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Capital Markets Day:
Craneware
November 17, 2015
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Craneware History
& Update
George Elliott
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Trusted Partner to ¼ of US Hospitals
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Customers
During the last 15 years, approximately one quarter of all
registered US hospitals have chosen Craneware to assist
them on their journey to improve financial performance and
revenue integrity.
Customers range from small community hospitals to large
healthcare networks.
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Today’s Presenters
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Russ Rudish, Non-Executive Director
Russ Rudish has more than 30 years' experience in serving the Healthcare industry, both in the United States and internationally. Russ holds a
directorship in Rudish Health Solutions, LLC, a healthcare consulting firm. Russ is also a principal in Healthcare IT Leaders and Run Consultants, both of
which provide IT staff augmentation services. Between 2006 and 2014, Russ served as partner and Global Sector Leader for Healthcare at Deloitte
Touche Tohmatsu, where he led the $2 billion global consulting, audit, tax and financial advisory business, developing the firm's Global health care
strategy. He is an active speaker and contributor to thought leadership on today's most pressing Healthcare business issues. Russ holds a directorship in
Rudish Health Solutions LLC. He previously held a partnership in Deloitte LLC, from 2006
Colleen Blye, Non-Executive Director
Colleen Blye is the Executive Vice President and Chief Financial Officer for Catholic Health Systems of Long Island ("CHS"), an integrated healthcare
delivery system which includes six hospitals, three nursing homes, a regional home care and hospice group and a community-based agency for persons
with special needs. Colleen joined CHS in 2010 from Catholic Health Initiatives (CHI), where she served as Executive Vice President and Chief Financial
Officer since 2005. She was with CHI for over twenty years, serving in various roles of increasing responsibility. Ms. Blye started her career in Finance
with Ernst and Young in Philadelphia, PA. She has been a certified public accountant since 1984 and is a member of the American Institute of Certified
Public Accountants, and the Pennsylvania Institute of Public Accountants. She is also a member of the Healthcare Financial Management Association
Mark Montgomery, Chief Marketing Officer
As Chief Marketing Officer, Mark Montgomery provides strategic and operational leadership for corporate development, product management and
marketing that drive to Craneware’s long-term goals. Prior to joining Craneware in 2013, Montgomery led several teams for Experian Healthcare’s client
services organization, encompassing reimbursement, client support and central operations. Montgomery joined Experian in 2011 with the acquisition of
Medical Present Value, Inc. (MPV). Prior to joining MPV in 2009, Montgomery spent eight years with McKesson and 17 years with Lanier Healthcare in a
variety of strategic sales, marketing and operations roles. Montgomery earned his bachelor’s degree in broadcast communications from Tennessee
Temple University and a master's degree in business administration from the University of Georgia.
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Healthcare Consulting Strategies for
a Consolidating Market
Russ Rudish
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Industry Impacts to the IT/Consultancy Market
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Regulatory
Evolution
Alliances &
Acquisitions
Renewed Focus
Toward Innovation
Consultancy as a
Strategic Partner
The industry continues to be
led by regulatory influences:
1960s—Medicare &
Medicaid
1980s—Prospective
Payment System
2000s—Medicare
Advantage
2010s—Affordable Care
Act
Health providers are
aggressively seeking
strategic partners that:
Expand current services
offerings
Expand to new markets
within the traditional
and non-traditional
service areas
Seek alliance/acquisition
of physicians and other
healthcare professionals
Quality care delivery
Optimal margin
performance and growth
Compliance with
regulatory and
commercial payor
polices
Innovation in care
delivery and patient
engagement
Expanded revenue and cost
management execution
People/Process/Technology
Channel partners: Group
Purchasing Organizations
Channel partners:
Consulting Services firms
HIS deployment
Cyber Security
Population Health
readiness
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The CFO Role: Managing Emerging
Risks in a
Value Based Market
Colleen Blye
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VALUE
=
{1}
Quality
Payment
{2}
{1}
Composite of patient outcomes, safety, and
experiences
{2}
Cost to all purchasers of purchasing care
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Revenue Cycle
• Fee-for-service
• Connect charges to units
of service provided
“All administrative and clinical
functions that contribute to the
capture, management, and
collection of patient
service revenue”
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Value Cycle
• Value-based and other
alternative payment models
• Connect costs to units of
service and charges
“The process and culture by which
healthcare providers pursue quality
patient outcomes and optimal financial
performance through the management of
clinical, operational and financial assets.”
Patient
Access
Service
Charge
Capture
Coding
Claim
Denial
Mgmt.
Clinical
Data
Operational
Data
Financial
Data
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Risks Will Increasingly Affect Your Margins
Population Health/Assumption of Risks
Example: Medicare's Comprehensive Care Joint Replacement (CCJR)
Program
•
•
Responsible for all aspects of care for a given population for life
Balancing care/payment to ensure financial viability for the provider
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Alternative Reimbursement Models = Less Predictable Cash
Flow
Example: payments tied to clinical outcome and quality
•
•
•
Bundled
Risk/quality contingency
Full risk: fixed payment for preventative and curative services
Consumerism and Patient Engagement
Example: growing patient engagement and patient responsibility
•
•
•
•
Clinical awareness and education
Self pay: High deductible / patient responsibility
Pricing transparency Uninsured & self-pay
Self insured: Companies are contracting directly with providers for outcomes-based
care delivery with transparent pricing
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Keys to Success
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Meeting the Challenge:
• For the patient: Competitive pricing that delivers optimal clinical
outcomes
• For the provider: balancing quality patient outcomes with
optimal financial performance
Information driven through Data Analytics
• Create the ability to measure clinical outcomes, quality and cost
data accurately in real-time
Care Management Infrastructure
• Meeting consumer expectations
• Delivering optimal clinical outcomes
• Creating the appropriate care network
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Healthcare Trends
Mark Montgomery
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An evolving healthcare marketplace is rapidly driving shifts to
new financial performance metrics focused on value.
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Revenue Cycle
Management
Value Cycle
Management
Capitation
Fee for Service
FFS/Value Based
Population Health
Previous
Recent
Now
Today/
Tomorrow
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Your
Population
Right
Patient
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11
Right
Payment
11
11
Right
Outcome
11
The Value
Cycle
Right
Place
Right
Diagnosis
Right
Cost
Right
Treatment
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Craneware Moving
Ahead
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Craneware in the value cycle, today and in the future
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Your
Population
Right
Patient
11
Right
Payment
11
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The Value Cycle
Right
Outcome
11
Right
Place
Right
Diagnosis
Right
Cost
Right
Treatment
Our Domain
Our Future
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Craneware Patient
Engagement Strategy
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Patient Responsibility for Payment is Escalating
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Higher Deductibles are the Reality
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Questions
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