Pulling IT All Together

1. Pulling IT All Together Madonna McDermott RN, MS, MPA – Director, Student Health Service Victoria Svoboda, MS – Associate Dean of Students

2. Learning Objectives • Identify key stakeholders to involve in the exploration and implementation process as it relates to mandatory insurance and third party billing. • Discuss strategies that best match your institution reflecting on mission, cost and resource availability. • Describe technology strategies to streamline communication and implementation processes for mandatory health insurance and third party billing.

3. Largest private institution in MN Catholic affiliation Urban setting 10,984 students 6,076 undergraduate 4,908 graduate 2,400 residential No medical school University of St. Thomas

4. Brief History at UST • 1998: Discontinued mandatory insurance • Hard waiver–manual process through Business Office • Retained insurance requirements for athletes and international students • <2000 visits to Student Health Service • 2004: ACHA Consultation • Institutional fit • Staffing / Space • Funding structure • ACHA Standards • 2004-2006: Times of transition • New senior administration, Law School, Office for Mission • ↑ undergraduates (1000 FR in 2003, 1300 in 2006) • ↑# of residential students (added 500+ beds) • >7500 visits to Student Health Service

5. Assumptions • Not experts in anything but our own experience • Lessons learned may be helpful to others on their own journey • Theoretical framework provides structure to our experience

6. Pulling IT All Together • Eight Stage Process of Creating Major Change (Dr. John Kotter) • Establishing a Sense of Urgency • Creating the Guiding Coalition • Developing a Vision and Strategy • Communicating the Change Vision • Empowering Broad-Based Action • Generating Short-Term Wins • Consolidating Gains and Producing More Change • Anchoring New Approaches in the Organization

7. 1. A Sense of Urgency (K) • This first step is essential. • Failure to create a sense of urgency is a major cause for organizational change to fail. • Must motivate people out of comfort zone. • Without motivation, the effort goes nowhere. • This requires strong leadership. • Make the status quo seem more dangerous than launching into the unknown.

8. Supports the mission of your university Increasing costs of higher education Increasing competition Important marketing tool Changing political environment Good stewards of scarce resources Promise of new revenue for your institution Increasing health care costs Increasing number of students requiring medical care (share stories) 1. A Sense of Urgency (UST)

9. 2. The Guiding Coalition (K) • Key Stakeholders • Must find them at all levels (VPs/Deans, support staff, IT, etc.). • Include supporters and critics/skeptics. • Assessment & Environmental Scanning • National and local data regarding mandatory insurance, third party billing and other funding structures

10. Stakeholders Mandatory Insurance: SHS Team, Dean of Students, VP of Student Affairs, Academic Deans, Registrar, Business Office, Advisors (financial/academic), Students and their families Third-Party Billing: all of the above + Controllers Office CFO Purchasing Office Catholic Social Teaching invited us to pay attention to issues of access and representation. 2. The Guiding Coalition (UST)

11. 2. The Guiding Coalition (UST) Assessment & Scanning • Benchmarks: • ACHA Standards and benchmarking data • Dialogue with and visits to other institutions • External Experts: • ACHA Consultants, • Multiple external consultants, • Training on coding • Internal Resources: • Background/history of AAL, • Surveys of students to determine insurance rates, • Interviews with those who were here when we last did hard waivers to learn from their experience, • Business analysts in IT, etc.

12. 3. Vision and Strategy (K) Every successful transformation effort must have a vision … • A picture of what the future will look like • A vision that is easy to communicate • A vision that is transparent

13. 3. Vision and Strategy (UST) Mandatory Student Health Insurance • Undergraduates with 12 or more credits • Graduate students with 9 or more credits • Identified “owner of process” • Already required of NCAA athletics and international students • History of previous requirement • Describe proposed process • Key communication strategies identified

14. 3. Vision and Strategy (UST) Third Party Billing - Preparation • Do you as a leader have the knowledge and skill set to launch this change process? • What type of assistance do you need? • Internal vs. external consultant? • Does your current insurance plan meet your students needs? • What is your time frame? • What start up costs will you need?

15. Software selection Negotiate (payer) insurance contracts Provider credentialing Billing and accounting policies and procedures Physician/NP/PA reimbursement (Provider fee schedule) Laboratory services reimbursement (Lab fee schedule) Proposed clinic fees and general payer allowed amounts Draft tools such as charge ticket, consents, etc. 3. Vision and Strategy (UST) Third Party Billing - Logistics

16. 4. Communicating the Change (K) • Be as transparent as possible. • Clearly articulate the what, why, who, how. Tailor this message to each audience. • Include all stakeholders in developing your plans.

17. 4. Communicating the Change (UST) • Build process into existing systems • Campus Media (daily bulletin, student newspaper, parent newsletter, faculty newsletter) • Direct Mail (letters to all students) • Email (to those who utilized SHS in past 12 months; to those needing to complete verification process on a weekly basis) • Personal Contacts (to students not responding to emails; to colleagues to build support) • Meetings (visits to AAL, President’s Council, University Council, Grad Records & Registration) • Misc. (enclosure in student bills, postcards, posters at SHS/on campus, web sites)

18. 5. Broad-Based Action (K) • Remove obstacles • Make change easy • Use of technology • Communicating with those who are resistant

19. 5. Broad-Based Action (UST) • Make change easy / remove obstacles • Began with registration holds, now billing for insurance. • Included appeal process. • Secured grants for uninsured/underinsured. • Bill by semester instead of year, ensuring it is included in financial aid. • Simplify reporting • A = auditing • B = billing • C = communication • Make technology work for you: • Banner: Student Records, mailings, status for insurance • Lyris: Listserv manager for sending communications • Nuesoft: Added billing module to existing medical software • Appworx: Generates queries and develops reports from Banner; runs chains to lift holds, change status, etc. • Cognos/Report Net: View holds and error reports

20. 6. Short-Term Wins • Kotter: Promote, make visible the wins • UST: • Identify short-term wins through data analysis and surveys • Communicate results • Patient satisfaction • Revenue • Compliancy • Additional services

21. 7. Consolidating Gains and Producing More Change • Kotter: • Hire, promote, develop people who can implement change. • Be careful of declaring victory too soon. • Change implementation takes years. • UST: • Partnered with talent across campus, increased staffing in SHS. • Phased processes with IRT to ensure continuous service. • Eliminated duplication within the organization. • Used new revenue to expand services, improve facilities.

22. 8. Anchoring New Approaches in the Organization • Kotter: • Make change stick by developing social norms and shared values. • Develop next generation of leaders. • UST: • Moved from “it can’t be done,” to “the way we do things around here.” • Can demonstrate how the new processes have helped (students, SHS, the institution). • Embed our work in existing systems such as enrollment, orientation, etc.

23. Lessons Learned • Stakeholders must include both your champions and your critics • Document everything and create a shared space (virtual and physical) • Language translation (Medical/IT/Immigration/Financial) • Never lose sight of your goal (Don’t prioritize process over people) • Discuss strategies that best match your institution reflecting on mission, cost and resource availability. • Use technology resources (people & systems) • Appreciative inquiry

24. References/Resources • Kotter, J.P. (1996). Leading change. Cambridge, MA: Harvard Business Press. • Collins, J.C. (2005). Good to great and the social sectors. A monograph to accompany Good to great: Why some companies make the leap—and others don’t. • Madonna McDermott - mkmcdermott@stthomas.edu • Victoria Svoboda - vasvoboda@stthomas.edu • Dawn Lunde - dlunde@thesyndeogroup.com • Christine Duprey - chris@carisinnovation.com

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28. Student Health InsuranceComplete Student Health Insurance information. Immunization, Health History and Physical FormsComplete Student Immunization Record and download other health forms.

29. Health Insurance Verification Process  • Please provide your existing health insurance company and policy number below. If your provider information changes you may return to this form to correct the information. This information will be audited and verified by the Student Health Insurance Office. If the information is found to be false, you will be subject to penalties under the University's Code of Conduct.Our records show that you had the insurance listed below last period. • If your information has not changed press ''Continue'' and this information will be used for this coming period. • If you have new information, please type it in below and press ''Continue''. •  Insurance Company Name:   Policy Number:   Insurance Company Phone Number:

30. Fall 2008Greetings Alex. Our records indicate that you are an Undergraduate Student with 12 or more credits.The University of St. Thomas requires all Undergraduate degree-seeking students enrolled in 12 or more credits on the 10th day of the Fall 2008 term to have health insurance coverage. You may provide your own coverage or participate in the UST Sponsored Health Insurance Program to meet this requirement.