The CHI Physician Services (CHIPS) Journey: Transforming the Physician Practice Model

Across a Large Hospital Based System

AMGA Conference – March 2015

Jamie Dye Chief Development Officer

MedSynergies

CHIPS Board Member

Beth Cafaro, JD Vice President

Practice Operations

President of CHIPS

Introductions

Organizational Overviews

Catholic Health Initiatives (CHI) Today

MISSION: To nurture the healing ministry of the Church, supported by research and education. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthy communities

About MedSynergies

24 Markets

Providers 7.6K

Number of Patients

2.2M Visits

10.6M 1.3B Total

Collections

MedSynergies – By the Numbers

Next Era Evolution Focused Next Era Strategic Priorities

Clinically Integrated Network (CIN) Development

Organic Growth Strategies

Care Management Models and Capabilities

Integrated National and Regional Service Lines

Retail, Ambulatory and Post-Acute Strategies

Demonstrated Quality and Service

Physician Network Growth and Engagement

Cost Effectiveness

Financial Performance

Organizational Model

IT Investment

Risk and Insurance Capability (Prominence Health)

Employee Health Management

Payer and Insurance Product Strategies

Consumer Engagement Strategies

Clinical and Operational Excellence

Integrated Care Delivery Payment for Value

The Next Era of Healthy Communities

Physician Enterprise Growth

Region # of Providers

Nebraska 898

Pacific Northwest 746

KentuckyOne 556

Iowa 517

East-Southeast 616

Minnesota/North Dakota 366

Texas 74

Total Providers 3,773

1,320 Advance Practice Clinicians

33%

55%

12%

Primary Care Specialists Other

Transforming the Physician Practice Model

Catholic Health Initiatives Physician Services is a management services organization created

to support our provider practices with resources and proven practice management solutions that optimize

performance and free up physicians, clinicians and their staffs to deliver better patient care.

What is CHIPS?

How Did CHIPS Transform the Model?

CHI Partnerships Drawing the Plans

Governance Laying the Foundation

3. Transition and on-board resources with diligent and thoughtful care.

2. Lead with a defined communications campaign.

4. Implement solutions on-time and on-budget.

1. Establish and maintain a clear organizational governance structure.

5. Identify data sources of truth.

6. Establish baseline standards and success criteria metrics.

Strategic Imperatives

MSIGHT Standard of Excellence Laying the Foundation

MSO Services Alignment Establishing the Framework

CHIPS

Coding Quality Metrics/Management

JV Management Services Revenue Cycle

Practice Management Centralized Scheduling (option)

Practice Marketing Strategy (option) Charge Entry

Human Resources

CHI Will Retain the Provision of Some Physician Services

Practice Accounting Services Legal

Communications Compliance

Care Management

5-Phase Implementation Starting the Build

Phase 1

Complete

Fargo

CHI Health Nebraska

Phase 2

Complete

KentuckyOne

Roseburg

St. Luke’s

Phase 3

Complete

Pendleton

Tacoma

Phase 4

Current

Reading

Mercy

Des Moines

Chattanooga

Little Rock

Phase 5

Future

Lufkin

Steubenville /Bryan

Bismarck

The People Transition Installation of Core Features

CHIPS employees have their own compensation, benefits and retirement programs aligned with ambulatory practice — not hospitals

All other practice employees transition to CHIPS

Common Job Descriptions

Billable providers (MD’s, DO’s, NP’s PA’s) and Directors remain employees of the MBO

Standardized compensation

Best Practices The Finish Out

Patient Outreach Solutions

Online Appointment Scheduling

Referral Management Solutions

CHIPS Suite of Tools

Enhancing Operational & Financial Performance Inspection

Pre Point-of-Service

First point of contact with the patient during which the appointment is

scheduled and continues through pre-registration and benefits verification

Point-of-Service

Activities begin with the check-in process prior to the patient seeing the physician and after they have received

care with patient check-out

Post Point-of-Service

Administrative and financial activities associated with collecting payment for

services rendered

Revenue Cycle Management

Process & Discipline The Walkthrough

Monthly Meetings with practice managers, client services managers and health system leadership

Metrics that are tracked and reviewed:

HR analytics

Five key metrics

Optimal Practice Model

Optimal Practice Model The Walkthrough

Business Reviews

Real-time Customer Service

Service Requests Client

Management

CHI Physicians/ Physician

Organization

Practice Managers

Operations Business Partner

Practice Partners

CHI/CHIPS MedSynergies

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Five Key Metrics The Walkthrough

Metrics – Revenue Cycle

Metrics – Project Management

Overall Financial Metrics The Punch List

Metric Sample Market Benchmark Variance

Total collections (in dollars) $ 4,982,071 $ 6,642,762 25%

Total Collection Rate (includes adjustments)3 96% 91% 5%

Payment per RVU3 $ 48.27 $ 52.71 -9%

Days in A/R (total A/R / (total charges/365))4 31.87 33.59 -5%

A/R% > 90 days4 17.2% 20.41% -3%

Charges % of Medicare (2013 Fee Schedule)2 250% 250-400% -

Successes Benefits of Building

Front End Process Improvements

Coding

Patient Outreach – remove burden to staff, excellent early results

Revenue Cycle Enhancements – starting to allow positive gains

CHIPS Today Fiscal Year 2014 Statistics

3,800 CHIPS Employees

Including approximately 3,500 employed physicians and advance practice clinicians

EMPLOYEE COMMUNITY Approximately 90,500 Employees

Lessons Learned

Sense of loss of control by market leadership

Unanticipated level of resistance to change

Lack of analytic tools in the markets

Training and education of staff

Difficulty in extracting data (willingness to share data)

Expectations for immediate results following transition

Prioritize markets using an overall needs assessment

Although providers are not in scope, they are a key audience

Need to over communicate to leadership in markets and national office

The Future of CHIPS

Closer alignment with our JV partners

Practice and Revenue Cycle Assessments across our Service Line Structure

Develop MSO Offerings for our Private Aligned Physicians delivered through our CIN’s

Q&A