The Central Healthcare Billing Agency - Patients Deserve More in Reducing Stress

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The Central Healthcare Billing Agency - Patients Deserve More in Reducing Stress by Mind Map: The Central Healthcare Billing Agency - Patients Deserve More in Reducing Stress

1. Evidence

1.1. Justifications for the immediate implementation and operation of the CHBA

1.1.1. Billing Errors

1.1.1.1. Quantity of Errors

1.1.1.2. Financial Impact from Errors

1.1.1.2.1. Credit Report

1.1.1.2.2. Patient Dollars

1.1.1.2.3. Insurance Company Dollars

1.1.2. Waste in healthcare

1.1.2.1. Wasted Heatlhcare Dollars

1.1.2.2. Low/No Value Healthcare

1.1.2.3. Useless Treatment

1.1.3. Non-Ideal Medical Center Throughput

1.1.3.1. Overcrowding

1.1.4. Declining Patient Satisfaction

1.1.4.1. Emergency Physician Wait Time

2. Innovation Process

2.1. Ideation and Brainstorming

2.1.1. " Idea generation [is used] instead of the more commonly used, and frequently misused, 'brainstorming' or 'creativity session' in order to differentiate the right way to follow this process from the way it is too often performed today" (Weiss, D., & Legrand, C., 2011, p. 124).

2.1.2. "Effective idea generation ensures that innovative thinkers systematically identify solutions to the real issue or issues within clear boundaries, thereby maximizing the value of the whole innovative thinking process" (Weiss, D., & Legrand, C., 2011, p. 124).

2.1.3. (Weiss, D., & Legrand, C., 2011, p. 126).

2.1.3.1. Stage 1: Prepare thoroughly

2.1.3.2. Stage 2: Introduce the process

2.1.3.3. Stage 3: Generate many ideas through divergence

2.1.3.4. Stage 4: Discover meaningful solutions through convergence

2.1.4. SMART EDISON

2.1.4.1. S (Specific)

2.1.4.1.1. Visualize the company's goal, as depicted in the company vision, and see the success as the goal is realized.

2.1.4.1.2. Use metrics, process improvement ideas/strategies, and leverage ideas and strengths of employees in order to succeed in achieving the company goal.

2.1.4.2. M (Measurable)

2.1.4.3. A (Accountability)

2.1.4.4. R (Relevant)

2.1.4.5. T (Timeline)

2.1.4.6. E (Emotion)

2.1.4.7. D (Decision)

2.1.4.8. I (Integration)

2.1.4.9. S (Sensory)

2.1.4.10. O (Optimistic)

2.1.4.11. N (Now)

2.1.5. The Right DIrection

2.2. Rapid Protoyping Process

2.2.1. Rapid Prototyping (StrataSYS, 2012)

2.2.1.1. Design iteratively

2.2.1.2. Reduce waste and rework

2.2.1.3. Communicate ideas

2.2.1.4. Test in the real world

2.2.2. Knowledge Sharing

2.2.2.1. Complex adaptive systems require variety and diversity in order to maintain viability and sustainability, looking long-term.

2.2.3. Diversity

2.2.3.1. Value in Employee Input

2.2.3.2. Creative solutions leveraging cooperative employee efforts

2.3. Course Correction Considerations

2.3.1. Innovation is unpredictable and changes often, thus it is vital to the success of the CHBA that certain course corrections be considered should significant barriers or events arise.

2.3.1.1. 1. Loss of grant funding

2.3.1.1.1. Creative solutions that can generate added revenue to keep the CHBA in operation

2.3.1.2. 2. Sustained low membership

2.3.1.2.1. Leverage IT to spearhead a meaningful advertisement campaign targeted at improving usage through membership

2.3.1.3. 3. High visibility scandal

2.3.1.3.1. Release key player involved in scandal, as appropriate

2.3.1.3.2. Leverage IT to spearhead an essential advertisement campaign targeted at improving public perception

2.3.1.4. 4. Pace of innovation outpacing CHBA innovation

2.3.1.4.1. Identify new facilitators, decision makers, and contributors in order to enable a more impactful ideation and brainstorming campaign

2.3.1.4.2. Initiate a talent search in order to acquire new innovation leadership

2.4. Building a Case for Innovation

2.4.1. Despite ambiguity leadership can harness the diversity within the company

2.4.1.1. Maximize Stengths

2.4.1.2. Realize the CHBA Vision

3. Finance

3.1. Challenges to Implementation: Financial Barriers

3.1.1. Insufficient investor support on budget

3.1.2. Lack of return with grants

3.2. Tax Status

3.2.1. 501(c)(3) - not for profit

3.2.1.1. Favored due to greatly reduced investor influence and control. This allows the CHBA to become an independent organization with a true focus on providing patient services rather than focused on maximizing profit margin in order to satisfy investor demands

3.3. Budget

3.3.1. CHBA Budget

3.3.1.1. Year 1

3.3.1.2. Year 2

3.3.1.3. Year 3

3.3.1.4. Year 4

3.3.1.5. Year 5

3.3.1.6. Year 6

3.3.1.7. Year 7

3.3.1.8. Year 8

3.3.1.9. Year 9

3.3.1.10. Year 10

3.3.2. Funding Sources

3.3.2.1. Personal Funds

3.3.2.2. Grants

3.3.2.2.1. Grant Watch

3.3.2.3. Investments

3.3.2.3.1. Nonprofit FinanceFund

3.4. Investor ROI

3.4.1. Proposed Investor ROI

3.5. GAAP

3.5.1. Proposed GAAP

4. Information Technology

4.1. Challenges to Implementation: Training/Certifications

4.1.1. Standardized Basic Minimum Qualifications (BMQ) per position

4.1.2. Individual Development Plan (IDP) with certification milestones

4.1.3. Standardized Training via Learning Management System (LMS)

4.2. Governance Model

4.2.1. Executive Committee

4.2.1.1. Members

4.2.1.1.1. Chief Executive Officer (CEO)

4.2.1.1.2. Chief Innovations Officer (CIO)

4.2.1.1.3. Chief Financial Officer (CFO)

4.2.1.1.4. Chief Operations Officer (COO)

4.2.1.1.5. Executive Vice President (EVP)

4.2.2. IT Staff - Functional Review

4.2.2.1. Develop and implement new technologies related to CHBA

4.2.2.2. Ensure IT training is up to date and accurately reflects the standardized base of the CHBA'

4.2.2.3. Review IT and innovative processes for optimization and full potential

4.3. Use of Techology

4.3.1. Support CHBA sites

4.3.2. Connect with patients and patient members

4.3.3. Solicit/compile feedback

4.3.3.1. Clients

4.3.3.2. Patient Members

4.3.3.3. CHBA Employees

4.4. Assets

4.4.1. CHBA mobile application

4.4.2. Data

4.4.2.1. Feedback

4.4.2.1.1. Clients

4.4.2.1.2. CHBA Employees

4.4.2.1.3. Patient Members

4.4.2.2. Metadata

4.4.2.2.1. Clients

4.4.2.2.2. CHBA Employees

4.4.2.2.3. Patient Members

4.4.3. IT Staff

4.4.3.1. Application Support Team (AST)

4.4.3.2. Data Analyst Team (DAT)

4.4.3.3. Customer Support Team (CST)

4.5. IT Strategy

4.5.1. IT Support

4.5.1.1. Application Support

4.5.1.2. Data Analysis

4.5.1.3. Customer Support

4.5.2. Innovative Process Improvement (IPI)

4.5.3. Data Integrity

4.5.4. Information Security (InfoSec)

5. Policy

5.1. Challenges to Implementation: Policy Hurdles

5.1.1. Lack of stakeholder support

5.1.2. Lack of stakeholder alignment

5.1.3. Lack of healthcare organization support

5.1.4. Red tape at healthcare organization site

5.2. Current Policies that Impede Innovation (CHBA)

5.2.1. From an operations perspective, there currently there are no policies that inhibit the innovation of the CHBA

5.2.2. From a financia/funding perspective, there currently are no policies that expressly aid programs similar to the CHBA, which could inhibit the innovative potential.

5.3. New Policies Needed

5.3.1. Establish patient rights under billing and coding errors

5.3.1.1. Statute of limitations on patients to pay bills that are duplicate, errant, or untimely bills.

5.3.1.2. Burden of proof to lie with healthcare organization on proper billing practices which aims to reduce complexity and patient cost.

5.3.2. Policies with Saint Johns Hospital in Oxnard, CA that would allow for external auditing of billing and coding practices by the CHBA.

5.3.2.1. Allow the fee-for-service model to be successfully implemented and set up a fee schedule between the healthcare organization and the CHBA.

5.4. Policy Change Plan

5.4.1. 1. In order to change a policy or move to have a policy implemented key stakeholders need to be 'on board'.

5.4.2. 2. Proactively champion a "win-win" scenario with key healthcare organization stakeholders that allows the CHBA to reduce cost and complexity by increasing efficiency at the healthcare organization.

5.4.3. 3. Proactively champion a "win-win" scenario with key healthcare insurance company stakeholders that allows the CHBA to reduce cost, patient claim turn-around-time, and increase patient membership.

5.4.4. 4. Leverage expertise and affiliation with state and local government's key stakeholders to endorse the vision and mission of the CHBA.

5.5. Policy Change Timeline

5.5.1. Proposal Deadline

5.5.1.1. January 2016

5.5.2. Presentation to Stakeholders

5.5.2.1. January 2016

5.5.2.1.1. Establish Action Items

5.5.3. Follow-up Meeting with Stakeholders

5.5.3.1. February 2016

5.5.3.1.1. Complete Action Items

5.5.4. Implement new policy

5.5.4.1. March 2016

5.5.5. Policy Review - Initiate

5.5.5.1. April 2016

5.5.6. Policy Review - Report and Stakeholder presentation

5.5.6.1. December 2016

5.6. Stakeholders

5.6.1. Investors

5.6.2. Chief Executive Officer

5.6.3. Chief Financial Officer

5.6.4. Chief Operational Officer

5.6.5. Chief Innovations Officer

5.6.6. Executive Vice President

5.6.7. Directors

5.6.8. Managers

6. Outcomes

6.1. Impact on Pilot Organization

6.1.1. Qualitative Impacts

6.1.1.1. Increase in patient satisfaction translates to increases of patient traffic. This happens due to the rise in person-to-person communication and referrals.

6.1.2. Quantitative Impacts

6.1.2.1. Saint John's Regional Medical Centerl in Oxnard, CA

6.2. Impact on Healthcare System

6.2.1. Qualitative Impacts

6.2.1.1. Increased efficiency of hospital billing departments, insurance claims departments and patients paying outstanding claims.

6.2.2. Quantitative Impacts

6.3. How CHBA delivers better health service

6.3.1. There is a need for the CHBA

6.3.1.1. Moderate to severe medical events can cost patients with less than ideal medical coverage a small fortune.

6.3.1.1.1. Detail 1

6.3.1.1.2. Detail 2

6.3.1.2. Bills from "out of network" services can be extensive

6.3.1.3. Too many people pay a bill they receive without knowing that they may be getting taken advantage of.

6.3.1.4. The CHBA can alleviate massive levels of stress that can further improve patient outcomes.

6.4. Evolution of CHBA in the Pilot Organization

6.4.1. Since the affordable Care Act has mandated that all adults (18+ in most cases) carry health insurance in the United States, over 250 million people will have a need for the services of the CHBA.

6.5. Metrics

6.5.1. Financial Performance (Positive outcome through Year 1)

6.5.1.1. Target: To return a minimum 5% increase over baseline

6.5.1.2. Baseline: St. Johns Hospital in Oxnard, CA; $117.8 million (Jeffers, 2015).

6.5.1.3. Baseline: CHBA Budget projection $23,750.

6.5.2. Financial Performance (Positive outcome for Years 2-10)

6.5.2.1. Target: To return a minimum 5% increase over baseline

6.5.2.2. Baseline: St. Johns Hospital in Oxnard, CA; project for year 2-10, need additional interview.

6.5.2.3. Baseline: CHBA budget projections for years 2-10 - please see CHBA budget/

6.5.3. Patient Satisfaction

6.5.3.1. Baseline: Current industry patient satisfaction level

6.5.3.1.1. "91.2% of patients claim to be satisfied with the service they receive at a healthcare organization" (Mohamed, 2012).

6.5.4. Insurance Claim Turn-Around-Time (TAT)

6.5.4.1. Target: Actively contrbute to reducing the TAT for medical insurance claims to under 20 days for 95% of all claims.

6.5.4.2. Baseline: "Nation average for medical insurance claim turnaround time (TAT) is within 30 days for 94% of all claims that are made, regardless of whether they were for in-network or out-of-network care" (Mohamed, 2012).

6.5.5. Patient Bill Payment TAT

6.5.5.1. Target: Improve the fulfillment of bills payable to less than 25 days with a CV of less than 10 days.

6.5.5.2. Baseline:Average fulfillment of bills payable for St. Johns Oxnard is 37 days, with a CV of 14 days (Jeffers, 2015).

7. CHBA Overview

7.1. Central Healthcare Billing Agency is a not-for-profit, fee-for-use patient service that provides billing and coding auditing and billing consolidation in order to realize the most positive patient outcomes possible.

7.2. Timeline

7.2.1. Proposal Deadline

7.2.1.1. January 2016

7.2.2. Presentation to Stakeholders

7.2.2.1. January 2016

7.2.3. New CHBA Site Start

7.2.3.1. February 2016

7.2.4. IT Connectivity - Implementation Deadline

7.2.4.1. May 2016

7.2.5. Innovative Review - Initiate

7.2.5.1. July 2016

7.2.6. Innovative Review - Report

7.2.6.1. December 2016

7.3. The Central Healthcare Billing Agency focuses exclusively on patient service while exploring avenues for optimization that saves time, money, and patient stress. The CHBA intends to help patients that have experienced medical events that range from minor to major. The pilot for this project will be St. John’s Regional Medical Center in Oxnard, California.

7.3.1. Saint John's Regional Medical Center, Oxnard, California

7.3.1.1. 24-hour Emergency Services

7.3.1.2. Cancer Care and Support

7.3.1.3. Diabetes Program

7.3.1.4. Health and Wellness Programs

7.3.1.5. Heart Health

7.3.1.6. Imagine Procedures

7.3.1.7. Intensive Care

7.3.1.8. Surgery

7.3.1.8.1. Inpatient

7.3.1.8.2. Outpatient

7.3.1.9. Maternity and Birth Services

7.3.1.10. Neonatal Intensive Care

7.3.1.11. Orthopedic Care

7.3.1.12. Palliative Care

7.3.1.13. Patient and Family Education

7.3.1.14. Primary Care

7.3.1.15. Rehabilitation Services

7.3.1.16. Spiritual CAre

7.3.1.17. Weight Loss Surgery

7.3.1.18. Women's Services

8. References

8.1. Links

9. Objective 2

9.1. Identify change theory and management of change

9.2. Describes system theory and application

9.3. Shows how teamwork will advance innovation program

9.4. Demonstrates organizational alignment for innovation

9.5. Shows your leadership skill of organizing, role modeling, mentoring, facilitating, coordinating and integrating

10. Leadership Structure

10.1. Stakeholders

10.1.1. Internal

10.1.1.1. Chief Executive Officer

10.1.1.2. Chief Financial Officer

10.1.1.3. Chief Operational Officer

10.1.1.4. Chief Innovations Officer

10.1.1.5. Executive Vice President

10.1.1.6. Directors

10.1.1.7. Managers

10.1.1.8. Specialists

10.1.1.9. IT Staff

10.1.2. External

10.1.2.1. Patient Members

10.1.2.2. Investors

10.1.2.3. Pilot Healthcare Organization

10.2. Barriers - Constructive Approaches

10.2.1. Create desired CHBA culture

10.2.2. Ensure clear direction of organization

10.2.3. Ensure open, honest, and prompt communication

10.2.4. Demonstrate CHBA value for client healthcare organization to ensure alignment on vision and buy-in

10.3. DiSC and VAT

10.3.1. Personal DiSC Style: iD

10.3.1.1. Leverage to understand how to best relate to other CHBA team members

10.3.1.2. Ability to connect with others

10.3.1.2.1. Valuing Collaboration

10.3.1.2.2. Information

10.3.1.3. Domination in conversation

10.3.1.4. Willingness to take on or solve problems

10.3.2. Personal VAT: 5-6-8

10.3.2.1. Visual

10.3.2.1.1. Weakest relative avenue for learning: taking in projects, notes, updates or meetings through use of sight

10.3.2.2. Auditory

10.3.2.2.1. Moderate relative avenue for learning: taking in projects, notes, updates or meeting conversation through use of hearing.

10.3.2.3. Tactile

10.3.2.3.1. Strongest relative avenue for learning: act of physically taking notes by writing or typing and working on projects through the use of touch.

10.4. Challenges to Implementation

10.4.1. Timelines

10.4.1.1. On Schedule

10.4.1.1.1. Outlined Development Phases

10.4.1.2. Expected delays

10.4.1.2.1. Accommodate and adjust timeline as needed

10.4.1.3. Unexpected Delays

10.4.1.3.1. Accommodate with timeline as needed

10.5. Systems Thinking

10.5.1. Collaboration

10.5.1.1. Influences

10.5.2. Employee Engagement

10.5.2.1. Process Improvements

10.6. Core Values

10.6.1. Compete Intensley and Win

10.6.2. Honesty and Integrity

10.6.3. Do the Right Thing

10.6.4. Teamwork Fosters Innovation

11. Vision

12. Voice-Over Presentations

13. Vision