Thinking Outside the Box Leveraging Education to Drive

Thinking Outside the Box: Leveraging Education to Drive Patient Access Initiatives Darcelle Johnson, MHA, Senior Manager, Educational Content Development, n. Thrive © 2018 n. Thrive, Inc. All rights reserved.

Introductions Darcelle Johnson, MHA n. Thrive Solutions Senior Manager, Educational Content Development © 2018

Agenda 1. Introduction 2. The Patient Access Workforce Challenge 3. The Transitions Concept 4.

Who Is n. Thrive Education? Over 2 Million Learners Over 80% of Academic Hospitals Over 60% of Pediatric Hospitals Over 5, 000 Facilities 17 of the Top 19 Hospitals © 2018 n. Thrive, Inc. All rights reserved. 4

How We Do It Assessments Mobile e-Learning Courses Performance Analytics Smartphone Apps Simulators and Labs Social Gaming DNA Community Webinars Onboarding and Transitions © 2018 n. Thrive, Inc. All rights reserved. 5

Patient Access Workforce Challenge © 2018 n. Thrive, Inc. All rights reserved. 6

Current Situation Front-line staff do not have work experience and receive little on-the-job training. Patient Access Representatives earn a median salary of $31, 700. According to a report from Insta. Med, 74% of providers saw an increase in patient financial responsibility in 2015. Typical education is high school diploma or equivalent. Job demand for 2014– 2024 is 10% higher than average. Industry estimates show that between 45% to 90% of claim denials could be prevented by obtaining accurate patient information at patient intake. Source: Department of Health and Human Services; Bureau of Labor Statistics © 2018 n. Thrive, Inc. All rights reserved. 7

Demographic Impact 1950 2050 In 1950, people 65 and older represented 8. 1% of the total US population. By 2050 the percentage is projected to reach 20. 2%. Source: Data – Department of Health and Human Services; Graphic - Sage Growth Partners © 2018 n. Thrive, Inc. All rights reserved. 8

The Healthcare Labor Market “The US healthcare system faces growing challenges. The US population is aging at a rapid rate; healthcare reform is expected to bring millions more patients into the system; and there anticipated shortages in numbers of trained healthcare professionals to care for these patients. Therefore, the need to start now to develop more effective and efficient workforce planning models for healthcare organizations is critical. ” - American Hospital Association Source: American Hospital Association, ‘Workforce Trumps Shortage’ Report, 2015 © 2018 n. Thrive, Inc. All rights reserved. 9

The Transitions Concept © 2018 n. Thrive, Inc. All rights reserved. 10

Build Your Own Workforce • Supply will continue to outstrip demand. • We need to “create” our own workforce/labor. • If not, we will continue to see: – Shortages in critical job roles/functions. – Unusual increase in wages – Productivity/workflow challenges. – Financial trickle-down effect. © 2018 n. Thrive, Inc. All rights reserved. 11

Patient Access Education PATIENT - TO - PAYMENT How does Patient Access impact the revenue cycle? Patient Access ═ Gatekeeper Jumpstarts the revenue cycle • Brings value to the position EDUCATION: • Emphasizes on the IMPORTANCE of the Patient Access role • Goes beyond point-and-click teaching Patient Access teams need to understand how the hospital works and their distinct role in providing patient care. Remember: Key performance indicators are linked to Patient Access education. © 2018 n. Thrive, Inc. All rights reserved. 12

Patient Access Education Solution Striking the balance between patient care advocate and financial counselor • Empower staff with over 100 courses, competency assessments, and simulation technology • Reduce errors and cost by enhanced job proficiency through key indicator training • Standardize POS collections with situational scripting and POS strategies • Elevate staff knowledge with first-of-its-kind Patient Access industry certifications • Optimize verification, coordination of benefits, and patient satisfaction with advanced insurance training • Promote patient advocacy for improved patient satisfaction Hospital Compare scores © 2018 n. Thrive, Inc. All rights reserved. 13

Patient Access Transitions Program © 2018 n. Thrive, Inc. All rights reserved. 14

Value of Apprenticeship Model Figure 1: Using Registered Internships to Build and Fill Career Paths In Health Information Technology: U. S. Dept. Labor • Experience utilizing existing online modules to train/educate PAS reps • Program will include “on the job” training once competency is achieved © 2018 n. Thrive, Inc. All rights reserved. 15

Benefits of Apprenticeships EMPLOYER COLLEAGUE • Loyal and dedicated workforce • Guaranteed employment if pass test • Highly motivated to learn new skills and move up • • Trained with practical, hands-on, and companyspecific program Increased wage compared to prior state • Free training and education • Learn new technical and transferrable skillset • College or academic credit for some programs • Ready to work with mentor support upon graduation • Create own “supply” for hard-to-fill or high-demand roles • Avoid offshoring or increased cost of recruitment • Initial lower labor cost per employee • Opportunity for advancement • Limited efforts to setup if assisted by intermediary • Tax credits, incentives • Join company with focus on employee education and advancement © 2018 n. Thrive, Inc. All rights reserved. 16

Veteran Unemployment • First-term veterans have hardest time landing a job, as about 16. 2% of veterans in the labor force between 18 and 24 years old are jobless • • Partnership with Department of Defense, Soldiers for Life, and Hire Heroes Goal to use apprenticeships to create labor from both Expiration of Active Obligated Service (EAOS) and veteran populations • Provides a supply of highly dedicated, hard-working professionals with top skills © 2018 n. Thrive, Inc. All rights reserved. 17

The Education Approach © 2018 n. Thrive, Inc. All rights reserved. 18

Pre-Education State of Team • Revenue cycle onboarding classroom curriculum – system/application oriented • On-the-unit training resulting in variation in process across facilities • Low attendance for classroom refresher courses • Super User communications and updates via email • Lack of knowledge of revenue cycle goals and Key Performance Indicators © 2018 n. Thrive, Inc. All rights reserved. 19

Overview of the Education Approach AUGUST 2017 – Assigned all Patient Access staff, regardless of role description, the Financial Counseling assessment to establish a baseline score: 273 out of 317 staff members completed – Included Schedulers, Pre-Access Coordinators, Authorization Specialists, Financial Counselors, and Registration Representatives – Assessment covered hospital finance basics, insurance and coverage, collections, patient communication, deductibles, and coinsurance scenarios © 2018 n. Thrive, Inc. All rights reserved. 20

The Initial Results • • Analytics from assessments identified strengths and weaknesses across Patient Access department and on a staff member level. Baseline average was 58. 52% with the overall performance by domain/competency shown to the right. Baseline Test - Average 58. 52% Content Area Average Collection 66. 71% Communication 58. 16% Deductible Co-Ins Scenarios 67. 13% Financial Counseling Scenarios 57. 01% Hospital Financial Basics 58. 51% Insurance & Coverage 68. 90% Case Study 1 47. 88% © 2018 n. Thrive, Inc. All rights reserved. 21

Post-Assessment Process • Evaluated results and distributed to management and individuals for 1: 1 coaching • Assigned the 10 most commonly recommended courses: – Rev Cycle Foundations: Hospital Revenue Cycle – Revenue Cycle Foundations: Billing and Reimbursement – Compliance: EMTALA – Compliance: Privacy Regulations – Insurance & Coverage: Introduction to Coordination of Benefits – Insurance & Coverage: Elements on Insurance Card – Insurance & Coverage: Advanced Beneficiary Notice Noncoverage – Patient Access: Collections - POS – Patient Access: Communication - Basics – Patient Access: Communication - POS Collections © 2018 n. Thrive, Inc. All rights reserved. 22

The Re-Test Results DECEMBER 2017 – Reassigned Financial Counseling assessment to evaluate progress: 237 staff completed – Over 8% overall improvement post-remediation – Over 31% improvement in speed/duration time to complete test Re-Test Average: 66. 04% Content Area Average Change Collection 73. 30% + 6. 59% Communication 70. 39% +12. 23% Deductible Coins Scenarios 75. 00% + 7. 87% Financial Counseling Scenarios 61. 49% + 4. 47% Hospital Financial Basics 61. 21% + 2. 70% Insurance & Coverage 70. 19% + 1. 29% Case Study 1 50. 70% + 2. 81% © 2018 n. Thrive, Inc. All rights reserved. 23

The Re-Test Results TOP LEARNER PERFORMANCE © 2018 n. Thrive, Inc. All rights reserved.

Current State of Team • Staff receiving more focused 1: 1 feedback. Staff understand where they need to focus their development and how they are performing. • More complete understanding of the Revenue Cycle and Revenue Cycle metrics, including Days in AR, Cash as Percent of Net Patient Revenue, AR % > 90 days. • More complete understanding of Patient Access metrics and how our work relates to the revenue cycle, including registration quality assurance, POS collections, patient experience, and denial experience. © 2018 n. Thrive, Inc. All rights reserved. 25

The Results and ROI Denied Count by Denial Reason 1800 1600 1400 1200 13 Count Denials Trends 1000 800 600 400 200 / 2017 - 2017 - 2017 - 2018 02 03 04 05 06 07 08 09 10 11 12 01 02 Month months Authorization Eligibility Medical Necessity Linear(Authorization ) Linear(Eligibility ) Linear(Medical Necessity )

The Results and ROI POS Collections Year over Year Comparison $1, 400, 000. 00 30. 00% $1, 200, 000. 00 20. 00% $1, 000. 00 10. 00% $800, 000. 00 -10. 00% $600, 000. 00 -20. 00% $400, 000. 00 -30. 00% $200, 000. 00 -40. 00% $0. 00 -50. 00% October November December January February March FY 17 $952, 185. 60 $1, 122. 29 $987, 723. 76 $1, 135, 228. 47 $1, 053, 260. 65 $1, 214, 952. 40 FY 18 $687, 614. 01 $676, 806. 38 $1, 185, 936. 64 $1, 150, 722. 17 $1, 317, 610. 51 $1, 316, 850. 70 %Δ -27. 79% -39. 69% 20. 07% 1. 36% 25. 10% 8. 39% FY 17 FY 18 %Δ © 2018 n. Thrive, Inc. All rights reserved. 27

Next Steps © 2018 n. Thrive, Inc. All rights reserved. 28

Next Step Suggestions • Design annual refresher training and core competencies by leveraging n. Thrive virtual content and traditional classroom settings • Design an onboarding process by incorporating n. Thrive virtual content with classroom setting; focus on new staff • Exercise knowledge by incorporating simulation labs and games for Patient Access staff • Develop standard scripting using n. Thrive as the model • Implement Patient Access Certification program © 2018 n. Thrive, Inc. All rights reserved. 29