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About Children’s Hospital
Colorado
 Private, not-for-profit pediatric healthcare network
 Obtained Magnet status in 2006
 In addition to one main campus facility
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 2 hospital locations within community hospitals
 2 urgent care sites
 1 urgent care site within another hospital
 1 free standing surgery center
 9 satellite specialty care centers
Level I trauma center
Maternal fetal medicine program opened in March 2011
Ranked among top 10 children’s hospitals for over a decade
Statistics
 318 licensed beds
 517,873 outpatient clinic visits (2011)
Celebrating over 100 years of commitment to pediatric care!
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What is RAVE?
R- Referral
A- Authorization
V-Verification
E-Eligibility
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Structure of Patient Access
• Prior to RAVE go-live
 Patient access included:
• Admissions (Main and ED)
• Financial Counseling
• IV staff (6 FTE)
 Inpatient, Ambulatory Surgery, and
Observation patient populations
• Both scheduled and non-scheduled
cases
• Function as a safety net
• Accounts worked via Ontrac tool
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Elements in Space
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Org Chart Pre RAVE
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Scattered Across the Universe
• Where did everyone live???
 Outpatient clinics
• Each reported to outpatient floor specific manager
• Team included scheduling, check-in/out, IV staff
• Worked floor specific accounts
 Administrative Pavilion
• In charge of obtaining authorizations for range of procedures
 Radiology procedure authorizations
 Radiology required authorization prior to scheduling
• Surgical initiation
• Cardiac DME
• Infusions
 Network of Care locations
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Planet Deficiencies
• Processes were sub-par workflows
• No dedicated back-up for these staff members
• No dedicated management structure for IV staff
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As the Planets Start to Align…
• Concept born 4 years prior
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VP of Ambulatory Services
VP of Finance
PFS
PAS
Managed Care
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Project Goal Statement
• Goal Statement
The goal of centralization is to reduce the overall number of
patient eligibility, no referral/authorization, non-covered
services, late/no notification, wrong insurance billed and
medically necessary denials The Children’s Hospital
receives, and better align resources, training, education,
and information to a single point of accountability within the
organization.
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Project Objectives
• Increase secured at admit rate across the organization to exceed 95%
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by the time the patient arrives for their scheduled appointment or
admission. Currently, this rate is at 90% (per 4-week average as
reported on week ending 8/27/10 IV Summary)
Maintain staff productivity to consistently work 45 accounts per day per
rep. Currently, this rate is at 50 across the organization (per weekly
productivity rate week ending 8/27/10).
Increase ‘days out’ in authorization rate (per 4-week average as
reported on week ending 8/27/10 IV Summary):
Goal:
0-3 days = 99%
4 days = 95%
5 days = 90%.
Reduce overall denied dollars and final write offs by 50%.
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The Jurassic Age….
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Early Phases
• On-boarding outpatient clinics to Ontrac (20082010)
 Rolled out in phases
• Over 2 years
• Main campus and network locations
• On-going meetings with management (2008-2010)
 To discuss centralization of IV
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Early Phases continued
• HR Meetings (Oct 2010)
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Employee transfer
Job descriptions
Reporting Structure
Career Ladder
• Promotion Ladder Insurance Verification.doc
 Work from home model
• Ongoing Management Meetings (Oct 2010)
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Early Phases continued
• Blending the “Families”
 Monthly PSC meetings (Oct 2010)
• HR Involvement
 Communication Tool for staff
• SBI (Situation, Behavior and Impact) Training
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 Team life cycle (Forming, Storming, Norming, Performing)
Team building
Learning process flows
Naming department
Committee creation
Management Structure
IT Resources
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Neanderthal Stage
“How centralize IV, Gorg want know”
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RAVE go-live structure
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Our New Home…
Gorg like!
Me too!
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RAVE Begins
• Go live 4/6/11 (27 employees) (Phase 1)
 Gained Efficiencies
• Merging worklist
• Cross training
 High Volume
 High Dollar
 Radiology Auth
• Scheduling prior to authorization allowed
• Back-filling for absences
• Installed robust QR process
• “Working Smarter not Harder”
 Electronic Eligibility Verification Restructure
 Creation of iRAVE (NOT TO BE CONFUSED WITH RAVE!!)
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iRAVE (NOT TO BE CONFUSED
WITH RAVE!!!)
• What is iRAVE?
 Online resource
• Insurance reference
• Available to all staff
• Documents payer specific requirements
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iRAVE continued
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iRAVE continued
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• What is iRAVE not to be confused with?
 A prize winning pony
 A planet
 Gorg
 RAVE
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The Next Planned Phases
• Phase 2 – July 2011 (OT/PT, 3 FTE’s)
• Phase 3 – August 2011 (Psych/CDU, ST, 4 FTE’s)
Why did we stagger these?
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Growth
• Expanding RAVE scope
Date
Clinic
Jun-11
Jul-11
Sep-11
Oct-11
Dec-11
Dec-11
TBD
MFM- Clinic & Auth Pool
Pain Clinic- Clinic & Auth
Pool
SIE Downs- Clinic & Auth
Pool
Monthly Volumes
Additional FTE
to RAVE
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No
460
No
70
No
Yes- moved 1FTE from
Neuro Dept
Neurology Auth Pool
Plastics, Urology, ENT, Ped
Surg-Auth Pool
Unsure at this time
North Campus-Auth Pool
South Campus and CO
Springs
Unsure at this time
No
Yes – Moved 0.8 FTE
to RAVE
2600
Yes – 1 to be hired
675
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Maintaining Communication
• Employees bringing issues they otherwise would not have
 Now employees have a ‘voice’
• Monthly meetings with clinic management
• Close working relationship with Patient Financial Services
 Work to decrease denials
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Current state (36 FTE)
• Restructure of Radiology authorization workflow
 Upgrade of Epic EMR for how workflow viewed
• Allows for better reporting
• Continued work to document process flows
 Team and workflow specific
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Anticipating efficiencies
Network of Care site addition to centralization
Medicaid PAR’s for Radiology services
Promotion of two employees to Rep III status
 Multiple duties
• Modular training
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Current state RAVE structure
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The Jetson’s Era
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Future State
• Move from safety net to initiation
 For Inpatient, Amb Surg & Obs cases
• Benchmark our existing pilot person from Orthopedics
• Standardizing Psych processes
• Adding more clinics
 Create a RAVE services ‘Application process’
• Service level agreement
• Creation of Registration Accuracy Task Force
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Carbon Dating
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So How Did We Do?
Secure at Admit
Pre RAVE= 90%
GOAL= 95%
Actual 2011 EOY= 94%
Staff Productivity
Pre RAVE =50 accts per day
Goal= Maintain 45 acct per day
Actual 2011 EOY= 68 accts per day
Write-offs for No Authorization
Goal= Decrease by 50%
Actual 2011 EOY= Increase by 235%
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So How Did We Do? Continued…
Increase “Days Out”
Pre RAVE=
0-3 days = 81%
4 days = 60%
5 days = 41%.
Goal=
0-3 days = 99%
4 days = 95%
5 days = 90%
Actual 2011 EOY=
0-3 days = 94%
4 days = 75%
5 days = 60%
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More Data……
• Quality Reviews
• Diligent monthly QR Process
 Increased Team Average from 2.68 to 2.9 (out of 3)
• Dashboard – SAVE RECENT COPY
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Lessons Learned
• Employee Satisfaction
 Dynamics of a large department
• What exactly are we taking on?
 Responsibilities transferred with employees
• Some tasks are out of scope of Insurance Verification Rep level
 Roles and Responsibilities – Saw a need once RAVE went live.
• Cleaner registrations
• Clearly defined roles
• Work From Home
 Re-evaluate current structure to help maintain relationships
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Contact Information
Tobi Knight – 720-777-5688
Tobi.Knight@ChildrensColorado.org
Berj Ermoyan – 720-777-5690
Berj.Ermoyan@ChildrensColorado.org
Questions?
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