Model BuilderCustomer Spotlights

Brian BelkinOptimization SME

©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary.

Session Moderator

Meet the Presenters

Tawana HowardSenior Application Specialist Carolinas HealthcareCarolinas HealthcareCharlotte, North Carolina

Eloise LynumySenior Financial AnalystCentral Florida Health AllianceLeesburg, Florida

Mara YancoskieContract Administrator, Decision SupportppTrinity HealthConshohocken, Pennsylvania

©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary. 2

Format

Problem to be solved

Description of the model definitionDescription of the model definition

Success measures

©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary. 3

Problem to be SolveddEstimated Net Revenue

• Build in logic for segmentation by account balancebalance– If balance, utilize expected paymentIf b l l– If zero balance, use actual payment

• Different thresholds by patient type

Model Builder DefinitionModel Builder Definition Utilized the aggregate 

within an encounterwithin an encounter template to summarize expected payment 

Utilized copy template to move actual payments

Results from both templates were stored in a new encounterin a new encounter extension

Problem to be SolvedService Lines

• Complex definitionComplex definition• Limitation in groupings

Model Builder DefinitionModel Builder Definition Utilized 

assignmentassignment template to store the service line title

Utilized rule data selection to qualifyqualify 

Results were stored in newstored in new encounter extension

Success MeasuresSuccess Measures

Initiative Measure OutcomeInitiative Measure Outcome

Cost Manipulating data in Excel spreadsheets $18,000 spreadsheets 

Quality Service line grouping complexity Increase in refinement 

Utilization Scorecard rollout Increase of end user buy‐in

Efficiency Consistency and more timely reporting   Priceless!

Carolinas HealthCare System

• 42 hospital locations• 7,800 licensed beds (acute and post-acute care), ( p )• 61,000 full and part-time employees• 11 million unique patient encounters annually• > 2,000 Employed Physicians, not including Residents• > 900 care locations

$8 5 billi i N t O ti R (2014)• $8.5 billion in Net Operating Revenue (2014)• > $1.63 billion in Community Benefit (2014)

Prior to Model Builder

Import data into custom-

b ilt

Build and

built application

QA of ANR data

Calculate Adjusted Net

Revenue

Build and Export 40

Worksheets in PM

Export processed

I t t

Revenue (custom –built application)

Process ANR in custom-

b ilt

processed ANR data in .txt files

10

Integrate and merge ANR data into PM

built application

10

Post Model BuilderPost Model Builder

CalculateCalculate Adjusted

Net Revenue (Model

Schedule PM batch

for MB processing

Apply PM batch for

MB processing

QA of ANR data

(Model Builder)

processing processing

1111

Success Measures

Initiative Measure OutcomeResource/module used to calculate

CostResource/module used to calculate ANR is fully integrated in PM and supported by McKesson

Resourcesreallocated

• Reduced risk of human error ReducedQuality

• Reduced risk of human error• Accurate allocations, current

collection rates

Reduced unintended

changesWeekly/Quarterly ANR calculations

UtilizationWeekly/Quarterly ANR calculations are performed via automated batch processes

Resources reallocated

Efficiency Significantly reduced manual processing time Priceless!

Problem to be SolvedEstimated Net Revenue

Previous Net Revenue Process Did not provide the transparency needed to understand

calculation behind the number Did not allow for any flexibility to meet needs of various

report requests • Standard vs hospital specific• Standard vs. hospital specific

Very time consuming and involved many steps

©2014 Trinity Health. All Rights Reserved. 13©2014 Trinity Health - Livonia, MI 13

Net Revenue Process

Calculate Revenue

Closed

• Total

Open

• For Inpatient –DRG Case

Contract Modeling

• Expected Payment

Employee Flag

• Calculation unique to the

Bad Debt Flag

• Total Payments

Medicare Flag

• Payments for Closed• Total

PaymentsDRG Case Rate based on Historical

• For Outpatient – Percent of Charge based

Payment

• Less Bad Debt Reduction based on Age

unique to the facility

• Modeled at the contracted rate to account for amount booked

• Total Payments Closed

• Historic Case Rate for Open

• Exclusion of Charge based on Historical

• Less Charity Reduction

amount booked in inter-company transfer

IME Payment

©2014 Trinity Health. All Rights Reserved. 14©2014 Trinity Health - Livonia, MI 14

Net Revenue Process

Revenue Bucket

Based on Flag

Est Net Rev

Before Adj

Bad Debt & Charity

Adj

Est Net Rev After

BDIME Adj

Estimated NR After MCR IME

Adj

Est NR Before Adds

Adds/ Reductions Estimated NR

* Capitation* State Subsidy* Liver & Kidney Transplant Subsidy

©2014 Trinity Health. All Rights Reserved. 15©2014 Trinity Health - Livonia, MI 15

* MA Modernization* Physician Fees

Estimated Net Revenue Example

Revenue based on

Flag

Est Net Rev After BD

Est Net Rev After IME

NR Before Adds

Final Estimated

NR

Bad Debt Adjustment

IME Adjustment

Capitation/Physician

Adjustment Adjustment Fees

©2014 Trinity Health. All Rights Reserved. 16©2014 Trinity Health - Livonia, MI 16

Success Measures

Initiative Measure OutcomeDramatically reduced the hours

Cost designated by staff & SR leadership to allocate one time items and audit the data

$20,000

Quality

Revenue allocated is more transparent to the end-users 80%

Reduced human error 60%

Utilization The turnaround on Profit/Loss 50%Utilization Releases is significantly reduced 50%

EfficiencyRemoved all manual intervention and process is housed in one Priceless!

©2014 Trinity Health. All Rights Reserved. 17©2014 Trinity Health - Livonia, MI 17

ylocation

Q ti ?Questions?

©2014 Trinity Health - Livonia, MI 18©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary.