Are You Ready For Revenue Cycle 2.0? Presentation Summary & Tools Presented by: Daniel J. Marino

1. Are You Ready For Revenue Cycle 2.0?Presentation Summary & Tools • Presented by:Daniel J. Marino

2. The Healthcare Reality of Today • Healthcare costs continue to rise placing pressures on patients, employers and healthcare providers • Movement from volume-based reimbursement to value-based contacts • Fee-for-services plus shared savings • Shared savings with PMPM care management fee • Risk-based contracts • The importance of data continues to rise • Process-driven outcomes • Performance and care results

3. Shift in Revenue Cycle Activities Future Present

4. New Generation of KPIs • New Generation of financial metrics include: • Tracking “Cost of Care” • Clinical performance • Patient satisfaction/engagement • Beneficiary/program management • Bundled payment indicators • PM systems tracking by value –based contract • Bundled service • Shared savings • Partial or full risk • A/R management reflecting performance incentive opportunity

5. Physician Key Performance Indicators

6. FocusedAnalytics Help Identify Where to Begin Stratify Data based PMPM, Cohorts • Build the total cost of care model on per member, per month bases • Indicators should include: • Allowed versus paid amount • Employee, spouse, child • With and without high cost claims

7. Top 10 Diagnoses by Total Cost * Diagnoses appeared in the primary, secondary or tertiary codes

8. Evaluating the High Cost Services Support Bundled Service Tracking • On a per encounter basis, colorectal cancer is the most expensive cancer type assessed, whereas breast cancer had the highest encounter rate • *Figures provided are in Paid Amounts. *Disease categories based off of grouped diagnoses corresponding to condition.

9. Collected vs. Collectable • Similar to net collection rate, but allows for more accurate review • Collected: • Payment received and line item posted (includes co-pay and deductible) • Collectable: • The allowable amount as negotiated in contract (includes co-pay and deductible) • Great metric to evaluate overall revenue cycle performance • Forces you to ask specific questions and drill down to find answers • Dependent on knowing contract fee schedule • Allows for better contract negotiations

10. Collected vs. Collectable 90 Day CvC: Goal 92-94% Payments received in the next 3 months Allowable posted 4 months ago 180 Day CvC: Goal 95-97% Payments received in the next 6 months Allowable posted 7 months ago Annual CvC: Goal 97-99% Payments received in the next 12 months Allowable posted 13 months ago

11. Sample 90 Day CvC Report

12. End Uses of Clinical Information to Support Revenue Cycle Performance Program Management • Quality scorecards • Patient chart view through continuum of care • Use of referrals and ancillaries Physician Performance • Chronic disease registries • Care gap management • Patient satisfaction Financial Effectiveness • Total cost of care reports • Payer analytics • Areas of improvement • Domestic Utilization Mgmt

13. Contact Health Directions, LLC Two Mid America Plaza, Suite 1050 Oakbrook Terrace, IL 60181 Phone: 312-396-5400 dmarino@healthdirections.com www.healthdirections.com Daniel J. Marino President/CEO dmarino@healthdirections.com @HDirections