Prepare For Health Reform With Revenue Cycle Management Insight From McKesson

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Achieving Revenue Cycle ExcellenceTo Prepare for
Health Reform

• Jim Morrison, VP and General Manager
• Revenue Cycle Solutions, McKesson

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Agenda
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Healthcare ReformThe Environment

• Healthcare reform legislation set things moving.
• The next steps are less clear

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Audience Survey

• Which of the areas listed below is your
  organization most prepared to address?
• Accountable care/shared savings strategy
• Value-based purchasing
• Readmissions and hospital-acquired conditions
• Bundled payments
• Strategy to address newly insured patient
  populations

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HFMA ANI 2011 Conference Survey
Please indicate your organizations preparedness
to address the areas listed below.
Sample size 84
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Four Building Blocks of ACOs
PCMH
ACO
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ACO Strategic Competencies

• Connectivity
• Interoperability
• Data Exchange
• Care Coordination
• Communication
• Messaging
• Notifications
• Results
• Referrals / Orders

• Engagement
• PHR
• Multi Modal Comm.
• Education
• Online Programs
• Decision Support
• Marketing
• Transformational Services

• Financial Management
• Eligibility
• Medical Necessity
• Auto-authorization

• Payment Mechanics
• Contract Repository
• Medical Policy
• Payment Policy
• Distribution Logic

PCMH
ACO
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Bundled PaymentRequired Capabilities
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Bundles PaymentsSuccess Requirements
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Healthcare ReformWhats Next?

• The world will include a mixed environment
  Capitation/fee for service, risk sharing
• The world will be a heterogeneous one Medical
  homes, legacy systems and significant
  investments, clinics, labs, doctors offices,
  unique payer relationships, unique employer
  relationships, consumer driven healthcare,
  regulatory reform, analytics to drive down cost,
  population management, increased demands and
  shrinking reimbursement all coming by 2014

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Healthcare ReformWhats Next?
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Agenda
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Provider ImpactThe Changing Landscape
ICD-10 Transition
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Agenda
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Audience Survey

• Are you talking with any of your payers about how
  the health reform changes will affect your
  relationship?
• Yes, were meeting regularly
• Yes, were in the early stages of discussion
• No, but we have plans to meet
• No, with no plans to meet

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Enhancing Payer Relations
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Agenda
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Reimbursement ManagementComplexities and
Mechanics

• Medicare 72-hour window
• Underpayment management

• Cost of care, quality of care, spend per-member
  per-patient
• Provider efficiency
• Benchmarking Incentive Modeling
• Reporting to regulatory bodies

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Agenda
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Driving Out CostsStrategies and Opportunities

• Big focus on clinical IT comes from ARRA
• Strengthen your revenue cycle processes by using
  your IT system to the full extent
• Process flow improvements
• Organizational changes and improvements
• Technology plan to improve results
• Optimize to drive to the best practice for each
  area
• Reduce total cost of ownership for IT

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Audience Survey

• What process do you use today to confirm patient
  identity?
• Photo ID
• Photo ID and insurance card
• Biometrics
• Other

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Driving Out Costs Patient Identification
Management

• Medical Identity Theft is one of the fastest
  growing crimes in the U.S.
• An estimated 1.4 million adults, approximately
  5.8 of the U.S population, were victims of
  medical identity theft in 2009.
• Biometrics identity confirmation
  can ensure the right patient
  receives the right care

According to the National Survey on Medical
Identity Theft prepared by Ponemon Institute in
2010
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Agenda
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Audience Survey

• What are your current net accounts receivable
  days?
• ? 40 days
• 41 45 days
• 46 50 days
• 51 55 days
• ? 56 days

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Case Study Mississippi Baptist Health System

• Staff education on IT and processes
• HIS table updates to align with best practices
• Process improvement for point of service
  collections

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Audience Survey

• What is your average time for patient
  registration to be completed?
• ? 10 minutes
• 11-15 minutes
• ? 16 minutes

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Case Study Spartanburg Regional Medical Center

• Streamlined insurance master tables
• Established electronic remittance advice for each
  payer
• Standardized graphical user interface for
  registration staff

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Agenda
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Whats Next?Managing Populations and Risk Under
Health Reform

• Connectivity Engagement
• Interoperability with identity management
• Patient communication
• Engagement Model

• Care Management
• Cross-continuum, patient centric care plan
• Quality and Evidence
• Holistic disease management

• Financial Management
• Eligibility
• Payment mechanics
• Disbursement Management

• Care Management
• Cross-continuum, patient centric care plan
• Quality and Evidence
• Holistic disease management

• Connectivity Engagement
• Interoperability with identity management
• Patient communication
• Engagement Model

• Analytics / Data Aggregation
• Performance evaluation
• Population analysis
• Network analysis
• Outcomes reporting

• Analytics / Data Aggregation
• Performance evaluation
• Population analysis
• Network analysis
• Outcomes reporting

• Financial Management
• Eligibility
• Payment mechanics
• Disbursement Management

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Whats Next?Managing Populations and Risk Under
Health Reform

• Connectivity Engagement
• Interoperability with identity management
• Patient communication
• Engagement Model

• Care Management
• Cross-continuum, patient centric care plan
• Quality and Evidence
• Holistic disease management

• Analytics / Data Aggregation
• Performance evaluation
• Population analysis
• Network analysis
• Outcomes reporting

• Financial Management
• Eligibility
• Payment mechanics
• Disbursement Management

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Extra Resources
sites.mckesson.com/AchieveHIT/reform.asp
More Information on Revenue Cycle Management
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Questions