations Medical Necessity Payment Estimate/Collect Pre-qual for Fin Assist Payment plan setup Quality Assurance Pre-Reg Completion Rate KPI? • Account activation • Pre-reg to scheduled rate KPI?

  13. How will we make this shift? Source: Multitasking Makes us Stupid, CPU Blog March 22, 2006 http://headrush.typepad.com/creating_passionate_users/2006/03/multitasking_ma.html

  14. Multi-tasking Tools? Well, sure! But… the real change we must drive is not to do more work, but to do different work

  15. Working Different Requires Patient Access Technology that will: • Keep pace with growing complexity & duties • Multitask, audit and distill for user action • Automate, centralize, standardize & interact • Serve, educate and empower the person • Enforce behavioral change (issues resolved) • Demonstrate value: • Increased duties • Improved quality • Revenue cycle results

  16. NAHAM Initiatives • Registration Components and Time Estimates • FTE Calculator • Develop Key Performance Indicators • For Patient Access Processes • Result-focused vs activity-focused • Comparison to peers • Correlate to back-end metrics to prove value • Identify and Publish Best Practices

  17. We can do this. Patient Access Leaders

  18. It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.Charles DarwinSurvivors adapt to change… Leaders drive change! Paul Shorrosh paul@accuregsoftware.com 251-338-3443

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