0. Improving Revenue Cycle Outcome: Harnessing the Power of Process Analytics and Automated Workflow
April 17, 2015

1. Agenda Introductions Baseline definitions
Why these solutions are important
Process analytic concepts
Automated workflow concepts
Using BPM as competitive advantage
Applying business rules to drive higher performance
Evolution of revenue cycle
Q&A 1

2. Need to look for different pictures to liven up the slides – cosmetic, will focus on after content is solidified.
Introductions

3. With us today Phillip Brooks Director KPMG LLP
Over 20 years healthcare experience
Focuses on Revenue Cycle Redesign, Capital Budgeting and Planning, Vendor Selection and Implementation, and Operational Efficiency and Cost Reduction
Works with community health organizations, large integrated providers, and academic medical centers
Phillip Brooks Director KPMG LLP

4. Baseline definitions

5. Baseline: Definitions
Workflow: repeatable patterns of activity that involve a system of resources, roles, knowledgeable worker interaction, and information flow
Automated Workflow: a collection of methods and tools used to document, improve, and monitor business processes as defined by standard workflows
Process Analytics: the ability to access data about individual instances of a process and use that data to monitor, analyze, and improve an organization’s critical operational processes
Business Process Management (BPM): the combination of Automated Workflow solutions that are specifically designed for revenue cycle operations and incorporate Process Analytic concepts to create an interactive system that can automatically prioritize high-value tasks to the right people to improve efficiency and drive down costs

6. Why these solutions are important
Tom
Why these solutions are important

7. Why these solutions are important
Do you need an automated workflow?
Have you driven 20 percent of costs out of your revenue cycle over the past five years?
Have you improved net revenue annually?
Have you reduced your headcount by 10 percent?
Have you improved processing times by 50 percent?
Tom
Examples:
Have you driven 20% - Do you have technology in place to reduce manually touching each account. Do all your systems talk or are you still using one system for this and another system for that…….A streamlined, integrated approach saves time and money.
Improved Annually - Do you have processes in place to CONTINUOUSLY review people, process, and technology? Do you address this once every 5 years and then move onto another project. This is a CONSTANT battle that needs your attention.
Headcount by 10% - Have you jumped on the EXCEPTION-BASED technologies? Do you leverage the HIPAA X12 EDI transactions to eliminate TOUCHING all accounts? 835 & 277 identifying problems early, electronically. DO more with LESS.
Processing – Not sure what this means
If you answered “no” to any of the above questions,
you likely need to think about implementing an
automated workflow approach.

8. Evolve your revenue cycle into revenue cycle 3.0
RC 1.0
RC 2.0
RC 3.0
Traditional assessments,
Automated workflow
Automated workflow
Recommendations, and
design and deployment
with process enabled
options and
analytics
Implementation
Allows for deeper penetration
into root cause issues and
Due to a change in
Automated workflow allows
enables automated workflow
organizational focus or
for repeatable, quicker-paced,
to perform continuous
change in personnel,
and sustainable
monitoring of micro-processes
benefits erode over time.
Improvements, even
that contribute to delays in
All
processing bills, delays in
when personnel changes,
cash flow, loss of revenue,
since workflow is hardcoded.
and increase costs.

9. Using BPM as competitive advantage
Placeholder – need to add slides.
Using BPM as competitive advantage

10. Using BPM as a competitive advantage: Transformation through automation
Business Process Management is not just about managing a defined basket of work activities faster or more efficiently. It is also about improving results.
What can BPM do?
Identify Highest value accounts for follow-up and push them up the queue
Route POS Collections efforts for prescreening by financial clearance staff
Help speed/standardize medical eligibility status processes and tasks
Christine & Kim
Tom to chime in
Identify root causes of identified anomalies
Display how a single problem manifests and interrelates across entire revenue cycle ecosystem

11. Process analytic concepts

12. Process analytic concepts: Why the need?
Business need to combine data from multiple systems
Requirement to compare historical and current comparative analysis to understand improvement strategies
Need to make real-time proactive decisions and move away from reactive actions
Must find ways to mitigate revenue at risk
Leverage info from slide 8.
Need to view consolidated revenue cycle operations

13. Process analytic concepts: Benefits of using data analytics
Root cause analysis of denied claims to reduce at source
Rapid identification of daily productivity performance to take appropriate actions
Simplify presentation of actionable management information allowing for faster decision making
Financial Improvement
Quickly understand process outcomes to make adjustments
Consolidation of data from multiple sources to provide quality scorecards for staff
Tom
Job/staff outcomes trending to monitor work outcomes

14. Process analytic concepts: Case study #1
Overview
A not-for-profit integrated healthcare system comprising of 12 hospitals whose net patient revenue is $3.7 billion with total system discharges of 172k.
Problem
Decentralized business offices that did not take advantage of system wide standards and economies of scale. Disparate patient accounting systems.
Outpace
Cash goals in the first year of implementation
Improve
Denial and underpayment processing by working active issues in an automated, timely manner
Scorecard
Tom
Study to get Hospital from Level 1.0 to 3.0.
Christine & Kim to reinforce from Revenue Cycle perspective
Reduce
Future denials through root cause analysis and process improvement
Equip
Support the centralized business office strategy while also redeploying associates to high-value roles

15. Automated workflow concepts

16. Automated workflow concepts
BPM is a collection of methods and tools used to document, improve, and monitor revenue cycle processes.
The Process
The Result 1 2 3 4 5
Revenue cycle processes are modeled to document current state.
An undefined, inconsistent, and over-complicated process... A B C =
The revenue cycle processes are simulated in order to identify gaps. D E
The processes are streamlined through reengineering to fill gaps and eliminate bottlenecks.
BECOMES
A simplified, consistent, and streamlined process.
All
Christine/Kim – discuss Process
Automation is introduced into the processes wherever possible. A B C =
The processes are monitored to ensure improved outcomes are achieved.
Unnecessary steps and task variability are reduced while efficiencies are gained and financial outcomes are improved.

17. Automated workflow concepts (continued)
BPM is used to identify bottlenecks, delays, loopbacks, and insufficient resourcing, then improve efficiency and effectiveness through streamlining activities.
Process bottlenecks are delays and activities that cost an excessive amount of money and/or time.
Delays occur because there is insufficient notification that one activity is finished so that the next one can start.
A process with loopbacks has bad process design: processes should always move forward in time and control.
All
Key: historically, it’s been retrospective…workflow is immediate and provides ability to deal with bottlenecks
Tom will chime in.
Insufficient available resource pools to execute an activity can cause a process to be drawn out, costing time and money.

18. Automated workflow concepts: Additional benefits
According to Info-Tech Research Group, Over 80% of organizations saw clear benefits as a result of automated workflow implementation.
Adaptability: Increased flexibility, scalability, to react to changes in the industry. 
Reliability: Processes are repeatable, automated, and more streamlined, which helps reduce variability. 
Profitability: Aligning RC activities closely with high-value outcomes may positively impact the bottom line, including increased net revenue and ROI. 
Improved efficiency: Identifying the next highest value activity for maximum value in a repeatable processes contributes to smoother operations. 
Kim to bring up process analytics to identify key metrics. (80% comes from 20% of volume)
Predictability: More projects and tasks will be completed on time with a reduced cost model. 
Increased productivity and efficiency: Higher request resolution means that end users have what they need to do their jobs. 

19. Effective BPM consists of a five-step lifecycle to maximize outcomes
Modeling
Revenue cycle processes are modeled to document current state.
Simulation
The revenue cycle processes are simulated in order to identify process gaps.
Streamlining
The processes are streamlined through reengineering to fill gaps and help eliminate bottlenecks.
Automation
Automation is introduced into the processes wherever possible.
Management
The processes are monitored through process analysis, alerting management when changes are needed and ensuring improved outcomes.
This may be a slide to skim over to ensure getting to slides 21 & 22.
Christine/Kim

20. Applying business rules to drive higher performance

21. Applying business rules to drive higher performance: case study #2
Overview
A not-for-profit integrated health system with an academic medical center comprising of 7 hospitals whose net patient revenue is $2.3 billion with total system discharges of 108k.
Problem
Lack of technology. Manual processes were inefficient and days in AR were not improving. Operational teams were not making headway against organizational goals.
Outpace
Three year risk-adjusted ROI of 435%
Improve
Account representative productivity and patient satisfaction – cost to collect
Scorecard
Tom
At one 700-bed provider, the implementation of an automated workflow delivered almost $14 million in savings in the first three years, just by reducing avoidable losses and improving claims processing. (Source: Forrester Consulting, “The Total Economic Impact Of Ontario Systems Artiva Healthcare,” (March 2008))
The key to this is technology.
Reduce
Future denials through root cause analysis and process improvement
Equip
Providing a single source of truth with data to make better management decisions

22. Evolution of revenue cycle

23. Evolution of the revenue cycle
1980 (DRGs) 1990 (APCs) (ACOs) Today
Loosely Managed
Highly manual/paper based
Charge based blended with cost + reimbursement
Localized Silo Management
RC departments managed independently
Improvement initiatives didn’t fully consider total impact
Primarily Cash Flow focus
Localized Revenue Cycle Management
Emergence of “Rev Cycle” vs. Dept focus
Denial Management becomes a discipline
Get paid the maximum appropriate
Net Revenue, cash flow, and overall cost mgmt
Christine/Kim
footnote – good to keep at end
Enterprise Revenue Cycle Management
“Systems Thinking” (ToC) and Connected
Efficiency and value-driven
Big data and guided discovery
Net Revenue and actual cost combination

24. What should you do next?
Evaluate automated workflow capabilities in your current environment
Evaluate Process Analytic capabilities
Build appropriate business case to support BPM deployment
Gain insight into revenue cycle processes and drive significant benefits
Christine/Kim
Tom – workflow capabilities

25. In summary New Business Models
At KPMG, we believe that health plans, providers, and life sciences companies should be thinking beyond transformation and focus more on healthcare “convergence” and the broader implications of operating in a more collaborative and integrated U.S. healthcare delivery model. While transformation of current operations is likely going to be a business requirement, the real question for forward-looking organizations is what role they plan to play in a new and more converged health system.
Christine/Kim

26. Questions?

27. Contact information
Phillip Brooks, Director, Advisory
KPMG LLP

28. Thank You

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