INTRODUCING EQHEALTH SOLUTIONS TO

FLORIDA'S HOSPITALS

March 24, 2011

Welcome and Introductions

Gary Curtis, MSW,

President, CEO

Ron Ritchey, MD

Chief Medical Officer

Cheryl Collins

Executive Director, Florida

Nancy Calvert

Manager, Outreach and Education

Ron Breitenbach, Florida Operations

Director

Edie Castello, Vice President/COO

Sherell Singleton, Corporate Project Director

Mayur Yermaneni, Director of Business

Development

The eQHealth Team

Overview of our Presentation

Our Company

Clinical Perspective

About Your Needs

Education, Outreach and

Communications

Answering Your Questions

Our Philosophy: Who we are

A clinical management

services company

Focus: Meeting the needs

of Florida Medicaid

recipients and providers

Our Goals:Promote quality of care for

Medicaid beneficiaries

Help Florida providers provide the

right care at the right time

Not-for-profit 501c(3)

2,000 physician members

200+ employees (will soon add 130 more in FL)

Medicare, Medicaid and private clients

almost 5 million lives impacted

Data systems backed up in multiple locations

Multi-State, Multi-Client Experience

Clinical Services Company

Medical Directors: 8

Physician

Members: 2,000+

Physician

Consultants: 200+

Nursing Staff: 150+

IT Staff: 25 and growing

Implementation Expertise

14 major start-ups

More than 100,000

calls received annually.

More than 100,000 mail

pieces distributed

annually.

We work with hundreds

of millions of records

Implementation Readiness

We understand you will need to contact us

You want your requests answered promptly

You don’t want to wait

You need to get paid

You want to know our processes

“Can you handle a large volume of calls?”

- Yes. More than 107,000 calls processed last year for one Medicaid agency.

“Will I be placed on hold?”

- Not for long. We answered 98% of the calls in an average of 33 seconds.

“Can you solve my problem? Quickly?

- Yes. More than 97% of inquiries are resolved within one day.

Getting Results for Providers

We Expect the Unexpected

• There will be glitches.

• There will be unique and unanticipated problems.

• There will be changes.

• There will be growing pains.

• All of these will be addressed. Immediately.

Anticipate Problems/Offer Solutions

• Provider-Focused – We have committed ourselves to

working tirelessly on your behalf.

• Provider Satisfaction – If there is a problem, and we

hope there won’t be any, we want you to call us first. We

will address it – and communicate back to you.

eQHealth’s Commitment

Ron Ritchey, MD

Our Chief Medical Officer

eQHealth Solutions is supporting the Florida program

with:

• Full-time Medical Director

• Full-time Associate Medical Director

• Panel of Review Physicians (residents of, and licensed in, FL)

Match geographical areas as well as specialists

• Also, Gary Curtis and others will meet with providers

throughout Florida

Medical Support for FL Contract

Inpatient facilities and their physicians are an

important part of our Florida program:

• eQHealth is a physician-sponsored organization

(2,000 members)

• Physician input regarding:

Best practices

Outcomes

Quality initiatives

Special projects

Commitment to Inpatient Facilities

• InterQual criteria for inpatient

• SmartReview algorithms for select

diagnoses

• Attempt to reach treating provider

before any adverse decision

The Florida Review Process

• Long standing excellence in provider

relationships

• Training is important … as is listening

• We strive to establish long term mutually

rewarding professional relationships

Committed to Excellent Provider

Relationships

Cheryl CollinsExecutive Director – Florida Division

eQHealth Solutions

Our Florida Team

Florida Management Team

Cheryl Collins, Executive Director

Ian Nathanson, MD, Associate Medical Director

Ron Breitenbach, Operations Director

Judyth Miranda, Inpatient Review Director

Melanie Clyatt, Home Health Review Director

Nancy Calvert, Provider Outreach and Training

Manager

Management Team (con’t.)

Soon to be hired:

Medical Director

Miami/Dade Director

Therapy Review Director (in the Fall)

Office Locations

Near the

Airports

in

Tampa

&

Miami

Performance Standards

Requests for Authorization

Within 4 hours

Calls Answered

Within 30 seconds

Calls Abandoned

No more than 10%

Inquiries Answered

Within 1 business day

Questions Escalated if necessary

eQSuite Web Entry Availability

24/7 for Authorizations

How we Meet the Standards

6 Customer Service Representatives

Able to handle ~ 500 calls/day

Transfer calls as appropriate to:

- Provider representatives (4)

- Inpatient review nurses (31)

- Inpatient supervisors for escalation (2)

- Inpatient director for escalation

- Nancy Calvert, Provider Outreach & Education Director

for escalation

- Cheryl Collins, Executive Director for escalation

- Edie Castello, COO for escalation

- Gary Curtis, CEO, for escalation

Plan B for Day 1

Can Routinely Handle ~ 500

calls/day in FL office

Additional Staff in FL to

handle ~700 more calls/day

Additional Staff in other

offices trained and ready for

~500 more calls/day

Day 1 Phone Capacity for

~1700 calls

Plan B for Day 1

Specific questions about an authorization

eQSuite help application has real time status updates

If more than 1,700 Calls

We are prepared to take messages and call back

Watch the Website

FAQ’s will be routinely updated with common

questions

What Could Go Wrong?

Failure to hire enough staff on Day 1

• Backup assistance identified and trained

System failure/ eQSuite “doesn’t work”

• Over a dozen IT staff standing by

• Working with FMMIS over last 6 weeks to ensure that we are transferring data correctly to them, including test cycles – June 1 will not be our first day to try this

Too many calls to handle

• Backup assistance identified and trained

• Messages and call backs if necessary

More that Can Go Wrong

Unexpected Questions

• Our experts, including system designers, will be on-hand

Disaster (natural) Happens

• But, our data systems are backed up in multiple locations

• Set up to transfer web operations to another corporate

data center for continuity of operations

Transition Planning

eQHealth’s contract begins

June 1, 2011

Currently working with AHCA

and KePRO on details

Cutoff for submission to

KePRO on Friday, May 27 at

5 pm EDT

eQHealth will begin accepting

web-based review requests

on Saturday morning, May 28

It’s a New Day . . .

We won’t be perfect, but …

We will continually watch for errors and fix them at the

root cause

We will constantly look for ways to improve our

performance and our service to you

We will look for problems

And a New Way . . .

• We will listen to you

• We operate in a culture of striving for excellence

• There will be changes between the program you know today and what we will provide.

• We want to be in Florida for a long time!

Nancy CalvertManager, Outreach and Education

“Our goal is to establish a relationship

of trust, respect and cooperation with

the provider community through consistent

and timely communication, education,

outreach and support.”

Provider Outreach, Education and

Technical Assistance

Provider Education & Outreach Team

Our Team:

Manager of Provider Outreach

and Education

Provider Outreach and

Education Representatives (4)

Customer Service Reps (6)

2 English-Spanish bilingual

Provider Communications

• Blast Fax Provider Alerts

• Dedicated Florida Website

http://fl.eqhs.org

• Customer Service(855) 444-3747

8 a.m. – 5 p.m. M-F

(except Florida state holidays)

• Secure, HIPAA compliant,

online inquiries via eQSuite

Provider Communications

Dedicated Florida Provider Websitehttp://fl.eqhs.org

• Access to eQSuite

• Training and webinar schedules and registration

• Service specific eQHealth provider manuals

• eQSuite Users Guide

• Frequently Asked Questions

• Important announcements and updates

• Downloadable forms

• Links to other pertinent websites

• Job postings

Implementation: Six inpatient facility trainings:

• Tallahassee: April 4 - AHCA

• Jacksonville: April 7 - Morocco Shrine Auditorium

• Tampa: April 11 - Egypt Shrine, 4050 Dana Shores Dr.

• Miami: April 14 – Miami Airport Hilton, 5101 Blue Lagoon

• Orlando: April 20 - Maitland Civic Center

• Miami: April 27 - Miami Airport Hilton, 5101 Blue Lagoon

All inpatient trainings are scheduled from 8:30 a.m. – 12:30 p.m.

Registration begins at 8:00 a.m.

Provider Education

Implementation:

15 eQSuite training webinars

May 2011

• Acute Inpatient – 9

• Physicians – 3

• Rehabilitation Facilities – 3

Sign up on our website

Provider Education

Ongoing:

• Three face-to-face trainings, per service

type, each year, in strategic geographical

areas

• Quarterly webinars

• PowerPoint trainings, with audio, posted on

website

Provider Education

Provider Education

Policy updates/changes

Issues identified by the

Provider Focus Groups

Trends identified by the

eQHealth staff

eQSuite new user and

“refresher” training

Topics:

• Provider Focus Groups

• Attendance at provider association

meetings

• Telephonic and on-site technical

assistance

• Open on-line “go-to” meetings

• FAQs posted on the website

Provider Outreach & Support

Provider Focus Groups:

• Provider service type specific

• Combined face-to-face and webinar format to

encourage participation

• Collaborative dialog soliciting provider input on

an identified topic to identify challenges and

improvement opportunities.

Provider Outreach & Support

Attendance at Provider Association

Meetings:

• Attendance at the Tallahassee AHCA/FHA

quarterly meetings

• Upon request, attendance at other provider

association meetings

Provider Outreach & Support

Post-implementation, open, on-line

“Go-To” Meetings:

• Begin June 2011

• Dial in “Go-to” meetings open to all

participating providers

• Real-time responses to questions

Provider Outreach & Support

Telephonic and On-site Technical

Assistance:

• Customer service toll-free number

• eQSuite helpline module

• Individualized assistance by regionally

assigned Provider Outreach and Education

Representatives

Each facility will have an assigned Outreach and

Education Provider Representative.

Provider Outreach & Support

Obtain logons for eQSuite, the eQHealth proprietary web based utilization management application

1. Complete the Provider Contact Form

2. Determine an “assigned facility liaison” and “system administrator”

3. Attend a face-to-face meeting

4. Attend an eQsuite webinar training

5. Assign logons to facility staff

Working Together - Getting Started

1. Complete the Provider Contact Form

• Mailed to hospital CEOs

• Download the form http://fl.eqhs.org

• Call Customer Service to request a faxed copy; (855) 444-3747

• Fax the completed form to (855) 440-3747

• Mail the completed form to:

eQHealth Solutions

5802 Benjamin Center Drive, Ste 105

Tampa, FL 33634

Getting Started

Provider Contact Form

Assigned Facility Liaison• The main contact for eQHealth

• Receives Provider Alerts and other correspondence

System Administrator

• The person responsible for management of eQSuite user access for facility staff.

• This person need not be an IT staff member

The form must be signed before returning it to eQHealth

Getting Started

2. Assign a “System Administrator”

The Administrator is responsible for:

• Assigning logons for staff members

• Granting levels of access for staff members based on their job responsibilities

• Training new staff members

• Terminating logons for staff members who leave employment with the facility or agency

Getting Started

3. Attend an eQHealth Training

• April: Attend an eQHealth face-to-face

training

• May: Attend an eQSuite webinar

• Logons cannot be assigned until the

Administrator has attended a webinar and

attendance is validated.

The training schedules and registration forms

are available on http://fl.eqhs.org

Getting Started

4. Assign eQSuite Logons to facility staff

• The System Administrator assigns logons to

existing and new staff.

• Levels of access are granted based on the

staff members’ job responsibilities:

- Authorization Requests

- View Letters

- View Reports

Getting Started

This PowerPoint presentation will be posted on our

website

The eQHealth team is looking forward

to working with you!

Thank You

Questions and Answers