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Pre-Access Redesign 2015

September 17th , 2015

John Zaharis

System Director Pre-Access

Presence Health

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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.

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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

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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.

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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

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Gap Analysis: the number of handoffs involved in the current

state process illustrated need for streamlining and for real-time

work driver

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Denial Risks Due to No Authorization

Every step in Process

is a potential denial risk

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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

Patient Satisfaction 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

Inconsistent experience for physicians regarding scheduling and authorization process

Physician Satisfaction Process that minimizes disruption to physicians and physician offices

High number of defects, lots of time spent searching for information (motion waste)

Process Improvement Standardize processes and integrate current functions and across Presence, defect-free process

Non-standard, inconsistent process for Meditech and EPIC, Downtimes, Numerous Software systems

Technology Coordination of care, navigation, communication, education

Inconsistent reporting structure leads to differences in site practices & standards

Reporting Structure System-based leadership structure that ensures a consistent experience with consistent expectations across Presence

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How do we fix it?

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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

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Future State Themes/Characteristics

ONE TOUCH CONCIERGE SERVICE

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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?

Ideal State for Pre-Access

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Phase II: Leadership Restructuring: completed 7/20/15

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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

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

Phase VII: PUSMC/PCMC 4/18/16 5/20/16

Current State as

of 9/17/14

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Real-time Work Driver Implementation Update

Customers

– Patients

– Physicians

– Hospital Administration

– Revenue Cycle System

Leader

– Account Resolution

System Director

– Patient Access Regional

Leads

– Case Management

Directors

– Hospital Departments

– HIM

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)

Suppliers

– Healthlink

– Meditech IS

– HWS

– Miramed

– Avadyne

– GLS

– MIDAS

– ONTRAC

– Passport

– emmi

Project Stakeholder High Level Overview:

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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

Revenue Cycle Project Management Tools: Gantt Chart

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Phase Desired Outcomes

Phase I – Foundational

Pre-Pilot Phase IS infrastructure in place and working well

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

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

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

Pilot sites up and running

Ready to roll out to next sites

Training Plan for Staff

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

Improved work flow

Communication with care management automated


Phase IV – VII Retrofit

Meditech Sites

All Meditech sites up and running

Improved work flow

Improved patient satisfaction


Phase VIII – Move

Away from On Trac

Workflow for historical accounts

Current work driver is no longer being used

What Success Looks Like: Work driver Project Phases and Descriptions

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KPI Source Current metric (baseline)

Future Metric Goal Date:

Reduction of 835 denials attributable to front end

Revenue Cycle KPI metrics

$0

$880,000 reduction

12 months after full implementation at all ministries

Increase net revenue attributable to Pre-Access redesign

Revenue Cycle KPI metrics

$0 $800,000 net revenue enhancement

12 months after full implementation at all ministries

Elimination of Current Work-driver, no PRE-Cert inpatient denials due to late status changes (occur because of limitations in work driver)

Revenue Cycle KPI Metrics

$314,000 per year due to work-driver errors, accounts not scoping in, late status changes, accounts left on FC worklist after status change

50% decrease 12 months after full implementation at all ministries

What Success Looks Like: Project Key Metrics

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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

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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

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Preliminary Results of Centralization Efforts at PSJHE

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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

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Questions?

Contact Information:

[email protected]

630.914.2433 (office)

mailto:[email protected]

Documents

Pre-Access Redesign 2015 - aipamaipam.net/doc/aIPAM_Presentation_PreAccess_Redesign_Central...Pre-Access Redesign 2015 Gap Analysis: ... − Want written documentation describing test,