Strategic outsourcing partnerships

A new model for revenue cycle operations delivering predictable outcomes, sustainability and growth.

This is a historic moment in the U.S. health care system. With spending near critical levels, organizations are under tremendous pressure to cut costs while meeting growing expectations of savvy consumers. They must prioritize scarce resources on competing needs while maintaining their core mission — serving patients and the community. Today’s providers must find a way to streamline processes and scale operations, or risk extinction.

ENTER EBOOK OVERVIEW TABLE OF CONTENTS Click to go to any section With today’s increasingly complex health system challenges, sustainability depends on taking a fresh look at opportunities for innovation, revenue improvement, growth and cost reduction.

This e-book explores the advantages of selectively leveraging industry experts to immediately innovate, enhance and scale revenue cycle operations for more predictable and efficient outcomes. Organizations must lead on quality care delivery while strategically partnering in operational areas to transfer financial risk, align trading partners, leverage global scale and ultimately thrive in this new economic era. Walking the sustainability tightrope

Every business deals with capital spending constraints, but for providers those decisions are BALANCE CAPITAL further complicated with the very human component of patient care. Spending decisions on INVESTMENTS things like clinical vs. administrative systems or brick and mortar improvements can’t be made using traditional risk and return models. Rightfully, the clinical improvements usually come LOOK FOR REVENUE out on top, resulting in less than optimal revenue cycle operations — the very place where OPPORTUNITIES financial stability is most easily influenced. BE NIMBLE Being nimble is key to remaining profitable and ultimately ensuring the financial stability to meet challenges head on. Walking the sustainability tightrope

DESPITE INDUSTRY CHALLENGES, WE SEE OPPORTUNITIES.

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Expense growth continues It’s projected there will be a 58% to outpace revenue growth increase in patients assuming for hospitals, which will remain greater financial responsibility the largest strain on hospital for out-of-pocket expenditures profitability through 2019. (between 2016–2026).

2017 report from Moody’s Centers for Medicare & Medicaid Services. National Investors Service health expenditure data. 2018.

Based on data from roughly Executives predict accelerated 6,000 U.S. private and public shift to value-based payments hospitals 8% percent are at risk in 2019 as 46 percent of health of closing; another 10 percent care executives believe their are considered “weak.” organization’s pace of change toward value-based payment is moving 2018 Bloomberg, U.S. Hospitals Shut at 30-a-Year Pace, With No End in Sight. quickly or very quickly.

Survey: Executives predict accelerated shift to value-based payments in 2019. HIT Consultant. An ideal future state for revenue cycle operations

Over the last decade, organizations have focused largely on specific improvements in CONNECT health care such as the need for electronic health records, system integration and provider EVERYONE productivity. Looking ahead, an ideal future state includes the operations side of the equation with an approach that seamlessly interconnects all stakeholders, invests in the INNOVATE newest technologies and embraces strategies for applying innovation. CONTINUALLY

BE OPEN TO CHANGE An ideal future state for revenue cycle operations

An ideal future state also includes a new model for revenue cycle operations that empowers financial sustainability through transformation.

Through collaboration and innovation with the right partner, the revenue cycle can deliver financial predictability and be leveraged as a competitive advantage with:

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Process automation Patient-centric approach through AI

Accurate reimbursement Data-driven decisions realization A new perspective on outsourcing

Outsourcing isn’t new, but it’s evolving. It’s moving beyond simple point-solutions that silo TRANSFER operations, or widgets that address single process steps, or overreacting to the latest industry PROCESSES buzzword. It’s growing into a more strategic tool to transfer processes from your business to a partner that’s going to result in better quality and speed of delivery, transfer financial risk and SHARE RISK reduce expenses. It’s not about temporary relief to meet a month-end or year-end goal — it’s evolved to the point where there are entire companies built solely to align payers and providers, SIMPLIFY ROLES simplify the revenue cycle and deliver permanent change. A new perspective on outsourcing

Health systems are recognizing that the revenue cycle — managing data capture, A STRATEGIC OUTSOURCING PARTNERSHIP completeness, and quality to build a claim all the way through final adjudication and payment is really a sort of supply chain. It’s long and complex, with impacts on all other aspects of the business And it requires more than orchestration from start to finish — it requires real, Reduces costs by eliminating unnecessary and interwoven, integration in the ideal state. More and more organizations are looking to position redundant work through technology innovation themselves with a strategic partner that has the expertise, the technology and the rigor to continually innovate and make the process more effective from start to finish.

Streamlines disconnected processes through Demand to outsource full revenue proven best practices % cycle management is up 86% 86 from 2015 among hospitals and 1 inpatient organizations. Introduces collaboration with industry experts to stay on the leading edge of change and stay Taking it one step further, a strategic outsourcing partnership allows organizations to focus on care quality while the partner focuses on technology innovation, cost control and revenue ahead of shifting market requirements optimization. It allows them to utilize precious, expert resources on advancing care and improving outcomes while delivering predictable financial outcomes through an infusion of technology, innovation and cash. Takes control of RCM processes through partnership for best of breed solutions and greater value

1. Black Book, May 2018 https://www.prnewswire.com/news-releases/by-2022-average-hospital-costs-must-be-reduced-by-24- to-breakeven-and-outsourcing-may-be-the-solution-says-black-book-300643743.htmlSource: Revenue Cycle Intelligence, May 2018https://revcycleintelligence.com/news/80-of-hospitals-vetting-full-revenue-cycle-management-outsourcing Three key innovation strategies Click options below to read more Three key innovation strategies

Process and technology automation

Clinically-aware artificial Intelligence (AI), when applied strategically to the revenue cycle, creates powerful insights and opportunities for meaningful action, but it’s also fair to consider whether investing scarce capital resources in new technology is the best course of action for your organization. Consider a plan that uses proven implementation methodologies and progressively deploys new capabilities as they come available for the best possible returns.

$34 billion $150 billion AI health care solution Use of AI can potentially save the spend by 20251 U.S. health care economy by 20262

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1. Becker’s Health IT & CIO Report - Machine learning and AI are taking healthcare by storm. Are you ready to rumble? November 6th, 2018” https://www.beckershospitalreview.com/healthcare-information-technology/machine-learning- and-ai-are-taking-healthcare-by-storm-are-you-ready-to-rumble.html 2. Emerj, How America’s 5 Top Hospitals are Using Machine Learning Today, February 19, 2019https://emerj.com/ai- sector-overviews/top-5-hospitals-using-machine-learning/ Three key innovation strategies

Patient financial transparency

Providers are aiming to attract, acquire and retain the loyalty of patients by providing a seamless financial experience in a time of heightened sensitivity around high-deductible plans and out-of- pocket costs. Without a smooth financial journey, patients are left feeling confused by multiple bills and statements and are unclear about the financial implications of their care.

of the average health of patients said they care bill is paid by % are confused by % 70 30 the patient2 their medical bills1

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1. Sara Heath. Patient Billing, Financial Responsibility Frustrates 70% of Patients. Patient Engagement HIT. Published June 5, 2018. 2. Becker’s Hospital CFO Report. 11 key statistics about the healthcare payment market. https://www. beckershospitalreview.com/finance/11-key-statistics-about-the-healthcare-payment-market.html. Published June 21, 2016. Three key innovation strategies

Payer alignment and collaboration

Provider-payer relationships are particularly complicated, with the average health care organization dealing with Medicare, Medicare Advantage, Medicaid, self-pay, direct to employer and at least a handful of commercial insurance relationships. Each has their own contracting guidelines, reimbursement outcomes and data sharing workflows that create standardization challenges and administrative burdens.

$200 billion Billing and insurance-related in administrative waste between costs make up the largest payers and providers1 share of administrative costs2

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1. David U. Himmelstein. A Comparison of Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed All. The Commonwealth Fund. https://www.commonwealthfund.org/publications/journal-article/2014/sep/comparison-hospital- administrative-costs-eight-nations-us. Published September 8, 2014. 2. Joshua D. Gottlieb and Mark Shepard. How Large a Burden are Administrative Costs in Health Care. ECONOFACT. https://econofact.org/how-large-a-burden-are-administrative-costs-in-health-care. Published September 6, 2018 Use a comprehensive approach for real transformation

Through a strategic partnership and outsourcing agreement, Optum360 works side-by- START side with organizations and delivers guaranteed revenue cycle outcomes on day one. We IMMEDIATELY allow organizations to focus on mission critical objectives, like care delivery, while we focus on innovation that radically transforms the revenue cycle, and infuse efficiencies that cut STAY MISSION- costs and accelerate revenue. Put your trust in a strategic outsourcing partner that has the FOCUSED experience to turn your revenue cycle into a predictable, sustainable advantage. PREDICT SUCCESS Use a comprehensive approach for real transformation

From day one, the Optum360 revenue cycle transformation model lets you see results and builds on each success throughout the relationship.

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Health care organizations are feeling a tremendous amount of pressure across the revenue EXPERIENCED cycle from reimbursement changes, growth in consumerism and increasing regulations. As a result, they are looking carefully at what initiatives should be driven by internal experts INNOVATIVE compared to those, such as revenue cycle, that are best suited for a strategic partner with the right expertise. FOCUSED Not all partners are created equal

And even with the right expertise, it can’t be just any partner.

As a strategic outsourcing partner, Optum 360: Learn how Optum360 empowers providers to thrive through innovation while advancing their core mission.

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