Building Sustainability for family planning programs

Transcription

1 Building Sustainability for family planning programs Tasmeen Weik, DrPH, MPH Health Scientist Office of Population Affairs

2 Agenda Framework for sustainability of family planning centers Tools to consider sustainability

3 3 ACA: What it means for Family Planning Health insurance marketplace Greater number of insured clients Potential for increased revenue Clients need to see providers in their network Centers need to contract with private health plans Investments in Health IT More focus on electronic data transmission (claims processing) Greater demand for information on patient care quality Centers need to invest in Electronic Health Records and information systems Medicaid Expansions Potential for increased Medicaid Revenue Clients need to be enrolled Centers need to help enroll clients Essential Health Benefits No Cost Sharing Preventive Services Clients will have better access to preventive services Clients want a usual source of care Service sites need to consider expanding services or partnering with primary care

4 Where do we need to go?

5 Where do we need to go?

6 Sustainability Assessment Service site tool--health center level Enrollment activities Primary care EHR system Quality monitoring and Improvement Revenue Gross collection Average days in account receivable claims denial Contracting with health plans Cost analysis

7 Financial Dashboard Provides at a glance views of Key Performance Indicators (KPI) Benchmark standard or set of standards used a a point of reference for evaluating performance. May be set by an organization or historical experiences KPI s Gross collection rate Accounts Receivable (A/R) Aging Days in Accounts Receivable (A/R) Utilization Payer Mix Net Program Revenue Months of Cash on Hand 1. Benchmark Source: Benchmarking Your Practice's Performance," Presentation by Anne Dunne, RN-BC, MBA, MSCN, of Health Care Consulting, Grassi & Co., September 25, McBride, Carter. "How to Calculate Cash on Hand at the End of a Period in Accounting." Chron. Demand Media. Web. 6 Aug

8 Collection Rate Financial Dashboard--KPI Gross Collection Rate Percentage of total charges is collectable with respect to insurance contracts and patient mix. Over time should be between 40-60% Below 40%--problem with collection process Over 75%--prices too low Does not account for contractual allowances (difference between what s billed and negotiated payment) Total collections from all payer sources Total Charges 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

9 Financial Dashboard-KPI Utilization Reflects how busy the clinic is. Number of unduplicated patients Utilization should be tracked over time. Benchmarks vary by site (strategic planning)

10 Financial Dashboard---KPI Payer Mix Can be calculated using revenue, unduplicated patient numbers, encounter numbers Diverse mix is desirable. Benchmark considerations: Medicaid eligibility as determined by patient financial demographic data Revenue goals necessary to meet program expenses Implementation of Medicaid expansion/securing commercial insurance contracts Ability/funding to subsidize sliding fee patients Source: LFA Group, "Community Clinic Case Studies Financial Health." Blue of California Foundation, Web. 12 Sept Revenues generated by payer Total program revenue Unduplicated patients by payer Total number of unduplicated patients BENCHMARK PAYER MIX 60% 10% 20% 10% Total ACTUAL PAYER MIX, 53.9% 10.6% 33.6% Client Fees Medicaid Private Insurance Donations 1.9% Client Fees Medicaid Private Insurance Donations

11 Variance Financial Dashboard--KPI Net Program Revenue (compared to budget) Total revenue from program less all program specific expenses Compare net program revenue to budget Occasional variability expected, perpetual variance may indicate financial instability Acceptable tolerance level +/- 5-10% 30% 20% 10% 0% -10% -20% -30% Month Benchmark Source: Centage Corporation, and The Institute of Management & Administration. "Budgeting Survey: Benchmarks & Issues." 1 Jan Web. 26 Sept

12 Title X NTC Resources Currently Available 12 Available national training: Clinical training (including LARC specific training) Cost Analysis Revenue cycle management (including contracting) 3-unit Coding e-learning Outreach and enrollment resources 5 things providers should know Onsite enrollment resources Podcasts Print ready flyer Front desk enrollment job aid Coming soon: Dashboards

13 Questions? Comments?