Children's Hospital Colorado - RAVE Project Overview

3. About Children’s Hospital Colorado • Private, not-for-profit pediatric healthcare network • Obtained Magnet status in 2006 • In addition to one main campus facility • 2 hospital locations within community hospitals • 2 urgent care sites • 1 urgent care site within another hospital • 1 free standing surgery center • 9 satellite specialty care centers • Level I trauma center • Maternal fetal medicine program opened in March 2011 • Ranked among top 10 children’s hospitals for over a decade • Statistics • 318 licensed beds • 517,873 outpatient clinic visits (2011) • Celebrating over 100 years of commitment to pediatric care!

4. What is RAVE? R- Referral A- Authorization V-Verification E-Eligibility

5. Structure of Patient Access • Prior to RAVE go-live • Patient access included: • Admissions (Main and ED) • Financial Counseling • IV staff (6 FTE) • Inpatient, Ambulatory Surgery, and Observation patient populations • Both scheduled and non-scheduled cases • Function as a safety net • Accounts worked via Ontrac tool

6. Elements in Space

7. Org Chart Pre RAVE

8. Scattered Across the Universe • Where did everyone live??? • Outpatient clinics • Each reported to outpatient floor specific manager • Team included scheduling, check-in/out, IV staff • Worked floor specific accounts • Administrative Pavilion • In charge of obtaining authorizations for range of procedures • Radiology procedure authorizations • Radiology required authorization prior to scheduling • Surgical initiation • Cardiac DME • Infusions • Network of Care locations

9. Planet Deficiencies • Processes were sub-par workflows • No dedicated back-up for these staff members • No dedicated management structure for IV staff

10. As the Planets Start to Align… • Concept born 4 years prior • VP of Ambulatory Services • VP of Finance • PFS • PAS • Managed Care

11. Project Goal Statement • Goal Statement The goal of centralization is to reduce the overall number of patient eligibility, no referral/authorization, non-covered services, late/no notification, wrong insurance billed and medically necessary denials The Children’s Hospital receives, and better align resources, training, education, and information to a single point of accountability within the organization.

12. Project Objectives • Increase secured at admit rate across the organization to exceed 95% by the time the patient arrives for their scheduled appointment or admission. Currently, this rate is at 90% (per 4-week average as reported on week ending 8/27/10 IV Summary) • Maintain staff productivity to consistently work 45 accounts per day per rep. Currently, this rate is at 50 across the organization (per weekly productivity rate week ending 8/27/10).   • Increase ‘days out’ in authorization rate (per 4-week average as reported on week ending 8/27/10 IV Summary): • Goal: 0-3 days = 99% 4 days = 95% 5 days = 90%.   • Reduce overall denied dollars and final write offs by 50%.

13. The Jurassic Age….

14. Early Phases • On-boarding outpatient clinics to Ontrac (2008-2010) • Rolled out in phases • Over 2 years • Main campus and network locations • On-going meetings with management (2008-2010) • To discuss centralization of IV

15. Early Phases continued • HR Meetings (Oct 2010) • Employee transfer • Job descriptions • Reporting Structure • Career Ladder • Promotion Ladder Insurance Verification.doc • Work from home model • Ongoing Management Meetings (Oct 2010)

16. Early Phases continued • Blending the “Families” • Monthly PSC meetings (Oct 2010) • HR Involvement • Communication Tool for staff • SBI (Situation, Behavior and Impact) Training • Team life cycle (Forming, Storming, Norming, Performing) • Team building • Learning process flows • Naming department • Committee creation • Management Structure • IT Resources

17. Neanderthal Stage “How centralize IV, Gorg want know”

18. RAVE go-live structure

19. Our New Home… Me too! Gorg like!

20. RAVE Begins • Go live 4/6/11 (27 employees) (Phase 1) • Gained Efficiencies • Merging worklist • Cross training • High Volume • High Dollar • Radiology Auth • Scheduling prior to authorization allowed • Back-filling for absences • Installed robust QR process • “Working Smarter not Harder” • Electronic Eligibility Verification Restructure • Creation of iRAVE (NOT TO BE CONFUSED WITH RAVE!!)

21. iRAVE (NOT TO BE CONFUSED WITH RAVE!!!) • What is iRAVE? • Online resource • Insurance reference • Available to all staff • Documents payer specific requirements

22. iRAVE continued

23. iRAVE continued

24. What is iRAVE not to be confused with? • A prize winning pony • A planet • Gorg • RAVE

25. The Next Planned Phases • Phase 2 – July 2011 (OT/PT, 3 FTE’s) • Phase 3 – August 2011 (Psych/CDU, ST, 4 FTE’s) Why did we stagger these?

26. Growth • Expanding RAVE scope

27. Maintaining Communication • Employees bringing issues they otherwise would not have • Now employees have a ‘voice’ • Monthly meetings with clinic management • Close working relationship with Patient Financial Services • Work to decrease denials

28. Current state (36 FTE) • Restructure of Radiology authorization workflow • Upgrade of Epic EMR for how workflow viewed • Allows for better reporting • Continued work to document process flows • Team and workflow specific • Anticipating efficiencies • Network of Care site addition to centralization • Medicaid PAR’s for Radiology services • Promotion of two employees to Rep III status • Multiple duties • Modular training

29. Current state RAVE structure

30. The Jetson’s Era

31. Future State • Move from safety net to initiation • For Inpatient, Amb Surg & Obs cases • Benchmark our existing pilot person from Orthopedics • Standardizing Psych processes • Adding more clinics • Create a RAVE services ‘Application process’ • Service level agreement • Creation of Registration Accuracy Task Force

32. Carbon Dating

33. So How Did We Do? Secure at Admit Pre RAVE= 90% GOAL= 95% Actual 2011 EOY= 94% Staff Productivity Pre RAVE =50 accts per day Goal= Maintain 45 acct per day Actual 2011 EOY= 68 accts per day Write-offs for No Authorization Goal= Decrease by 50% Actual 2011 EOY= Increase by 235%

34. So How Did We Do? Continued… Increase “Days Out” Pre RAVE= 0-3 days = 81% 4 days = 60% 5 days = 41%. Goal= 0-3 days = 99% 4 days = 95% 5 days = 90% Actual 2011 EOY= 0-3 days = 94% 4 days = 75% 5 days = 60%

35. More Data…… • Quality Reviews • Diligent monthly QR Process • Increased Team Average from 2.68 to 2.9 (out of 3) • Dashboard – SAVE RECENT COPY

36. Lessons Learned • Employee Satisfaction • Dynamics of a large department • What exactly are we taking on? • Responsibilities transferred with employees • Some tasks are out of scope of Insurance Verification Rep level • Roles and Responsibilities – Saw a need once RAVE went live. • Cleaner registrations • Clearly defined roles • Work From Home • Re-evaluate current structure to help maintain relationships

37. Contact Information Tobi Knight – 720-777-5688 Tobi.Knight@ChildrensColorado.org Berj Ermoyan – 720-777-5690 Berj.Ermoyan@ChildrensColorado.org

38. Questions?