1. Patient Estimator Facility View Leah Klinke Director, Patient Financial Services

2. Agenda Industry Changes in Self Pay Our Journey to Price Transparency Successes Additional Opportunities

3. INDUSTRY CHANGES Price Transparency

4. Changes in Self Pay More patients are covered Through government programs like Medicaid and CHIP Through commercial coverage available through the marketplace Insured patient remaining balances are increasing Higher deductibles Higher share of cost (coinsurance) Coverage and tiering restrictions

5. Out of Pocket Expenses on the Rise

7. Decline in Collectability $0-$250$250-$500 >$500 *WVUH Data - Balance after Insurance Only The higher the balance, the less collectable % of Patient Balance Ultimately Collected

8. Effort Shift to Insured Patients

9. Changing Focus How do we focus on speeding up payment for balances after insurance? How do we increase collectability on balances after insurance? Could patient education prior to service change a patient’s payment behavior? We decided to give it a try – ICD-10 gave us the justification.

10. OUR JOURNEY Price Transparency

11. Our Plan of Action Implement a tool to estimate a patient’s out-of- pocket expense prior to service Engage the patient prior to service to educate them about their financial obligation Collect a deposit on that obligation Inform patients of our payment options, including prompt-payment discounts and payment plans, prior to service Increase patient collections on insured patients

12. Exploring Options In 2012 & 2013 we met with a number of vendors who provide patient estimator tools Priorities: Combined physician and hospital estimate Incorporate actual patient benefit levels Must be accurate Should produce a letter that was easy for the patient to read The estimate letter must be available for viewing downstream

13. Redesigning Financial Counseling With the reduction in self pay, the need for traditional role of Financial Counselor position was decreasing Goal was to keep existing positions, even with self-pay down 65% Attempted to re-define Financial Counselor to be more relevant to the current market

14. Tool Selection Were leaning toward a vendor who we already work with for eligibility Explored EPIC’s estimate tool and found that it did most things that we wanted it to Was not as user friendly as the external tools Did not require the system interfaces required by external vendors Believed that accuracy would be comparable Tracking of estimates and collections would need to be built No cost to implement

15. Tool Implementation EPIC’s tool was not widely used, so there was some trial and error to the process Worked with faculty practice to make sure that file feeds were built accurately Developed estimate letters with the input of the financial counselors Decided to focus on Day Surgery first as it was the highest opportunity and simplest workflow

16. How It Works 1.Estimates Expected Charges Hospital – Historical Case - complicated cases such as surgeries Per Charge Price - line item charged items such as radiology and lab services Physician – Planned procedures entered Suggested add-ons based on history (e.g. pathology, anesthesia)

17. How It Works 2.Estimates Expected Allowable – Hospital – The system uses either our programmed contract terms or historical pricing to come up with the expected allowable for the average case Physician – The system applies the actual fee schedule to the charge based on the payer

18. How It Works 3.Estimates Patient Benefits Based on an electronic eligibility response, current benefit levels are applied to determine the patient’s expected out-of-pocket for the visit.

19. How It Works 4.Estimate Letter is Produced Letter displays expected charges, allowable, and out of pocket Letter instructs patient on payment options and potential discounting

20. How It Works 4.Estimate Letter is Produced Displays expected charges and out of pocket Instructs patient on payment options and potential discounting

21. How It Works 5.Financial Counselor Communicates Estimate to Patient Financial counselor calls patient to communicate estimated out-of-pocket expense Discusses payment options and requests a deposit in advance No advance payment plans at this time No delay or cancelation if patient refuses to pay in advance

22. Financial Counselor Concerns Accuracy of Estimates Did not understand billing & charge variation enough to explain the estimate to patients Not experienced at collection conversations with insured patients (vs. uninsured patients needing financial clearance) Did not understand patient benefits well enough to explain to the patient Concerned that patients may opt out of services

23. Testing for Accuracy Testing Charge Levels: Took some high volume procedure and tested EPIC’s estimate against actual averages from an external data source. Reviewed results to determine how close we came to the actual average charges

24. Sample Test: T&A

25. Testing for Accuracy Testing Contract Expected: Viewed sample cases and reviewed against stand- alone models for contract expected Found that the tool only calculates expected for actual claims for that payer in history (on hospital esimtate), which makes pricing sample smaller than charge sample Provided financial counselors with a “cheat sheet” of contract expected so that they could utilize if no history was found.

26. Testing for Accuracy Testing Benefit Levels: Took sample cases that had already processed and checked the estimate against what the patient’s actual out-of pocket Found that accuracy of benefit levels were more important than charge level estimates for high dollar surgical cases Many nuances to benefits that are not picked up with electronic eligibility that caused some accuracy problems (e.g. individual vs. family OOP limits, is deductible applied before or after coinsurance?)

27. Education Prepared some slides on charge variation to explain how charges varied from case to case

28. Education Hired external group to come in and conduct shadowing and training on how to educate the patient on their out-of-pocket liability Participated in role playing conversations to bring up scenarios and discuss possible responses Provided reference tools and optional scripting to assist in formulating the conversation

29. SUCCESSES Price Transparency

30. Collectability is Increasing $0-$250$250-$500 >$500 *WVUH Data - Balance after Insurance Only *2015 (est) = annualized Q1 results Based on Q1 results, we are having more success collecting balances in 2015 % of Patient Balance Ultimately Collected

31. Success of Payment Plans $0-$250$250-$500 >$500 Collectability is higher when patients commit to payment plan at any balance level % of Patient Balance Ultimately Collected *WVUH Data - Balance after Insurance Only

32. Payment Plans on the Rise $0-$250 $250-$500 >$500 Payment plans have increase, especially at higher balance % of Patient Balance on a Payment Plan *WVUH Data - Balance after Insurance Only *2015 (est) = annualized Q1 results

33. ADDITIONAL OPPORTUNITIES Price Transparency

34. Opportunities Expand to other areas (e.g. radiology) Continue to increase pre-service collections Increase payment plan commitment Set up auto-pay payment plans