Conifer Health Solutions Tenet Investor Webinar

Transcription

2 Forward Looking Statements Certain statements contained in this presentation constitute forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of Such forward-looking statements are based on management's current expectations and involve known and unknown risks, uncertainties and other factors that may cause the Tenet Healthcare Corporation s (the Company s) actual results to be materially different from those expressed or implied by such forward-looking statements. Such factors include, among others, the following: the passage of heath care reform legislation and the enactment of additional federal and state health care reform; other changes in federal, state and local laws and regulations affecting the health care industry; general economic and business conditions, both nationally and regionally; demographic changes; changes in, or the failure to comply with, laws and governmental regulations; the ability to enter into managed care provider arrangements on acceptable terms; changes in Medicare and Medicaid payments or reimbursement; liability and other claims asserted against the Company; competition, including the Company s ability to attract patients to its hospitals; technological and pharmaceutical improvements that increase the cost of providing, or reduce the demand for, health care; changes in business strategy or development plans; the ability to attract and retain qualified personnel, including physicians, nurses and other health care professionals, and the impact on the Company s labor expenses resulting from a shortage of nurses or other health care professionals; the significant indebtedness of the Company; the Company's ability to integrate new businesses with its existing operations; the availability and terms of capital to fund the expansion of the Company's business, including the acquisition of additional facilities; the creditworthiness of counterparties to the Company s business transactions; adverse fluctuations in interest rates and other risks related to interest rate swaps or any other hedging activities the Company undertakes; the ability to continue to expand and realize earnings contributions from the revenue cycle management, health care information management, capitation management, and patient communications services businesses under our Conifer Health Solutions ( Conifer ) subsidiary by marketing these services to third party hospitals and other health care-related entities; and its ability to identify and execute on measures designed to save or control costs or streamline operations. Such factors also include the positive and negative effects of health reform legislation on reimbursement and utilization and the future designs of provider networks and insurance plans, including pricing, provider participation, coverage and co-pays and deductibles, all of which contain significant uncertainty, and for which multiple models exist which may differ materially from the company's expectations. Certain additional risks and uncertainties are discussed in the Company s filings with the Securities and Exchange Commission, including the Company s annual report on Form 10-K and quarterly reports on Form 10-Q. The forward-looking information in this presentation is as of May 16, 2012, the date it was presented. The Company specifically disclaims any obligation to update any forward-looking statement, whether as a result of changes in underlying factors, new information, future events or otherwise Conifer Health Solutions, LLC. All Rights Reserved. 2

3 Announcement Details 10 year, strategic business process management partnership Revenue cycle management for 56 owned and operated hospitals in 13 states Processing more than $6 Billion in annual revenue Transitioning approximately 2,500 revenue cycle employees Confirms the importance of financial performance to healthcare providers and the need for this type of business model for the future of value based healthcare Solidifies Conifer as the leader in healthcare business process management, in particular, revenue cycle management Conifer Health Solutions, LLC. All Rights Reserved.

4 Why CHI Chose Conifer Best in class RCM Capabilities Best in class RCM capabilities that will deliver benefits over time and position CHI for success in a post health reform world. Significant Financial Performance Improvements Aligned Cultures and Values Centric Approach Improvement of 3 6% in CHI s yield from its revenue cycle operations through comprehensive management of Access, Health Information and Financial functions Aligned cultures and values that resonate together with a shared foundation one built on integrity, reverence and respect, compassion and unity, innovation and service excellence. Collaborative approach that puts the patient and his or her needs first. We emphasize this point continually to ensure it is a primary focus of every Conifer employee everyday Conifer Health Solutions, LLC. All Rights Reserved.

6 2003: Tenet s Changing Landscape External Industry Factors 1. Commercial and governmental reimbursement pressures 2. Shifts in care consumption, acuity, and delivery models 3. Legislative, regulatory, and compliance pressures Care and Profitability 1. Launch Tenet Commitment to Quality Initiative to improve continuum of patient care 2. Launch Operational Efficiency Initiative to improve value capture and enable value creation Tenet s Focus Conifer Health Solutions, LLC. All Rights Reserved.

7 2008: Conifer Health Solutions Launched Conifer brand launched November ,100+ employees 100+ hospitals in our client portfolio 8National Centers of Excellence $9 Billion Revenue Processed Annually Conifer Health Solutions & Revenue Cycle Corporate Office Communications Corporate Office 5 million Accounts Processed Annually Conifer Centers of Excellence Revenue Cycle Client Locations Communications Client Locations Conifer Health Solutions, LLC. All Rights Reserved.

8 Conifer s Strategic Business Model Desired end state Completely hospitalbased revenue cycle operations Redundant operations Significant variation Little to no scale benefits Hybrid model Most hospitals with centralized business offices to manage AR Some stand alone hospitals with high performing/ low cost revenue cycle operations Centralized business offices Manage A/R Handle some revenue integrity activities May have some centralized patient access responsibility Centers of Scale and Expertise Mostly virtual model Business offices specialize around payors, e.g., National Insurance Centers Center of Expertise focuses on business intelligence and standards Process Focused Organization Focus on Customer and related goals Clearly defined results owners & accountabilities Process metrics linked to organization output metrics Improvement actions focused on process results and organizational objectives Conifer Health Solutions, LLC. All Rights Reserved.

9 Scope of Post-Visit Outreach Marketing Campaign Support Communications Outpatient Imaging Scheduling Financial Revenue Cycle Access Clinical Admission Reviews Health Information Consulting ACO Capitation TPA Health Plan Clinical Integration Conifer Health Solutions, LLC. All Rights Reserved.

10 Revenue Cycle Access Revenue Integrity Financial Centralized Access Medical Eligibility & Counseling Access On-Site Referral Authorization Insurance Verification & Financial Clearance Liability Notification & Collection Pre-Registration Quality Assurance Government Programs and Charity Screening On-Site Financial Counseling Education on Financial Responsibilities Collect POS Cash Scheduling POS Liability Collections ED Registration Non Pre-Registration Registration Registration/Admitting ABN Medical Necessity Quality Assurance Training & Support Health Information (HIM) Clinical Revenue Cycle CDM Charge Capture HIM Staffing Coding & Compliance Oncology Data EHR ICD-10 Consulting Clinical Revenue Cycle Consulting Clinical denials management Clinical clearance or precertification Government Audit Appeal services Retrospective authorizations status post Medicaid eligibility CDM Maintenance CDM Reviews Charge Capture Reviews Charge Entry by Department Pre-Bill Charge Audit Clearing Bill Holds PA, HIM, CM Insurance Billing/Rebilling Third-party Follow-Up Remittance Processing Retrospective Denial Follow-Up/Appeal Credit Balance Resolution Customer Service Clinical Appeals Government Billing/Rebilling Medicaid Follow-Up Remittance Processing Retrospective Denial Follow-Up/Appeal Credit Balance Resolution RAC/MIP Appeals Self-Pay / Bad Debt Self-Pay Follow-Up Payment Posting Charity Screening Bad Debt Follow-Up Conifer Health Solutions, LLC. All Rights Reserved.

11 Communications Marketing Scheduling Clinical Post Visit Outreach Physician referral Classes and events scheduling Service line campaigns Online Search Tools Outpatient appointment scheduling Outpatient appointment reminder Clinical admission review Emergency admissions Concurrent reviews Satisfaction/ HCAHPS Discharge planning and adherence Physician satisfaction Conifer Health Solutions, LLC. All Rights Reserved.

12 Capitation Clinical Integration TPA Health Plan ACO Consulting Leveraging our systems NCQA certification Risk Fully delegated clinical and risk management Individual services on fee basis Delivered via web and data line. Delivered via CMS Staff Delivered via web and CMS clinical team Leveraging: Intake/Workflow Configured transaction platform Data warehouse Reports library Transaction processing Call Center Risk modeling Performance analysis Accounting Network Credentialing Clinical Ambulatory Concurrent Referrals Health Ed Disease Data warehouse Delegated status Experience Primarily Hospitals Delegated Groups/IPAs ACO Primarily Hospitals Conifer Health Solutions, LLC. All Rights Reserved.

13 Conifer Health s Operations with CHI National Business Process Leader 6,500+ employees 380+ healthcare entities in our client portfolio 7Centers of Excellence $18 Billion Revenue Processed Annually Capitation Corporate Office Industry Leading Performance and Scale Conifer Health Solutions & Revenue Cycle Corporate Office Conifer Centers of Excellence Revenue Cycle Client Locations Communications Client Locations Cap Systems Client Locations CHI Facility Communications Corporate Office Office Communications Corporate Office 9.5 million Accounts Processed Annually 600,000+ managed lives Conifer Health Solutions, LLC. All Rights Reserved.

14 Centric Approach: Our People The Community Employee Wellness Programs Rooted In Community (Corporate Social Responsibility) Quality & Care Ethics and Compliance Career Development Training and Education Conifer Health Solutions, LLC. All Rights Reserved.

16 Centric Approach: Technology and Process Innovation IT Infrastructure & Risk Client Technologies Technologies Hospital Information System Claims Integration Real time (HL7) Batch (MFT) Transformation, Mapping & Lifecycle Reconciliation Conifer Financial Record epremis Contract Document Productivity Solutions Client Portal Correspondence Micro Segmentation TM Workflow Engine Revenue Cycle System (ACE) Payor Direct Connect Denials Call Center Portal Conifer Health Solutions, LLC. All Rights Reserved.

17 Keys to Conifer s Success Education and Wellness Scheduling Service Line Marketing Education and Health Screening Physician Referral Scheduling RAC Audit and Defense Financial Clearance Payment Posting (ACO and Bundled Payments) Clinical Clearance Collections Third party or private pay) Denials Quality & Care Admission and Registration First Level Clinical Admission Review Clinical Appeals Eligibility Assistance and Financial Counseling Claim Submission Point of Service Collections Post Discharge Communications Satisfaction/HCAHPS Surveys Conifer Health Solutions, LLC. All Rights Reserved. Charge Description Master Coding and Clinical Documentation Health Information

18 Conifer Health Solutions Post-Visit Outreach Marketing Campaign Support Communications Outpatient Imaging Scheduling Financial Revenue Cycle Access Clinical Admission Reviews Health Information Physician Consulting Risk Plan Future ACO Capitation TPA Health Plan Clinical Integration Conifer Health Solutions, LLC. All Rights Reserved.