Building Leaders – Transforming Hospitals – Improving Care

Chronic Care Management and Reimbursement: Are your Physicians Leaving Money on the Table

Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination & Lean Consulting

HealthTechS3

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Faith M Jones, MSN, RN, NEA-BC began her healthcare career in the US Navy over 30 years ago. She has worked in a variety of roles in clinical practice, education, management, administration, consulting, and healthcare compliance. Her knowledge and experience spans various settings including ambulance, clinics, hospitals, home care, and long term care. In her leadership roles she has been responsible for operational leadership for all clinical functions including multiple nursing specialties, pharmacy, laboratory, imaging, nutrition, therapies, as well as administrative functions related to quality management, case management, medical staff credentialing, staff education, and corporate compliance.

Healthcare Focus

45 Year Company History

Technology Partnerships

Experienced Consultants

Sara Stanton Vice President, Business Development Sara Stanton is responsible for marketing and business growth for both new and existing clients. She is a business development leader with over 15 years of experience in healthcare strategy, consulting, data analytics, and patient communications. Sara has worked with large provider organizations, community hospitals, regional health systems, national ASCs and specialty providers, and the largest IDN’s in the nation. This experience and exposure has given her a broad understanding of the American healthcare market and the initiatives, challenges, and mandates that hospital executives are facing. Stanton earned a BA in Communication Studies from Baylor University.

HealthTechS3 History

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•Company was formed as Brim Healthcare by Gene Brim. Brim Healthcare was one of the first hospital management companies in the US. Within 2 years Brim had over 13,000 employees on the books in owned, managed, and leased hospitals.

1971

• Brim Healthcare operated one of the largest hospital management companies in the US with 59 hospitals, 14 managed retirement facilities, and 8 owned senior living facilities.

1985

• Brim partnered with Province Healthcare and moved the company headquarters from Portland, OR to Brentwood, TN. Dave Woodward soon became CEO. 1998

• A subsidiary of Brim Holding signs a long-term agreement to lease Pike’s Peak Regional Hospital in Woodland Park, Colorado and Pike’s Peak Regional Hospital opens. (Brim managed the construction of this hospital from the ground up)

2004

•Brim Holdings and their owned facilities are sold to IASIS Healthcare. Managed services are then established in Plano, TX as HealthTech Solutions Group with the goal to develop innovative products and solutions using technology to reduce the costs for community hospitals.

2009

•Under the leadership of Derek Morkel, Hospital Management and Technology are separated and established as HealthTech Management Services and Gaffey Healthcare. HealthTech Management Services was managing 36 hospitals as Gaffey was developing and taking to market a suite of Revenue Cycle Management solutions.

2010

HealthTechS3 Management Team

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More than 20 years of experience in both health care

and technology industries. Previously served as Senior

Vice President at MedCath Corporation, Operations

CFO at IASIS Healthcare, CEO US Operations for

Craneware, Hospital CFO at Province Healthcare and

Division Director Finance HCA.

Derek Morkel, CEO

Neil Todhunter, President Brings over 37 years of healthcare experience, of

which 30+ years were in the capacity of President and

CEO of hospitals ranging from 200 to 300 beds, with

services including acute care, behavioral health,

home care, skilled care and physician practice

management.

Certified Public Accountant with over 25 years of

experience in health care management and has a

deep understanding of business intelligence technology to drive operating improvements.

Previously, he served as a Division CFO at IASIS

Healthcare, HCA & Hospital CFO at Universal Health.

Michael Jennesse, CFO

Voss has more than 30 years of healthcare

administration experience including the past 20 years with HealthTech Management Services (formerly Brim

Healthcare), serving as Executive Vice President and

CEO at St. Anthony’s Memorial Effingham, Illinois.

Greg Voss, Regional VP

Ron Winger, Regional VP Winger has more than 35 years healthcare

administration experience, serving as president and

CEO of four different not-for-profit and for-profit

hospitals and health systems, including most recently

as president and CEO at the Heart Hospital of New

Mexico, a 55-inpatient bed facility in Albuquerque,

New Mexico.

Brian Moyer, EVP / CIO Moyer served as President and CEO of NOVAS

Technology Group, In the 1990's, Moyer was founder

and President of MW Technologies, where he

developed and sold the TAMS (Total Asset

Management System) product suite into hospitals

across the Midwest. He is heavily involved in the health

IT community, serving as President of the HIMSS

Tennessee Chapter.

Peter Goodspeed, VP Executive Placement Peter Goodspeed is an accomplished healthcare

executive recruiter having more than twenty-five

years of executive search experience. With his wealth

of knowledge, Goodspeed is a proven recruiter when

your hospital is searching for a knowledgeable and

experienced healthcare professional whether for an

interim or permanent engagement.

Sara Stanton, VP Marketing Responsible for marketing and business growth for

both new and existing clients. She is a business

development leader with over 15 years of experience

in healthcare strategy, consulting, data analytics, and

patient communications. Sara has worked with large

provider organizations, community hospitals, regional

health systems, national ASCs and specialty providers,

and the largest IDN’s in the nation.

HealthTechS3 Clients

• HealthTech S3 – currently provides hospital management, consulting, turnaround, supply chain management, and professional and physician recruitment services to:

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– More than 50 hospitals and health systems

nationwide

– Community Hospitals, Critical Access hospitals,

district hospitals, non-profit hospitals

– Most operate physician clinics

– Net Revenue between $20M and $400M

– Business Partner Illinois Critical Access Hospital

Network (ICAHN)

– Preferred vendor with California Critical Access

Hospital Network and Texas Organization of

Rural and Community Hospitals

HealthTechS3 Client Recognitions January 2015 Becker’s 50 Rural CEOs to Know

• Nicole Clapp, Grant Regional Health Center • John Gallagher, Sunnyside Community Hospital • Chandler Ralph, Adirondack Health • Phil Stuart, Tomah Memorial Hospital

April 2015

HealthStrong Top 100 Hospitals (iVantage Health Analytics)

• Barrett Hospital & Healthcare • Carlinville Area Hospital • Grant Regional Health Center • Hammond-Henry Hospital • Hillsboro Area Hospital • Tomah Memorial Hospital

May 2015 Becker’s Top Hospitals for Physician Communication (scored 92% or higher)

• Spooner Health System – score 94% • Tri Valley Health System – score 93% • Grant Regional Health Center - score 92%

June 2015 Becker’s 100 Great Community Hospitals • Adirondack Health • Grant Regional Health Center • Hammond-Henry Hospital

June 2015

Top 100 Critical Access Hospitals (iVantage Health Analytics)

• Barrett Hospital & Healthcare • Hillsboro Area Hospital • Tomah Memorial Hospital

July 2015 Most Wired Hospitals – Small & Rural (published H&HN magazine)

• Hammond-Henry Hospital • Sunnyside Community Hospital

September 2015 Becker’s 50 CAH CEOs to Know • Nicole Clapp, Grant Regional Health Center • Florence Spyrow, Hammond-Henry Hospital • Ken Westman, Barrett Memorial Hospital

HealthTechS3 Consulting

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HealthTechS3 Consulting

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Strategy

Growth Strategy – Market Positioning

– Network Collaboration and Development

– Physician Relations and Integration

Turnaround Strategy – Financial and Operational

Restructuring

– Risk Advisory

– Creditor Consultancy

Transaction Advisory – Merger Integration

– Deal Structuring

– Contract Analysis and Negotiations

– ACO Transition Analysis

– Payment Strategy Transitions

– Financial Modeling

– Capital Sourcing

Operations

Financial – Budgeting/Financial

Planning

– Capital Programs

– Supply Chain

– Labor Productivity

–Managed Care Negotiations

– Risk Advisory

– Revenue Cycle

– Business Office Consolidation

– Clinical Documentation and Coding Reviews

Operations – Lean Workflow Analysis

and Redesign

– Patient Access, Throughput, Level of Care

Corporate Compliance

Clinical & Quality

Quality Improvement – Quality Program

Development

– Clinical Process Redesign

– Care and case Management Process

– Benchmarking and Reporting

Regulatory Compliance and Accreditation Preparation – Survey Readiness

– Plans of Correction

– Public Reporting of Quality and safety Indicators

– Evidence Bases care

Population Health Management – Care Coordination

– Transitional Care Management

Governance &

Leadership

Board Advisory – Education

– Retreats

Executive Recruiting – Interim

– Long Term

Hospital Governance Management – Licensing Advisory

Services

– Regulatory Strategy Development

– Annual Report Preparation

Creating Efficiencies and Mitigating Risk

Compliance Lean Healthcare Culture

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A systematic process aimed at ensuring that the organization and those that perform duties on behalf of the organization comply with the applicable laws, regulations and standards.

“Lean is not just a process improvement program; it’s about creating a culture of empowered thinkers. A lean organization will drive out waste so that all work adds value and serves the patients’ needs.”

Lean Experience …In the last two years Faith Jones has facilitated 28 Lean courses at 13 Community Hospitals and Trained 25 onsite instructors through the ‘train the trainer’ program with a total of 290 participants and projects with a projected annualized Lean project Savings: $7.6 million

• Compliance Effectiveness Assessment

• Provide ongoing support to improve and strengthen your Compliance Program.

• Education programs for your trustees, providers and staff.

• Review and Periodic Reassessments

Compliance Consulting Provides:

Building Leaders – Transforming Hospitals – Improving Care

Care Coordination: Real Revenue Opportunities

Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination & Lean Consulting

America is Getting Older

0

10

20

30

40

50

60

70

80

2000 2010 2020 2030

Mill

ion

s

People age 65+

People age 65+

http://www.aarp.org/livable-communities/info-2014/livable-communities-facts-and-figures.html

20% of the population

OR

88.5 Million people aged 65+

By 2050

http://www.aarp.org/livable-communities/info-2014/livable-communities-facts-and-figures.html

87%

Aging in Place

of adults age 65+ want to stay in

their current home and

community as they age.

http://www.aarp.org/livable-communities/info-2014/livable-communities-facts-and-figures.html

Triple Aim

“Our goal is to recognize the trend toward practice transformation and overall improved quality of care, while preventing unwanted and unnecessary care”

CMS CFR 11-12-2014

Caring. Community. Connections.

Population Health: It Takes a Village

“We acknowledged that the care coordination included in services such as office visits does not always describe adequately the non-face-to-face care management work involved in primary care and may not reflect all the services and resources required to furnish comprehensive, coordinated care management for certain categories of beneficiaries”

CMS CFR 7-15-2015

Changing Model

• Transitional Care Management (TCM)

– Effective January 1, 2013

• CPT codes 99495 and 99496

• Chronic Care Management (CCM)

– Effective January 1, 2015

• CPT code 99490

• CCM for RHCs and FQHC

– Effective January 1, 2016

• CPT code 99490

Changing Model

Reimbursement Calculator

$250,000.00 Annually

Practice Eligibility

• Qualified EMR

• After hours coverage

• Care Plan Access

Patient Eligibility

• Medicare Patient

• Two or more chronic conditions expected to last at least 12 months or until the death of the patient

• At significant risk of death, acute exacerbation, decomposition, or functional decline without management

Eligibility for CCM Billing

• Signed Consent

• Documentation of at least 20 minutes per calendar month spent coordinating care

• Patient Centered Care Plan

– Include outside healthcare providers (as appropriate)

– Include community resources (as appropriate)

Criteria to Bill for CCM

• Connect and integrate existing informal/non-traditional community networks with the healthcare team

• Invest in tools & processes to maximize the benefits of connectivity

Bridging the Gap

• Referral and coordination System

• User friendly product

• Easy to learn and implement

• Responsive to customer needs and changing environments

• Create reports and work lists

• Avoid duplication of work

• Affordable and scalable

Right Tool for the Job

Coordination Model

• Primary Care Coordination Workflow Assessment

• Process Development and Adaptation

• Implementation of CrossTx Tool

Care Coordination Chronic Care Management Program

• Observation of Current Practice

• Assessment and Planning

• Product Option Review

• Implementation

– Consent and care plan template

– Policy and Procedure modifications

• Follow-Up and Billing

Process Steps

| Page 27

Building Leaders – Transforming Hospitals – Improving Care

Faith.Jones@ht-llc.com cell-307.272.2207

Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination & Lean Consulting

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