Agenda

Registration and Continental Breakfast

Chairperson’s Welcome & Introduction

Achieving Success in Value Based Payments -- Essential Elements in Risk Contracting & Health Care Delivery

In this session, we will frame the challenges in going from Fee For Service to Value Based Care. We will better understand how value-based transformation drives the need for new financial, clinical and operational capabilities, tools and services… in order to deliver expected rewards and better serve Medicare, Medicaid and commercial populations in value-based programs.

• Explore innovative models in win/win risk contracting and payment, population health management, and clinically integrated provider networks. And, how this creates opportunities for critical payer-provider collaboration.
• Understand the essentials of a population health MSO infrastructure, including episodes of care and pharmacy—powered by a health IT platform to enable risk management, care coordination/management, and clinical quality/integration.
• Grasp the changing roles of primary care, independent and affiliated CINs/IPAs and preferred provider networks of specialists and acute/post-acute entities.

Surprise Billing & Price Transparency – Defining, Implementing Solutions and Communicating to Patients

What is surprise billing?  It is a question both patients and providers are attempting to define and understand in accordance with the legal explanation provided through the establishment of new laws.  The overall objective is to protect the patient and create an environment of transparency.

This presentation will explore Novant Health’s journey to define surprise billing in comparison to our patient’s perception of what surprise billing is by focusing on the following:

• Definition of Surprise Billing vs. Patient Perception
• Pro-active member communication
• Partnership between providers and payers
• Partnership between providers and employer groups
• Vendor partnerships to help generate a long term solution
• Definition of Surprise Billing vs. Patient Perception
• Pro-active member communication

Measuring Real Returns on Patient Financial Experience Improvements

Patient Financial Experience can be measured, improved and monetized. Patient Financial Experience is an emerging hot topic driven by the move towards the “patient is the new payor.” This implies that patients are also now consumers and healthcare organizations should treat them as such. This presentation explores the journey St. Luke’s has taken to stand up a patient financial experience program with the ability to measure and monetize performance.

• Multiple bill payment choices
• Portals
• Chat functions
• Mobile pay

Billing and Collections: Patient Engagement Strategies to Reduce Bad Debt

Securing patient payments has become an increasingly challenging endeavor in healthcare.  High Deductible/High Out of Pocket plans create a situation in which the patient the patient’s financial liability for their encounter continues to rise.  Other patients misunderstand their benefit plans, often being surprised by the amount due on their bill.  Finally, patients can be confused regarding their medical bills, not understanding what is due, when its due, and how to pay.   These challenges often manifest themselves as bad debt. 

In this session, we will review strategies that Cleveland Clinic has leveraged to reduce its bad debt.  We will review market research and human centered design done in modifying our Enterprise Single Billing statement.  Additionally, we will discuss implementation of Patient Segmentation and Predictive Analytics, the use of zero interest payment options, and various outreach mechanisms designed to engage the patient in their financial experience.

Networking Refreshment Break

The Patient is the New Payor:  How to Secure 100% of Patient Revenue at Time of Service

With the progressive shift in revenues for hospitals from payors to patients, combined with poor patient revenue capture rates from all of the 200+ revenue cycle vendors in the market, providers can no longer ignore the challenge of securing payment from patients.  This presentation will discuss the market drivers that are exacerbating this problem and present solutions that are proven in addressing it. The new standard is to secure 100% of the patient’s known AND UNKNOWN liabilities at time of service or before.  The key question is “How do I secure 100% of the patient’s liabilities at time of service when it is impossible to know exactly the amount of their liabilities?” This presentation will not only show you how, but demonstrate 40+ months of proven efficacy in solving this problem across all hospital settings.

Natural Language Processing Improves Documentation and Claims Accuracy in Value-Based Care

Accurate documentation and coding of diagnoses is critical for provider performance in value- based care.  Natural language processing (NLP) can identify diagnoses that have been captured in the past, as well as diagnoses that are suspected based on clinical evidence.  UPMC has developed a provider-facing NLP solution that allows for pre-visit, point-of-care, and post- encounter reviews to ensure accurate diagnosis capture and claim submission.

Following the success of leveraging natural language processing for retrospective coding, which delivered another 12-15% in shared savings revenue to the provider side, point-of-care and post- encounter tools were developed to assist providers with documentation and capture of clinically relevant diagnoses for risk adjustment.  In 2018, a pilot with 37 providers realized over $1Million in 4 months.  The point-of-care and post-encounter tools have now been implemented with over 200 providers, and updated results will be shared during the presentation. 

The number of risk-adjusted lives is growing at a rate of 15-20 percent annually, creating an opportunity and a challenge as payers and providers look to accurately quantify risk and accurately reflect the true disease burden across a population. Providers need tools to assist them to compliantly capture the risk of their population, while payers need a way to validate risk. UPMC is a payer and provider who has dealt with this challenge firsthand using NLP-based technology to optimize risk adjustment performance.

Block Chain in Healthcare Payments, RCM, Claims Integrity & More - Early Adopters and Emerging Use Cases

The past year has seen plenty of hype about blockchain being a potential solution to some of healthcare's biggest challenges.  While the industry is seeing an increase in early trailblazers, plenty of people still want to know what it is, how it works and where it's being deployed.  By providing faster access to trusted information, better collaboration and increased transparency, blockchain could go a long way to help transform healthcare in areas such as personalized patient engagement, payment and claims integrity, reduced counterfeit medicines and more effective research and development (R&D).

In this session we will provide an overview of the core concepts and technology underlying the blockchain operating model.  We will share insights on some of the emerging use cases and early adopters that are generating the earliest transformational investments.  And we will dive deeper into a specific example of Revenue Cycle, Provider Licensure & Credentialing.

Networking Lunch

Robotic Processing Automation – Retrieving Supplemental Data Related to Authorizations and Claims

Driving Claims Payments Integrity to Boost Member & Provider Experience

As consumers face reduced switching costs and become, on the whole, more involved in their healthcare, we will all need to meet new standards of quality and price, impacting both the clinical and administrative aspects of health care delivery. At Kaiser Permanente, we are driving improved levels of auto-adjudication, which of course improves administrative costs, but more importantly drives better claims payment quality, which in turn, favorably impacts the member and provider experience. We currently measure quality through audit results and claims adjustment rates. Going forward, through the continued use of data management and analytics, our view of quality will advance to be more comprehensive and be an “end-to-end” definition.

• The Criticality of “System” Quality
• Analytics Team Roles (the traditional, some mold breaking, the power of struggle and cross functional unity)
• Data Architecture & Integration (design with the end in mind, dimensional modeling)
• Desktop Data Blending Tools (a new layer: data prep tools)
• Front End Analytics (analysis, dashboard systems, reports, tools)
• Economies of Scope (using the data for another subject)

Harnessing AI, Natural Language Processing, Machine Learning to Manage Correspondence

Payer correspondence creates a number of challenges for healthcare providers.  First and most important, it represents unpaid payer reimbursements which has an immediate impact on cash flow and days in AR.  Second, not all correspondence is equal in importance and the required after action follow through needed by the provider to address.  Learn how one provider has chosen to solve this problem by automating their correspondence workflows through AI Correspondence Document Typing and Routing along with a better understanding of the return on investment they are already achieving.

Networking Refreshment Break

Navigating the Payment Channels

Panel Discussion: Driving Down Costs in RCM Operations

With the continuing operating pressure from decreasing reimbursement across all payers, providers must become more operationally efficient across every spectrum of their organization. Effective Revenue Cycle Leaders are leading this charge by working to reduce their overall cost to collect. In this session attendees will learn about opportunities and strategies which can lead to a cost to collection reduction in revenue cycle operations. Panelists will share ideas used in their shops to improve efficiency and productivity, driving down overall labor cost, reducing vendor expenses and will explain how it is possible, and sometimes necessary, to incur or even increase an expense to ultimately drive down your cost to collect.

Panelists:

Feature Presentation

Networking Reception

Networking Continental Breakfast

Chairperson’s Remarks

Panel Discussion: Merging the Clinical Interface to Payments – Increasing Net Reimbursements

Moderator:

Engaging Medical Providers in Coding and Documentation Improvement Strategies to Optimize Reimbursement and Quality Metrics

Risk stratification within Diagnosis-Related Groups (DRGs) created a clear link between documentation and medical resource allocation – and currently act as the gold standard for inpatient reimbursement models (including pay for performance), healthcare purchasing contract models and institutional prestige in national metrics such as the US News & World Report Rankings

(USNWRR). This session will review how to utilize internal and external benchmarking solutions, create and deploy provider facing IT focused solutions to ensure capture of comorbid conditions that providers are managing but not currently documenting sufficiently. We will also discuss Coding and Documentation Improvement (CDI) facing solutions to help improve workflow of CDI queries to providers within the EHR. Finally, we will review potential dashboard solutions to help monitor the success of these interventions as well as identify areas for further opportunity. Medical providers are already delivering the best care they can for their patients, this session will help health systems ensure that they are being optimally reimbursed for all the care that is already being delivered.

Panel Discussion: Automating Denials Workflow Using AI and Other Technologies

Panelists:

Networking Refreshment Break

Preparing for the Interoperability Ecosystem – Facilitating Payments and Assuring Accuracy/Security

Discussion of various initiatives (i.e. 21 st  Century Cures Act, Draft TEFCA; Health IT Certification and Information Blocking, FHIR) and the implications of creating an interoperable data exchange ecosystem, facilitating payments and assuring privacy/security are met. The focus is on practical aspects of data exchange offering examples/Best Practices of what your organization needs to implement to assure readiness and the implications for Payment Processing.

Learn about the new industry collaboration to develop an accreditation model specific to Trust Networks. Specifically, the Trusted Network Accreditation Program (TNAP’s) goal is to raise the “health data exchange, privacy and security measurement bar” for many healthcare ecosystem stakeholders (QHIN’s ACO’s; HIO’s; Application Developers in health care space); medical device companies and many more whether subject to HIPAA or not) so that a proactive agreement on “standards” to access the digital highway and the on/off “ramps” of standardized electronic data exchange can become a reality.

• Discuss various initiatives i.e. TEFCA, Health IT and Information Blocking, 21 st Century Cures Act, FHIR and the implications of creating an interoperable data exchange ecosystem, assuring privacy/security, integrating emerging technologies such as Blockchain and the Payment factor
• Provide stakeholder perspectives, issues, value proposition, concerns and the challenges faced
• This thought-provoking very timely discussion will discuss the challenges that the healthcare industry and the federal government encounter as they move the regulatory initiatives forward and discuss “what’s in your data exchange quiver?”
• Understand the challenges and opportunities for your organization to participate in the dialogue and become engaged in many of the initiatives underway

Diabetes Case Study: New Full Value-Based Contracting Model: No Billing, No Denials, Payment Up Front

The United States healthcare industry is undergoing a fundamental shift from fixed-fee service reimbursement (FFS) to a new generation reimbursement strategy based on around quality, outcomes, and Value-based reimbursement (VBR) where healthcare organizations are rewarded for value rather than volume.  Therefore, healthcare organizations must search for and install next generation software that provides clinical decision support at the point of care based on national and regional clinical guidelines designed to improve the overall health of specific populations.  This session will describe how a rural healthcare system in East Texas was able to increase quality for diabetic patients while improving financial viability.   Under this model, there was no billing, no eligibility checking, no denials and no claim adjustments – just a monthly payment per month per identified patient.  This session will identify revenue opportunities and how we were able to reduce overall diabetic costs by 38% while decreasing the administrative billing costs by 93%.

Successfully Operationalize Prospective Episodes of Care Bundled Payment Programs

A successful transformation from fee for service reimbursement models to value based quality care programs includes thoughtful planning around many key elements. This session addresses how Blue Cross NC operationalized a prospective orthopedic episode of care bundled payment program that is averaging over 30% in medical expense savings to the plan while increasing quality outcomes for its members. We will discuss key operational components of the transformation that ensures proper provider payments and member benefit applications. The presentation describes a phased approach used to build the program including a roadmap strategy with technology partners. Opportunity analysis, marketing to groups/members, and savings and outcomes measurements are addressed in the discussion. These operational components are critical to the success of the value program being implemented.

Close of Conference