Improving the Revenue Cycle with Innovative Patient Engagement Technologies July 30, 2014

2

Learning Objectives

Explore the role of technology

used for patient engagement

to address the challenges of

revenue cycle management

1

Understand best practices

that improve collections and

the patient experience

through financial patient

engagement

3

Outline a strategy for

accelerating revenue

opportunities with every

patient at check-in and across

the care continuum

2

Discuss tips for implementing

process and culture to help

ensure success 4

3

Reform & Revenue Cycle

MORE PATIENTS

• 8 million signed up in

Marketplace

• 5 million enrolled in plans

that meet ACA standards

outside the Marketplace

• 3 million more people

enrolled in Medicaid and

CHIP as of February,

compared to before the

Marketplaces opened

MORE &

POTENTIALLY

RISING PATIENT

PAYMENTS

• Patient financial

responsibility is projected

to be 30%-40% (The

Ryder Group, January

2014)

NEED FOR NEW

STRATEGIES AND

PROCESSES TO

HELP… • Balance staff workload

through efficiencies that lead

to higher employee

satisfaction

• Drive collections earlier in the

revenue cycle

• Facilitate higher overall

collections-all while

increasing patient satisfaction

in a more consumer-driven

environment

Source: Department of Health & Human Services. Press Release. May 2014. http://www.hhs.gov/news/press/2014pres/05/20140501a.html

4

Cost of Revenue Cycle Inefficiency

8%

First-past denial

rate (1)

40%-50%

Of claims denials

due to

demographics (2)

$25-40

To rework 1

claim (3) (4)

35%

Of copay and

collections

missed (1)

$40/day

Savings from

printing and

handling of paper

formsSources: (1) MGMA. Performers and Practices of Successful Medical Groups - 2012; Primary Care Single Specialties. 2012. (2) Health Directions. Improving the Physician Revenue Cycle Through KPIs. 2012. (3) Moore, P. “Fix your denial problems,” Physician Practice, April 2004. (4) Cost to appeal denial, analysis by Susanne Madden, The Verden Group.

5

Past Solutions

Patient Portal Project 227%

growth by

2017 (Frost and Sullivan,

2013

50% of U.S.

hospitals and 40%

office-based

physicians have a

portal through

their electronic

health record

(EHR) or practice

management

system.

Despite offering

patient payment

solutions and cost

transparency

capabilities, portal

adoption remains

lower than

expected due to

cost,

interoperability or

workflow issues

and limited

functionality

TAKEAWAY

Practices are seeking

alternative options to

engage patients

Source: Frost & Sullivan. U.S. Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012–2017. February, 2013.

6

What Can Providers Do to Improve?

Create Efficiency

& Capacity 1

Increase Capabilities

to Maximize

Reimbursement 3

Create

Access 2

7

Framework for Optimizing ROI Opportunities

Data Accuracy Real-time

collections

Electronic

consents /

signatures

Patient

Experience

8

Innovations Driving the Framework

Point-of-Care Kiosk Pre-/Post-Care Mobile Access

Patient Services Command Center

9

Electronic Check-In

• Improve efficiency

• Close gaps-in-care

• Promote adherence

• Enhance the patient experience

Point-of-Care: Visit Maximization & Clinical and Administrative Efficiencies

10

Patient / Practice Impact Using Kiosks

Shortened wait times (25% first visit, 75% subsequent)

(Newark Beth Israel Medical Center, NJ,

InformationWeek)

Nearly all copayments (97%) collected at time of service

(Elmhurst Clinic, IL, Healthcare Finance News)

Reduced expenses associated with paper statements

(HealthLeaders Media)

Can support practice portal strategy (Gartner)

May be leveraged as tool to educate patients about

other services (e.g. LASIK in ophthalmology practices,

patient portal, patient education)

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ROI: Data Accuracy

Source: (1) The economy-busting revenue cycle. HealthLeadersMedia. 2009. http://www.healthleadersmedia.com/content/234307.pdf (2) MGMA Connection. Building Success: Strong Financial Management Fuels Patient-Centered Practice. February 2014. (3) AMA. Appeal that Claim. http://www.ama-assn.org/ama/pub/advocacy/topics/administrative-simplification-initiatives/appeal-your-claim.page

Improves clean claim rates by

• Demographics Update

• >50% recent claims denied by payers are a direct result of patient access

errors (1)

• Better up-front processes may cut denials by up to 80% (1)

• Insurance Verification

• Net revenues lost to third-party claim discrepancies average 3%–5% (2)

Bottom line:

Denied, rejected, resubmitted and underpaid claims can cost a practice up

to$100k per month (3)

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ROI: Real-Time Collections

Source: (1) "Surviving the Deductible Reset in 2012: How to Collect Deductibles and Improve Self Pay Collections." Kareo.com. January 9, 2012.

http://www.kareo.com/gettingpaid/2012/01/lets-collect-deductibles-in-2012-tips-for-improving-self-pay-collections/ (2) "Examining The Newly Covered Under The Affordable Care Act." Health Affairs Blog. October 2012. http://healthaffairs.org/blog/2012/10/30/examining-

the-newly-covered-under-the-affordable-care-act/ (3) MGMA. Performers and Practices of Successful Medical Groups - 2012; Primary Care Single Specialties. 2012.

Copays and outstanding balances

• 5-15% increase in collections (PatientPoint)

• Likelihood of collecting payment drops to ~40% once patient leaves the

practice (1)

• Even more important now due to increase in covered lives, private

exchange plans and high deductible plans (2) (3)

• Staff does not have to follow up after the appointment or send additional

paper statements

• Employees will have fewer discussions with patients about fees and

outstanding balances

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ROI: Electronic Consents / Signatures

Source: (1) Touchscreen Check-In: Kiosks Speed Hospital Registration. California Healthcare Foundation. March 2009. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/T/PDF%20TouchscreenCheckInKiosks.pdf

Automates an entirely paper-based process

Electronic consent forms also save staff time

• Up to a 50% reduction in time spent scanning and filing the completed

forms (1)

• Digitizing forms saves an average of 3 pages per visit (PatientPoint). One

PatientPoint customer saved 13 pages per visit, totaling nearly 3 million

pages and a projected savings of $1.2M over a 12-month period.

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ROI: Patient Experience

Source: (1) Touchscreen Check-In: Kiosks Speed Hospital Registration. California Health Care Foundation. March 2009. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/T/PDF%20TouchscreenCheckInKiosks.pdf

Overall patient satisfaction from

• Reduced check-in and wait times

• Improved data accuracy

• Increased autonomy and privacy for the patient

75% of members felt that checking in through the kiosk is faster than checking in

through a receptionist (1)

90% of members who used a kiosk to check in were able to do so successfully

without assistance (1)

90% felt comfortable with the level of privacy offered by the kiosk (1)

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Innovations in Mobile Patient Access at the Point of Care

Introduce significant

opportunities to

improve the patient

experience and

streamline practice

operations regardless

of care setting by:

AUTOMATED

SCHEDULING

OF

PATIENTS

PRE-REGISTRATIO

N OF

PATIENTS

MOBILE

BILL PAY

1 2 3

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Greater Opportunity with Mobile Patient Access Technology

Source: http://www.himss.org/files/HIMSSorg/content/files/DieboldHCSelfServicePositionPaper.pdf

INCREASE PATIENT

SATISFACTION

• Present only the details necessary for that

user-specific encounter

• Reduce check-in and wait times

• Improve data accuracy

• Increase autonomy and privacy for the

patient

STREAMLINE PRACTICE

OPERATIONS

• Systemize data input and information

workflow for greater accuracy

• Realize cost savings and greater efficiency

by offering self-service options

• Increase throughput by expanding customer

service options

• Reduce wait times for patients who require

personal attention

• Collect payment upfront instead of billing

later, enabling staff reallocation

• Increase staff productivity

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CareSpot Case Study

Profile: CareSpot-operated

centers provide a wide range

of healthcare services such as

urgent care, health checks,

and occupational health

services.

56 urgent care

centers across

Tennessee, Texas,

Kansas, Missouri

and Florida

Online and mobile scheduling

tools at CareSpot.com allow

patients to find a convenient

location, book appointments

and save a spot in line.

Two-phase project

PHASE 1

Patient Portal

PHASE 2

Electronic

Check-in

Tablet

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CareSpot Phase 1

INITIATIVE SOLUTION RESULT

Establish and brand a

unique, innovative

consumer experience at

each center

Introduce online and mobile

patient portal fully integrated

with NextGen practice

management platform in all

CareSpot centers

30% increase in scheduled

appointments by patients through

the online and mobile patient portal

• Fills otherwise open

appointments

• Allows patients to find the

closest and most convenient

location, compare wait times,

“save a spot” for same-day visits,

schedule future appointments,

and complete most pre-

registration forms online to

reduce time spent at a center

Up to 90% utilization in first 3

months of go-live

3-5 minutes staff time savings

per patient

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CareSpot Case Study

21

MCH Results

Miami Children’s Hospital

(MCH) has over 650 physicians

providing all-inclusive pediatric

medical care to patients from

birth to adolescence. MCH

features more than 40 pediatric

specialties and subspecialties

and includes Florida’s only

freestanding pediatric trauma

center.

ELIMINATED

13 PAPER

FORMS

per check-in,

totaling nearly 3

million pages

A

PROJECTED

SAVINGS OF

$1.2M OVER

A 12-MONTH

PERIOD

INCREASED

STAFF

EFFICIENCY

1 2 3

As a result of electronic check-in, MCH:

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OIM Results

Orlando Internal Medicine

(OIM) has four board-certified

general internists and three

nurse practitioners serving as

primary care providers to adults

in the Orlando Metrowest area.

EXPERIENCED

A MORE

EFFICIENT

PREVENTIVE

SCREENING

PROCESS

REDUCED

POST-CARE

BILLING TIME

AND COSTS

IMPLEMENTED

MEDICATION

ADHERENCE

PROGRAMS

1 2 3

As a result of the credit card payment feature during electronic check-

ins, used for nearly 90% of all tablet-based check-ins in 2013, OIM:

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FPG Results

The Family Physicians Group

(FPG) has more than 20

patient-centered medical home

offices around Florida. FPG

offers comprehensive services

to patients, ranging from

disease management and

diagnostics/procedures to

behavioral health and

pharmacy services.

VALIDATED

PATIENT

DEMOGRAPHICS

AND INSURANCE

INFORMATION AT

TIME OF CHECK-

IN

RECOGNIZED a

36% REDUCTION

IN REJECTED

CLAIMS DUE TO

INVALID OR

INCORRECT

PATIENT AND/OR

INSURANCE

INFORMATION

USED THE

SPANISH-

TRANSLATION

FEATURE TO

SERVE 30% OF

ITS PATIENT

POPULATION

1 2 3

As a result of 52 physicians using electronic check-in, FPG:

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