Pricing Transparency and Patient Education Ochsner Health System Wendy Burns and Katherine Cardwell January 22, 2018
Agenda OHS Background Revenue Cycle Structure Consumerism at OHS Patient Education Initiatives Current state Future initiatives Staff Education
Ochsner Health System Our Mission is to Serve, Heal, Lead, Educate, and Innovate
Ochsner Health System Our Mission is to Serve, Heal, Lead, Educate, and Innovate Our Vision 11 19 Hospitals (Owned & Managed) OHN or OHS Affiliated Hospitals 277 Residents in 26 Programs 80+ Health Centers And Urgent Care Centers 670,000 1,800,000 Patients Served in 2016 Active 640+ 1,200+ Clinical Trials Employed Physicians 90 Medical Specialties & Subspecialties Clinic Visits In 2016 24,500 Telemed Consults More Than 10,800 Regional Referrals
Excellence In Quality National Rankings: #1 for Organ Transplant #1 for Liver Transplant #4 for Neurological Surgery #9 for GI Hemorrhage 12 other Specialties in the top 10% Overall State Rankings: OMC BR #3 Overall Medical Care OMC BR #3 Overall Hospital Care 12 Different Specialties: #1 in State #1 Hospital in Louisiana Nationally Ranked in 4 Adult Specialties: #22 in Gastroenterology & GI Surgery #24 in Neurology & Neurosurgery #27 in Ear, Nose and Throat #28 in Nephrology Nationally Ranked in 1 PEDIATRIC Specialty: #49 in Cardiology & Heart Surgery
Ochsner Health System Locations St. Tammany Parish Hosp Covington, LA JOA OMC-BR Baton Rouge, LA Owned SMH Slidell, LA JOA OMC-NS Slidell, LA Owned Hancock Bay St. Louis, MS Managed River Parishes LaPlace, LA Managed OMC-K Kenner, LA Owned OMC New Orleans, LA Owned Baptist New Orleans, LA Owned Terrebonne Gen. Houma, LA JOA St Charles Parish Luling, LA Managed Chabert Houma, LA Managed St. Anne Raceland, LA Leased OMC-WB Gretna, LA Owned St. Bernard Parish Hospital Chalmette, LA Managed 6
Statewide Ochsner Health Network Shreveport CHRISTUS * Alexandria CHRISTUS Lake Charles CHRISTUS * Financially Integrated Affiliated *LOI Signed
Revenue Cycle Organizational Chart
CONSUMERISM AT OHS July, 2016
Healthcare to a Consumer Navigating healthcare today is like producing a movie. Patients have to find the actors, directors and sets and then figure out the financing for everything separately without knowing what anything costs until the night of the premiere. Veer Gidwaney CEO and co-founder of Maxwell Health 11
Education Challenges Patients do not always have a full understanding of their benefits A patient s procedure, test, or visit may change from the scheduled service resulting in a change from the estimated cost Difficult to provide estimates prior to an office visit or lab due to out of pocket amounts varying based on payor, benefit plan, office visit level, and new vs established Patients are requesting the cash pay price to compare to the out of pocket cost based on their insurance Patients are not eligible for the uninsured discount if they are insured Amounts not billed through insurance are not counted towards their deductible Ochsner Health System Confidential & Proprietary Information
Pre-Service: Financial Clearance Pre-Service Financial Clearance Unit verifies benefits and creates a patient estimate for scheduled radiology tests, surgeries, office procedures, and infusions Patients are contacted approximately two weeks ahead of the scheduled event regarding their liability Automated calls Manual calls Message through the patient portal Payment is requested in full If a patient is not able to pay in full We offer an interest free payment plan Financial counselors screen the patient for financial assistance Patients < 200% of the FPL are eligible for financial assistance Ochsner Health System Confidential & Proprietary Information
Financial Clearance Implementation Desired Project Objectives Stability: Reduce bad debt by ensuring that patients who are able to pay do pay their fair share Community: Enhance Ochsner s charity care by offering proactive Financial Assistance for those who truly cannot pay Loyalty: Improve patient experience through clear, consistent, and timely communication so they are fully informed to make decisions about their care Quality: Increase physician satisfaction through more timey financial service delivery (e.g., increasing lead days) 14
Point of Service Education Registration staff request copayments at the time of service Financial Counselors are stationed in select locations to meet with patients who were unable to be contacted prior to service Understanding Your Liability brochures available in waiting rooms Educational video in development for waiting rooms Ochsner Health System Confidential & Proprietary Information
Understanding Your Out-of-Pocket Costs
Provider-based Billing Public Awareness Signage is posted in all departments indicating provider based status Government payors and selfpay patients sign an acknowledgement form on initial visit to the facility Other forms of public awareness Clinic Poster & Patient Handout Patient Estimate Handout Provider-Based Acknowledgement Form Website Information Clinic Signage Photos Ochsner Health System Confidential & Proprietary Information
Provider-based Signage & Website Information Ochsner Health System Confidential & Proprietary Information 18
Facility Disclosure Notification Notification to patients whether or not their insurance coverage is contracted with the facility Benefits reviewed prior to date of service All patients sign an acknowledgement form upon check-in Ochsner Health System Confidential & Proprietary Information 19
Drug Copay Assistance Program Covers hospital outpatient infusion suites (Chemo, Rheum, Infect Disease) Commercially insured patients are eligible for the program Some programs have income criteria and others do not Program Statistics 2017 collections: $850K 58 drug programs identified with eligibility ~205 patients qualify per month with an average $871 average payment posted per drug encounter Program Performance Ochsner Health System Confidential & Proprietary Information
Project Timeline Inform and Empower Consumers Ease anxiety provide estimates in Empower clinical teams to provide pricing Clearance Unit 17 clinic 18 at Scheduling 19 Educate consumers Understanding your Insurance video transparency Targeted Campaigns to inform patients Make it easy! Self service options through MyOchsner Take out the surprise: Out of Network Notification Develop On- Demand financial counseling structure Streamline proactive communications: Financial Q4 Q4 Q1 Q1 Q2 Q3 Q1 Create Personalized financial education experience at checkout
Lessons Learned Updated patient statements based on feedback from patient and family advisory board Identified opportunities to work with outside providers to catch errors on the front end to prevent erroneous statements Ochsner Health System Confidential & Proprietary Information 22
STAFF EDUCATION July, 2016
New Hire & Continuing Education Health Insurance 101 Shadowing with departments Customized checklist according to processes Precyse Modules 100+ Modules tailored to Patient Access, PFS, Billing, Collections, etc. Journey through the Revenue Cycle Managed Care In- Person Presentations & Webinars Ochsner Health System Confidential & Proprietary Information
Patient Access Education Insurance and Coverage Series Health Insurance Overview Coordination of Benefits Elements on an Insurance Card Hospital Payer Mix Insurance Terminology Medicare Guidelines Introduction to Medicaid Managed Care Plans Medicare Advantage Plans Private Payers Self Pay Worker s Compensation Veteran s Affairs and Military Insurance Medicare Secondary Payers Ochsner Health System Confidential & Proprietary Information
Patient Access Education Training Type Description Required Hours Per Year Classroom- Based Topics based upon new workflows, continuing education, and compliance regulations One Per Quarter 5 E-Learning Topics similar to classroom-based training, but less complex and easily comprehended via e- learning format. One Per Month 10 E-mail Distribution Onboarding Notification to inform employees of payor/plan updates and minor Epic changes. Also used in conjunction with classroom-based and e-learning courses. Delivered after completion of Epic training. Topics include compliance documents, additional insurance education, and department-specific scripting. As Needed 2 Within First 60 Days 7
Operations and Clinician Education Coding & Health Insurance 101 during Physician Onboarding One on One Coding Educator sessions Facility Revenue Cycle & Insurance 101 Lunch and Learns with Strategic Business Partners Specialty Financial Councils Pharmacy Partnership with Strategic Business Partners Facility Operations Director/Manager Meetings Ochsner Health System Confidential & Proprietary Information
Customer Service Training Orientation & System Training (week 1 & 2) Department policies & expectations Medical Terminology Health Insurance 101 & Rev Cycle 101 CPT & ICD-10 Telephone Doctor - customer service communication training System Training (Epic) SBO & PACS/PFS Protocols & Processes Phase (week 3 & 4) PACS Telephone Triage & CRM s Tool Box and P&P documents Insurance (Types, Filing Limits, COB, etc) Payment Posting & logic Claims, EOB s, Denials & Statements Collections, Financial Assistance & Payment Plans Top 4 Calls Module (Coding, Ins Updates, COB & Payment Plans) Hands On Activities (week 4 & 5) Lagniappe ABNs, Discounts, Escalating Calls, etc Workshops MYO, Faxes & Correspondence Shadowing Mock Calls & Live Calls in Classroom Testing Nesting process Side by side calls taken with team leads, taking turns speaking & navigating; feedback shared between calls Continued Education Phase Monthly quality assurance audits behavioral standards account for half of overall score Ex: Solution & Ownership, People Skills, Communication Skills Coaching sessions review phone calls with reps Monthly team training on needed areas of focus Annual team retreat includes half day refresher of all training, protocols & process
Contact Information Wendy Burns, Assistant Vice President, Revenue Cycle Solutions wburns@ochsner.org 504-842-0988 Katherine Cardwell, Assistant Vice President, Financial Clearance kcardwell@ochsner.org 504-842-7208
Questions?