Physicians Connecting to Physicians Through Referral Management

Get Connected Knowledge ForumDallas, Texas

June 27-29, 2005

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Session Speakers

Larry Stofko

Nan Crawford

Jeff Allport

Dan Cusator, M.D.

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$3.0 billion in revenues14 hospitals in 3 statesLicensed beds range from 47 to 851Home health agencies, hospice care, outpatient services, skilled nursing facilities, managed care operations, and multiple physician organizationsIn FY 2004, SJHS provided more than $310 million in community benefit and care for the poor services

St. Joseph Health System Highlights

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Sick Patient Well Patient

Sche

dule

Visit

Lab

Inte

rpre

tatio

n

Re-s

ched

ule

Re-V

isit

Pres

cribe

Conf

irm

Wait State

Value Add

• Payer Verification• Scheduling• Voice to Voice Live Confirmation• Manual Chart Storage & Retrieval• Confirming Eligibility• Checking, Re-checking Patient History• Waiting for Confirmation

• Lower Patient Satisfaction• Higher Cost• Increased Errors• Harmful Delays

• Waste / Rework• Patient Dissatisfaction• Medical Errors• Frustrated Care-Givers• Unnecessary Costs

The “Wait State” of Health Care

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Industry Leadership

Organizational Excellence

Systemic InnovationExcelExecutePrepareOrganizeAssess

07060504030201009998

Core System Implementation

IT Leadership Restructure

Century Preparation

Strategic IT Partnership

Strategic Plan Foundation

OrganizationPreparation

Complete VisionIntegration

System Optimization

Web Deployment Infrastructure Modernization

Web Transformation

IT Clinical Innovation (CPOE, Clin Doc, PACS, AEMR)

Business Process Design

Change Management Services

Manage with Information

Next GenerationTechnology

Ubiquitous Access

Transform Clinical Care

10 Year IT Innovation Strategy

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Thin

Clie

nt

Phys

icia

n Si

tes

Supp

ly

Chai

n PACS

CPOE

Ente

rpri

se

Man

agem

ent

Smar

t Car

e

Ubiquitous Access Goal

Consumer Sites

HR Web

Clinical

Documentation

AmbulatoryEMR

Enviro-Smart

“Wait-State”

Provide 80% of the information required in the physician/clinician experience through secure browser based access

“Great-State”

Yesterday Day After Tomorrow

Intranet

Disease

Management

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Strategic Theme Review

Make it easier for physicians to practice medicine

Make it easier for patients to receive care

Provide timely information to all stakeholders

Improve service quality and customer satisfaction

Utilize information technology to unify the care delivery effort

Maximize efficiencies to improve total performance

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Initial goals were identified for the Referral Management Project

Online referralsElectronic communication between referring and consulting cliniciansLinkages to results and reportsSharing of ambulatory lab and radiology resultsPCP offices representing 78% of total SJHAP enrollment have been initiated to the process of Referral Management, and are creating and sending referrals on line. Specialist offices are in the rollout phase.

The Referral Management product allows for:

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While the improved process efficiencies support SJHS Core Values*

Service – “We design and evaluate our organizational systems and structures to assure that they meet the needs of those we serve.”

Justice – “We develop a work environment that promotes mutual respect, participation, equitable compensation, growth, and effective use of talents.”

Excellence – “We work together to be effective and efficient in the uses of resources and to provide a safe environment.”

Dignity – “We share needed information and encourage decision making, responsibility, and accountability at all levels.”

* Representative sample

Redesign of patient referral process to meet the needs of patients and physician staff.

Automation of manual processes reduces excessive workload, and frees up resources for other tasks, making more effective use of talent, while providing time for personal growth and development.

The improved process allows staff to work together more effectively and efficiently, and provides patients access to specialty care in a more timely manner.

Better access to information through system integration better balances responsibility and supports decision making and accountability.

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Increased usage of the referral management application on the web can impact nearly 200,000 patients

MHAP(5,843)

3%

SJAP (17,733)

9%

SJuHMG (58,365)

30%

SJoHMG (30,940)

16%

SJHAP (79,383)

42%

Currently Impacted

Member PopulationCurrent implementation schedule will impact 42% of Heritage Members (SJHAP)

Long term strategy to implement across entire St. Joseph Heritage Healthcare Medical Foundation would potentially impact an additional 112,881 members… and could considerably increase efficiency gains. Total Members: 192,264

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An additional benefit of the Referral Management program is reduced cycle time in a fully deployed model

Pre-Implementation* Post-Implementation

Automated – 1 MinuteManual – 3 minutes

Manual – 15 minutes

Manual – 1 minute

Manual – 3 minutes

Manual –2 minutes**

Manual –0.5 minutes

Manual – 1 minutes

Automated – 3 Minutes

Manual – 1 Minutes

Automated – 0.5 Minutes

Automatic – 0 minutes

Automated – 0 Minutes

10 to 11 Minutes46.5 – 51.5 Minutes

* Does not occur in all instances, or process time varies. ** Effective 2/1/05 Note:Measures taken in process of developing work flows, externally and internally.

Automatic – 3 minutes

Manual –4 minutes

Manual – 15 minutes

Automatic – 0 minutes

Manual –2 to 5 minutes Automated – 1 to 2 minutes

Manual – 1 minutes Automated– 0 Minutes

Referral Management Process - Old and NewRPRA (Referring

PhysicianReferral Admin)

UtilizationManager

Specialist’sOffice

ReferringPhysician

DetermineProvider Type

Receive andDistribute Fax

CompleteReferralRequest

Determineservice type and

urgency

Verify Eligibility/Benefits

F/U with UM onStatus

DistributeRequests

Data Enter infointo IDX

Review referraland approve, pend

or deny

Verify Eligibility/Benefits

Route

FAX to UMManual – 1 minute Automated – 0.5 Minutes

Automatic – 0 minutes

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…which is significant, given the large amount of monthly referral activities

St. Joseph Hospital Affiliated Physicians Referral Related Activities October 2003 – March 2004

5,660

1,1702,177

9,089

4330

2,000

4,000

6,000

8,000

10,000

IDX Fax Out Manual FaxesOut

Cust Svc Calls UM Calls Ref PendedClaims

5,2485,248 average monthly referralsgenerate considerable faxes, calls and other activities

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Process Improvement Gains thru June 2006

By the end of June 2006 cumulative gained efficiencies could total 40 thousand hours

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45

Jul-

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May

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Year 1 Year 2

Gai

ned

Eff

icie

ncy

in

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urs

'00

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Implementation: Goal 100% Review 12/04

Adaptation: Goal 100% Review

6/05 1st Year Gains: Review 12/05 & 6/06

Total Combined Efficiencies

UM: HH EmployessPhysician Office Staff

Physicians

Total

UM

Physician Office Staff

Physicians

Physicians = Referring MD + Specialist, Physician Office Staff = RPRA ( Referring Physician Referral Administration)

ADAPTATION STATUS REPORT:100% Organizational buy-in and supportDeployed rapid roll-out to specialty offices January, 2005Ability to track referral activity through weekly reports effective February, 2005Active communication plan in place

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Vision for the future…

By redirecting staff from a Manual Referral Management Process to an Integrated Dynamic System, all parties involved will benefit.

Opportunity to redirect staff

Physicians will be able to:Spend more time with patientsProcess patient referrals faster and with higher accuracy

Physician Office Staff (RPRA) will be able to:Spend more time making decisions, decreasing turnaround time and increasing accuracyRespond faster to provider/patient needsDecrease supply costs

Other HH Employees will be able to:Spend more time making decisions, decreasing turnaround time and increasing accuracyRespond faster to provider/patient needsDecrease supply costs

= mean result 2004

HOW LONG DO YOU USUALLY WAIT TO GET A RESPONSE ON FFS

REFERRALS?

0%

10%

20%

30%

40%

50%

60%

1-2 days 3-4 days 5-7 days > 1 week

2003 2004

QUESTIONS ON REFERRALS ARE HANDLED QUICKLY AND

APPROPRIATELY

0%

10%

20%

30%

40%

50%

60%

stronglyagree

agree neutral disagree stronglydisagree

Desired FutureState

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Once on the Web Portal, physicians and clinicians may also use it for:

Viewing patient insurance dataHospital lab resultsTranscribed reportsAmbulatory lab informationPatient hospital admittingObtaining industry data and informationCommunication with patientsSecure messagingCare managementImaging data (PACS) Ambulatory Radiology Results

156% Increase in users since “go-live” of Referral Management at SJHAP; 25% increase in physician usage.

216% Increase in web portal sessions since “go-live” of Referral Management at SJHAP

Physician

Clinical Professional - Super User

Totals

While using the Web for Referral Management, users may also connect (link) to results and reports

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Preliminary returns confirming expectations

Referral to User & Session-SJHO

1455

289 372 399

4715

64916961

1129649

710

1000

2000

3000

4000

5000

6000

7000

8000

Feb-05 Mar-05 Apr-05 May-05

Referral Count User Count Session Count

Steady rise in referrals per month

Portal usage in sessions

Steady rise in users

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Referrals with a view

Automate here

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The big picture

Organizational Processes

EMPI

Multiple patient populations Referral

Mgmt

Disease Registry Outcomes (P for P)

Patient Access

Ambulatory reference lab

Alignment to SJHS Strategy:Improving physician relationships through Physician Connect

Improve patient access to physicians and information

Disparate data from provider

systems

CCR, Import/export, secure document

sharingClaims data

warehouse, population reporting

Interfaced inpatient EMR

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Linking outpatient and inpatient identifiers through EMPI

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PACS – general view for physicians

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Linking to external service provider through SSO

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Linking to outside ambulatory lab results