Sutter Physician Services

Driving Revenue Cycle Improvements through Self Service Analytics

The Story

•  Prologue – Corporate Background •  Chapter 1 – The Journey Begins •  Chapter 2 – Our Leap Forward •  Chapter 3 – Challenges and Responses •  Chapter 4 – Happily Ever After

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Prologue

•  Your Speakers for Today •  Sutter Physician Services Corporate Overview •  Our Client Structure

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Speaker Introduction

•  Erich Olson - Assistant Director, Enterprise Analytics Services

•  Kristine Krueger – Director, Forensic Analytics •  Chris Sharp - Assistant Director, Data and Application

Services •  Brian Finn – Business Intelligence Architect

Sutter Physician Services Overview §  Sutter Physician Services is an industry leading physician-focused healthcare services company

that provides revenue cycle management, patient access solutions and accountable care solutions to integrated delivery networks and large physician groups

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Support Capabilities

EPIC and GE/IDX-certified support for implementation, optimization, and ongoing applications support of the physician enterprise

Integrating independent practices through EHR, practice management, and other solutions

Routine and ad hoc reporting and analysis for finance, operations, utilization management, clinical performance, regulatory compliance, and quality performance

Analytics and Business Intelligence Technology Independent Practice Services

Patient Access Solutions

Accountable Care Solutions

Revenue Cycle Management

Supporting all facets of managed care and risk administration including: Commercial and Medicare plans, care coordination, population health and advanced analytics

Provides patient focused , high-tech billing and AR management services for physicians, home health, and Ambulatory Surgery Centers Patient Access: Calls rerouted from doctor’s office to Patient Service center for patients seeking general information and patient registration and/or scheduling

Clinical Call Services: 24×7 nurse advice services, Rx refills, health outreach programs, readmission management, and MD on-call services

Sierra  Region  

West  Bay  Region  

East  Bay  Region  

Peninsula  Coastal  Region  

Central  Valley  Region  

•  not-for-profit •  48,000 employees and 5,000

doctors

2013 by the numbers •  Emergency room visits

- 757,598 •  Sutter Care at Home

health visits - 419,275 •  Sutter Care at Home

hospice visits - 246,927

•  Outpatient visits - 10,131,343

•  Charge Transactions – 22,000,000

Su8er  Physician  Services  

Su8er  Physician  Services  

Chapter 1 The Journey Begins

•  Our motivation for change •  Ambulatory Revenue Cycle Management •  Denials Rate Management in a Land Far Away •  Our first step toward change •  Finding Goldilocks

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Our Motivation for Change

Classic approaches to reporting take a lot of time if what you really need to do is detail analysis.

Time lag translates into lost productivity and lost

opportunity for improvement. Our goal is to provide insights to our clients that are

actionable, accurate, consistent, and timely. Using Self Service Analytics we knew we could better

achieve our goal and improve our client experience.

Ambulatory Revenue Cycle Process

Encounter form is filled

out with information related to the visit.

Patient Sees

Doctor

“Scrub” claim, fix

errors prior to billing

Generate Claim

Claim is outstanding for a period

of time

Send Claim to

Insurance

• Collect Payment

• Appeal denied claims

Receive Response

from Insurance

Bill patient for unpaid copay, deductable,

or non-covered services

Generate Patient

Statement

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• Date of Service • Department • Coverage • Plan • Copay Due/Collected • Patient Info • Diagnosis • Specialty • Claim Rule Violations • Performing Provider • Referring Provider

• Post Date • Guarantor Account • Procedure CPT Code(s) • Procedure Modifier(s) • Charge Amount(s) • Billing Provider • Original Payor • Current Payor • Revenue Location • Place of Service

• Payment Date • Payment Amount • Denial Date • Denial Payor • Denial Reason Code • Denial Category

Key Data Points

Sutter Physician Services Our Clients

(Medical Foundations)

Denials Rate Management in a Land Far Away

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Go to SharePoint and check the Core Team Dashboard – DENIALS

Go to SharePoint and check the Denial Summary by Category Report

Go to SharePoint and check the Denial Summary by Remit Code

What was my denial rate this

month?

How do I get more information about the

denial types?

How can I tell which Department

has the highest rate?

OR

Go to LaunchPad and run the Denial Details Report – From there you can see the detail of the denials and pivot on total

volumes by department

BUT If you want the denial rate you will have to request an Ad

Hoc report to get your transaction count denominator

Requires several clicks and you may not ultimately get to your answer in the same day.

Our First Step Toward Change

•  It all started with a Proof of Concept (POC) –  Identify a question and model the answer in

MicroStrategy – Denials rate –  Engage MicroStrategy Professional Services –  Present findings to our Executive Team

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Denials Rate POC •  2 days to a working Denials Rate prototype •  Now we could see a problem and drill to the detail

behind it •  Answers came as fast as the execs could ask them

Now we needed to find the Goldilocks project

What does Just Right look like?

•  Speed to delivery •  Relevance to our business objectives •  Opportunities to drive Business

Intelligence (BI) Maturity

Too Small

Too Big Just Right

Our Goldilocks Project

•  Revenue Cycle Core Team Dashboard –  Speed –  Relevance –  Opportunities to Drive BI Maturity

Chapter 2 Our Leap Forward

•  The Demo

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Reminder

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Go to SharePoint and check the Core Team Dashboard – DENIALS

Go to SharePoint and check the Denial Summary by Category Report

Go to SharePoint and check the Denial Summary by Remit Code

What was my denial rate this

month?

How do I get more information about the

denial types?

How can I tell which Department

has the highest rate?

OR

Go to LaunchPad and run the Denial Details Report – From there you can see the detail of the denials and pivot on total

volumes by department

BUT If you want the denial rate you will have to request an Ad

Hoc report to get your transaction count denominator

Requires several clicks and you may not ultimately get to your answer in the same day.

Limitations of Classical Reporting Methods

•  Reporting was historical in nature forcing us to be reactionary

•  Reporting had low sensitivity which made root cause analysis of KPI performance difficult

•  Decentralized reporting structure lead to data governance issues

•  Drill down analysis was performed in a manual ad hoc manner which was time consuming

Denials  Dashboard  go-­‐live  4/1/2014  

Denial  Trending  

Chapter 3 Challenges and Response

•  Challenges to Self Service Implementation •  Governance •  User Training

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Challenges to Self Service Implementation

•  Delivery Process/Development Lifecycle •  Governance •  Managing Change

Metric Stewardship Committee

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Governance Advisory Committee

Prioritize Changes

Approve Review Proposals

Super Users

Collect Ideas &

Collaborate

Analytics

Execute

User Groups/Training Strategy

•  Train the trainer –  Identify your super users/SMEs and help them learn the

tool –  Direct local resources to engage SME as first level support

•  User Groups –  Regular Meetings –  Work sessions with real world questions –  Use Case Based Examples

Architecture Considerations

•  POC was based upon views on top of a normalized data structure which was not scalable

•  Required a model that was automated, scalable and easy to use –  Physical dimensional model with conformed

dimensions which was easily transformed to MicroStrategy schema’s

–  Automated data refreshes through SQL Server Integration Services, MicroStrategy schedules

Architecture Considerations - Cont.

Required an architecture that was secure and provided for flexibility and quality –  Established a security model to filter data by client –  Established a ‘path to prod’ –  Track and document changes –  Created three separate environments

•  Development •  Quality Assurance •  Production

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Chapter 4 Happily Ever After

•  Our Recommendations •  Plans for the Future

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Our Recommendations

• Use ePEPs

• Professional Services

• Sandbox Environment

• Standardize Dashboards

• Change Request Management

Plans for the Future

Data Forensics Accountable Care

Quality Measures

Questions

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