Building an Automated Financial Clearance Process

1. Building an Automated Financial Clearance Process Niobis Queiro, MBA Corporate Vice President, Revenue Cycle Hartford HealthCare Corporation Hartford, CT

2. Hartford HealthCare • 4 hospital system serving 63 towns in Connecticut • 75,711 inpatient visits per year • 2 Million outpatient and homecare visits a year • 280,000 ED patients per year • 60% of all behavioral health visits in the state of CT • $52 million in charity care FY 2011 • $14 million invested in research • 15,000 Employees • 2,100 Physicians • $2.0B Total Revenue

3. Current Issues Facing Healthcare Industry • Hospitals will Never Be Paid as Well as They are Today • Losing 7.2% on Medicare Cases, losing 14% on Medicaid* • Medicare Reimbursement rates declining** • Increasing Medicare & Medicaid population • Increasing high deductable plans and bad debt • Fee for Serviceversus Fee for Value • Rewards chasing revenue, not margin/quality • Capitation payment encourages less volume • Evidence Based Care Plans are needed • Care Delivered in Silos • Physicians, hospitals, providers and plans not aligned (incentives) • Coordination lacking inside/outside walls of hospital • EMR Adoption/MU requires new processes** • Data is housed in silos • Chronic Disease Patient Volume Increasing • Rapid increase in patients with multiple chronic diseases (CHF, COPD, Diabetes); 133M Americans have a chronic disease*** • 5% patients = 55% of admissions, care at Medicare rates • Health Plans shift risk to provider. Bundled care, ACO *Source:Modern HC 6-29-09, pg 16 MEDPAC . FierceHealthFinance, 12-15-09 **ObamaCare Impact this for Primary care Physicians. 1 – Appropriate Tort Reform when practice pattern reflects standard. ***CDC 2005 Chronic Disease Prevention and Health Promotion Report.

4. Traditional Operating Models Will Fail UnderThe Complexities of Healthcare Reform • Short term: • Increased access to care • New shared reimbursed at government rates • Outcome risk • Reduced operating margins • On the horizon: • ICD-10 • Outcomes Performance • Clinical integration • IT interoperability • ACO investments • Next generation gain sharing • Bundled payments Greater Access – Reduced Reimbursement – Growing Operational Complexity

5. Patient Access: The Root of Much Evil • Percent of data needed for billing originates at registration: 70% • National average registration error rate: 46% • Percent of denials that could be prevented at registration: >50% Sources: Patient Access Resource Center: HCPro Quarterly Benchmarking Report 12/10, Healthcare Informatics Research Series Data, NAHAM, Modern Healthcare

6. Cash Collection Curve

7. Hartford HealthCare Project Goals • Create an Optimal Patient Experience that Makes HHC the Provider of Choice • Create and Automate a Data Rich Financial Clearance Process • Produce Patient Liability Estimates for Transparency • Improve POS Cash Collections • Centralize Scheduling • Real-time Quality Assurance to empower the end-user • Enable Field Level Registration Edits • Link patient Access Errors to Denials and A/R Liquidation • Provide structure around E&B and Authorizations • Establish a Partnership with all HHC providers and assets

8. Hartford HealthCare: Flashback 18 months • No patient access standardization • Variable financial clearance process • No centralized scheduling • No patient liability estimates • < $1M/Yr in POS cash collections • No registration quality edits • No link between access & denials • IT patchwork across 4 hospitals

9. Address • Validation 201 Current state:Hartford HealthCare Patient Access • ATB Data • Centralized Scheduling • ADT Feed • Eligibility & Benefit Verification • Automated Financial Clearance Workflow Platform • Reg • Integrity • Prior Auth • (pilot) • Medical Necessity • Patient Funding w/ Via Note • (pilot) • Patient Estimates HCIT Integration Reporting & Metrics Post Go-Live

10. Point of Service Patient Liability Estimates

11. Linking Patient Access Errors to Denials 12% 20%

12. Hartford HealthCare KPIs

13. Joys of the Open Road

14. Joys of the Open Road • Employee Engagement • HHC offers employees access to Local Community College • HHC covers tuition and salary for Wednesday afternoon coursework • Clear career path and education boost employee morale • HHC maintains a 99% employee retention rate • Team Building Exercises • Rewards For Outstanding Performance

15. Lessons From The Road

16. Lessons from the Road • Appraise organizational readiness • Finance will likely want to run faster than departments • Provide training to physicians and nursing staff • Communicate early and often with hospital leadership (CEO/CFO) • Appraise Financial Clearance Staff • Some personality types are not suited to ask for payments • Be aware of HR challenges • 9 Benefits Packages • 4 Compensation Models • Union job descriptions • Employee transfer requires new employee paperwork • HHC full homogenization by 2013

18. Leadership Behaviors • Be In The Moment • Be Authentic & Humanistic • Volunteer Discretionary Effort Constantly • Model High Performance-Desired Behaviors that Drive Desired Results • Respect & Leverage Separate Realities • Be Curious vs. Judgmental • Look in the Mirror First – Be Accountable • Have Courageous Conversations • Provide Timely, Clear & Specific Performance Expectations & Feedback • Teach, Coach & Mentor - Spend at Least Half of Your Time Developing Others

19. Questions to Ask Yourself Everyday • What more can I do right now to be a role model for those around me? • What more can I do right now to achieve the outcome we desire? • What more can I do right now to prevent something undesired from occurring? • What expectations or feedback can I deliver right now to make a positive difference? • What more can I do right now to seek or provide the clarity that I think does not exist? • What more can I do right now to make this meeting more productive? • When some outcome has not met my expectations, ask, “How did I contribute to that?” and “What more will I do next time to make it successful?”

20. A journey of a thousand miles begins with a single step. • Lau-Tuz, Chinese philosopher (604 BC - 531 BC)