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About Children’s Hospital Colorado  Private, not-for-profit pediatric healthcare network  Obtained Magnet status in 2006  In addition to one main campus facility  2 hospital locations within community hospitals  2 urgent care sites  1 urgent care site within another hospital  1 free standing surgery center  9 satellite specialty care centers  Level I trauma center  Maternal fetal medicine program opened in March 2011  Ranked among top 10 children’s hospitals for over a decade  Statistics  318 licensed beds  517,873 outpatient clinic visits (2011)  Celebrating over 100 years of commitment to pediatric care! 3

What is RAVE? R- Referral A- Authorization V-Verification E-Eligibility 4

Structure of Patient Access Prior to RAVE go-live  Patient access included: Admissions (Main and ED) Financial Counseling IV staff (6 FTE)  Inpatient, Ambulatory Surgery, and Observation patient populations Both scheduled and non-scheduled cases Function as a safety net Accounts worked via Ontrac tool 5

Elements in Space 6

Org Chart Pre RAVE 7

Scattered Across the Universe Where did everyone live???  Outpatient clinics Each reported to outpatient floor specific manager Team included scheduling, check-in/out, IV staff Worked floor specific accounts  Administrative Pavilion In charge of obtaining authorizations for range of procedures  Radiology procedure authorizations  Radiology required authorization prior to scheduling Surgical initiation Cardiac DME Infusions  Network of Care locations 8

Planet Deficiencies Processes were sub-par workflows No dedicated back-up for these staff members No dedicated management structure for IV staff 9

As the Planets Start to Align… Concept born 4 years prior  VP of Ambulatory Services  VP of Finance  PFS  PAS  Managed Care 10

Project Goal Statement Goal Statement The goal of centralization is to reduce the overall number of patient eligibility, no referral/authorization, non-covered services, late/no notification, wrong insurance billed and medically necessary denials The Children’s Hospital receives, and better align resources, training, education, and information to a single point of accountability within the organization. 11

Project Objectives Increase secured at admit rate across the organization to exceed 95% by the time the patient arrives for their scheduled appointment or admission. Currently, this rate is at 90% (per 4-week average as reported on week ending 8/27/10 IV Summary) Maintain staff productivity to consistently work 45 accounts per day per rep. Currently, this rate is at 50 across the organization (per weekly productivity rate week ending 8/27/10). Increase ‘days out’ in authorization rate (per 4-week average as reported on week ending 8/27/10 IV Summary): Goal: 0-3 days = 99% 4 days = 95% 5 days = 90%. Reduce overall denied dollars and final write offs by 50%. 12

The Jurassic Age…. 13

Early Phases On-boarding outpatient clinics to Ontrac ( )  Rolled out in phases Over 2 years Main campus and network locations On-going meetings with management ( )  To discuss centralization of IV 14

Early Phases continued HR Meetings (Oct 2010)  Employee transfer  Job descriptions  Reporting Structure  Career Ladder Promotion Ladder Insurance Verification.doc  Work from home model Ongoing Management Meetings (Oct 2010) 15

Early Phases continued Blending the “Families”  Monthly PSC meetings (Oct 2010) HR Involvement  Communication Tool for staff SBI (Situation, Behavior and Impact) Training  Team life cycle (Forming, Storming, Norming, Performing) Team building Learning process flows Naming department Committee creation Management Structure IT Resources 16

Neanderthal Stage 17 “How centralize IV, Gorg want know”

RAVE go-live structure 18

Our New Home… 19 Gorg like! Me too!

RAVE Begins Go live 4/6/11 (27 employees) (Phase 1)  Gained Efficiencies Merging worklist Cross training  High Volume  High Dollar  Radiology Auth Scheduling prior to authorization allowed Back-filling for absences Installed robust QR process “Working Smarter not Harder”  Electronic Eligibility Verification Restructure  Creation of iRAVE (NOT TO BE CONFUSED WITH RAVE!!) 20

iRAVE (NOT TO BE CONFUSED WITH RAVE!!!) What is iRAVE?  Online resource Insurance reference Available to all staff Documents payer specific requirements 21

iRAVE continued 22

iRAVE continued 23

What is iRAVE not to be confused with?  A prize winning pony  A planet  Gorg  RAVE 24

The Next Planned Phases Phase 2 – July 2011 (OT/PT, 3 FTE’s) Phase 3 – August 2011 (Psych/CDU, ST, 4 FTE’s) Why did we stagger these? 25

Growth Expanding RAVE scope 26 DateClinicMonthly Volumes Additional FTE to RAVE Jun-11MFM- Clinic & Auth Pool40No Jul-11 Pain Clinic- Clinic & Auth Pool460No Sep-11 SIE Downs- Clinic & Auth Pool70No Oct-11Neurology Auth PoolUnsure at this time Yes- moved 1FTE from Neuro Dept Dec-11 Plastics, Urology, ENT, Ped Surg-Auth Pool675No Dec-11North Campus-Auth PoolUnsure at this time Yes – Moved 0.8 FTE to RAVE TBD South Campus and CO Springs2600Yes – 1 to be hired

Maintaining Communication Employees bringing issues they otherwise would not have  Now employees have a ‘voice’ Monthly meetings with clinic management Close working relationship with Patient Financial Services  Work to decrease denials 27

Current state (36 FTE) Restructure of Radiology authorization workflow  Upgrade of Epic EMR for how workflow viewed Allows for better reporting Continued work to document process flows  Team and workflow specific Anticipating efficiencies Network of Care site addition to centralization Medicaid PAR’s for Radiology services Promotion of two employees to Rep III status  Multiple duties Modular training 28

Current state RAVE structure 29

The Jetson’s Era 30

Future State Move from safety net to initiation  For Inpatient, Amb Surg & Obs cases Benchmark our existing pilot person from Orthopedics Standardizing Psych processes Adding more clinics  Create a RAVE services ‘Application process’ Service level agreement Creation of Registration Accuracy Task Force 31

Carbon Dating 32

So How Did We Do? Secure at Admit Pre RAVE= 90% GOAL= 95% Actual 2011 EOY= 94% Staff Productivity Pre RAVE =50 accts per day Goal= Maintain 45 acct per day Actual 2011 EOY= 68 accts per day Write-offs for No Authorization Goal= Decrease by 50% Actual 2011 EOY= Increase by 235% 33

So How Did We Do? Continued… Increase “Days Out” Pre RAVE= 0-3 days = 81% 4 days = 60% 5 days = 41%. Goal= 0-3 days = 99% 4 days = 95% 5 days = 90% Actual 2011 EOY= 0-3 days = 94% 4 days = 75% 5 days = 60% 34

More Data…… Quality Reviews Diligent monthly QR Process  Increased Team Average from 2.68 to 2.9 (out of 3) Dashboard – SAVE RECENT COPY 35

Lessons Learned Employee Satisfaction  Dynamics of a large department What exactly are we taking on?  Responsibilities transferred with employees Some tasks are out of scope of Insurance Verification Rep level  Roles and Responsibilities – Saw a need once RAVE went live. Roles and Responsibilities Cleaner registrations Clearly defined roles Work From Home  Re-evaluate current structure to help maintain relationships 36

Contact Information Tobi Knight – Berj Ermoyan –

Questions? 38