Prepare For Health Reform With Revenue Cycle Management

1. Achieving Revenue Cycle ExcellenceTo Prepare for Health Reform Jim Morrison, VP and General Manager Revenue Cycle Solutions, McKesson

2. Agenda

3. Healthcare Reform:The Environment • Healthcare reform legislation set things moving. • The next steps are less clear …

4. Audience Survey Which of the areas listed below is your organization most prepared to address? • Accountable care/shared savings strategy • Value-based purchasing • Readmissions and hospital-acquired conditions • Bundled payments • Strategy to address newly insured patient populations

5. HFMA ANI 2011 Conference Survey Please indicate your organization’s preparedness to address the areas listed below. Sample size = 84

6. Four Building Blocks of ACOs Care Management Connectivity, Engagement, Medical Home • Leverage evidence based decisions in delivering programmatic care • Support integrated/holistic approach to managing patients across the continuum of care • Support integrated workflow in managing cost/quality • Actively engage patients in their care process • Provide patients with access to their pertinent information • Enable care coordination and connectivity • Enable a range of personal health management and health information tools Payment Mechanics Analytics • Manage multiple payment models at the POC including traditional FFS • Leverage analytics to define/ support care bundles and prepare for bundled payments • Tools to manage contracts and payment distribution logic • Stratify populations for management. • Identity opportunities to manage cost and quality • Report and act up care gaps • Understand and optimize provider performance • Support internal/external reporting demands PCMH ACO

7. ACO Strategic Competencies Care Management Connectivity, Engagement, Medical Home • Connectivity • Interoperability • Data Exchange • Care Coordination • Communication • Messaging • Notifications • Results • Referrals / Orders • Engagement • PHR • Multi Modal Comm. • Education • Online Programs • Decision Support • Marketing • Transformational Services • Holistic Management • UM / DM / CM • ID & Stratification • Medical Necessity • Decision Support • Readmission Mgmt. • EBM • Assessments • Care Plans • Care Guidelines • Education • Campaign Mgmt • Payment Mechanics Analytics • Performance Analytics • Operational Efficiency • Service Line Analysis • Cost Trend • Population Analytics • ID & Stratification • Care Gaps • Intervention Outreach • Network Analytics • Cost & Quality • PMPM Spend • Efficiency Profiles • Attribution Logic • Benchmarking • Incentive Modeling • Outcomes Reporting • HEDIS. NQF, PQRI, IQR • Financial Management • Eligibility • Medical Necessity • Auto-authorization • Payment Mechanics • Contract Repository • Medical Policy • Payment Policy • Distribution Logic PCMH ACO

8. Bundled PaymentRequired Capabilities Clinical & Claims Data EpisodeRegistration Evidenced-Based Guidelines Analytics Engine Care Management Tools Efficiency Profiles Distribution Logic

9. Bundles PaymentsSuccess Requirements • Analytics • Advanced Tools • Operational analytics to identify service line opportunities • Network analytics to determine and track provider efficiency in support of bundled contracts • Analytics to track associated claims activity • Utilization management tools to reduce variation in resources supporting bundled payment • Integrated analysis of operational & network performance against contracts • Care management tools to ensure integrity of bundle • Tools to register and trigger bundle • Payment distribution logic

10. Healthcare ReformWhat’s Next? • The world will include a mixed environment: Capitation/fee for service, risk sharing • The world will be a heterogeneous one: Medical homes, legacy systems and significant investments, clinics, labs, doctors’ offices, unique payer relationships, unique employer relationships, consumer driven healthcare, regulatory reform, analytics to drive down cost, population management, increased demands and shrinking reimbursement … all coming by 2014

11. Healthcare ReformWhat’sNext? • Population Management • Changes in Care Settings • Analytics supporting the ID and risk-adjusted stratification of a population of patients • Integrated analysis of clinical and claims data • Tools to intervene to address gaps in care • Reporting tools to define and report on metrics • Profiling tools to assess provider efficiency and optimize performance • Hospitals expanding footprint to non-traditional settings • Connectivity between all care settings – clinical & financial – is essential

12. Agenda

13. Provider ImpactThe Changing Landscape • Reduced Reimbursement • Payment Reform & Evolution • Quality Improvement • Fee-for-service payments cut • Commercial payers driving to Medicare levels • Pay for performance • Bundled payments • Capitation • Shared savings • Pay for performance • Public reporting measures • Meaningful use • Enterprise care management ICD-10 Transition

14. Agenda

15. Audience Survey • Are you talking with any of your payers about how the health reform changes will affect your relationship? • Yes, we’re meeting regularly • Yes, we’re in the early stages of discussion • No, but we have plans to meet • No, with no plans to meet

16. Enhancing Payer Relations • Holistic view of the patient • Match clinical & claims data • Reduce administrative costs with automation • Regular educational updates from payers • Collaboration & Information Sharing • 5010 allows more information sharing between provider and payer • Cleaner claims results in fewer denials • Collaborate with your payers on contract reviews prior to ICD-10 transition • 5010 & ICD-10 Transition Advantages

17. Agenda

18. Reimbursement ManagementComplexities and Mechanics • Disparate information management systems • Provider-based Physicians • Analytics to understand performance Contracting and Understanding Cost • Medicare 72-hour window • Underpayment management • Acute and Ambulatory billing integration • Case Management/Length of stay control • Single source to track and manage patients • Historical view of payments • Cost of care, quality of care, spend per-member per-patient • Provider efficiency • Benchmarking & Incentive Modeling • Reporting to regulatory bodies

19. Agenda

20. Driving Out CostsStrategies and Opportunities • Big focus on clinical IT comes from ARRA • Strengthen your revenue cycle processes by using your IT system to the full extent • Process flow improvements • Organizational changes and improvements • Technology plan to improve results • Optimize to drive to the best practice for each area • Reduce total cost of ownership for IT

21. Audience Survey • What process do you use today to confirm patient identity? • Photo ID • Photo ID and insurance card • Biometrics • Other

22. Driving Out Costs Patient Identification Management • Medical Identity Theft is one of the fastest growing crimes in the U.S. • An estimated 1.4 million adults, approximately 5.8% of the U.S population, were victims of medical identity theft in 2009. • Biometrics identity confirmation can ensure the right patient receives the right care * According to the National Survey on Medical Identity Theft prepared by Ponemon Institute in 2010

23. Agenda

24. Audience Survey • What are your current net accounts receivable days? •  40 days • 41 – 45 days • 46 – 50 days • 51 – 55 days •  56 days

25. Case Study Mississippi Baptist Health System • Staff education on IT and processes • HIS table updates to align with best practices • Process improvement for point of service collections

26. Audience Survey • What is your average time for patient registration to be completed? •  10 minutes • 11-15 minutes •  16 minutes

27. Case Study Spartanburg Regional Medical Center • Streamlined insurance master tables • Established electronic remittance advice for each payer • Standardized graphical user interface for registration staff

28. Agenda

29. What’s Next?Managing Populations and Risk Under Health Reform Connectivity & Engagement • Interoperability with identity management • Patient communication • Engagement Model Care Management • Cross-continuum, patient centric care plan • Quality and Evidence • Holistic disease management Care Management • Cross-continuum, patient centric care plan • Quality and Evidence • Holistic disease management Financial Management • Eligibility • Payment mechanics • Disbursement Management Connectivity & Engagement • Interoperability with identity management • Patient communication • Engagement Model Analytics / Data Aggregation • Performance evaluation • Population analysis • Network analysis • Outcomes reporting Analytics / Data Aggregation • Performance evaluation • Population analysis • Network analysis • Outcomes reporting Financial Management • Eligibility • Payment mechanics • Disbursement Management

30. What’s Next?Managing Populations and Risk Under Health Reform Connectivity & Engagement • Interoperability with identity management • Patient communication • Engagement Model Care Management • Cross-continuum, patient centric care plan • Quality and Evidence • Holistic disease management Analytics / Data Aggregation • Performance evaluation • Population analysis • Network analysis • Outcomes reporting Financial Management • Eligibility • Payment mechanics • Disbursement Management

31. Extra Resources sites.mckesson.com/AchieveHIT/reform.asp More Information on Revenue Cycle Management

32. Questions