Model Builder Customer Spotlights Brian Belkin Optimization SME ©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary. Session Moderator
Model BuilderCustomer Spotlights
Brian BelkinOptimization SME
©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary.
Session Moderator
Meet the Presenters
Tawana HowardSenior Application Specialist Carolinas HealthcareCarolinas HealthcareCharlotte, North Carolina
Eloise LynumySenior Financial AnalystCentral Florida Health AllianceLeesburg, Florida
Mara YancoskieContract Administrator, Decision SupportppTrinity HealthConshohocken, Pennsylvania
©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary. 2
Format
Problem to be solved
Description of the model definitionDescription of the model definition
Success measures
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Problem to be SolveddEstimated Net Revenue
• Build in logic for segmentation by account balancebalance– If balance, utilize expected paymentIf b l l– If zero balance, use actual payment
• Different thresholds by patient type
Model Builder DefinitionModel Builder Definition Utilized the aggregate
within an encounterwithin an encounter template to summarize expected payment
Utilized copy template to move actual payments
Results from both templates were stored in a new encounterin a new encounter extension
Problem to be SolvedService Lines
• Complex definitionComplex definition• Limitation in groupings
Model Builder DefinitionModel Builder Definition Utilized
assignmentassignment template to store the service line title
Utilized rule data selection to qualifyqualify
Results were stored in newstored in new encounter extension
Success MeasuresSuccess Measures
Initiative Measure OutcomeInitiative Measure Outcome
Cost Manipulating data in Excel spreadsheets $18,000 spreadsheets
Quality Service line grouping complexity Increase in refinement
Utilization Scorecard rollout Increase of end user buy‐in
Efficiency Consistency and more timely reporting Priceless!
Carolinas HealthCare System
• 42 hospital locations• 7,800 licensed beds (acute and post-acute care), ( p )• 61,000 full and part-time employees• 11 million unique patient encounters annually• > 2,000 Employed Physicians, not including Residents• > 900 care locations
$8 5 billi i N t O ti R (2014)• $8.5 billion in Net Operating Revenue (2014)• > $1.63 billion in Community Benefit (2014)
Prior to Model Builder
Import data into custom-
b ilt
Build and
built application
QA of ANR data
Calculate Adjusted Net
Revenue
Build and Export 40
Worksheets in PM
Export processed
I t t
Revenue (custom –built application)
Process ANR in custom-
b ilt
processed ANR data in .txt files
10
Integrate and merge ANR data into PM
built application
10
Post Model BuilderPost Model Builder
CalculateCalculate Adjusted
Net Revenue (Model
Schedule PM batch
for MB processing
Apply PM batch for
MB processing
QA of ANR data
(Model Builder)
processing processing
1111
Success Measures
Initiative Measure OutcomeResource/module used to calculate
CostResource/module used to calculate ANR is fully integrated in PM and supported by McKesson
Resourcesreallocated
• Reduced risk of human error ReducedQuality
• Reduced risk of human error• Accurate allocations, current
collection rates
Reduced unintended
changesWeekly/Quarterly ANR calculations
UtilizationWeekly/Quarterly ANR calculations are performed via automated batch processes
Resources reallocated
Efficiency Significantly reduced manual processing time Priceless!
Problem to be SolvedEstimated Net Revenue
Previous Net Revenue Process Did not provide the transparency needed to understand
calculation behind the number Did not allow for any flexibility to meet needs of various
report requests • Standard vs hospital specific• Standard vs. hospital specific
Very time consuming and involved many steps
©2014 Trinity Health. All Rights Reserved. 13©2014 Trinity Health - Livonia, MI 13
Net Revenue Process
Calculate Revenue
Closed
• Total
Open
• For Inpatient –DRG Case
Contract Modeling
• Expected Payment
Employee Flag
• Calculation unique to the
Bad Debt Flag
• Total Payments
Medicare Flag
• Payments for Closed• Total
PaymentsDRG Case Rate based on Historical
• For Outpatient – Percent of Charge based
Payment
• Less Bad Debt Reduction based on Age
unique to the facility
• Modeled at the contracted rate to account for amount booked
• Total Payments Closed
• Historic Case Rate for Open
• Exclusion of Charge based on Historical
• Less Charity Reduction
amount booked in inter-company transfer
IME Payment
©2014 Trinity Health. All Rights Reserved. 14©2014 Trinity Health - Livonia, MI 14
Net Revenue Process
Revenue Bucket
Based on Flag
Est Net Rev
Before Adj
Bad Debt & Charity
Adj
Est Net Rev After
BDIME Adj
Estimated NR After MCR IME
Adj
Est NR Before Adds
Adds/ Reductions Estimated NR
* Capitation* State Subsidy* Liver & Kidney Transplant Subsidy
©2014 Trinity Health. All Rights Reserved. 15©2014 Trinity Health - Livonia, MI 15
* MA Modernization* Physician Fees
Estimated Net Revenue Example
Revenue based on
Flag
Est Net Rev After BD
Est Net Rev After IME
NR Before Adds
Final Estimated
NR
Bad Debt Adjustment
IME Adjustment
Capitation/Physician
Adjustment Adjustment Fees
©2014 Trinity Health. All Rights Reserved. 16©2014 Trinity Health - Livonia, MI 16
Success Measures
Initiative Measure OutcomeDramatically reduced the hours
Cost designated by staff & SR leadership to allocate one time items and audit the data
$20,000
Quality
Revenue allocated is more transparent to the end-users 80%
Reduced human error 60%
Utilization The turnaround on Profit/Loss 50%Utilization Releases is significantly reduced 50%
EfficiencyRemoved all manual intervention and process is housed in one Priceless!
©2014 Trinity Health. All Rights Reserved. 17©2014 Trinity Health - Livonia, MI 17
ylocation
Q ti ?Questions?
©2014 Trinity Health - Livonia, MI 18©2015 McKesson Corporation. All rights reserved. Confidential and Proprietary.