Marti Strand, CRO Allegheny Health Network

Transcription

1 Marti Strand, CRO Allegheny Health Network

2 About Us The Network is comprised of 8 Hospitals: Allegheny General Hospital Allegheny Valley Hospital Canonsburg Hospital Forbes Hospital Jefferson Hospital St. Vincent Hospital West Penn Hospital WHO WE ARE Westfield Memorial Hospital The Network employs 17,000 people, has more than 2,800 Physicians. WE HAVE YOU COVERED The Network provides: Primary & Emergency Care Cardiovascular Disease Care Cancer Care Orthopedic Surgery Neurology & Neurosurgery Women s Health Diabetes Care Comprehensive Research Health & Wellness Pavilions Home & Community Based Health Services Employed Physician Organization Revenue Cycle: 900 FTEs, Access, Business Office, CDI, Coding, HIM, UR, Cash Apps, SBO

3 Nobody can start crying until 10:30 The problem first day of work: Greater than $160 million in backlog billing with team planning to bring in 20 temporary resources who have never billed. 60 days post Epic install with no internal leaders focus on the management of Epic still working legacy system. No outsourcing plan to vendor to complete Legacy work. Team managing 3 broken patient accounting systems including Epic. Limited management resources (Recruitment island!) Unskilled and unengaged workforce. No formal training and no standard of work. $34 million dollar cash shortfall for the year as of Feb 22, More then one third of receivable outsourced to 22 vendor with limited reconciliation. 12 prior leaders in 12 years. Two major consulting attempts to correct revenue cycle. $300 million outsourced to 22 vendors. Largest Trauma hospital went live two months prior with no outsource transition plan

4 The Plan

5 Foundation for the Plan 1. Implementation of LEAN methods to: ü real time escalation of issues, ü daily communication & feedback, ü accountability for resolving issues. 2. Simplification of work (break it down) 3. Investment of people (Pittsburgh team) 4. Build culture of engaged leadership and teams 5. Three rules: Have Fun, Share, & Get Results It s a Journey!

6 Huddle Boards EPIC Board Leadership Board

7 Step 1: Get your team right first! Is the structure appropriate for the size and scale? Supplement team with consulting coaches and project management. Make sure you have organizational chart set up to have Laser Focus on the big rocks of your plan. Hire the absolutely smartest people you can find even if they don t know revenue cycle. Partner them with an expert. Set up the structure to simplify the work. Do one thing amazing! Ex: Eligibility Team, Attachment Unit, Appeals Team Access your teams strengths & weakness. (A,B,C,D,F). Play strengths. Set Management Expectations to drive a culture of continue improvement. Week 2: New Jobs for

8 Functional Team ( Pod ) Approach Issue Identification: Identified backlog of claim denials for eligibility, authorization, coding, and clinicalbased reasons at March 2016 Focused Resolution: Designed functional Pods with integrated team members and PMs to identify and drive claims resolution, focused on high-dollar impacts

9 Care Management Strategy Summary The new model will have Care Management reporting through Revenue Cycle, to Marti Strand, Chief Revenue Cycle Officer, and will facilitate a centralized payer-based Utilization Review model. Care Coordination responsibility will remain at the hospital facilities with daily on-site oversight by the CFOs. The model will address several identified issues: Methods to Address: Avoidable days, rejections and denials related to medical necessity and authorization. Utilization Review will be centralized and organized by payer. Development of a career pathway with entry level positions through a standardized management model across AHN that ensures a future of expertise and succession planning and allows for appropriate staffing based on volumes and acuity. In order to maintain staffing levels, the model also addresses the development of a centralized float pool of staff to support vacancies, retirements, FMLAs and terminations. Development of system-wide CM/UR education & quality, data analytics, and business support to track. Provides greater integration with insurance verification and coding/cdi.

10 Manager Expectations Earn your paycheck everyday. Be a McDonalds auditor. Offices are for people who curse to much. Be a sponge. Learn the name of your people s dog. You re not a diva so don t act like one. Paint the face first. I don t do no. let your team know what it takes to be successful!

11 Train your team the one way to do work Level set the brainstorming session around workflow with current state review using process map. Use SWOT (Strength, Weakness, Opportunity, & Threats) to review current state for workflow improvement. Design ideal state solving for the SWOT feedback (Play Strength, Eliminate Weakness, plan for the next years opportunities or threats) Develop a detailed project plan to achieve the results. Do a Start-Stop-Continue process to get employee feedback to improve the department. The Lean Way!

12 SWOT People Process Technology

13 Project Management Critical to revenue cycle operations. Purpose to implement change with excellent communication to internal and external stakeholders, holding team accountable, and get and monitor results. 124 projects completed in 2016 and to date projects currently in the works. 14 critical projects for 2017 $5.2 million annual cost savings & $21+ million annual improvement opportunity Let s your work live on. Entry point for talent from other industries into the revenue cycle. Makes change management feel not chaotic.

14 Epic Optimization New IT Collaboration Process Prior State Review More than 300+ open revenue cycle tickets without standard method to escalate and prioritize. Lack of standardized work processes for assigned tasks/work queue management in Epic. Identified needs to optimize work flow configurations, including auto flow of tasks to next responsible parties and worklist redirect to correct functional areas. Redesigned Approach for IT Ticket Collaboration

15 Vendor Management Receivables Prior State Review Complex vendor structure for receivables management, comprised of 9 disparate vendors. Duplication of vendor efforts, particularly in receivable collections with 3 insurance vendors. Collection needs not fully met due to lack of vendor specialization. Informal vendor management program with contracts permitting exclusions and caveats to resolve accounts. Outsourcing New Vendor Management Program Pillars

16 Vendor Management for Receivables Implementation of new Vendor Management Program has resulted in the following 2016 outcomes: Elimination of 5 vendors and re-focus of one additional vendor (BLS) on contract variance expertise. Simplification of collection vendors and achievement of consolidated focus on accounts. Addition of new expertise for auto and WC (Accelerated Claims), Medicare conversions (Chamberlin Edmonds), third party eligibility (20/20 Revenue), and contract/collections (Triage, MediFinancial).

17 Culture of Continual Improvement Implement Lean stacked huddles. 1. Buy a large white board (don t automate it). 2. Have a call in number. Invite your CFO. 3. Include a clock by the board and never go over 15 minutes. 4. Do it every day and be relentless on that point 5. Don t solve a problem at the board. 6. No blame. 7. Cover: Facility issues, new workflow issues, status of existing projects with areas assigned a report out daily, include announcements, recognitions, and good catches for the day. I will survive Fun, Share, Results!

18 Have a plan to develop people 26 Leaders certified or proficient in Epic. Promoting from within. Formal speaking courses. Human Resources sessions. Leadership Basics training. Greatest failure is not using the abilities of people!

19 Driving Staff Engagement Recognition & Big Catches Accomplishment & Highest Cash Month Bowling Celebration CFO Prepared Pancake Breakfast Celebration Spring Break Celebration for Highest Cash Month Potluck Holiday Celebration Weekly Friday Dance Parties

20 The Results $141 Million Dollar increase from 2015 to 2016 Already $100 Million Dollar increase from CY 2016 to CY 2017 AR Days 40.7 days Top Quartile 43.3 days Coding days went from in October 2016 to.8 days in August 2017

21 Next Steps Focus to the front end CVU Redesign in Patient Access Focus on Training Implementing additional EPIC modules Work from home options Implementation of EPIC at remaining hospitals

22 Questions?