Pre-Service Financial Clearance: Having the right conversation with the right patient at the right time

New Environmental Paradigm - Define Agenda New Environmental Paradigm - Define Connance surveys and results Implications to front end staff How we to address this in a Pre-Service world

THE RISE OF THE CONSUMER AS A PAYOR The shift to high-deductible health plans, both in employer sponsored plans and the Exchanges, has a fundamental impact on net income and cash flow for providers HSA / HDHP Enrollment* (Covered Lives MM) Self-Pay % of A/R as % of Total Outstanding A/R Net Cash Collections ($000) (Per $1MM NPR) 700% increase Pure Self-Pay 25 - 40% decrease All Other Classes *Non-Government Sources: AHIP 2014 January Census; David Wiener, Self-Pay is Here to Stay: And It’s Scary, May 18, 2013 2016 Confidential & Proprietary

Why Incentives

For Amazon Inc. Gifts Cards! Health Care Costs For Amazon Inc. Gifts Cards! If food costs increased at the same rate as healthcare costs from 1945 - 2011… Source: NHE 1945:2011 Dozen Eggs Gallon of Milk Dozen Oranges $55 $48 $145

Market Study

Survey Demographics 500 random consumers (recent patients) 95% had health insurance Of those with insurance 33% identified their coverage as a high-deductible type, up from 24% in Connance’s 2014 Consumer Impact Survey (see Figure 3). The more than 50% increase in share of high deductible is consistent with the national shift toward high-deductible plan design

Business Office Satisfaction This year’s survey continued to show opportunities to improve the patient billing experience. 33% of respondents gave their business office experience a top score of 5 50% scored their experience 3 or lower (see figure 4). Looking solely at the 95% who had insurance 35% are Very Satisfied— a bit higher than the overall sample 50% scored their experience a 3 or lower.

Net Promoter Score What is the definition of Net Promoter Score? Gift Card Quiz (Remind me!)

Net Promoter Score Across the sample, the net promotor score for this sample of 500 patients was 17% Strong correlation between business office satisfaction and Net Promoter Score Those giving their business office experience a top score of 5 had a hospital net promotor score of 80% Those giving their business office interactions a score of 1 or 2, the lowest options, had a net promotor score of -63%.

Correlation and Impact

High Deductible versus Low Deductible Of the those who identified as having high deductible insurance 49% owed > $500 55% were surprised by the amount they owed Non-High Deductible plans 11% owed > $500 11% were surprised by the amount they owed

Provider Response What Keeps Healthcare Finance Executives Up at Night? And What Are They Planning to Do About It? Based on responses of 93 senior execs to an online survey:

Number of Initiatives Respondents on average selected 14 listed initiatives as among their organizations’ top priorities. Among the respondents, 49% selected 10 to 15 initiatives from the list. More than a third selected more than 15 initiatives (see fig. 2).

Top Prioities

Current Self Assessment

WHAT IS REQUIRED TO SUCCEED? Patient convenience Personalized, patient-centric experience while improving patient satisfaction $ Hospital Experience Patient-Hospital Financial Experience Staff convenience Effective work queue management Ability to accelerate and maximize cash collected 2016 Confidential & Proprietary

Patient Financial Clearance Patient Stratification & Payment THE CONNANCE PLATFORM Improve net income and reduce cost to collect across the revenue cycle Create a consumer centric financial relationship with patients meeting them exactly where they are in terms of both ability and willingness to pay. PRE-REGISTRATION REGISTRATION CHARGE CAP./CODING CLAIMS ACCOUNT RES. COLLECTIONS Missing Charges ID Denial Management Vendor Management FRONT END MIDDLE BACK END Patient Financial Clearance Patient Stratification & Payment PRE-ADMISSION ADMISSIONS SERVICE DISCHARGE BILLS RECEIVED COLLECTION CALLS 2016 Confidential & Proprietary

COMPLETE FINANCIAL VIEW OF THE PATIENT Prioritize the best financial options and modes of communication in every patient interaction Provide your staff with a single source of truth of your patient’s financial resources, estimated obligations and ability to pay Integrated advanced propensity to pay model Presumptive charity evaluation Current deductible status Assessment of financing options 2016 Confidential & Proprietary 19

PRIORITIZED AND PERSONALIZED PATIENT OUTREACH Predictive analytics drive appropriate pre-service patient outreach Empower your staff with the tools needed to provide guidance to patients in their financial journey and to collect payments earlier with less effort. Begin MCD/ Charity Application YES Charity Prioritized Financial Pre-Clearance Outreach Patients highly unlikely to make payment post service: Call These First Now, once you have an understand of the patient's financial plan, predictive analytics can identify patients who would benefit most from an outbound call prior to service to review their financing options and secure payment. Not only does it empower your staff with the tools that that we just looked at but it gives patients guidance in their financial journey, as well has helping your facility collect payments earlier and with a lot less effort. Connance stratifies patients the amount you are likely to collect and how the patient will engage in the process.   For example, we can segment patients who are likely to pay.  Your staff wont need to worry about them. For those patients that are deemed to be highly unlikely to make payment post service, you'll want to call those first ahead of the service and try to secure payment or establish a payment plan.     With limited resources hospitals need to focus outreach efforts pre-service; without the staff to do this today, what options do hospitals have? Benefit of the Connance solution is that the patient’s financial plan then moves through the organization Patients who may pay but need help working through options: Call these second Advanced Propensity to Pay Patients who are likely to pay : Do nothing 2016 Confidential & Proprietary

COMPREHENSIVE SOLUTION TO OPTIMIZE PATIENT INTERACTIONS The right message, to the right patient, at the right time and frequency Predict expected cash value, payment patterns, a optimal payment plan Segment-specific workflow sequences maximize return on collection investment Segment-specific collection methods and frequency for improved patient experience with billing operations Activity by Segment “Investment” Day Activity 0-10 Electronic Statement 10-20 20-30 Balance Notification 30-40 40-50 Text Message 50-60 60-70 Reminder Message 70-80 Letter Patient Repayment Behavior Reluctant Payor Self-Directed Expected Cash Value Low High Segment 1 Segment 2 Segment 4 Segment 3 Segment 5 “Wait and Watch” “Investment” “Conserve” Proprietary and Confidential © 2016 Connance, Inc

THE IMPORTANCE OF A FINANCIAL PLAN It all begins with a clear financial plan for the patient Provide patient’s with a clear plan of their responsibilities and options, to establish their financial expectations and commitment early in the process Patient financial assessment Outstanding balances and history Available patient financial assistance Proposed payment arrangements Agreement terms and patient acceptance Financial plans can be printed for patients and easily accessed in each patient’s online account 2016 Confidential & Proprietary

PAYMENT PORTAL: PAYMENT ANYTIME, ANYWHERE eMail Facility’s Portal Patient Statement Reach the Patient Portal 2016 Confidential & Proprietary

Your office dashboards Provide complete Oversight Do you know when patients can pay you upfront and in full?

THE NEW PATIENT FINANCIAL EXPERIENCE Achieve early payments with less work with upfront clarity and payment expectations, flexible payments options, and proactive patient communication What do I owe? What payment methods do you accept? I don’t have that much right now. What do I owe now? No information or estimates Payment methods which may or may not be easy for the patient. Skip treatment, provider financing, borrow from family, 2nd mortgage or predatory tenders. Don’t pay or protracted or back and forth calls. Patient Today With Connance Patient Eligibility Patient Portal Patient Finance Assistance Clear information about patient responsibility amount Personalized payment plan design Ability to accept: Credit, debit, checks, HSA and many other payment forms. Payments via the office, phone, online. Flexible financing terms for all patients regardless of credit history. Easy enrollment & active managed Balanced notification Communication Up to date information Account posting Provider reporting & administrative functions Refund management

Nick Kuzera Senior Regional Director of Sales THANK YOU Nick Kuzera Senior Regional Director of Sales Connance, Inc.                     M: 615 440 2313 nkuzera@connance.com