The Future of Access: A Patient-Centric Vision NAHAM Presentation

The Future of Access: A Patient-Centric Vision 2014 NAHAM Presentation

Presenters Karen Shaffer-Platt Georgina Trunzo Vice President, Revenue Cycle/Patient Concierge Services at UPMC 25 years experience in Access and Revenue Cycle Management in both the Hospital and Physician Services 15 years of IT project management experience, including direction of system training and development, system installation and data conversion Graduate of the University of Pittsburgh Member of the National Association of Health Care Access Management (NAHAM), American Association of Health Care Administrative Management (AAHAM), and Healthcare Financial Management Association (HFMA) Executive Director for Patient Access Services at UPMC 30 years of Health Care experience Includes Patient Registration, including the various hospital integrations and conversion to new computer ADT systems. Graduate of the Pennsylvania State University with a degree in Health Planning/ Hospital Administration and a minor in Finance. Member of NAHAM (National Association of Healthcare Access Management) and she has published articles and presented nationally on Access topics.

UPMC Health Systems UPMC is a world-renowned health care provider and insurer based in Pittsburgh, PA, inventing new models of accountable, cost-effective, patientcentered care. The largest non-governmental employer in PA (62,000+ employees) Operates 22 academic, community, and specialty hospitals and 400 outpatient sites, employs approximately 3,500 physicians, and offers an array of rehabilitation, retirement, and long-term care facilities.

UPMC Health Systems: Annual Patient Activity Admits more than 264,000 inpatients and observation cases Sees more than 3.6 million outpatient office visits Cares for nearly 650,000 emergency visits Performs nearly 174,000 surgeries Makes more than 500,000 home care visits

Patient Experience Value Every patient believes that every individual involved in his or her care has demonstrated dignity, respect and kindness while listening to his or her unique needs. This vision is only achieved by showing every patient in every interaction that we truly care. The UPMC patient experience vision is built upon our values as an organization.

Access of the Future UPMC conducted a revamp of the current access models within the Hospital and Physician divisions to prepare for Access of tomorrow. Accountable Care Measures Transparency Competing Demands More Payors in the Marketplace New Competitive Marketplace Transition from Quantity to Quality Measures

UPMC Patient Experience KPIs One Touch Scheduling POS Enhancements Concise Registration Data Patient Centric Experience Flow of Services Scheduling Protocols Administrative Collaboration Continuum of Care Financial Coaching

Access Redesign Timely and Appropriate Access Positive Patient Experience Streamline Points of Entry Standardized and Simplified Workflows Transition Across Business Units Administrative Cost Savings

UPMC Patient Experience KPIs Concise Registration Data Flow of Services One Touch Scheduling POS Enhancements Patient Centric Experience Scheduling Protocols Continuum of Care Financial Coaching Administrative Collaboration

New Patient Volume 5+ Million Patients currently in Epic 16,000 Epic Patients Daily 425 New Epic Patients Daily 150 Registration via automation or not necessary 50 ED and Urgent Care 40 Newborns that use parents registration ONLY 185 New Detailed Registrations per day

Welcome Patients Welcome Calls for all NEW patients to UPMC 1 Complete new person interview for the organization Way-finding information Payment expectations Pre-payments secured Walk-in Patients Streamlined process Appt &Quick Reg

Central Contact Center The Patient Central Scheduling Contact Center Workforce Management Decentralized Ancillary Schedulers Decentralized Department Schedulers Virtual Call Center

Decision Support Epic Questionnaires Used as a decision support tool by the Contact Center to allow cross training of scheduling agents Enables scheduling agents to schedule for 20+ diverse sub specialties. Including: Orthopaedics, ENT, Neurosurgery, Dermatology, etc

Technology for Optimization Epic Questionnaire

Technology for Optimization CRM (Customer Relationship Management) Epic feature utilized by the Contact Center to allow a concise communication pathway between Patient Access Specialists, Centralized Billing and decentralized department staff CRM topics used to kick off backend automation. For example, patients removed or added to work queue. Provides central location for documentation of patient contact, call activity and resolution

Customer Service CRM Reporting for Operations Customer Service provides Access feedback on why patients are calling, and how future calls maybe prevented. Tutorials/training sent with report cards. SUB TOPIC Sep Oct Nov Dec Jan Feb 6 Mo Trending 6 Mo Avg 6 Mo Min 6 Mo Max Feb Daily Avg 23 - Insurance Not On Account 929 1117 924 1010 1002 1144 1021.00 924 1144 57.2 13 - Charge on Wrong Account 329 417 355 387 307 363 359.67 307 417 18.15 52 - Incorrect Insurance Information 291 351 304 261 297 320 304.00 261 351 16 8 - Coordination of Benefits Issue 265 266 200 292 355 412 298.33 200 412 20.6 37 - Missing Patient Payment 106 121 112 110 108 98 109.17 98 121 4.9 16 - Coding Review Procedure Code 80 103 77 152 108 133 108.83 77 152 6.65 53 - Incorrect Demographic Information 58 94 83 66 155 62 86.33 58 155 3.1

Agent Monitoring Tools CMS Interval reports are delivered every 3 hours: Agent Report Card QA Score 90% 90% 98% 95% 97% Adherence 88% 88% 94% 96% 96% Other Job Duties 2 2 1.0 1.0 0.8 Scheduling Overflow AHT 358 420 323 299 293 Scheduling Overflow ACW 111 180 74 60 52 Scheduling Overflow Calls Taken 918 543 837 Consumer Referral AHT 359 360 319 295 263 Consumer Referral ACW 107 150 87 67 58 Consumer Referral Calls Taken 186 101 162 Televox AHT 407 510 388 391 360 Televox ACW 113 312 101 140 63 Televox Calls Taken 50 12 31 Total Calls Taken (All Skills) 1368 764 1259 Outbound Calls 311 233 248 #N/A 102 202

Point of Service Model The access model at UPMC stresses a positive patient overall experience. UPMC is changing its Point of Service (POS) model to allow for value based care and moving away from the transactional model. Some topics that will be covered include: 72 Hour Initiative Post appointment scheduling Discharge Planning transition of care Technology requirements

Access Leadership Managed Centrally

Recruitment and Placement Services Applicants Human Resources Site Management Simplified and efficient interview process. Applicants seeking jobs only need to apply once to be considered for all available open Patient Access positions. Promotes staff retention and job satisfaction new hires have the opportunity to try-out a job before they commit to permanent placement. Applicants are consistently provided the appropriate training and orientation to be successful in their Patient Access role. Centralizing recruitment and placement of Patient Access staff simplifies the HR processes. Applicants only need to be processed once. Cost saving in HR time and in background check utilization. Use of a consistent partnership with the Floater Pool provides for a consistent workflow for recruitment and hiring of Patient Access staff. Replace competition with collaboration in attracting and hiring the best Patient Access candidates. Operational site management can focus on day-to-day business operations rather than time intensive recruitment process. Promotes staff retention and a better patient experience. Operational managers try out new hires prior to permanent placement. A happy employee who fits in the site culture provides for a better patient experience. Cost savings with being able to maintain an efficient staffing model with the ability to flex-up with floater pool staff to cover incremental patient volume days or PTO.

2014 What to expect? Continued shift in liability to patient Consumer Centric Approach ACA Guideline Changes 1/1/2014 All Large Employers must change or be subject to fines Increased Patient Advocacy and Education Traditionally Patient Liability Consisted of Copays Deductible Thresholds have grown and will continue to grow Coinsurance is included on many plans

Time of Service Collections - Education is Essential Historically 60% of copays are paid at the time of service. During the full life cycle of a claim only an additional 20% of copays are collected. We collect 65.5% of deductibles and 49.1% of coinsurance during the full life cycle Education has begun and will be critical moving forward to ensure collection of Deductible and Coinsurance at the time of service. At the Enterprise level, we collect 60% of Copays at the POS At Physician Offices, we collect 80% of Copays at the POS At Radiology sites, we collect 21% of Copays at the POS Based on historical AR for PSD and Hospital services using UPMC Health Plan Commercial data from January 2013 to January 2014.

Patient Experience Patient Counseling: Our most effective approach Proactive discussions with patients at appropriate times in comfortable settings Not on a gurney, while under sedation or medicated for a procedure

Patient Education Scheduling Reminder of benefit changes Out of pocket liability Pre-Arrival Benefit overview Out of pocket liability Financial Assistance Point of Service Customer Service Out of pocket liability Payment Collection Financial Assistance Referral to Patient Concierge Patient Education Claims Adjudication Financial Assistance Post Service Work Queues Outstanding balances Communication MyUpmc / HealthTrak Dynamic Messaging on Statements estatement Hyperlinks

Post Appointment Scheduling and Discharge Planning Transition of care is accomplished by a proactive Discharge Planning program and onsite post appointment scheduling for all necessary follow-up appointments, labs, and testing continuum of care plan. Both programs are very patient orientated and value services for the patients that transition across business units. The Physician Services Central Scheduling facilitates and schedules appointments for targeted patients through the Discharge Planning Protocol (DPP) program. This concierge service follows discharge instructions for each patient qualifying for any of the DPP initiatives, scheduling appointments with both Primary Care Physician (PCP) and Specialists. Attempts include scheduling of PCP appointments to occur within five days of discharge.

Discharge Planning

Patient Experience Several wellness visit campaigns are conducted within the Contact Center and at the department level for existing patients Happy Birthday Campaign Patient Quality Outreach Benefit Education Calls Welcome Back Calls to Patients that have not been to a UPMC Facility for over 18 months.

POS Enhancements MyUPMC Welcome/Kiosk Telephony Direct Scheduling Appointment Reminders& Appointment Check In Pre-registration On-line bill payment, estatements Payment due reminders 24/7 Live Chat for appointments, billing and payments Discharge Summaries Automated Check In Streamline Throughput Improved Patient Experience Centrally managed Workforce/real time call monitoring Hold departments to phone scheduling KPI and reporting standards Call Forecasting to staff to current volume Quality Assurance (QA) for call recording Standardized Training

New Operational Model An evidence-based management approach Proactively, point of service departments are given report cards that measure: Department KPIs Copays, Press Ganey scores, etc. Operational KPIs down to the user level Check-ins by users, scheduled appointments by user, etc. Quality assurance checks are done via randomly monitored phone calls and department site visits. This data is available monthly for all departments to see and the data is shared among peers.

Front Desk KPIs KPIs measured, reported and trended centrally. Business Units held accountable. Registration Updates Check In Volume Same Day Appointment Volume Appointments by Phone Volume Total Appointments Scheduled Daily Average Check In Daily Average Same Day Appts Patient Wait Time (EpicCare sites) Patient Liability Copay, Coinsurance, Deductible, Prepayment, other patient payments 72 Scheduling Charge Posting Reconciliation Validation and verification of Privacy/TPO/HIE on Account HealthTrak Adoption Concierge Form Usage QA Results Utilization of FYI Notes Offered concierge services Offered to schedule follow up appointment Advised of MyUPMC activation number

Department Report Card User Level Weighted Score 1 1 0.5 0.5 0.5 Avg Daily Avg Daily Avg Daily Avg Daily Edits/Denials/ Avg Daily Name Login ID Job Title Check In Scheduling Referrals EDIs UPAY Tx Total Front Desk User 1 USER1 Access Lead 0.80 6.70 0.00 0.15 1.70 8.43 Front Desk User 2 USER2 Access Lead 0.05 24.30 0.00 0.00 22.60 35.65 Front Desk User 3 USER3 Patient Information Coordinator 0.90 23.20 0.00 0.00 14.15 31.18 Front Desk User 4 USER4 Patient Information Coordinator 31.20 16.10 0.00 0.00 10.65 52.63

Press Ganey HVI February 2014 All CMI February 2014 All UPP February 2014 Press Ganey 75th Percentile Rank CGCAHPS Questions - AVG% Yes Definitely Clerks treat with courtesy/respect 97.39 94.99 93.77 95.40 Clerks/receptionists helpful 96.54 92.20 90.53 92.00 Standard Press Ganey Questions Access Ability to get desired appointment* 90.8 89.6 86.7 90.9 Convenience of our office hours 92.1 90.3 88.2 90.5 Courtesy of registration staff 95.8 94.0 92.9 94.0 Ease of getting clinic on phone 90.6 91.0 88.0 88.9 Ease of scheduling appointments 92.5 92.3 90.0 91.2 Information about delays 90.7 87.9 82.0 86.3 Moving Through Your Visit Wait time at clinic 90.2 88.4 81.3 86.2 Waiting area comfort/pleasantness* 91.2 89.4 86.9 91.7

Cognos Reporting Encounter Charge Posting Efficiency & POS Cash Collections

UPMC Real Guiding Principal for Change Insanity: doing the same Patient thing over Centric and over again and expecting Experience different results. Albert Einstein

Questions