Transcript Shifting the Payment Culture and Processes: Viewing People Without Insurance as Valuable Customers New Haven, CT.

Shifting the Payment Culture and
Processes: Viewing People Without
Insurance as Valuable Customers
New Haven, CT
Context
For over 40 years as a private, 501 (C) 3, non-profit
organization the APT Foundation has successfully
provided services to individuals with substance use
and mental health disorders in our community.
Most staff have never worked anywhere else.
The Foundation offers a variety of services including,
out-patient
treatment,
medication
assisted
treatment, group treatment, individual therapy,
primary care, vocational services, and residential
care. The programs have historically operated
fairly independently from one another.
Since 2007, a key emphasis has been on access, and
the company has grown from about 13M in size to
about 20M by 2010.
Revenue Picture
• For decades, the organization was heavily reliant
on grant dollars from the State of CT which
represented approximately 60% of revenues in
2006.
• Most other revenues were Medicaid or SAGA
(general assistance) – 30%.
• First party clients represented about 10% of
revenues, and were often discharged from
treatment for failure to pay.
Growth Strategies and Values
• Time to treatment was a barrier to admission
and reducing time became key to welcoming
clients, but sometimes challenged the culture of
organization.
• Financial screening was a barrier to timely
admission – moving the screening process to
after admission was key to improving census and
admitting all persons in need – regardless of
ability to pay.
Waiting Days to Admission – APT
Foundation
Waiting Days
25
20
15
10
5
0
June, 2006
June, 2007
June 2008-2010
APT Foundation - Outpatient
Census
Outpatient Census
3500
3000
2500
2000
1500
1000
500
0
June, 2006
June, 2007
June, 2008
June, 2009
June, 2010
APT Foundation in Deliberate Growth
Mode – Access Matters
FY 2009
FY 2010
Evaluations
2642
2937
Admission
1955
2092
Total Census
(All Programs)
2729
3276
Despite difficult financial challenges (loss of approximately
$1.6M/year in FY 10 revenue due to State of CT budget recessions) we
continued to grow services to all clients, regardless of payment status,
in the belief that persons in recovery become more responsible over
time and theorizing that an open door would position APT as the “goto” provider in the community. A MAJOR OPPORTUNITY
1. AIM (Plan) – Accelerating Reform
Initiative – January 2010
• Improve 1st Party collections
(people who
pay out of pocket – our major opportunity)
• Proactively manage the entire revenue
cycle (i.e. bill and collect for services delivered,
with constant data informing the process)
• Improve 3rd Party Authorizations
Back to the Basics – A Walk Through
• To get started thinking about the payment
process for first party clients, we did a walkthrough. Our biggest surprise – After a person
was assessed a fee on our sliding scale, he/she
was never asked for payment again! Payment
issues were only discussed if the client became
delinquent, and then often resulted in a
discharge from care.
First Party Goals – The Changes (Do)
Took financial management out of the back room
• Created a practice manager position –staffed with
a person that has both a business and clinical
background – added that person to the senior
management and operations management teams.
• Inserted a friendly payment request into the checkin process “Are you prepared to make a payment
today?”
• Educated clinicians regarding client finances as a
clinical issue and engaged them to problem solve
with clients around financial issues
• Met with clients and offered amnesty from past
due balances. Wrote off about $120,000 in 3 mths.
3. Results – 1st Party Collections
Average 1st Party collections
▫ Weekly cash increase of 85%
▫ Annual cash increase: $510,952
$25,000
$20,000
$15,000
$10,000
$5,000
$0
Pre-Change
Post-Change
Third Party Authorizations – The
Changes (DO)
• Established a team approach to collections;
engaged clinicians in collections process as
opposed to only to the business managers
• Created a revenue cycle team to oversee a circular
process vs. a linear process
• Wide sharing of data regarding authorizations and
collection, both for first party and third party
clients
It Takes A Village…
A/R Staff
Front Door Staff
APT Foundation Leadership
3. Results – 3rd Party Collections
▫ 3% improvement in billed amount
▫ 5% improvement in collected amount
▫ $402,187 annual revenue increase
$680,358
$659,783
$638,711
$604,409
Pre-change
(Billed)
Pre-change
(Collected92%)
Post-change
(Billed)
Post-change
(Collected94%)
4. Next Steps
• Conduct a review of 1st party clients to look for
opportunities for increased collections as a
result of health care reform and state of CT
Medicaid changes (i.e. 18-20 year olds will now be
covered under Medicaid)
• Staff will assist clients in application process
• Regular staff discussion around increased
opportunity for Medicaid benefits and other
emerging coverage options.
5. Impact
• Clients reported feeling more engaged and secure
• Collection process is not punitive so clients come
forward to discuss financial issues as they are coached
in recovery skills
• Continued decrease in grant revenue as the primary
revenue source (from 60% to 35%)
• Multi-disciplinary cohesion around financial issues and
patient care
• Improved financial performance and improved census
Systems Driven Behavior
“most managers get into trouble because they forget
to think in circles. I mean this literally. Managerial
problems persist because managers continue to
believe that there are such things as unilateral
causation, independent and dependent variables,
origins and terminations”.
Karl Weick, The Social Psychology of Organization, 1979
Acknowledgements/Contact Info
• Thanks to the many APT Foundation staff who
shifted their roles and continue to work toward
customer friendly approaches to business
processes.
• Lynn Madden and Michele Bissell can be
reached at the APT Foundation, 203-781-4600.