September 17 th, 2015 John Zaharis System Director Pre-Access Presence Health
2015 Reason for Action: Our Burning Platform The front end must adapt to current marketplace changes which make it critical to secure every dollar in an environment of decreasing reimbursement. The identification of sponsorship, increased POS collections, and implementing the Pre-Access 2014 redesign supports net revenue enhancement and reduced cost to collect. 2
Reason for Action: Our 2015 Front End VSA determined that All orders whether faxed, electronic or held by patient must be scrubbed for validity, medical necessity, and clinical clearance All required authorizations and referrals should be secured before the patient is contacted Patients need reminder calls to decrease no-show rates Contact to patients should be kept to a minimum to have a truly one stop shop Patients desire an online solution for Central Scheduling Currently most denials for outpatient services occur in areas where insurance verification is not performed by a centralized unit Unique challenges due to 5 hospitals using EPIC and 6 using Meditech 3
Our 2014 Pre-Access EVSA determined via Voice of the Customer Surveys that included Patients, Physicians, and Hospital Departments that experiences with the Pre-Access department were varied in regards to process glitches and customer service. After root cause analysis, many of these inconsistencies were attributable to Pre-Access functions operating in silos and having inconsistent technologies. 4
2014 Voice of the Customer Survey Results Technology Gaps: They need a better process [at Central Scheduling] for tracking faxes that come in. I faxed an order over, they said they never received it even though I m holding the confirmation in my hand. I sent it a second time and got the person s name. They call back later and say they never received it and that this person never talked to me. Certain glitches reported with some frequency: Lost paperwork is not uncommon, with scheduling and the physician office blaming each other Difficulty handling situations that don t conform to a standard pathway, e.g. workers compensation, treatment for injuries where a lawsuit is involved Insurance approvals not secured and patient is threatened with a cancellation Constant repetition of information, even for patients who are already in EPIC 5
Gap Analysis: the number of handoffs involved in the current state process illustrated need for streamlining and for real-time work driver 6
Denial Risks Due to No Authorization Every step in Process is a potential denial risk 7
Voice of the Customer: Creating an Exceptional Experience 2014 2015 Current State Dimension Ideal State Inconsistent experience between hospitals regarding scheduling process and customer satisfaction Inconsistent experience for physicians regarding scheduling and authorization process High number of defects, lots of time spent searching for information (motion waste) Non-standard, inconsistent process for Meditech and EPIC, Downtimes, Numerous Software systems Inconsistent reporting structure leads to differences in site practices & standards Patient Satisfaction Physician Satisfaction Process Improvement Technology Reporting Structure Single interaction with patient that minimizes handoffs including communication of full financial responsibility; provide a single point of contact for patient; allow patient to report directly to service area Process that minimizes disruption to physicians and physician offices Standardize processes and integrate current functions and across Presence, defect-free process Coordination of care, navigation, communication, education System-based leadership structure that ensures a consistent 8 experience with consistent expectations across Presence
How do we fix it? 9
Creating the Ideal Pre-Access Experience Patient-defined service expectations through Voice of the Customer: Greater control over initiating the scheduling process: phone, online Urgent tests scheduled for same day/within 24 hours Routine tests scheduled for 5 days from physician order Reminder call contact customized by mode and patient s time frame Use of demographic information from EMR to solve problems, minimize repetition All calls answered by a live person Want written documentation describing test, what/how to prepare, where to park and enter the facility not just verbal instructions Bypass onsite check in on day of test so that patient goes straight to department, which is prepped and ready for their arrival 10
Future State Themes/Characteristics ONE TOUCH CONCIERGE SERVICE 11
Ideal State for Pre-Access Patients value ease of access to services, One Touch (or call) before the scheduled service and want ease of access to services Tasks that patients deem administrative such as Order Management, Insurance Verification and authorization process should occur in the background and not involve patients How do we get there? 12
Future State Themes/Characteristics Beyond the 2015 Redesign Implementation Patient Calls One Unified Call Center for all services inclusive of Presence Medical Group (PMG), Presence Info Line and Acute Care Needs Patient Navigator to help coordinate visits in multiple departments Integration with PMG in Scheduling, Authorization, Referrals Billing and Collections 13
Future State Themes/Characteristics Beyond the 2015 Redesign Implementation How will we get there: Real Time work-driver eliminating defects in process Implementation of payment estimation software Implementation of call recording software for quality Online scheduling with System approach for surgical and outpatient Services Appointment reminders Centralized unit with consistent policies and procedures 14
Best Practices: HFMA Central Scheduling Use single scheduling software enterprise wide Have unit dedicated to Central Scheduling The Central Scheduling unit answers to the Chief Revenue Officer Scheduling System interfaces with Registration System Processes and information systems are integrated between scheduling and pre-registration Medical Necessity is screened before the service is provided Services are postponed if not pre-authorized in advance Financial Counseling is part of the scheduling process Patient balances and payment obligations are discussed with the patients The hospital s policy for POS collections is explained to the patient 15
Best Practices: HBI Healthcare Business Insights Major advantage of centralized model is the opportunity to standardize policies and procedures This standardization further enhances productivity and performance by allowing the following: Consistent performance expectations for staff Improved visibility through individual and department-level reporting In addition, Centralized Scheduling offers providers the ability to monitor quality in a standardized manner through staff evaluations on skills that impact patient satisfaction 16
Best Practices: HBI Healthcare Business Insights (Cont.) Additional Benefits of Centralized Central Scheduling Patients can schedule multiple procedures through one scheduler Patients are not as often put on hold, transferred or dropped Interaction with fewer staff members can reduce the number of times that patients are asked to repeat demographic/insurance information Foundation for further consolidation and innovation Optimized productivity through automation (e.g. work optimization software, automated workqueues, autodialers, etc. Increased pre-service collection due to standardized policies and protocols Earlier detection of patients eligible for financial assistance/charity care Improved hand-offs to authorizations or staff can be cross-trained to handle authorizations for certain departments Is a pre-cursor to a schedgistration model 17
Solution Approach We determined the best solution for a real-time work driver after an RFP went out to multiple vendors. A decision to move forward was made with participation of IS Reduce and Eliminate Vendors to enable staff to be cross-trained Develop Flow Cells for the Front End to mitigate defects Integration with PMG referral management department Expansion of financial clearance process to departments outside of current scope including PET Scan at the PCAC building Scheduling for ambulatory MRI clinics such as Park Ridge and Healing Arts Center in Joliet Coordination and standardization of exam preps across Presence Health 18
The Pre-Access Redesign occurred in 2014 where the needs of the voice of the customer were addressed. Our process was redesigned to have Order Management and Insurance Verification occur before the patient was contacted for scheduling and Pre-Registration to have a one-touch process 19
2015 Pre-Access Redesign Efforts for Central Scheduling Phase I: Central Scheduling Call Center Virtualization due to VOIP (Cisco) upgrade Phase II: One Integrated Leadership Team for Pre-Access Benefits include: A consistent patient experience at each ministry Decreased Call Abandonment Rates Increased Average Speed of Answer Increase in Scheduled/Booked Appointments Leveraging cross-trained staff for absences Consistent financial clearance practices Elimination of defects at the beginning of Revenue Cycle Process Integration with PMG Centralized Referral Department Phase III: Real-Time Work driver Installation Real-time work driver for all staff with enhanced Order Management capabilities Phase IV: Centralization of Pre-Access Staff Consistent experience and cross-training to mitigate absences 20
Phase I: VOIP Phone Upgrade Allows for greater call clarity and virtualization of call center Greater call quality than traditional analog lines Sets the foundation for unified reporting and centralization of staff We also have installed recording software at the EPIC call center and plan to expand to the Meditech ministries in 2016 This allows supervisors to monitor call quality and also provide training opportunities 21
Phase II: Leadership Restructuring: In order to support the vision of the 2014 and 2015 Pre-Access redesign it was determined that a leadership restructuring would take place in Pre-Access This restructuring is budget neutral and allows for one Director to be responsible for both EPIC and Meditech Scheduling Each of the Meditech and EPIC Central scheduling units will report to one Pre-Access manager to ensure that consistent practices are followed across the continuum Order Management will be expanded to include both EPIC and Meditech 22
Phase II: Leadership Restructuring: completed 7/20/15 23
Phase III: Real-Time work driver Installation In process Phase: Description: Begin Date: End Date: Phase I: Foundational/Pre-Pilot Phase 6/22/15 9/10/15 State as Phase II: Pilot Sites PSJH/PSFH 9/14/15 11/06/15 Phase III: PRMC/PHFMC 11/09/15 12/11/15 Phase IV: PSMEMC 1/04/16 2/05/16 Phase V: PSJMC/PSMH 2/08/16 3/11/16 Phase VI: PMMC/PSJHE 3/14/16 4/15/16 Current of 9/17/14 Phase VII: PUSMC/PCMC 4/18/16 5/20/16 24
Real-time Work Driver Implementation Update Project Stakeholder High Level Overview: Core Team Patient Access System Director Pre-Access System Director Financial Counseling Sys. Dir. Pre-Access Manager Central Scheduling Director Project Manager HIM Director Surgery Director(s) Radiology Director(s) Customers Patients Physicians Hospital Administration Revenue Cycle System Leader Account Resolution System Director Patient Access Regional Leads Case Management Directors Hospital Departments HIM Suppliers Healthlink Meditech IS HWS Miramed Avadyne GLS MIDAS ONTRAC Passport emmi 25
Revenue Cycle Project Management Tools: Gantt Chart Gantt Chart created encompassing duration of Project Key events and deliverables have been outlined including workshops to outline key workflows Synced Gantt chart to HWS project plan and vvsm events 26
Phase What Success Looks Like: Work driver Project Phases and Descriptions Desired Outcomes Phase I Foundational IS infrastructure in place and working well Pre-Pilot Phase Future scope for Pre-Access, Patient Access and PPE Identified Workflow clearly defined standard work Business object rules defined Future process for OM identified Adequate Reporting Developed Clearly defined cut over plan Automate key trigger events Best practices identified Phase II Pilot Resolve any issues that arise so they don t happen at later implementations Vendor responsible to issues and involved in training Identify downtime and maintenance Phase III IV Spread to Epic Sites All Epic sites up and running on HWS Consistent concierge process Improved patient satisfaction No Delays for patients due to work driver issues New work driver set up for Vendor access Standardized process for orders Auto coding for traditional Medicaid Consistent rules in place to handle account w/o auth in place Vendor system auto coding IS infrastructure in place and working well Future scope for Pre-Access, patient access and PPE Identified Training plan for Staff Pilot sites up and running Ready to roll out to next sites Training Plan for Staff Improved work flow Communication with care management automated Training Plan for Staff Phase IV VII Retrofit Meditech Sites Phase VIII Move Away from On Trac All Meditech sites up and running Improved work flow Workflow for historical accounts Current work driver is no longer being used Improved patient satisfaction Training Plan for Staff 27
What Success Looks Like: Project Key Metrics KPI Source Current metric (baseline) Revenue Cycle KPI metrics Reduction of 835 denials attributable to front end Future Metric $0 $880,000 reduction Goal Date: 12 months after full implementation at all ministries Increase net revenue attributable to Pre-Access redesign Elimination of Current Workdriver, no PRE- Cert inpatient denials due to late status changes (occur because of limitations in work driver) Revenue Cycle KPI metrics Revenue Cycle KPI Metrics $0 $800,000 net revenue enhancement $314,000 per year due to work-driver errors, accounts not scoping in, late status changes, accounts left on FC worklist after status change 12 months after full implementation at all ministries 50% decrease 12 months after full implementation at all ministries 28
Important IS Project Milestones Achieved to date: HWS Server build complete HWS Fax Server racked and configured 7/28/15 EPIC outbound ADT feed complete 7/1/15 Desktop Faxing workflow developed for CDA/CBO 7/29/15 Workflows Developed for Central Scheduling, Pre-Registration and Insurance Verification Workflows in Process for Financial Counseling 29
Phase IV: Revenue Services Centralization Plan - In Process Will result in the creation of an integrated EPIC Pre-Service Unit at SMEMC and an integrated Meditech Pre-Service Unit at PSJMC Blackhawk Building Central Scheduling Order Management Pre-Registration Multi-faceted move involving: Central Scheduling Order Management Pre-Registration Billing and Follow-up Customer Service Vendor Management Financial Counseling Customer Service Staff 30
Preliminary Results of Centralization Efforts at PSJHE 31
Conclusion Future State for Pre-Access includes integration at a System level with Presence Info line and Presence Medical Group to create a truly one-stop shop for Presence Health The 2014 Pre-Access Redesign has been implemented in 2015 with progress made towards Cisco phone integration for call center virtualization Leadership Restructuring for consistent experiences Healthware real-time work driver implementation Centralization of both EPIC and Meditech Pre-Access Units to achieve a scalable work force 32
Questions? Contact Information: John.Zaharis@Presencehealth.org 630.914.2433 (office) 33