Ensuring a Remarkable Patient Experience is Delivered in Every Dimension, Every Time Mimi Helton, Senior Director Marty Lambeth, Vice President Karen

Transcription

1 Ensuring a Remarkable Patient Experience is Delivered in Every Dimension, Every Time Mimi Helton, Senior Director Marty Lambeth, Vice President Karen Nichols, Senior Director

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3 Novant Health Making healthcare remarkable Not-for-profit, integrated health system that spans communities in the Carolinas, Virginia and Georgia Over 24,000 employees and physician partners 463 physician locations and 15 medical centers Nationally recognized for quality and safety measures HIMSS Stage 7 Ambulatory Award Epic Professional Billing MPV Award

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5 Continuously growing patient connectivity

6 NHmg: Clinic Locations

7 Clinic Services

8 Building the infrastructure to support our clinics

9 Novant Health Clinic Services Service lines Clinic Patient Revenue cycle and finance Clinic services

10 Clinic Services Team: Leadership Structure Chief operating officer Vice president 5 senior directors 2 directors

11 Centralized Services Clinical Resource Services Education and Training Operational Engagement Major projects include: Clinical workflow training Improving the safety and efficiency of clinical processes Regulatory support for various accreditation certifications Care design Major projects include: Education and training around: RCS Dimensions Coding and compliance Clinical training General education and orientation Major projects include: Maximizing patient engagement Improving MyChart shared access Developing virtual care strategy Business Operations Clinic Ancillary Services Referral Optimization Major projects include: Current state analyses Business plan development Operations, finance and quality projects Major projects include: Optimizing external vendor relationships Educating and training on client billing Improving satisfaction with lab services Major projects include: Referral reporting Developing actionable plans to create operational referrals efficiencies Dimensions Optimization Government Programs Growth and Integration Major projects include: Site visits for Dimensions education Providing Dimensions workflow training Improving the safety and efficiency of the use of Dimensions Major projects include: Improving quality of care/value to patients Reporting of NHmg s value to payors CDI, PQRS/MU, VBM, MIPS/MACRA MSSP Track 1 Reporting and Liaison for CIN Major projects include: Managing start-up, acquisitions, net new clinics, de-affiliations and satellite locations, provider-based conversions, and name changes

12 Centralized Services Operational Excellence PRN Float Pool Recruitment/Managed Care Major projects include: Clinic assessments with a direct financial impact on the business (e.g., copay collection initiative) Provide patient experience support for clinics Major projects include: Managing float pool team members Promoting usage of internal float pool rather than external contract resources Developing consistent workflows for float pool team members across NHmg Provider float pool Major projects include: Powering organic provider growth Overseeing provider recruitment process Managing negotiations, contract implementations, contract maintenance and payor privileging and credentialing Patient Services Care Management Consumer Engagement Center Major projects include: Supporting service recovery work for escalated patient complaints and grievances Creating a standardized approach when we do not meet patient expectations Major projects include: Managing chronic disease patient populations Pharmacy consultations Care coordination Major projects include: Doctor connect After-hours triage Call coverage Appointment scheduling

13 Case Studies

14 Case Studies: Copay Collection Initiative

15 Copay Collection Initiative Comprehensive analysis revealed 77 percent collection rate in 2013 Goal: 95 percent of all copays collected at the time of service Copay collection strategy team formed to: - Identify barriers to effective copay collection - Create metric measurement tools - Develop process to assist clinics with best practice workflows

16 Copay Collection Strategy Team: Phased Approach Research Education Evaluation

17 Copay Collection Strategy Team: Research Phase Identified common barriers during clinic visit observations Solicited direct feedback from clinics on system functionality including a 4-week testing phase Benchmarking against similar healthcare organizations across the nation

18 Copay Collection Strategy Team: Education Phase Internal education Quarterly newsletters Tip sheets with step-by-step instructions on most common issues affecting clinics Distribute each clinic s performance across the entire medical group Clinic progress was shared monthly Clearly indicated clinics meeting the 95 percent average collection rate and clinics that had significant improvement (at least a 10 percent improvement) from previous months Also identified clinics that had significant declines (at least 10 percent decline) from previous months Clinics with continued success (reaching at least a 95 percent copay collection rate each month) and those clinics with significant improvement were also given special recognition in the monthly distribution Routine conference calls with any low-performing clinics to understand each clinic s specific barriers and to provide appropriate feedback

19 Copay Collection Strategy Team: Education Phase External Education Written documentation letter Defined what a copay was, when it was due, the patient s financial obligation, and the potential consequences for not paying a copay Personal contact from clinic administrator to patients who frequently declined to pay reinforced patient s financial obligation and consequences

20 Copay Collection Strategy Team: Evaluation Phase Reports to track medical group s overall performance Reports to track individual clinic performance Tied clinic administrator bonus program to co-pay initiative aligning clinic leadership with medical group vision for improvement Reports to identify non-collections or under-collections Listed the specific visit encounters where a copay was due but the collected copay amount did not equal the copay due amount Enabled clinic managers to investigate the reasoning and take action to educate team members on best practice workflows

21 Copay Collection Strategy Team: Results Co-pay collection percentage increased from 77% to 93% in a twelve-month timeframe $3.84 million increase in total cash collected as a result of initiative during 2014 fiscal year As of December 2016, clinics were maintaining a 95% co-pay collection rate throughout the 400-plus clinic locations

22 Case Studies: Clinical Assessments

23 Clinical Assessment Overview Team members with operational and revenue cycle backgrounds make site visits to assess current operational workflows, staffing levels, charge capture, operating expenses, charge review workqueues, coding profiles, patient access, provider schedule utilization and adherence to policies Team members utilize financials, position management reports, expense analysis reports, and Epic reports to analyze current state and prepare recommendations Team meets with clinic administrator, regional manager (one-up of clinic administrator), and lead physician to review the assessment and recommendations With a collaborative approach, the group develops an action plan to address recommendations or amend as necessary 90 day follow-up visit is scheduled during the assessment meeting Team is available to assist with recommendation implementation during the 90-day timeframe

24 Clinical Assessment Success Story Novant Health Clinic A Originally assessed 4 years ago Recommendations resulted in more than half a million in annual expense savings/revenue enhancements Clinic administrator and physicians were not engaged in the process and recommendations were not implemented

25 Clinical Assessment Success Story Novant Health Clinic A Two years later, the team was asked to reassess the clinic Assessment resulted in approximately $700k in projected expense savings or revenue capture With the direction of the physician service line leader, the clinic engaged in the action plan and implemented recommendations resulting in $520k in annual expense savings or revenue improvement Financial improvements included: Eliminated both clinical and clerical positions (made possible with Epic and operational efficiencies) Coding improvements based on appropriate documentation Reduced OT

26 Case Studies: Referral Navigator Optimization

27 Referral Navigator Optimization Overview Service line expert navigates patients with unassigned and external (outgoing) referrals to the right care at the right time An unassigned referral is a referral that has a blank referred to department and/or referred to provider field If a referral is marked to go external, providers will get a staff message asking permission to change the referral to an internal provider Participating service lines: HVI Cancer Orthopedics Neurosciences

28 Timeline Jan. 11 Operational Assessments completed Week of Jan. 16 Assessment review and planning Week of Jan. 22 Float pool training Testing in Winston-Salem and Charlotte markets Feb. 1 Go-Live Navigators will begin to work unassigned and outgoing referrals

29 Navigator Progress by Market Greater Charlotte Market Internal External Total Internal % External % Baseline 1, ,682 76% 24% Feb Avg. 1, ,759 82% 18% Greater Winston-Salem Market Internal External Total Internal % External % Baseline ,258 75% 25% Feb Avg. 1, ,336 78% 22%

30 Challenges Around Executing Our Clinic Services Strategy

31 Challenges Around Executing Our Clinic Services Strategy Could not successfully execute strategy without team being developed Identifying gaps in structure; unmet needs Constantly re-evaluating, reassessing and realigning as needed (nimbleness built in as organization as grown) Crucial conversations among team Intentional Candor No stone unturned Painful at times.but we are stronger for it Wide geographic distribution Achieving effective communication to the entire medical group Challenges with matrixed service line structure Accountability Decision rights

32 Lessons Learned

33 Lessons Learned Do not be afraid to unwind after a mistake If you are not making mistakes, you are not being innovative Physician partnership and collaboration is vital to success This includes collaboration with lead clinician if an action plan needs to be implemented Work towards trust and respect Dedicated and deliberate investment in the team Working sessions monthly Creating safe environment for brain trust Quarterly retreats (two onsite, two offsite with mandatory fun) Professional/leadership development curriculum StrengthFinders for leaders Work Rules! Happiness Advantage Fierce Conversations

34 Questions

35 Contact Information Mimi Helton: Marty Lambeth: Karen Nichols: