1. 2183–Blending Insights with Optimization Using Client Metrics to drive change Matt Wormser, GE Healthcare. Laura Steinkraus, Schumacher Group

2. 2 Track Owners: Zinc Instructions Please update the chart to the right before submitting the presentation into Active Following review and approval in Active, each presentation given by GE employees or customers at Centricity LIVE must be approved through Zinc Jessica Diniz will be uploading each presentation into Zinc following Active review Before submitting this presentation in Active for review, Track Owners must select the appropriate answer to each Legal and Regulatory question ALL QUESTIONS MUST BE ANSWERED If further substantiation is required, please email the appropriate permissions, sources, or citations to jessicadiniz@ge.com so she can upload to the Zinc Galleryjessicadiniz@ge.com Once the presentation is approved in Zinc, please delete this slide from the final deck before presenting at Centricity LIVE Individual Page Use?: Yes Are all Uses and Applications Discussed or Referenced in the Proposed Material on Label for the Product?: Yes Relates to a Major new Product/Services Launch?: Yes Includes Product or Service Claims, Features, Benefits or similar information?: Yes – from Design History File (in Gallery) Contains Competitive or Comparative Claims?: No Includes Return on investment (ROI), quantifiable cost of ownership, reimbursement, or meaningful use claim or reference?: Yes Include References to Market / Segment Share or Market / Segment Leadership?:No Include identifiable Patient Information / Data?: No If Customer Names are Used, are Necessary and Appropriate Permissions in Writing and on File?:Yes – Permission to use on File (in Gallery) Include Customer Testimonials?: Yes – Permission to use on File (in Gallery) If any non-GE Stock Images are Used, are Necessary and Appropriate Permissions in Writing and on File?: N/A Do the Proposed Materials Contain Images of GE Products?:No This is a Translation of a Previously Approved Piece in Which no Changes Have Been Made?: Yes This is a Revision of a Document Previously Approved for Ad / Promo Use?:Yes

3. ©2015 General Electric Company – All rights reserved. The results expressed in this document may not be applicable to a particular site or installation and individual results may vary. This document and its contents are provided to you for informational purposes only and do not constitute a representation, warranty or performance guarantee. GE disclaims liability for any loss, which may arise from reliance on or use of information, contained in this document. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE. DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. GE, the GE Monogram, Centricity, and imagination at work are trademarks of General Electric Company. All other product names and logos are trademarks or registered trademarks of their respective companies. General Electric Company, by and through its GE Healthcare division. 3

4. The content of this presentation represents the views of the author and presenters. GE, the GE Monogram, Centricity and Imagination at Work are trademarks of General Electric Company. 4

5. Agenda 5 Revenue cycle challenges Lessons from the other industries Putting theory into practice: Schumacher experience The use of cross-functional teams and root cause analysis Takeaways Q & A

6. Endemic failure in the revenue cycle Typical organizations see between 5% and 20% of their claims fail upon initial submission*. Imagine if one in ten products you purchased were defective upon initial use? Our challenge is to implement systems to prevent past failures from recurring. 6 * Source: internal GE documentation on “clean claim” performance, HFMA MAP metrics.

7. Core tenets of quality improvement 7 Cross functional teams Root cause analysis Eliminate variation Define>Measure>Analyze>Improve>Contro l Process analysis & redesign Continuous improvement Six Sigma Total Quality Management Reengineering

8. What is a ‘defect’? Think of the revenue cycle as a manufacturing line creating billing successes. A defect is anything that requires rework in order to get paid – rejected or denied claims requiring calls to the patient, clinic or payer. Each defect delays payment, driving up AR days and leading to reduced collections. Industry estimates rework costs at $15 per denial. 8

9. Toyota Production System Jidoka: “Quality must be built in during the manufacturing process! If an equipment malfunction or a defective part is discovered, the affected machine automatically stops, and operators cease production and correct the problem.” * Daily monitoring the use of reporting tools / analytics, along with a commitment to “doing it right the first time” are critical to achieving the same results in the healthcare revenue cycle. 9 * Source: http://www.toyota-global.com/company/vision_philosophy/toyota_production_system/

10. The holy war of healthcare billing 10 Billing Team IT : Just say “no” and hope they go away. Back End : “If only they would get off their duffs and enter good data.” Front End : “If they had any clue what we have to go through up front…”

11. The Iron Triangle of billing success 11 Revenu e Cycle Succes s People : Train, inspire, reward, succeed Process : Clear processes, enforced through training, reporting Technology : Leverage what you have, implement what you don’t.

12. Building project teams to drive success The revenue cycle covers all elements of the enterprise – project teams need to as well. The billing office: The front line of seeing what didn’t happen upstream. The front desk (scheduling, pre-arrival, charge entry team, etc.): Critical to success at each stage. IT: Provides the technology backbone of any successful enterprise. Training: Ensures that process and knowledge gets disseminated successfully. 12

13. Team composition Leader: drives balance and accountability. Regular members: a core group meeting typically weekly to review metrics, research issues and make and track action items. Ad Hoc: “SMEs” (subject matter/process experts) called in for specific issues. Resource: Called in as needed for specific projects/issues. Executive Sponsor: Responsible for driving the process and serve as escalation point. 13

14. Keys to success T – E – A – M mentality: think as an enterprise to succeed as one. No turf mentalities allowed. A surprisingly small number of bad attitudes can doom a team. Productive skeptics are welcome. Celebrate successes, understand failures. Cycle: the work can be a grind, but it’s highly valuable. Enroll a cross-section of the enterprise to get exposure to multiple roles. Have fun – it’s actually possible! 14

15. Six Sigma’s “5 Whys” Why did my claim get denied? Because the payer indicated that the patient was not eligible on service date. Why did we send a claim for an ineligible patient? Because we weren’t able to verify insurance prior to patient arrival. Why weren’t we able to verify insurance? Well we tried, but our staff-person missed that the patient was covered under a Medicare Advantage plan (Medicaid HMO, carve out plan, etc.). How did the staff-person miss that key data? Because our training materials were not up to date (time constraints during check-in / understaffed pre-arrival team / new hires / poor tools, etc.). Why were my training materials not up to date? ICD-10 / ACA / insufficient funding / multiple mandates, you name it!!! 15

16. Change = Challenge Process change is inherently difficult and underestimated. It is human nature for us to gravitate back to ‘the old way” when new tools and processes are put in place. Simply throwing technology at a problem is doomed to fail. Monitoring is critical! Process changes, need to be continually monitored until the “new way” becomes the norm. Likewise to make sure you got it right! 16

17. Schumacher Group Medical Billing Medical staffing and billing group active in 28 states, 264 facilities. Primary focus Emergency and Hospital staffing and billing. Over 3,000 providers treating 4 million patients annually. Management changes in late 2012 led to process improvement effort. 17

18. Pre-existing Challenges & Opportunities Departure of existing leadership at same time. Departments working in Silos. Lack of Communication. Outdated and inefficient policies and procedures. Practice management application split between IT and operations. Incomplete knowledge of existing technology setup 18

19. Strategy Quick Wins. Cross department participation. Key Stakeholder buy in. Work out sessions. Cross Training Monthly KPI report outs to executive leadership GE “Performance Manager” Partnership to help leverage technology 19

20. Key Performance Indicators 20 Claim and Charge Lag Days EDI Remittance Posting Rates and Top non-posting reasons Eligibility Automation, Utilization and Verification Rates Eligibility payer gap & rejection analysis Denials Analysis by category, “scenario”, payer, clinic, etc. Rejections (pre-adjudication) by category, payer, etc. Clean Claims rate Paper claim volume & drivers Technology opportunity assessments Claim form setup / logic issues Assessments for additional automation opportunities. Process improvement analyses – Credentialing, Call Center, Insurance Verification, etc. Billing Performance Metrics Pre-Billing Performance Metrics Opportunity Appraisal

21. Denials Improvements 21 20,000 fewer denials per month Note: for reporting purposes, a “Denial” is any ERA with a “Denied” status, or $0 payment and allowed amount.

22. Categories, denial scenarios help drive root cause analysis 22

23. Transitioning to new web-based tools 23

24. Claim Rejection Improvements 24 Rejections down 63 percent

25. Eligibility Improvements 25 Closure of 86% of the verification gap

26. Paper Claims Improvements 26 13,500 fewer paper claims per month

27. Remittance Posting Improvements 27 61% improvement in EDI posting

28. Remittance Edit Improvements 28 75% reduction in EDI remit edits

29. Improvement summary Denials: 20,000 fewer denials per month Claim rejections: down 63 percent Paper claims: 13,500 fewer paper claims/mo Eligibility verification: Closure of 86% of gap Remittance posting: 61% increase in posting ERA remittance “kick-outs”: 75% decline Clean claim rate: 43% improvement In sum – a more efficient, successful operation 29

30. Challenges, Lessons Learned Managing in a matrix environment. Resources, resources, resources. Knowing what we don’t know. Maintaining support for the effort when time, conflicting priorities exist. Understanding what we could and can’t do with our practice management system. Getting users to adapt to new processes. 30

31. Process overview: Set KPI-based goals Build a solid team Use reliable, consistent metrics Set your schedule – weekly/monthly/quarterly Drive root cause analysis – what went wrong? Determine your follow up actions Record your victories and failures Stick to it – process improvement is a journey, not a destination. 31

32. Metrics Subscription Options 32 Client Metrics Client Metrics Plus Client Metrics Premium Performance Manager Allows for tracking performance over time, identifying problem areas, and peer to peer benchmarking capability Leverages GE Healthcare expertise to help implement sustainable processes and improved workflows, resulting in optimized departmental productivity. Provides monthly reporting, with enhanced metric suite and breakdowns, providing greater insight into performance opportunities. Helps your organization better understand how to analyze metrics and track performance. Quarterly report on key financial metrics at enterprise level Some benchmarking Quarterly report on key financial metrics at enterprise level Some benchmarking Access to Client Metrics Plus Partnership with GE Healthcare consultants, who will complete all analysis and provide 1)targeted action plans to implement change, 2)regular monitoring, 3)monthly reviews, 4)KPI focused workouts, 5)active configuration, as necessary Access to Client Metrics Plus Partnership with GE Healthcare consultants, who will complete all analysis and provide 1)targeted action plans to implement change, 2)regular monitoring, 3)monthly reviews, 4)KPI focused workouts, 5)active configuration, as necessary Monthly reporting on key financial metrics with drill through capability Enhanced breakdown capabilities and benchmarking Access to enhanced metric suite Monthly reporting on key financial metrics with drill through capability Enhanced breakdown capabilities and benchmarking Access to enhanced metric suite Access to Client Metrics Plus Partnership with GE Healthcare consultants to 1)understand how to leverage the value of Client Metrics, 2)identify improvement areas, and 3)develop targeted action plans to implement change Access to Client Metrics Plus Partnership with GE Healthcare consultants to 1)understand how to leverage the value of Client Metrics, 2)identify improvement areas, and 3)develop targeted action plans to implement change Part of existing support agreement Monthly subscription 2-year term Monthly subscription 2-year term Monthly subscription Ongoing Monthly subscription Ongoing Monthly subscription 2-year term Monthly subscription 2-year term

33. 33 Questions