WEBVTT
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... program titled "John Muir Health and AI:
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A Case Study in Managing Costs."
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My name is Amanda Norris,
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and I'm the associate content manager
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of our finance markets here at HealthLeaders,
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and will be your moderator for today's event.
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Our program will be 60 minutes in length.
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Note that an on-demand version of this program
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will be available approximately one day
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after the completion of the event,
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and can be accessed using the same login link that you used
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for the live program.
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Today's program is sponsored by Optum.
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Thank you to our sponsor, and to you and our audience
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for giving us your time and attention.
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Before we get started, I have a few housekeeping details.
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First, to ensure that you can see
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all the content for the event,
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please maximize your event window
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and/or PC speakers for optimal sound quality.
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Second, you will find a resources list for today's webinar
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in the upper right of your screen.
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Here, we have listed the webinar slide deck
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and other materials for you to interact with.
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Third, at the bottom of your console
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are multiple widgets you can use.
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To submit a question, click on the Q&A widget.
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It may be open already
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and appear on the left side of your screen.
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You may submit questions
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at any time during the presentation.
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However, please note that it's likely
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your questions will not be answered
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until the Q&A portion of the program.
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If you experience any technical difficulties
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during today's program and need assistance,
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please click on the help widget,
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which has a question mark icon,
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and covers common technical issues.
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So at this time, it's my pleasure to introduce our speakers.
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We have Dexter D'Costa,
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Senior Director of Revenue Cycle Value Management at Optum,
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and Susan Ingebretsen,
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Director of Health Information Management Services at Optum
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and supporting John Muir Health.
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Thank you both for taking the time to speak with us today.
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And with that, the audience is yours.
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Thank you, Amanda, I appreciate that.
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Hi, everyone, my name is Susan,
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and today, we're going to talk a little bit
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about John Muir Health's journey
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to transform our middle revenue cycle
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through technology and innovation.
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So in front of you is our agenda,
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and we'll be going through these various areas here
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regarding cost management, some managing cost overviews,
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and some of our outcomes-driven results,
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and some of our key takeaways.
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We're gonna start off with a poll question.
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So think about what is your top pain point
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in managing costs within your revenue cycle.
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And so here's some options.
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We have cost optimization, revenue performance,
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clinical efficiency, all of the above.
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Maybe you don't have any problems within your revenue cycle,
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or you're not quite sure.
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So any of your top pain points
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in managing costs within your revenue cycle.
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Okay, we'll start looking at some results here.
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Looks like we've got several, about half don't know.
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About another quarter percent, about all of the above.
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So hopefully we'll give you some key insights here.
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First, I wanna talk a little bit about John Muir Health.
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It's a community-based health system
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located in the San Francisco Bay area.
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It includes two of the largest medical centers
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in Contra Costa County, one being in Walnut Creek,
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which actually also serves as
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Contra Costa's only designated trauma center.
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The other medical center is located in Concord,
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they specialize in cardiac and stroke care.
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And together, they're recognized
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as highly regarded centers for the neurosciences,
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orthopedics, cancer care, cardiovascular care,
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and high risk obstetrics.
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They also specialize in general surgery, robotic surgery,
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weight loss surgery, rehabilitation, and critical care.
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Both of these hospitals are accredited
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by the Joint Commission,
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which is the national surveyor of quality care.
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John Muir also offers a complete inpatient outpatient
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for adult and adolescent behavioral health program,
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and they have services at a behavioral health center,
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which is a 73 bed psychiatric hospital located in Concord.
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So our strategic partnerships began in July of 2019.
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This is when Optum and John Muir announced
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a comprehensive new focused relationship
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on advancing delivery of high quality care,
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affordable for the patients in the Bay Area.
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And the new innovative partnership was really designed
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to bring an extensive set of capabilities,
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including operational technologies,
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analytic solutions and tools,
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and administrative services expertise
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to help John Muir further advance
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its clinical and operational performance.
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And to support this effort,
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Optum would be managing key nonclinical functions,
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including information technology, revenue cycle management,
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analytics, purchasing, and claims processing.
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Optum would also support and further enhance
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John Muir's physician network,
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ambulatory care coordination,
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and utilization management services.
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So through this new relationship,
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Optum and John Muir identified a set of strategic goals
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that they wanted to work on together.
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One being increasing the efficiency
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of administrative operations
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using innovative technology solutions
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to reduce administrative workload
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and enable John Muir to maintain its focus on patient care.
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Another key goal was to accelerate
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John Muir Health's ability to deliver value-based care
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and lower care delivery costs
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by applying some proven approaches
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to integrated coordinated care.
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Third, bringing more data-driven insight to care providers
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and patients at the point of care
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using Optum clinical technologies
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and advanced analytical tools.
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And finally, some expected benefits
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would be a more fully engaged,
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more fully engaging our consumers in their health,
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and identifying chronic conditions sooner,
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and reducing overall delivery costs.
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So as part of this very unique comprehensive partnership,
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approximately 540 John Muir Health employees
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were rebadged to Optum.
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I was one of those.
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I've been with John Muir for three years,
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and then they announced this partnership,
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and I rebadged to Optum.
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So I've been there almost four years
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as a, quote, Optum employee.
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We would continue to directly support
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John Muir Health's work and mission
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as part of a dedicated John Muir Health business unit
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within Optum.
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And with access to new skill development opportunities,
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and technologies, and processes at Optum,
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we now have the opportunity to build on our successful work
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in making John Muir Health's system
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the choice for the people in the Bay Area.
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I'm now gonna hand this over to Dexter
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to talk a little bit more about Optum as a partner.
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Thank you, Susan.
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Good afternoon, everyone.
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My name is Dexter D'Costa.
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Thank you for taking the time to be on this webinar today.
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So one of the things we pride ourselves at Optum
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is our expertise.
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You see, we have more than 20 years
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in the industry leading NLP business,
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30 plus years in the coding experience,
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as well as about 14 NLP patents.
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We also pride ourself on our insight, our partnerships,
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and four of five US hospitals
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rely on our information and capabilities.
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And last, but not least, is our success
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with advanced technologies.
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When you look at the volume of encounters
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that are processed through our computer-assisted coding
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and CDI technologies,
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and the medical facts that are scanned through NLP engine.
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When you look at Optum, we are truly one of those vendors
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that provides end-to-end revenue cycle solutions.
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Whether it's front end, whether it's mid end, mid cycle,
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or whether it's the back end of revenue cycle,
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Optum provides solutions across the spectrum of healthcare.
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It's not just solutions, but we also provide services,
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one of the few vendors that actually provides
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technology solutions as well as services
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when it comes to process improvements, education,
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and leadership engagement,
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and provider engagement, more importantly as well.
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Our belief is our solutions
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are here to transform revenue cycle,
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whether it's the pre-admission process,
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the admission process, or the discharge process,
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our goal is to ensure that our Optum engine,
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through a technology powered automation,
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artificial intelligence, proprietary content,
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and delivery and value management,
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provides value to our clients and our partners.
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And thus providing the results that you seek,
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whether it's financial, whether it's clinical,
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whether it's operational.
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So let's talk about managing costs.
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Managing costs is not just a coast problem,
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or a middle America problem.
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It's not just a problem that urban hospitals
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or rural hospitals deal with.
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It's not just a problem that academic teaching hospitals
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or critical access hospitals deal with.
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In fact, it's not just a problem
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that the US healthcare systems deal with,
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but a lot of other countries have the same problems
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with regards to how do you manage costs
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in the healthcare arena.
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So let's start with a quick poll question.
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Do you currently outsource your revenue cycle?
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And by outsourcing your revenue cycle,
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the options that you have is yes,
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we outsource our full end-to-end revenue cycle services
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and the technology,
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we outsource just our services only,
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or you do a little bit of outsourcing when it comes to,
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maybe it's just your front end, or the middle,
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or the back end of revenue cycle.
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Or option D, which is we do not currently outsource
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any part of our revenue cycle,
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but are likely to explore in one or two years,
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or option E, we have no plans for RCM,
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revenue cycle management outsourcing,
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or F, I do not know.
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So let's give a few seconds before we view the results.
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Okay, we've got a few results coming in,
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so I'm gonna wait a few more.
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Okay, let's look at the results.
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So looking at the results,
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you see that most of you,
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48% said we have no plans for RCM outsourcing.
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The second most was I don't know,
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or we do not currently outsource
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any part of our revenue cycle, but are likely to explore,
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or you have a limited form of outsourcing,
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whether it's front, middle, and back end.
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And I think that's what we've seen
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in terms of the clients that we've worked with
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is sometimes, they question the value
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and how does it help with managing costs.
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And that's what we are here today
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is to share the story with John Muir
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in terms of what they did
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in terms of helping manage the cost conundrum.
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So one of the things,
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we recently published a white paper wherein
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healthcare executives talked about their pain points,
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and it revolved around three factors,
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cost optimization, revenue performance,
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and clinical efficiencies.
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In fact, when you look at the key market divers
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and industry challenges,
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50% of hospitals have a negative margins this year.
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The number one pain point that most CEOs talk about
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is personnel shortages.
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Denials continues to be a big problem
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that a lot of health systems are facing.
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And on top of that, you have regulation,
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consumerism, and decentralization of care.
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Whether it's bed and clinical resource shortages,
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you look at the nursing shortage,
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you look at personnel shortage in general,
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or you look at the aging population
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and the need for more clinical staff.
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Whether it's efficiencies in workflow,
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it could be the medical necessity reviews,
270
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for those of you that work in CDI and coding,
271
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around staffing accuracy,
272
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or for those of you that work in authorization.
273
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So the problems are many, and yet the solutions
274
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tend to be focused on silos
275
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and not so much an integrated solution,
276
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and more importantly, how can we leverage technology
277
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to help solution for those pain points.
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Going further, you look at costs,
279
00:13:35.880 --> 00:13:38.550
and you look at revenue variability,
280
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the ever increasing problem of denials,
281
00:13:41.130 --> 00:13:44.790
the appeals process, and how painful that can sometimes be,
282
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as well as looking at the eventual gross operating revenue
283
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continuing to decrease.
284
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So health systems in general,
285
00:13:54.900 --> 00:13:57.180
no matter where you are in America,
286
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no matter what type of health system
287
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or hospital you might be,
288
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continue to face unprecedented headwinds.
289
00:14:04.740 --> 00:14:08.190
And these are just a few of some of the issues
290
00:14:08.190 --> 00:14:10.320
that we've tried to summarize.
291
00:14:10.320 --> 00:14:11.680
So the question then be is
292
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what can we learn from John Muir Health
293
00:14:14.160 --> 00:14:17.280
in terms of what they do to help accomplish
294
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some of the cost containment strategies
295
00:14:19.620 --> 00:14:21.676
that they're gonna share with you
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in the next couple of slides?
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One of our beliefs at Optum
298
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is we are here to solve middle revenue cycle
299
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industry pain points.
300
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We talk about the CDI coding, charging digital workforce,
301
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and it's driven by our AI cubed model.
302
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What I mean by that is automation, innovation, intelligence,
303
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and integration.
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There's a lot of vendors out there
305
00:14:49.920 --> 00:14:51.600
that talk about automation,
306
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there's a lot of vendors out there that talk about
307
00:14:53.880 --> 00:14:56.820
having the best when it comes to BI analytics,
308
00:14:56.820 --> 00:14:58.590
but there's very few vendors out there
309
00:14:58.590 --> 00:15:02.130
that can truly provide all of that experience
310
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in one integrated product.
311
00:15:04.860 --> 00:15:07.080
And that's what we believe is our differentiator
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in terms of solving for industry pain points.
313
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We look at a snapshot of the typical results we've achieved,
314
00:15:15.660 --> 00:15:19.230
whether you are a CFO and you're focused on revenue,
315
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we've been able to deliver value
316
00:15:21.240 --> 00:15:23.910
for the investment you've made.
317
00:15:23.910 --> 00:15:26.580
Whether you're looking from a COO's perspective,
318
00:15:26.580 --> 00:15:29.490
and looking at productivity and efficiency,
319
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labor savings, and more importantly,
320
00:15:31.860 --> 00:15:35.340
being able to leverage your staff for other opportunities,
321
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expanded scopes,
322
00:15:37.284 --> 00:15:39.120
whether it's hierarchical condition categories,
323
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whether it's a (indistinct),
324
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those are some things that we are able to provide
325
00:15:43.350 --> 00:15:46.950
in terms of the labor efficiency gains that you get.
326
00:15:46.950 --> 00:15:51.510
And yet, we focus on revenue and productivity
327
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without compromising on the accuracy or the quality.
328
00:15:55.500 --> 00:15:57.270
So that's been one of our big focus
329
00:15:57.270 --> 00:15:59.460
in terms of its automation,
330
00:15:59.460 --> 00:16:02.280
but yet, we wanna focus on data integrity
331
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and the accuracy of the data as well.
332
00:16:05.520 --> 00:16:07.290
So these are just a few snapshots
333
00:16:07.290 --> 00:16:10.530
with regards to whether it's CDI, whether it's coding,
334
00:16:10.530 --> 00:16:12.540
whether it's inpatient or outpatient,
335
00:16:12.540 --> 00:16:14.820
initial reviews or subsequent reviews,
336
00:16:14.820 --> 00:16:17.520
whether it's auditing and looking at decreasing
337
00:16:17.520 --> 00:16:20.790
the amount of time your auditors spend on doing audits,
338
00:16:20.790 --> 00:16:24.420
or whether it's just looking at AI acceptance
339
00:16:24.420 --> 00:16:25.980
in terms of the match rates,
340
00:16:25.980 --> 00:16:27.810
or the precision and the recall.
341
00:16:27.810 --> 00:16:29.460
Our results tell the story
342
00:16:29.460 --> 00:16:32.634
with regards to the efficiency that we bring in,
343
00:16:32.634 --> 00:16:35.643
and through those efficiencies, being able to manage costs.
344
00:16:37.050 --> 00:16:40.800
So without much ado, I'm gonna pass the ball on to Susan
345
00:16:40.800 --> 00:16:44.010
to talk about what did John Muir do
346
00:16:44.010 --> 00:16:47.280
leveraging AI in terms of managing costs.
347
00:16:47.280 --> 00:16:48.900
Susan?
348
00:16:48.900 --> 00:16:51.060
Thank you, Dexter.
349
00:16:51.060 --> 00:16:55.170
Okay, so let's start off with another poll question.
350
00:16:55.170 --> 00:16:58.740
Do you currently have an integrated and automated
351
00:16:58.740 --> 00:17:01.353
coding and CDI software?
352
00:17:05.520 --> 00:17:07.230
So here are some options here.
353
00:17:07.230 --> 00:17:12.230
Yes, you have both an integrated and automated enterprise
354
00:17:12.240 --> 00:17:16.740
computer-assisted coding, even for your professional,
355
00:17:16.740 --> 00:17:19.143
or inpatient, or hospital-based.
356
00:17:21.600 --> 00:17:22.980
You use multiple vendors.
357
00:17:22.980 --> 00:17:25.890
You use eCAC and CDI technology, but don't use
358
00:17:25.890 --> 00:17:29.973
a professional services computer assisted coding.
359
00:17:31.470 --> 00:17:36.210
You use eCAC, which is your enterprise or CDI.
360
00:17:36.210 --> 00:17:37.473
Lots of options here.
361
00:17:39.060 --> 00:17:41.550
You currently don't have anything.
362
00:17:41.550 --> 00:17:44.150
You don't have any plans for it, or you're not sure.
363
00:17:46.230 --> 00:17:47.790
Let's give it a few seconds here
364
00:17:47.790 --> 00:17:50.163
to read through those options.
365
00:17:58.500 --> 00:18:00.303
Okay, let's see what we got here.
366
00:18:01.230 --> 00:18:04.170
All right, looks like we've got a little, a mixture here.
367
00:18:04.170 --> 00:18:07.620
Some have no plans, some are not sure,
368
00:18:07.620 --> 00:18:11.040
they currently don't use, but they're likely to explore it,
369
00:18:11.040 --> 00:18:12.093
so very good.
370
00:18:16.560 --> 00:18:20.223
So John Muir faced a lot of challenges,
371
00:18:21.600 --> 00:18:24.273
and so what they were looking for
372
00:18:24.273 --> 00:18:25.950
was a partner that shared some common values,
373
00:18:25.950 --> 00:18:27.480
and they found Optum.
374
00:18:27.480 --> 00:18:30.885
They were committed to, John Muir was committed to staying
375
00:18:30.885 --> 00:18:34.470
as an independent health system,
376
00:18:34.470 --> 00:18:36.570
but also wanted to embrace partnerships
377
00:18:36.570 --> 00:18:39.123
to help them grow to serve more patients.
378
00:18:40.440 --> 00:18:43.560
So some of the key challenges that we face,
379
00:18:43.560 --> 00:18:45.600
especially in revenue cycle,
380
00:18:45.600 --> 00:18:48.810
was the lack of integrated middle revenue cycle technology
381
00:18:48.810 --> 00:18:51.420
and advanced data analytics.
382
00:18:51.420 --> 00:18:52.920
We also, our existing
383
00:18:52.920 --> 00:18:57.330
computer-assisted coding system and CDI solution
384
00:18:57.330 --> 00:19:00.390
was really intended to address ICD-10 transition
385
00:19:00.390 --> 00:19:04.350
versus renewed focus on labor productivity,
386
00:19:04.350 --> 00:19:08.103
improving our review rates, workflow, and revenue uplift.
387
00:19:12.030 --> 00:19:13.743
This is kind of a nice little,
388
00:19:16.063 --> 00:19:20.467
a quote from the then CEO of OptumInsight in 2020, Eric.
389
00:19:20.467 --> 00:19:22.560
I mean, basically, this partnership vision
390
00:19:22.560 --> 00:19:24.390
was an opportunity by John Muir
391
00:19:24.390 --> 00:19:27.060
to bring John Muir's exceptional skills and knowledge
392
00:19:27.060 --> 00:19:29.370
together with Optum's advanced technologies
393
00:19:29.370 --> 00:19:32.940
and analytical solutions to improve patient outcomes
394
00:19:32.940 --> 00:19:35.460
and reduce our total cost of care.
395
00:19:35.460 --> 00:19:37.372
And we feel we've done that,
396
00:19:37.372 --> 00:19:39.960
and hopefully we'll talk a little bit about
397
00:19:39.960 --> 00:19:40.920
what that looks like.
398
00:19:40.920 --> 00:19:43.710
So as part of our partnership,
399
00:19:43.710 --> 00:19:47.313
we embarked on five cost management strategies.
400
00:19:48.840 --> 00:19:52.650
The first would be our technology workflow integration,
401
00:19:52.650 --> 00:19:54.420
which was essential.
402
00:19:54.420 --> 00:19:56.130
So pre-Optum, our pain point was
403
00:19:56.130 --> 00:19:58.410
we had lack of collaboration
404
00:19:58.410 --> 00:20:00.860
between our coding and CDI team.
405
00:20:00.860 --> 00:20:03.810
They basically worked independently on the same cases.
406
00:20:03.810 --> 00:20:05.198
They didn't use,
407
00:20:05.198 --> 00:20:08.040
the CDI specialists didn't use coding as much,
408
00:20:08.040 --> 00:20:10.380
they were just beginning to use coding.
409
00:20:10.380 --> 00:20:14.193
They were pretty much focusing on CDI concepts.
410
00:20:15.120 --> 00:20:18.030
So the solution that Optum brought was a single platform
411
00:20:18.030 --> 00:20:22.422
enterprise computer-assisted coding, and computer-assisted
412
00:20:22.422 --> 00:20:24.960
clinical documentation integrity solution,
413
00:20:24.960 --> 00:20:28.053
which we implemented in March of 2020.
414
00:20:29.010 --> 00:20:30.870
The result of that is we improved
415
00:20:30.870 --> 00:20:33.420
our CDI and coding collaboration.
416
00:20:33.420 --> 00:20:36.300
They now could see each other's reviews.
417
00:20:36.300 --> 00:20:39.450
The reconciliation was a very seamless communication
418
00:20:39.450 --> 00:20:41.550
between those two teams.
419
00:20:41.550 --> 00:20:44.220
They could preview code assignments, and working DRGs,
420
00:20:44.220 --> 00:20:46.080
and communicate with coding,
421
00:20:46.080 --> 00:20:49.350
which has really helped improve our coding turnaround time,
422
00:20:49.350 --> 00:20:52.560
and really reduced our discharged not final billed days
423
00:20:52.560 --> 00:20:54.810
from about six days to four.
424
00:20:54.810 --> 00:20:57.813
So that was a pretty significant improvement.
425
00:20:59.280 --> 00:21:01.470
Currently, our discharged not final billed days
426
00:21:01.470 --> 00:21:03.090
are actually under five,
427
00:21:03.090 --> 00:21:07.440
and they remain between probably four and five.
428
00:21:07.440 --> 00:21:10.320
And we continue to be in the top fifth percentile
429
00:21:10.320 --> 00:21:14.160
in the Epic Financial Pulse, which is a national dashboard,
430
00:21:14.160 --> 00:21:16.830
if you will, for Epic clients across the country.
431
00:21:16.830 --> 00:21:19.800
And we lead in coding days at 0.1,
432
00:21:19.800 --> 00:21:22.890
and our coded final days at 1.3.
433
00:21:22.890 --> 00:21:24.840
So we actually are a diamond,
434
00:21:24.840 --> 00:21:28.113
which is your top of the class in those areas.
435
00:21:29.160 --> 00:21:31.830
Higher employee satisfaction.
436
00:21:31.830 --> 00:21:35.880
Our CDI team used to have, didn't have such good engagement.
437
00:21:35.880 --> 00:21:40.020
And so prior to new leadership and transformation,
438
00:21:40.020 --> 00:21:44.010
or since that, sorry, the new leadership and transformation,
439
00:21:44.010 --> 00:21:46.820
we've got a higher employee satisfaction.
440
00:21:46.820 --> 00:21:48.180
So some really good results there.
441
00:21:48.180 --> 00:21:49.920
A second cost management strategy
442
00:21:49.920 --> 00:21:53.370
was enabling AI technology.
443
00:21:53.370 --> 00:21:57.600
One of our pain points is our CDIs were missing case reviews
444
00:21:57.600 --> 00:22:01.470
due to staffing issues, due to workflow.
445
00:22:01.470 --> 00:22:04.860
We were only focused on Medicare/DRG payers.
446
00:22:04.860 --> 00:22:06.870
There were some missed opportunities
447
00:22:06.870 --> 00:22:10.290
due to our review rates and that type of thing.
448
00:22:10.290 --> 00:22:12.330
So the solution was
449
00:22:12.330 --> 00:22:16.501
Optum provides this clinical language intelligence engine,
450
00:22:16.501 --> 00:22:19.140
which actually kind of scans 100% of the charts.
451
00:22:19.140 --> 00:22:22.293
And then what it's looking for and highlighting
452
00:22:22.293 --> 00:22:24.150
are clinical markers, and these identified
453
00:22:24.150 --> 00:22:26.640
possible query opportunities.
454
00:22:26.640 --> 00:22:30.090
And the highlighting of these indicators in the record
455
00:22:30.090 --> 00:22:33.390
are really based on clinical and coding algorithms.
456
00:22:33.390 --> 00:22:34.950
And so they get presented,
457
00:22:34.950 --> 00:22:37.200
these cases get presented to the CDI staff
458
00:22:37.200 --> 00:22:40.020
that helps them to prioritize their workflow.
459
00:22:40.020 --> 00:22:42.990
And the results were, we had an improvement of 22%
460
00:22:42.990 --> 00:22:45.900
of our average monthly review rates,
461
00:22:45.900 --> 00:22:48.060
and we didn't have to hire any additional staff.
462
00:22:48.060 --> 00:22:50.580
So same staff, higher review rates.
463
00:22:50.580 --> 00:22:54.090
Our career rate is meeting and exceeding
464
00:22:54.090 --> 00:22:55.680
our established goals.
465
00:22:55.680 --> 00:22:58.050
We saw improvement to that query response rate,
466
00:22:58.050 --> 00:23:00.153
and our agree rate also improved.
467
00:23:01.402 --> 00:23:03.870
And our CDI reviews are of higher quality today,
468
00:23:03.870 --> 00:23:07.547
and to improve and adjust existing staffing
469
00:23:07.547 --> 00:23:09.180
to improve and include weekend coverage.
470
00:23:09.180 --> 00:23:13.110
So we basically, we're now able to expand our coverage
471
00:23:13.110 --> 00:23:17.310
to six days a week and not increase our staffing,
472
00:23:17.310 --> 00:23:19.353
so that was a nice cost saving strategy.
473
00:23:21.030 --> 00:23:25.530
A third strategy was collaborative physician engagement.
474
00:23:25.530 --> 00:23:28.890
And prior to our Optum partnership,
475
00:23:28.890 --> 00:23:32.760
we had limited physician support.
476
00:23:32.760 --> 00:23:35.310
We had physicians that were designated
477
00:23:35.310 --> 00:23:36.780
to support the program.
478
00:23:36.780 --> 00:23:40.530
We had recently entered a contract with two physicians,
479
00:23:40.530 --> 00:23:43.440
a hospitalist and a surgeon,
480
00:23:43.440 --> 00:23:45.750
she's actually chief of surgery,
481
00:23:45.750 --> 00:23:47.583
to be our physician advisors.
482
00:23:48.549 --> 00:23:51.150
And we didn't have a clear escalation policy.
483
00:23:51.150 --> 00:23:52.710
So once we had this partnership,
484
00:23:52.710 --> 00:23:55.950
we were able to optimize the provider workflow.
485
00:23:55.950 --> 00:23:58.950
We implemented a query workflow
486
00:23:58.950 --> 00:24:00.870
that was part of actually Epic,
487
00:24:00.870 --> 00:24:03.843
which was really nice for the physicians.
488
00:24:04.680 --> 00:24:08.640
It made things much more efficient on the physician side.
489
00:24:08.640 --> 00:24:13.640
We collectively, let's see, we used our BI Power reports.
490
00:24:15.870 --> 00:24:19.321
We were able to develop, give the provider,
491
00:24:19.321 --> 00:24:21.667
the physician advisors information
492
00:24:21.667 --> 00:24:23.590
that they could talk to the physicians
493
00:24:24.510 --> 00:24:28.290
to leverage our query escalation policy,
494
00:24:28.290 --> 00:24:31.501
and to also give them information
495
00:24:31.501 --> 00:24:33.150
to provide just-in-time training.
496
00:24:33.150 --> 00:24:37.383
So as a result of that streamlined provider query workflow,
497
00:24:38.340 --> 00:24:41.640
the physicians were able to answer queries much easier.
498
00:24:41.640 --> 00:24:44.653
The physician query response and turnaround time
499
00:24:44.653 --> 00:24:46.140
was increased due to the ability
500
00:24:46.140 --> 00:24:49.350
to have good valuable conversations
501
00:24:49.350 --> 00:24:53.520
with the physician advisors and the providers
502
00:24:53.520 --> 00:24:55.143
regarding unanswered queries.
503
00:24:57.930 --> 00:25:01.980
The fourth cost management strategy was using,
504
00:25:01.980 --> 00:25:04.080
having the ability to have intelligent reports
505
00:25:04.080 --> 00:25:05.133
and dashboards.
506
00:25:06.348 --> 00:25:08.250
So prior to our partnership, we really lacked
507
00:25:08.250 --> 00:25:10.854
some real-time data analytics
508
00:25:10.854 --> 00:25:12.840
to drive our operational changes,
509
00:25:12.840 --> 00:25:15.300
or to even provide information and feedback
510
00:25:15.300 --> 00:25:16.500
to the physicians.
511
00:25:16.500 --> 00:25:18.720
And we needed to have some dashboards and reports
512
00:25:18.720 --> 00:25:21.660
that would allow us to customize and drill down
513
00:25:21.660 --> 00:25:23.493
for any kind of action planning.
514
00:25:24.660 --> 00:25:27.000
So as part of the solution,
515
00:25:27.000 --> 00:25:30.150
we had access to what they call BI Analytics,
516
00:25:30.150 --> 00:25:32.010
and this is ad hoc reporting.
517
00:25:32.010 --> 00:25:36.600
It's customizable, it's drill down, it's real-time.
518
00:25:36.600 --> 00:25:40.950
We established a monthly performance management program.
519
00:25:40.950 --> 00:25:43.800
It's a meeting that we need to review metrics,
520
00:25:43.800 --> 00:25:48.800
identify opportunities, gaps, those types of things.
521
00:25:48.870 --> 00:25:53.100
And as a result, we had a very robust
522
00:25:53.100 --> 00:25:55.000
performance monitoring mechanism
523
00:25:55.920 --> 00:25:58.590
that was now supported by these analytics.
524
00:25:58.590 --> 00:26:02.730
And this governance structure really gave us an opportunity
525
00:26:02.730 --> 00:26:06.270
to report on key accomplishments and challenges,
526
00:26:06.270 --> 00:26:08.610
and it was a data-driven report then.
527
00:26:08.610 --> 00:26:12.210
And it allows us to have information
528
00:26:12.210 --> 00:26:14.840
for justification of a business case.
529
00:26:14.840 --> 00:26:16.860
Like if we wanted to, if we wanted to add more staffing,
530
00:26:16.860 --> 00:26:18.540
or just do a process redesign,
531
00:26:18.540 --> 00:26:21.603
we now had data to support that request.
532
00:26:23.910 --> 00:26:25.380
And finally, the fifth one
533
00:26:25.380 --> 00:26:28.073
was professional fee service coding
534
00:26:28.073 --> 00:26:29.490
and risk-adjustment innovation.
535
00:26:29.490 --> 00:26:34.490
So prior to implementing the system, or the partnership,
536
00:26:35.880 --> 00:26:38.610
our JMH provider group were doing,
537
00:26:38.610 --> 00:26:41.192
they had their own staff doing the coding,
538
00:26:41.192 --> 00:26:42.570
or they were doing their coding and charging.
539
00:26:42.570 --> 00:26:46.470
There was minimal process standardization,
540
00:26:46.470 --> 00:26:48.270
and we lacked a enterprise-wide
541
00:26:48.270 --> 00:26:51.691
professional coding trends and reporting.
542
00:26:51.691 --> 00:26:53.963
So we weren't even really able to monitor anything.
543
00:26:55.020 --> 00:26:56.910
So we implemented what they call
544
00:26:56.910 --> 00:27:00.650
professional computer assisted coding, PCAC,
545
00:27:00.650 --> 00:27:01.890
in December of 2020.
546
00:27:01.890 --> 00:27:05.813
And this then did standardize our coding workflow.
547
00:27:05.813 --> 00:27:09.060
It gave us some reporting capabilities,
548
00:27:09.060 --> 00:27:11.610
and it also supported
549
00:27:11.610 --> 00:27:16.260
the HCC risk-adjustment capture methodology.
550
00:27:16.260 --> 00:27:18.118
So that was new.
551
00:27:18.118 --> 00:27:20.220
We didn't really have any trends for that as well.
552
00:27:20.220 --> 00:27:23.910
The result of that was standardizing the workflow
553
00:27:23.910 --> 00:27:25.560
across all specialties.
554
00:27:25.560 --> 00:27:27.480
We are still in the process of,
555
00:27:27.480 --> 00:27:29.550
I think there's a couple of specialties left.
556
00:27:29.550 --> 00:27:32.880
We have multiple specialties that we were transitioning,
557
00:27:32.880 --> 00:27:34.890
but we do have less edits.
558
00:27:34.890 --> 00:27:38.190
The work-queue volume for the office is reduced.
559
00:27:38.190 --> 00:27:42.090
We have education now available to the providers
560
00:27:42.090 --> 00:27:44.220
based on real coding trends,
561
00:27:44.220 --> 00:27:47.190
and we are working towards minimizing physicians
562
00:27:47.190 --> 00:27:49.085
doing their own coding.
563
00:27:49.085 --> 00:27:50.730
So letting them do what they do best,
564
00:27:50.730 --> 00:27:52.380
which is caring for the patients.
565
00:27:56.310 --> 00:28:00.930
Okay, at this point, I think I'm gonna hand it back over.
566
00:28:00.930 --> 00:28:02.854
Oh, we have one poll question,
567
00:28:02.854 --> 00:28:04.020
and then we'll hand it back over.
568
00:28:04.020 --> 00:28:09.020
So does your computer-assisted coding or CDI technology
569
00:28:09.660 --> 00:28:14.130
provide ad hoc or customizable data analytics, reports,
570
00:28:14.130 --> 00:28:15.363
and dashboards?
571
00:28:17.610 --> 00:28:20.313
So let's see what some of the questions we have here.
572
00:28:23.010 --> 00:28:26.820
You have them, you have canned reports,
573
00:28:26.820 --> 00:28:29.070
you don't currently have any tools,
574
00:28:29.070 --> 00:28:31.500
but you're going to explore that,
575
00:28:31.500 --> 00:28:34.100
you don't have any plans for it, or you're not sure.
576
00:28:42.030 --> 00:28:43.413
Give a few seconds here.
577
00:28:50.370 --> 00:28:53.610
Okay, so it looks like
578
00:28:53.610 --> 00:28:57.794
most have ad hoc or customizable, well, 30%,
579
00:28:57.794 --> 00:29:00.840
and 30% have canned reports with some customization,
580
00:29:00.840 --> 00:29:03.030
and 30% are not sure.
581
00:29:03.030 --> 00:29:05.373
Okay, nice little variety there.
582
00:29:07.980 --> 00:29:09.570
Ah, yes, let me talk a little bit more
583
00:29:09.570 --> 00:29:11.223
about our value impact.
584
00:29:12.660 --> 00:29:16.620
So how it all started, again,
585
00:29:16.620 --> 00:29:20.400
we started back in transitioning our coding
586
00:29:20.400 --> 00:29:24.093
and our CDI teams to Optum in March of 2020.
587
00:29:25.260 --> 00:29:30.120
We implemented the eCAC and our CDI 3D system.
588
00:29:30.120 --> 00:29:32.790
And we restructured the coding workflow,
589
00:29:32.790 --> 00:29:36.603
and we really got our physician advisor engagement on board.
590
00:29:37.530 --> 00:29:39.430
So some of the metrics,
591
00:29:39.430 --> 00:29:41.280
just to compare the then and the now.
592
00:29:42.315 --> 00:29:46.800
At the time, our baseline prior to this, the partnership,
593
00:29:46.800 --> 00:29:48.420
was our commercial capture rate,
594
00:29:48.420 --> 00:29:51.870
baseline performance was just about 48%.
595
00:29:51.870 --> 00:29:56.870
And as of quarter 2024, 2022, sorry, Q4 2022,
596
00:29:57.030 --> 00:30:00.783
we had about a 10% increase, so about 58%.
597
00:30:00.783 --> 00:30:02.350
So a really nice increase.
598
00:30:02.350 --> 00:30:06.060
That impact of that change is about $17.5 million.
599
00:30:06.060 --> 00:30:10.590
So a huge win for us at John Muir
600
00:30:10.590 --> 00:30:12.993
in terms of financial impact.
601
00:30:14.670 --> 00:30:16.500
In terms of the physician performance,
602
00:30:16.500 --> 00:30:18.720
that's a physician metric, when you see JPI,
603
00:30:18.720 --> 00:30:21.600
that's our John Muir performance indicator,
604
00:30:21.600 --> 00:30:26.490
the query response rate was about 91% back at our baseline,
605
00:30:26.490 --> 00:30:31.130
and we finished quarter 4 2022 at about 98.4%.
606
00:30:32.775 --> 00:30:35.310
So good employee engagement.
607
00:30:35.310 --> 00:30:38.940
We have two amazing, and I can brag about this,
608
00:30:38.940 --> 00:30:41.460
two very amazing physician advisors.
609
00:30:41.460 --> 00:30:42.510
One is a hospitalist.
610
00:30:42.510 --> 00:30:45.030
The other, as I said, is a surgeon.
611
00:30:45.030 --> 00:30:47.040
So supportive of this program.
612
00:30:47.040 --> 00:30:48.440
We are very, very fortunate.
613
00:30:50.700 --> 00:30:53.550
So when we look at today, are we still sustaining this?
614
00:30:53.550 --> 00:30:54.693
And the answer is yes.
615
00:30:55.710 --> 00:30:57.510
Obviously, everything ebbs and flows,
616
00:30:57.510 --> 00:30:59.070
but basically, our outcome,
617
00:30:59.070 --> 00:31:01.680
we have improved our productivity turnaround time.
618
00:31:01.680 --> 00:31:03.947
We're above our peer group.
619
00:31:03.947 --> 00:31:05.760
So part of this monthly performance management meeting
620
00:31:05.760 --> 00:31:09.060
we have, we get compared to our peer groups,
621
00:31:09.060 --> 00:31:10.770
and we continue to be above
622
00:31:10.770 --> 00:31:13.113
for inpatient and ED productivity.
623
00:31:13.950 --> 00:31:18.780
Our career rates have maintained very strong,
624
00:31:18.780 --> 00:31:21.720
just about 24% query response rate
625
00:31:21.720 --> 00:31:26.520
compared to initially, where we were just under 20%.
626
00:31:26.520 --> 00:31:30.690
We've had a nice shift in physician engagement.
627
00:31:30.690 --> 00:31:35.280
Again, at the first quarter, 2023, 96%.
628
00:31:35.280 --> 00:31:39.780
Our query, or sorry, our physician response rate
629
00:31:39.780 --> 00:31:44.780
really kind of ranges between 96 and 98%.
630
00:31:45.210 --> 00:31:47.640
So it's a pretty strong response rate,
631
00:31:47.640 --> 00:31:50.310
and our agree rate remains very strong as well.
632
00:31:50.310 --> 00:31:55.310
We also saw an improvement in our CMI, which today,
633
00:31:56.700 --> 00:31:58.650
continues to be above our peer group
634
00:31:58.650 --> 00:32:00.690
for both of our campuses.
635
00:32:00.690 --> 00:32:02.850
And also our risk adjustment scores
636
00:32:02.850 --> 00:32:07.850
continue to be very, very strong as a result of all of this.
637
00:32:09.870 --> 00:32:14.160
From a process and people-centric improvements,
638
00:32:14.160 --> 00:32:16.620
we've got our performance management program,
639
00:32:16.620 --> 00:32:19.470
where we're looking at key operational metrics.
640
00:32:19.470 --> 00:32:23.250
We have continual staff education opportunities.
641
00:32:23.250 --> 00:32:27.360
So we've got coding webinars, product release training.
642
00:32:27.360 --> 00:32:29.660
It's just, it's constantly moving and ongoing,
643
00:32:30.611 --> 00:32:32.390
which is really, really great.
644
00:32:32.390 --> 00:32:33.900
And then we have interactive user groups.
645
00:32:33.900 --> 00:32:36.000
So our team has an opportunity to find out
646
00:32:36.000 --> 00:32:38.223
what are our other Optum clients doing.
647
00:32:42.570 --> 00:32:46.173
And some key takeaways from this whole process.
648
00:32:48.180 --> 00:32:50.463
What are the lessons that we've learned?
649
00:32:52.410 --> 00:32:55.440
This is a, some of our,
650
00:32:55.440 --> 00:32:58.620
our key takeaways is basically,
651
00:32:58.620 --> 00:33:00.390
we were able to control some costs
652
00:33:00.390 --> 00:33:02.973
through integrated platforms and workflows,
653
00:33:03.870 --> 00:33:06.779
easing workforce challenges through automation
654
00:33:06.779 --> 00:33:10.080
and innovative approaches.
655
00:33:10.080 --> 00:33:11.520
We were able to simplify costs
656
00:33:11.520 --> 00:33:13.801
through improved collaboration,
657
00:33:13.801 --> 00:33:14.700
streamlined physician engagement,
658
00:33:14.700 --> 00:33:17.133
and intelligent reports and dashboards.
659
00:33:18.180 --> 00:33:20.760
We were able to incorporate change management strategies
660
00:33:20.760 --> 00:33:23.520
to drive accuracy and productivity
661
00:33:23.520 --> 00:33:28.050
using robust BI Analytics reports and dashboards.
662
00:33:28.050 --> 00:33:29.670
And finally, allowing the physicians
663
00:33:29.670 --> 00:33:30.870
to do what they do best,
664
00:33:30.870 --> 00:33:32.700
and that's caring for our patients
665
00:33:32.700 --> 00:33:34.643
while establishing accurate Profee
666
00:33:34.643 --> 00:33:36.603
and HCC coding automation.
667
00:33:42.180 --> 00:33:44.250
I think another big thing that we learned
668
00:33:44.250 --> 00:33:46.950
is really leveraging a single partner
669
00:33:46.950 --> 00:33:49.380
to help us connect our revenue cycle silos
670
00:33:49.380 --> 00:33:51.780
and really drive innovation.
671
00:33:51.780 --> 00:33:54.300
And I think the hallmark of a strong,
672
00:33:54.300 --> 00:33:56.430
it's the hallmark of a strong partnership
673
00:33:56.430 --> 00:33:59.010
versus just a vendor.
674
00:33:59.010 --> 00:34:01.470
And we have built this partnership.
675
00:34:01.470 --> 00:34:02.940
It's been a very comprehensive,
676
00:34:02.940 --> 00:34:05.880
very connected end-to-end revenue cycle,
677
00:34:05.880 --> 00:34:09.240
bringing revenue cycle technologies and services together.
678
00:34:09.240 --> 00:34:11.970
We're very client-centric,
679
00:34:11.970 --> 00:34:13.710
and we are very outcomes-based,
680
00:34:13.710 --> 00:34:15.663
and are committed to the success.
681
00:34:20.070 --> 00:34:23.190
Okay, I think I'm gonna hand this on to Dexter
682
00:34:23.190 --> 00:34:26.850
to talk about innovation today, tomorrow, and beyond.
683
00:34:26.850 --> 00:34:28.887
Awesome, thanks, Susan.
684
00:34:28.887 --> 00:34:30.150
So we at Optum believe that
685
00:34:30.150 --> 00:34:33.180
we are not just gonna rest on our success today,
686
00:34:33.180 --> 00:34:36.480
but we want to constantly innovate for today, tomorrow,
687
00:34:36.480 --> 00:34:37.680
and beyond.
688
00:34:37.680 --> 00:34:39.540
We've got some amazing technologies
689
00:34:39.540 --> 00:34:41.850
that are coming out by the end of this year.
690
00:34:41.850 --> 00:34:44.190
If you are an existing client of ours,
691
00:34:44.190 --> 00:34:45.780
we'd love to talk to you about it.
692
00:34:45.780 --> 00:34:47.310
If you are not a client of ours,
693
00:34:47.310 --> 00:34:50.610
we'd love to still talk to you about what we have to offer.
694
00:34:50.610 --> 00:34:52.500
So one of the first things that we have coming up
695
00:34:52.500 --> 00:34:55.800
is Optum Mobile Query.
696
00:34:55.800 --> 00:34:59.460
This is a physician-centric mobile solution
697
00:34:59.460 --> 00:35:01.440
for your query process.
698
00:35:01.440 --> 00:35:02.670
So you don't need the physician
699
00:35:02.670 --> 00:35:04.770
to necessarily log into the EMR,
700
00:35:04.770 --> 00:35:07.803
but the query comes to them through the telephone.
701
00:35:08.790 --> 00:35:11.460
Another product that we have that will be coming out soon
702
00:35:11.460 --> 00:35:14.220
is Optum Integrity One.
703
00:35:14.220 --> 00:35:15.840
This is, you're talking about
704
00:35:15.840 --> 00:35:19.170
within the middle revenue cycle, CDI coding,
705
00:35:19.170 --> 00:35:20.370
whether it's enterprise,
706
00:35:20.370 --> 00:35:22.980
whether it's professional, charge capture,
707
00:35:22.980 --> 00:35:27.980
audit and compliance, analytics, all within one platform.
708
00:35:28.080 --> 00:35:30.750
It's more than just a single sign-on,
709
00:35:30.750 --> 00:35:34.800
but it's about ensuring the integrity of what you do
710
00:35:34.800 --> 00:35:36.900
within one integrated platform,
711
00:35:36.900 --> 00:35:39.930
and that's why we call it Optum Integrity One.
712
00:35:39.930 --> 00:35:42.960
Another big exciting change, talking about change,
713
00:35:42.960 --> 00:35:47.640
is a recent acquisition of Change Healthcare,
714
00:35:47.640 --> 00:35:50.880
and the power that it brings in terms of InterQual
715
00:35:50.880 --> 00:35:54.210
and Denials Assurance program.
716
00:35:54.210 --> 00:35:57.480
So all of these, Mobile Query, Integrity One,
717
00:35:57.480 --> 00:36:00.750
the Change acquisition are things that we believe
718
00:36:00.750 --> 00:36:04.830
is gonna help innovate for today, tomorrow, and beyond.
719
00:36:04.830 --> 00:36:06.810
And speaking of Integrity One,
720
00:36:06.810 --> 00:36:09.120
so this is just a visual with regards to
721
00:36:09.120 --> 00:36:11.700
whether you are inpatient or outpatient,
722
00:36:11.700 --> 00:36:13.800
professional or facility,
723
00:36:13.800 --> 00:36:17.430
whether you are charging, or coding, or CDI analytics,
724
00:36:17.430 --> 00:36:18.780
auditing compliance,
725
00:36:18.780 --> 00:36:21.060
or you're looking for artificial intelligence,
726
00:36:21.060 --> 00:36:25.350
we provide all those solutions in a singular platform,
727
00:36:25.350 --> 00:36:27.150
and that is what we believe
728
00:36:27.150 --> 00:36:29.760
is what's going to help you manage costs
729
00:36:29.760 --> 00:36:33.600
based on the success stories that Susan just shared
730
00:36:33.600 --> 00:36:36.723
around the five case studies around John Muir Health.
731
00:36:39.450 --> 00:36:42.540
If you are interested in more information from Optum
732
00:36:42.540 --> 00:36:45.150
on learning how our revenue cycle solutions
733
00:36:45.150 --> 00:36:48.660
can help contain costs, please let us know.
734
00:36:48.660 --> 00:36:51.510
We are happy to answer any questions.
735
00:36:51.510 --> 00:36:54.870
We will have a Q&A round after this,
736
00:36:54.870 --> 00:36:56.850
but it doesn't end over here.
737
00:36:56.850 --> 00:37:00.338
If you happen to be at HFME, we have,
738
00:37:00.338 --> 00:37:02.490
come visit our HFME booth, 1019,
739
00:37:02.490 --> 00:37:04.890
as well as any other conference.
740
00:37:04.890 --> 00:37:06.330
And feel free to reach out to us.
741
00:37:06.330 --> 00:37:08.100
We are here to help solution for you
742
00:37:08.100 --> 00:37:11.970
and ensure that your pain point gets to a level one,
743
00:37:11.970 --> 00:37:14.043
and not a level seven, or eight, or nine.
744
00:37:17.853 --> 00:37:20.563
All right, so with that, we are at the Q&A round.
745
00:37:22.530 --> 00:37:23.820
Great.
746
00:37:23.820 --> 00:37:26.610
Thank you both once again for an excellent presentation.
747
00:37:26.610 --> 00:37:30.030
This now brings us to the Q&A portion of the program.
748
00:37:30.030 --> 00:37:31.620
So we would now like to invite you
749
00:37:31.620 --> 00:37:34.140
to ask live questions of our speakers.
750
00:37:34.140 --> 00:37:36.300
As a reminder, to submit a question,
751
00:37:36.300 --> 00:37:39.330
click on the Q&A widget at the bottom of your screen.
752
00:37:39.330 --> 00:37:41.283
It may be open already
753
00:37:41.283 --> 00:37:42.810
and appear on the left side of your screen.
754
00:37:42.810 --> 00:37:45.600
Please note that your questions will remain anonymous
755
00:37:45.600 --> 00:37:48.363
and will not be viewable by other audience members.
756
00:37:50.070 --> 00:37:51.453
Our first question is,
757
00:37:52.932 --> 00:37:56.400
"What was the competitive advantage of outsourcing
758
00:37:56.400 --> 00:38:00.027
both MRC services and technology?"
759
00:38:07.260 --> 00:38:08.413
Susan, you want...
(indistinct)...
760
00:38:08.413 --> 00:38:09.246
Go ahead.
Yeah, I wanted,
761
00:38:09.246 --> 00:38:11.290
I'm sorry, could you repeat the question?
762
00:38:14.271 --> 00:38:15.104
Sure, the question was,
763
00:38:15.104 --> 00:38:16.950
"What was the competitive advantage
764
00:38:16.950 --> 00:38:21.237
of outsourcing both MRC services and technology?"
765
00:38:25.320 --> 00:38:28.770
From my perspective, I'm middle revenue cycle.
766
00:38:28.770 --> 00:38:31.608
I believe that it allowed,
767
00:38:31.608 --> 00:38:32.850
because Optum was able to bring
768
00:38:32.850 --> 00:38:37.740
more technology solutions for John Muir Health,
769
00:38:37.740 --> 00:38:40.620
they were not able to really bring those solutions.
770
00:38:40.620 --> 00:38:42.540
And I think it was a good partnership
771
00:38:42.540 --> 00:38:45.000
that they could lean on
772
00:38:45.000 --> 00:38:50.000
to help drive forward with technology
773
00:38:50.130 --> 00:38:52.230
and really allow the hospital
774
00:38:52.230 --> 00:38:54.450
to focus on the clinical care.
775
00:38:54.450 --> 00:38:55.283
Yeah.
776
00:38:56.310 --> 00:38:57.600
And I can add to it, Susan.
777
00:38:57.600 --> 00:38:59.670
So I think one of the things we've seen in our experience
778
00:38:59.670 --> 00:39:02.520
is a lot of times, hospitals or health systems
779
00:39:02.520 --> 00:39:04.653
work with multiple vendors.
780
00:39:05.887 --> 00:39:07.560
The vendors on the services side,
781
00:39:07.560 --> 00:39:10.200
whether it's process improvement, change management,
782
00:39:10.200 --> 00:39:12.840
are different than the vendors on the technology side.
783
00:39:12.840 --> 00:39:15.186
In fact, the two of them don't talk.
784
00:39:15.186 --> 00:39:17.940
So I think what our experience has been is
785
00:39:17.940 --> 00:39:21.450
when you marry the two together, services and technology,
786
00:39:21.450 --> 00:39:23.790
it ensures that the process improvements
787
00:39:23.790 --> 00:39:26.100
that you bring about in workflow
788
00:39:26.100 --> 00:39:28.020
are embedded in your technology
789
00:39:28.020 --> 00:39:31.230
as well as the technology changes that you're implementing
790
00:39:31.230 --> 00:39:33.150
align with your workflow.
791
00:39:33.150 --> 00:39:36.330
And that, again, helps with employee satisfaction,
792
00:39:36.330 --> 00:39:37.470
retention.
793
00:39:37.470 --> 00:39:38.983
Again, going back to the,
794
00:39:38.983 --> 00:39:43.344
how do you reduce costs by reducing the staffing turnover,
795
00:39:43.344 --> 00:39:45.723
or for that matter, having to get extra staff.
796
00:39:51.247 --> 00:39:54.090
Okay, so how does HIM, CDI, and coding
797
00:39:54.090 --> 00:39:56.703
help with managing cost for the health system?
798
00:39:59.640 --> 00:40:03.560
Well, I think what we do is we're able to...
799
00:40:05.040 --> 00:40:08.045
I think getting our coding done faster,
800
00:40:08.045 --> 00:40:09.810
getting bills out the door quicker,
801
00:40:09.810 --> 00:40:13.950
having complete and accurate records for coding.
802
00:40:13.950 --> 00:40:17.673
I think we've seen an impact without having to add staff.
803
00:40:19.260 --> 00:40:24.240
We've really been able to achieve
804
00:40:24.240 --> 00:40:29.100
some pretty high cost saving measures
805
00:40:29.100 --> 00:40:32.253
just in terms of I think the financial impact,
806
00:40:33.780 --> 00:40:35.310
if that makes any sense.
807
00:40:35.310 --> 00:40:37.080
Our capture rates,
808
00:40:37.080 --> 00:40:42.080
all of that has been a nice incentive and financial impact.
809
00:40:45.900 --> 00:40:47.400
Hope I answered that properly.
810
00:40:51.450 --> 00:40:53.730
Good, next question.
So are all...
811
00:40:53.730 --> 00:40:55.890
Yep, are all of the providers employees,
812
00:40:55.890 --> 00:40:59.403
and what steps did you take to increase provider engagement?
813
00:41:01.440 --> 00:41:03.810
So not all the employees, sorry,
814
00:41:03.810 --> 00:41:04.890
the physicians are employees.
815
00:41:04.890 --> 00:41:07.050
We do have a medical group
816
00:41:07.050 --> 00:41:08.640
called the John Muir Medical Group,
817
00:41:08.640 --> 00:41:12.183
and that is mostly a lot of our hospitalists,
818
00:41:13.350 --> 00:41:15.480
but they're community-based physicians.
819
00:41:15.480 --> 00:41:19.260
And I think honestly, one of the big successes
820
00:41:19.260 --> 00:41:21.750
for us to have with physician engagement
821
00:41:21.750 --> 00:41:25.350
was our two physician advisors.
822
00:41:25.350 --> 00:41:28.500
They have excellent rapports with the physicians.
823
00:41:28.500 --> 00:41:33.500
They've got data, and documents, report trends to, again,
824
00:41:34.410 --> 00:41:37.110
to communicate and educate.
825
00:41:37.110 --> 00:41:39.090
It's been, I think honestly
826
00:41:39.090 --> 00:41:41.610
having good, strong physician advisors
827
00:41:41.610 --> 00:41:43.983
is one of the keys to your program's success.
828
00:41:48.720 --> 00:41:50.970
Why was the emphasis on having
829
00:41:50.970 --> 00:41:54.270
an integrated middle revenue cycle technology solution
830
00:41:54.270 --> 00:41:57.590
versus best-in-breed standalone tech solutions
831
00:41:57.590 --> 00:42:00.723
in CDI and enterprise professional coding?
832
00:42:03.780 --> 00:42:05.250
Well, I think what we wanted to do
833
00:42:05.250 --> 00:42:08.190
was to have an integrated system
834
00:42:08.190 --> 00:42:11.610
so that there was communication across the continuum
835
00:42:11.610 --> 00:42:12.840
of these technologies.
836
00:42:12.840 --> 00:42:15.300
So I feel that...
837
00:42:15.300 --> 00:42:17.130
I mean, I do think best-in-breed
838
00:42:17.130 --> 00:42:19.230
is always a good thing for something.
839
00:42:19.230 --> 00:42:23.190
In this case, the integrated solutions
840
00:42:23.190 --> 00:42:27.990
just allows a seamless workflow and communication.
841
00:42:27.990 --> 00:42:31.110
Keeps everybody definitely on the same page.
842
00:42:31.110 --> 00:42:34.800
And it allows the teams to communicate
843
00:42:34.800 --> 00:42:36.810
and actually educate each other.
844
00:42:36.810 --> 00:42:39.930
So it's been really good for coding
845
00:42:39.930 --> 00:42:44.220
to be able to respond to CDI in a review, saying,
846
00:42:44.220 --> 00:42:45.060
"Okay, this is why I would query,"
847
00:42:45.060 --> 00:42:47.640
or, "This is why I wouldn't have queried,"
848
00:42:47.640 --> 00:42:49.323
and vice versa.
849
00:42:50.163 --> 00:42:52.413
So it's really opened up that nice continuum.
850
00:42:55.530 --> 00:42:57.810
Great, so I have another similar question.
851
00:42:57.810 --> 00:43:01.380
How are your Optum systems connected to better support
852
00:43:01.380 --> 00:43:04.740
the various patient financial support programs
853
00:43:04.740 --> 00:43:05.913
from manufacturers?
854
00:43:07.620 --> 00:43:08.453
Hmm.
855
00:43:11.490 --> 00:43:13.713
Well, I'm not sure.
856
00:43:14.910 --> 00:43:16.060
That's a good question.
857
00:43:17.125 --> 00:43:20.375
I think I have to think about that one.
858
00:43:24.088 --> 00:43:25.088
Yeah, I can jump in.
859
00:43:25.088 --> 00:43:26.520
I think the key thing is,
860
00:43:26.520 --> 00:43:28.563
the good thing about Optum is
861
00:43:28.563 --> 00:43:30.840
we are not necessarily just front, or middle,
862
00:43:30.840 --> 00:43:31.833
or back, right?
863
00:43:32.993 --> 00:43:34.650
So we are constantly looking at with our partnerships,
864
00:43:34.650 --> 00:43:36.090
no matter who it might be,
865
00:43:36.090 --> 00:43:39.000
whether it's channel partners, or even beyond.
866
00:43:39.000 --> 00:43:42.270
So the goal is it's not just in the provider space.
867
00:43:42.270 --> 00:43:45.840
We are also looking on the peer side of it.
868
00:43:45.840 --> 00:43:48.729
So we wanna make sure that at the end of the day,
869
00:43:48.729 --> 00:43:50.700
what can we do to help solve problems
870
00:43:50.700 --> 00:43:52.410
for the health systems?
871
00:43:52.410 --> 00:43:53.850
And it's a work in progress.
872
00:43:53.850 --> 00:43:55.860
So if we do not have a solution today,
873
00:43:55.860 --> 00:43:59.280
we will have a solution tomorrow, and the key thing is
874
00:43:59.280 --> 00:44:01.580
making sure that we are constantly innovating.
875
00:44:04.830 --> 00:44:06.398
Great, thank you.
876
00:44:06.398 --> 00:44:09.420
So how have changes in technology or improvements
877
00:44:09.420 --> 00:44:11.700
impacted the coding profession?
878
00:44:11.700 --> 00:44:14.763
Any decrease in numbers of full-time employees needed?
879
00:44:17.250 --> 00:44:18.210
Actually, no,
880
00:44:18.210 --> 00:44:20.820
it hasn't decreased any of the numbers
881
00:44:20.820 --> 00:44:23.037
of full-time employees needed.
882
00:44:23.037 --> 00:44:25.860
In fact, it's allowed them to do more.
883
00:44:25.860 --> 00:44:30.860
So the technology has been actually a positive impact.
884
00:44:31.740 --> 00:44:33.270
It hasn't replaced any,
885
00:44:33.270 --> 00:44:35.130
you always hear about it replacing coders,
886
00:44:35.130 --> 00:44:40.130
but it really is just helping them focus in
887
00:44:40.200 --> 00:44:44.253
and drive down, deeper dives into these charts.
888
00:44:47.160 --> 00:44:51.120
Yes, and I think that's an important point is
889
00:44:51.120 --> 00:44:53.100
what our technologies enable to do
890
00:44:53.100 --> 00:44:56.100
is allowing you to do more with less,
891
00:44:56.100 --> 00:44:59.250
or allowing you to do more with what you have.
892
00:44:59.250 --> 00:45:01.650
So tomorrow, if you were to have a team member
893
00:45:01.650 --> 00:45:03.120
that were to leave,
894
00:45:03.120 --> 00:45:05.580
you're still being able to be more efficient,
895
00:45:05.580 --> 00:45:08.463
or as we like to call it, work smart, not hard.
896
00:45:09.630 --> 00:45:11.370
So that's the key thing of,
897
00:45:11.370 --> 00:45:13.740
in terms of it's not just automation,
898
00:45:13.740 --> 00:45:15.990
but it's intelligent automation,
899
00:45:15.990 --> 00:45:20.010
in terms of redefining how we do workflows,
900
00:45:20.010 --> 00:45:23.668
and being able to ensure that we are able,
901
00:45:23.668 --> 00:45:26.880
whether it's beyond just peers, being peer agnostic,
902
00:45:26.880 --> 00:45:29.030
it's being able to look at it
903
00:45:29.030 --> 00:45:29.910
not just from a financial standpoint,
904
00:45:29.910 --> 00:45:32.040
but also from a clinical and a quality,
905
00:45:32.040 --> 00:45:34.830
or more importantly, from a risk-adjustment standpoint.
906
00:45:34.830 --> 00:45:36.390
So those are just some of the ways
907
00:45:36.390 --> 00:45:40.740
in which the technology helps, and as Susan indicated,
908
00:45:40.740 --> 00:45:43.140
it's not about letting go of coders,
909
00:45:43.140 --> 00:45:46.410
but more about what can we now allow our coders
910
00:45:46.410 --> 00:45:49.500
or CDI members to do above and beyond
911
00:45:49.500 --> 00:45:51.840
than the traditional way of doing business,
912
00:45:51.840 --> 00:45:53.190
and that's what we are not about,
913
00:45:53.190 --> 00:45:55.950
but more about how can we kind of think outside the box
914
00:45:55.950 --> 00:45:58.530
and do the things that we've never been able to do
915
00:45:58.530 --> 00:46:00.843
limited by technology in the past.
916
00:46:04.320 --> 00:46:05.940
Great, so what are some ways
917
00:46:05.940 --> 00:46:08.550
that finance or revenue cycle executives
918
00:46:08.550 --> 00:46:12.483
can help to streamline technology implementation like this?
919
00:46:18.630 --> 00:46:22.382
I can take that, Susan, or do you wanna go first?
920
00:46:22.382 --> 00:46:23.215
No, go ahead.
921
00:46:23.215 --> 00:46:24.510
Yeah, no, I think the first thing
922
00:46:24.510 --> 00:46:26.400
is to ask the right question, right?
923
00:46:26.400 --> 00:46:28.500
You wanna pick...
924
00:46:28.500 --> 00:46:30.540
It's more than just picking a vendor
925
00:46:30.540 --> 00:46:31.950
versus picking a partner.
926
00:46:31.950 --> 00:46:34.080
Someone that understands your pain points
927
00:46:34.080 --> 00:46:35.700
is able to capture that.
928
00:46:35.700 --> 00:46:39.240
Someone that is able to solve, not just in silos,
929
00:46:39.240 --> 00:46:41.970
but being able to look at the big picture,
930
00:46:41.970 --> 00:46:43.980
or what we would call the end to end.
931
00:46:43.980 --> 00:46:45.930
Someone that's not just looking at,
932
00:46:45.930 --> 00:46:49.110
here's the technology that's gonna solve your problem,
933
00:46:49.110 --> 00:46:51.360
but here's the technology and the services
934
00:46:51.360 --> 00:46:54.390
that actually work together and align,
935
00:46:54.390 --> 00:46:57.600
so there's common messaging to the staff.
936
00:46:57.600 --> 00:47:00.120
And more importantly, someone that's looking at
937
00:47:00.120 --> 00:47:03.180
being able to bring in efficiencies,
938
00:47:03.180 --> 00:47:06.720
bring in innovation, bringing the integration
939
00:47:06.720 --> 00:47:08.910
and the innovation, as I've talked about.
940
00:47:08.910 --> 00:47:11.250
So I think that's what we will look for
941
00:47:11.250 --> 00:47:14.160
when we talk to our client leadership
942
00:47:14.160 --> 00:47:16.500
in terms of the C-suite
943
00:47:16.500 --> 00:47:21.060
is looking to them to tell us what they want,
944
00:47:21.060 --> 00:47:23.460
but also being able to ask those tough questions
945
00:47:23.460 --> 00:47:26.067
to ensure that we are not just able
946
00:47:26.067 --> 00:47:27.360
to solve our problems for today,
947
00:47:27.360 --> 00:47:30.333
but be able to solve our problems for tomorrow and beyond.
948
00:47:32.490 --> 00:47:33.843
Susan, anything to add?
949
00:47:35.670 --> 00:47:36.990
Nope, nothing to add to that.
950
00:47:36.990 --> 00:47:37.823
Thank you.
951
00:47:43.020 --> 00:47:44.100
Okay, great, thank you.
952
00:47:44.100 --> 00:47:48.510
Well, this now brings us to the end of our program.
953
00:47:48.510 --> 00:47:50.280
That's all the time we have for questions.
954
00:47:50.280 --> 00:47:52.740
So I wanted to thank our presenters once again
955
00:47:52.740 --> 00:47:54.990
for an excellent presentation.
956
00:47:54.990 --> 00:47:57.660
I also would like to thank our sponsor, Optum,
957
00:47:57.660 --> 00:48:00.300
for making today's program possible.
958
00:48:00.300 --> 00:48:03.930
Finally, thank you and our audience for participating today,
959
00:48:03.930 --> 00:48:05.730
and we hope you'll join us in the future
960
00:48:05.730 --> 00:48:07.770
for another HealthLeaders webinar.
961
00:48:07.770 --> 00:48:10.083
This concludes today's presentation.