Leveraging Integrated Hospital Care to Revenue Cycle ManagementPHARMACIST ENABLED CHRONIC CARE CYCLE MANAGEMENT

Foreword1. Care cycle management of patients in the Meridian system require more integrated

foundation and experience in order to increase total reimbursement mix.

2. Forward looking innovation coupled with risk minimization can drive cultural change and increase adoption speed towards market changes.

3. Drawing value and delivering accountable management techniques will decreas oeperational friction to improves outcomes, reduces waste and increase efficiency.

Objectives1. Finalize current pilot initiative to expand, grow and leverage pharmacy operations to

optimize HCAHPs scores.

2. Explore, pilot and demonstrate capabilities of pharmacist interventions at inpatient and outpatient setting aligned to hospital revenue goals of HCAHPs, Readmissions, Costs and Revenue generation.

3. Evaluate, initiate, develop and prepare processes for outpatient pharmacy program management including medication reconciliation and adherence, HCAHPs pull through, Annual Wellness Exam enrollment and Transition of Care Management initiation.

Overview1. Cost Savings and Revenue Generation Options

1. All Unit HCAHPs Program 2. Transition of Care Management (TCM)3. Medication Adherence (iMPAK Health Customer Validation)4. Medication Reconciliation Process Change

2. Inpatient Program Expansion1. Program Overview2. Timeline3. Implementation Keys4. Process

Strategic Hospital and Corporate ValueService additions and program management leads to growth in operating margins

Revenue & Care Cycle Enhancements

1. Improved Operating

Costs & Efficiencies

2. Cash Conversion

Cycle Optimization

3. Improved Outcomes &

Revenue Generation

4. Staff Accountability

& Cultural Shift

5. Community Brand

Enhancement

6

Strategic Value & Importance Weight of value predominantly relies on timing, location, benefit upside and immediacy of margin improvement

HighLow Current Level Of Strategic Value & Importance

iMPA

K He

alth

ED P

harm

acist

TCM

Pro

gram

Out

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nt

Phar

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y

HCAH

Ps

Prog

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Annual Wellness Exam/CLIA Waived Exams

HCAHPs Program Roll Out

Medication Adherence Pilot and Validation

Medication Reconciliation Process Change

Transition of Care Management Service Role

& Billing

Program Roll Out Overview 5 Key Programs lead incremental improvements in operating margins and efficiency aligned to outcomes, talent management and patient journey improvement

• Program Approval, Expansion and Roll out• iPAD Usage and Discussion with Nursing

1. HCAHPs Training and Continuous MonitoringTraining, Change & Change (iPAD Face:Face Counseling)

• Program Exploration and Development• Facilitate discussion with managed care, billing and physician groups

2. Initiate TCM Program Implementation Services, Roles, Billing

• Program Approval, Support and Meridian BD Validation• Pilot launch with Meridian Business Development March 1st

3. Medication Adherence Pilot iMPAK Health

• Process Change Approval and Error Prevention• ED Pharmacist Opportunity Discussion

4. Medication ReconciliationAdmission – Discharge Process Change

• Full Business Opportunity Discussion• Service business model exploration

5. Outpatient Pharmacy MaximizationAnnual Wellness Exams/CLIA Waived Tests & Checkup

1. HCAHPs Nursing Unit Program Overview10 week comprehensive program enables nursing to own patient experience with ‘as needed’ interventions

• Seminar and Training (HCAHPS) – (1 Unit/Time)• Best practice and activity breakouts• Unit specific discussion and focus points*

1. Program Onboarding(2 wks)

• 4 Week Service Execution and Monitoring • Face-Face Accountability Checking and Reporting

2. Program Roll Out(4 wks)

• Tight Feedback Loop and Monitoring• *Pharmacist enabled face-face video enrollment and

sessions

3. Transition Improvement

(4 wks)

2. Transition of Care Program Overview CMS (CPT) Billing codes of transition of care management can be explored for enhanced discharging and profitability

• Program billing discussion and exploration• Service role creation and nomination • Process and documentation development• Cross functional group discussion and meetings*

Program Exploration(2 wks)

• Unit process development, training and documentation creation• Review of billing, CMS rejections, outcomes and patient feedback• Assessment of program potential, staff operating changes• Cross functional evaluation of expansion

Program Initiation (4 wks)

• Post Evaluation Discussion Program Expansion(Ongoing)

3. Med. Adherence Program Pilot Overview10 Week Program focuses on medication adherence and follow up validates iMPAK Health product acquisition value

• Nominate and enroll patients previously identified• Begin process and enrollment• Adjust program ongoing as needed

Program Initiation (1 wk)

• Follow up post discharge adds additional HCAHPs touch points• Product investigation of safety and effectiveness claims• Product branding and positioning evaluation

Program Enrollment & Follow up

(4 wks)

• Data gathering and adherence monitoring• Patient follow up phone calls and device collection• *Additional CRM enrollment (Outpatient)

Tracking & Outcomes(4 - 6 wks)

4. Med. Reconciliation Program OverviewProgram shifts work burden to pharmacy owned med rec upon admission and oversight of stay and discharge med rec

• ED Pharmacist Proposal Review • Process review and medication reconciliation committee onboarding• Talent recruitment and/or FTE shifting to ED

Program Initiation(2 wk)

• ED Department documentation and process optimization• KPI development and results tracking • Save costs by encouraging patient’s specialty /non formulary med use

Program Development & Growth(4 wks)

• Quarterly reporting and med reconciliation meetings • Cost savings by selectively encouraging patient’s own medicationsTracking & Outcomes

(4 - 6 wks)

5. Outpatient Pharmacy OptimizationRiverview Outpatient Pharmacy preparation and diligence are key to maximizing future hospital revenue and value

• Explore Outpatient Business Models including MTM/TCM/AWVs• Optimize Outpatient Pharmacy Dispensing Flow• Partner with Physician Business Development and Managed Care to

discuss billing capabilities

Program Initiation (1 wk)

• Create model, roles and P&L depending on potential• Create Trackable CRM Program • Liaise with HCPs on pilot initiative and process development

Program Business Model Development & Discussion

(4 – 8 wks)

• Implement and pilot initiative process• Track billing, patient outcomes and adjust program as necessary• Improve design and implementation

Tracking & Outcomes(4 - 6 wks)

Init

iate

Exec

ute

1 2 3 4May

1 2 3 4April

3 41 2

March June1 2 3 Q1

J - S

Asse

ss

TCM Program HCAHPs Program Med Adherence (iMPAK Health) Program

Medication Reconciliation

Program TimelinesExploration & Discussion

Training

Discussion

Pilot Enrolment

Accountability

iPad Program Pilot

Report 1 Report 2

KPI Assessment

Program Development (HCP Partnership)

Report 1

Monitoring Monitoring Ends

Product Assessment

Report 2

Role fulfilment Employment

Program Begin

Implementation Process & Strategy

As ACO models continually shift against CMS changes for reimbursement, it has become more clear a team-based care approach would improve outcomes and reimbursement.

Key Execution Points

1. Individual practitioners require more conscious use of talent including knowledge of skill set building and enhancements.

2. ‘Group think’ surrounding feedback transparency with accountability reporting towards results will induce sentiment change.

3. Employee sentiments require increased desire to align towards results. (Multifaceted Drivers*)

4. Technology surrounding information and communication can optimize fluidity and continuity of care for patient satisfaction.

5. Partnership with commercial cross functional departments can leverage increased value to hospital stakeholders and carve out Riverview’s niche amongst future competition.

Objectives:

1. Review future pharmacy outlook and evolution.

2. Understand potential upside and exploration points to enhance community perception.

3. Align on program next steps and initiate communication needed.

ER Admission Unit Admission

Continued Stay Discharge

LTC/ALF

Outpatient Pharmacy

Self/Caregiver

Observation Discharge

1. Med Reconciliation 2. Nursing Continuity 3. Elective Medication CounselingPharmacist Initiation Nursing Owned and Trained Touch Point Addition and Medication Reconciliation Q/A

Pharmacy Follow up Pharmacy Oversight and ‘PRN Intervention’ *Outpatient Pharmacy, Med Adherence, iPad Med Records, CRM Enrollment

Minimize Errors Increase Accountability and Culture Change Enhance Patient Outcomes and Experience

Pharmacist Enabled Care Cycle Management 1. ER Pharmacist 2. Pharmacy Oversight 3. Video: Pharmacist 4. CRM Contact *

March April May June July August0

20

40

60

80

100

120

Sales Volume

AWVs TCM

March April May June July August September0

5000

10000

15000

20000

25000

30000

35000

40000

45000

Net Income vs Profit

Total Profit Cost Net Income