Modernizing Clinical Communications, Analytics, and the Revenue Cycle Process in the Era of ACOs

1. Modernizing Clinical Communications, Analytics, and the Revenue Cycle Process in the Era of ACOs Jason Tipton, Director of Value Operations – Holston Medical Group Jim Lacy, CFO & General Counsel - ZirMed

2. Jim Lacy, CFO & General CounselZirMed

3. Learning Objectives • Identify the clinical and financial challenges that provider organizations face when moving to an ACO model • Assess the workflow, process improvements and strategies that HMG implemented while becoming an ACO • Evaluate the internal challenges and determine which tools, technologies and processes could be applied to their organization • Help attendees sort through the high volume of ACO advice to cut through the noise

4. The Technological & Financial Challenges Operating in an ACO World • Changing market needs and regulatory requirements • Integration of healthcare IT systems • Exchange of clinical data on patient referrals and engagement • Expanding regional storage and of patient records and documents • Selecting the appropriate reimbursement model • Understanding and navigating risk

5. Powering ACOs & Reimbursement “A health information technology platform that connects providers in the ACO is essential, along with a strong financial database and reporting platform.” -- Commonwealth Fund*

6. How will new payment models impact your revenue? Risk • Not being paid for all of the care your organization has provided Opportunity • Improve the quality of care you provide while becoming more efficient and getting paid more for the care you’ve provided

7. Holston Medical GroupOnePartner HIEQualuable Medical Professionals – “ACO” Scott R. Fowler, JD, MD, FACOG

8. Holston Medical Group • Established 1977 – Kingsport, Tennessee • 150 primary care physicians, specialists and mid-level providers • Preventive medicine focus • More than 80 primary-care providers • Emphasis on electronic medical record utilization, clinical research and integrated health management • Focused on delivering latest advanced technologies and treatment

9. Patient Centered Approach to Care

10. How to Succeed – In a Value Based World • Provide the highest quality of care with limited resources • “Do more with less”

11. Clinical & Financial Challenges: The Shift from Volume to Value • Integrating data from multiple different PMS & EHR systems • Aggregate cost data • Aggregate clinical data • Achieving the most critical success factor for ACO: Patient and Provider Engagement • Patients engaged in management / compliance • Providers engaged with patient and comprehensive record • Providing easy real-time access to comprehensive data from multiple sources

12. ACO Financial Models • Bundled Payments • Capitation-based • Combination • Medicare Shared Savings

13. HOW HMG Built an ACO • Collaborative intelligence • Leveraging economies of scale • Chronic disease management • Less touch required throughout revenue cycle • Incorporating the right technology • Coordinating clinical data • Workflow solutions • Analytics

14. 5 Essential Components • Patient / Doctor Engagement • Interactive Data • Footprint – Economies of Scale • Patient Lives • Brand

15. Is It Working? Success Metrics • Contracts / renews • Financial Results ($)

16. Questions ?

17. Thank You! Scott Fowler, MD Scott.Fowler@HolstonMedicalGroup.com 423-857-2091 Jim Lacy Jim.Lacy@ZirMed.com 502-779-4302