The CHI Physician Services (CHIPS) Journey: Transforming the Physician Practice Model Across a Large Hospital Based System AMGA Conference March 2015
Introductions Beth Cafaro, JD Vice President Practice Operations President of CHIPS Jamie Dye Chief Development Officer MedSynergies CHIPS Board Member
Organizational Overviews
Catholic Health Initiatives (CHI) Today MISSION: To nurture the healing ministry of the Church, supported by research and education. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthy communities
About MedSynergies
MedSynergies By the Numbers 24 Markets 7.6K Providers 10.6M 2.2M 1.3B Visits Number of Patients Total Collections
Next Era Evolution Focused Next Era Strategic Priorities Clinical and Operational Excellence Demonstrated Quality and Service Physician Network Growth and Engagement Cost Effectiveness Financial Performance Organizational Model IT Investment Integrated Care Delivery Clinically Integrated Network (CIN) Development Organic Growth Strategies Care Management Models and Capabilities Integrated National and Regional Service Lines Retail, Ambulatory and Post-Acute Strategies Payment for Value Risk and Insurance Capability (Prominence Health) Employee Health Management Payer and Insurance Product Strategies Consumer Engagement Strategies The Next Era of Healthy Communities
Physician Enterprise Growth Region # of Providers Nebraska 898 Pacific Northwest 746 KentuckyOne 556 Iowa 517 East-Southeast 616 Minnesota/North Dakota 366 Texas 74 Total Providers 3,773 12% 33% 55% Primary Care Specialists Other 1,320 Advance Practice Clinicians
Transforming the Physician Practice Model
What is CHIPS? Catholic Health Initiatives Physician Services is a management services organization created to support our provider practices with resources and proven practice management solutions that optimize performance and free up physicians, clinicians and their staffs to deliver better patient care.
How Did CHIPS Transform the Model?
CHI Partnerships Drawing the Plans
Governance Laying the Foundation 1. Establish and maintain a clear organizational governance structure. 2. Lead with a defined communications campaign. 3. Transition and on-board resources with diligent and thoughtful care. 4. Implement solutions on-time and on-budget. 5. Identify data sources of truth. Strategic Imperatives 6. Establish baseline standards and success criteria metrics.
MSIGHT Standard of Excellence Laying the Foundation
Coding JV Management Services Practice Management MSO Services Alignment Establishing the Framework Practice Marketing Strategy (option) Human Resources CHIPS Quality Metrics/Management Revenue Cycle Centralized Scheduling (option) Charge Entry CHI Will Retain the Provision of Some Physician Services Practice Accounting Services Communications Care Management Legal Compliance
5-Phase Implementation Starting the Build Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Complete Complete Complete Current Future Fargo KentuckyOne Pendleton Reading Lufkin CHI Health Nebraska Roseburg St. Luke s Tacoma Mercy Des Moines Chattanooga Steubenville /Bryan Bismarck Little Rock
The People Transition Installation of Core Features Billable providers (MD s, DO s, NP s PA s) and Directors remain employees of the MBO All other practice employees transition to CHIPS CHIPS employees have their own compensation, benefits and retirement programs aligned with ambulatory practice not hospitals Common Job Descriptions Standardized compensation
Best Practices The Finish Out CHIPS Suite of Tools Referral Management Solutions Online Appointment Scheduling Patient Outreach Solutions
Enhancing Operational & Financial Performance Inspection Pre Point-of-Service First point of contact with the patient during which the appointment is scheduled and continues through preregistration and benefits verification Point-of-Service Activities begin with the check-in process prior to the patient seeing the physician and after they have received care with patient check-out Post Point-of-Service Administrative and financial activities associated with collecting payment for services rendered Revenue Cycle Management
Process & Discipline The Walkthrough Monthly Meetings with practice managers, client services managers and health system leadership Metrics that are tracked and reviewed: HR analytics Five key metrics Optimal Practice Model
Ticketing, Metrics, Reporting Systems and Lean Analysis/Improvement Michael Stroope Tactical Strategic Optimal Practice Model The Walkthrough CHI/CHIPS MedSynergies CHI Physicians/ Physician Organization Business Reviews Client Management Service Requests Operations Business Partner Business Reviews Practice Managers Real-time Customer Service Practice Partners
Five Key Metrics The Walkthrough
Metrics Revenue Cycle
Metrics Project Management
Overall Financial Metrics The Punch List Metric Sample Market Benchmark Variance Total collections (in dollars) $ 4,982,071 $ 6,642,762 25% Total Collection Rate (includes adjustments) 3 96% 91% 5% Payment per RVU 3 $ 48.27 $ 52.71-9% Days in A/R (total A/R / (total charges/365)) 4 31.87 33.59-5% A/R% > 90 days 4 17.2% 20.41% -3% Charges % of Medicare (2013 Fee Schedule) 2 250% 250-400% -
Successes Benefits of Building Revenue Cycle Enhancements starting to allow positive gains Coding Front End Process Improvements Patient Outreach remove burden to staff, excellent early results
3,800 CHIPS Employees CHIPS Today Fiscal Year 2014 Statistics EMPLOYEE COMMUNITY Approximately 90,500 Employees Including approximately 3,500 employed physicians and advance practice clinicians
Lessons Learned Training and education of staff Expectations for immediate results following transition Unanticipated level of resistance to change Need to over communicate to leadership in markets and national office Sense of loss of control by market leadership Although providers are not in scope, they are a key audience Lack of analytic tools in the markets Prioritize markets using an overall needs assessment Difficulty in extracting data (willingness to share data)
The Future of CHIPS Develop MSO Offerings for our Private Aligned Physicians delivered through our CIN s Practice and Revenue Cycle Assessments across our Service Line Structure Closer alignment with our JV partners
Q&A