Sutter Physician Services. Driving Revenue Cycle Improvements through Self Service Analytics

Transcription

1 Sutter Physician Services Driving Revenue Cycle Improvements through Self Service Analytics

2 The Story Prologue Corporate Background Chapter 1 The Journey Begins Chapter 2 Our Leap Forward Chapter 3 Challenges and Responses Chapter 4 Happily Ever After 2

3 Prologue Your Speakers for Today Sutter Physician Services Corporate Overview Our Client Structure 3

4 Speaker Introduction Erich Olson - Assistant Director, Enterprise Analytics Services Kristine Krueger Director, Forensic Analytics Chris Sharp - Assistant Director, Data and Application Services Brian Finn Business Intelligence Architect

5 Sutter Physician Services Overview Sutter Physician Services is an industry leading physician-focused healthcare services company that provides revenue cycle management, patient access solutions and accountable care solutions to integrated delivery networks and large physician groups Revenue Cycle Management Patient Access Solutions Accountable Care Solutions Provides patient focused, high-tech billing and AR management services for physicians, home health, and Ambulatory Surgery Centers Patient Access: Calls rerouted from doctor s office to Patient Service center for patients seeking general information and patient registration and/or scheduling Clinical Call Services: 24 7 nurse advice services, Rx refills, health outreach programs, readmission management, and MD oncall services Supporting all facets of managed care and risk administration including: Commercial and Medicare plans, care coordination, population health and advanced analytics Independent Practice Services Integrating independent practices through EHR, practice management, and other solutions Support Capabilities Technology EPIC and GE/IDX-certified support for implementation, optimization, and ongoing applications support of the physician enterprise Analytics and Business Intelligence Routine and ad hoc reporting and analysis for finance, operations, utilization management, clinical performance, regulatory compliance, and quality performance 5

6 Sierra Region West Bay Region not-for-profit 48,000 employees and 5,000 doctors East Bay Region Peninsula Coastal Region Central Valley Region Su8er Su8er Physician Physician Services Services 2013 by the numbers Emergency room visits - 757,598 Sutter Care at Home health visits - 419,275 Sutter Care at Home hospice visits - 246,927 Outpatient visits - 10,131,343 Charge Transactions 22,000,000

7 Chapter 1 The Journey Begins Our motivation for change Ambulatory Revenue Cycle Management Denials Rate Management in a Land Far Away Our first step toward change Finding Goldilocks 7

8 Our Motivation for Change Classic approaches to reporting take a lot of time if what you really need to do is detail analysis. Time lag translates into lost productivity and lost opportunity for improvement. Our goal is to provide insights to our clients that are actionable, accurate, consistent, and timely. Using Self Service Analytics we knew we could better achieve our goal and improve our client experience.

9 Ambulatory Revenue Cycle Process Our Clients (Medical Foundations) Sutter Physician Services Patient Sees Doctor Encounter form is filled out with information related to the visit. Generate Claim Scrub claim, fix errors prior to billing Send Claim to Insurance Claim is outstanding for a period of time Receive Response from Insurance Collect Payment Appeal denied claims Generate Patient Statement Bill patient for unpaid copay, deductable, or noncovered services Date of Service Department Coverage Plan Copay Due/Collected Patient Info Diagnosis Specialty Claim Rule Violations Performing Provider Referring Provider Key Data Points Post Date Guarantor Account Procedure CPT Code(s) Procedure Modifier(s) Charge Amount(s) Billing Provider Original Payor Current Payor Revenue Location Place of Service Payment Date Payment Amount Denial Date Denial Payor Denial Reason Code Denial Category 9

10 Denials Rate Management in a Land Far Away What was my denial rate this month? Go to SharePoint and check the Core Team Dashboard DENIALS How do I get more information about the denial types? Go to SharePoint and check the Denial Summary by Category Report OR Go to SharePoint and check the Denial Summary by Remit Code How can I tell which Department has the highest rate? Go to LaunchPad and run the Denial Details Report From there you can see the detail of the denials and pivot on total volumes by department BUT If you want the denial rate you will have to request an Ad Hoc report to get your transaction count denominator Requires several clicks and you may not ultimately get to your answer in the same day. 10

11 Our First Step Toward Change It all started with a Proof of Concept (POC) Identify a question and model the answer in MicroStrategy Denials rate Engage MicroStrategy Professional Services Present findings to our Executive Team 11

12 Denials Rate POC 2 days to a working Denials Rate prototype Now we could see a problem and drill to the detail behind it Answers came as fast as the execs could ask them Now we needed to find the Goldilocks project

13 What does Just Right look like? Too Small Too Big Just Right Speed to delivery Relevance to our business objectives Opportunities to drive Business Intelligence (BI) Maturity

14 Our Goldilocks Project Revenue Cycle Core Team Dashboard Speed Relevance Opportunities to Drive BI Maturity

15 Chapter 2 Our Leap Forward The Demo 15

16 Reminder What was my denial rate this month? Go to SharePoint and check the Core Team Dashboard DENIALS How do I get more information about the denial types? Go to SharePoint and check the Denial Summary by Category Report OR Go to SharePoint and check the Denial Summary by Remit Code How can I tell which Department has the highest rate? Go to LaunchPad and run the Denial Details Report From there you can see the detail of the denials and pivot on total volumes by department BUT If you want the denial rate you will have to request an Ad Hoc report to get your transaction count denominator Requires several clicks and you may not ultimately get to your answer in the same day. 16

17 Limitations of Classical Reporting Methods Reporting was historical in nature forcing us to be reactionary Reporting had low sensitivity which made root cause analysis of KPI performance difficult Decentralized reporting structure lead to data governance issues Drill down analysis was performed in a manual ad hoc manner which was time consuming

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19 Denial Trending Denials Dashboard go- live 4/1/2014

20 Chapter 3 Challenges and Response Challenges to Self Service Implementation Governance User Training 20

21 Challenges to Self Service Implementation Delivery Process/Development Lifecycle Governance Managing Change

22 Metric Stewardship Committee Super Users Governance Advisory Committee Analytics Collect Ideas & Collaborate Review Proposals Prioritize Changes Approve Execute 22

23 User Groups/Training Strategy Train the trainer Identify your super users/smes and help them learn the tool Direct local resources to engage SME as first level support User Groups Regular Meetings Work sessions with real world questions Use Case Based Examples

24 Architecture Considerations POC was based upon views on top of a normalized data structure which was not scalable Required a model that was automated, scalable and easy to use Physical dimensional model with conformed dimensions which was easily transformed to MicroStrategy schema s Automated data refreshes through SQL Server Integration Services, MicroStrategy schedules

25 Architecture Considerations - Cont. Required an architecture that was secure and provided for flexibility and quality Established a security model to filter data by client Established a path to prod Track and document changes Created three separate environments Development Quality Assurance Production 25

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27 Our Recommendations Plans for the Future Chapter 4 Happily Ever After 27

28 Our Recommendations Standardize Dashboards Change Request Management Use epeps Professional Services Sandbox Environment

29 Plans for the Future Accountable Care Data Forensics Quality Measures

30 30 Questions