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New Healthcare Revenue
Opportunities for Banks
April 5, 2011

Karen Doyle
SVP, Sr. Product Manager, First Tennessee Bank

John Reynolds
President, Healthcare, Government & Biller Solutions, FIS
Session Overview


New Healthcare Revenue Opportunities for Banks

The recent healthcare reform bill creates new imperatives for stakeholders to take
action to address the industry's chronic inefficiencies − creating opportunities for
those that are part of the solution. Leading financial institutions cannot afford to
ignore the healthcare sector as it represents significant opportunity for financial
institutions to strengthen existing customer relationships, grow deposits and fee
income, increase household penetration, add new customers and stay ahead of
competition. FIS™ and First Tennessee discuss the convergence of the healthcare and
financial services industries − and the emerging revenue opportunities for banks,
including provider revenue cycle management, payment automation and CDH
accounts/services.




                                                                                       2
Introduction to
FIS and First Tennessee Bank
Experience in Healthcare
4
Strategic Focus in Healthcare


                  • Healthcare Payments Solutions Division created in 2006 to
                    create a seamless consumer healthcare experience
                  • Leverage core financial institution solutions
                  • Investing in Strategic Acquisitions
We Are an           − BenSoft
Industry Leader
                    − Printing for Systems (PSI)
                    − Medibank (MBI)
                    − AdminiSource
                    − CapMed
                  • Participate in the CAQH/CORE;
                    ABA/ABIA HSA Council
                  • Leader in SIGIS and IIAS Initiatives

                                                                                5
Strategic Focus in Healthcare


                     • 60 million healthcare ID cards created in 2009: No. 2 Market
                         Share
                     • More than 9 million benefit payment cards: No. 1 Market
                         Share
We Provide Mission   • Over 190 financial institutions utilizing HSA Solution
Critical Solutions
                     • Over 550,000 HSAs processed
                     • Over 1 million CDH accounts administered
                     •   7 million healthcare authorizations per month
                     •   260+ Third-party administrator clients
                     •   90+ Health plan clients
                     •   155+ TPAs use BenSoft full flexible benefits platform


                                                                                      6
Treasury Management

At First Tennessee, we offer a package of dedicated services designed to take much of the manual
process out of the provider’s back-office and streamline their cash conversion efforts.

Benefits that save time and money:
• Timely, accurate collection options that
  accommodate electronic payments, cash and
  checks
• Acceleration of claim payments into cash for debt        •   Headquartered in Memphis, Tenn.
  reduction or investment                                  •   $23 billion in assets
• Management reporting tools for effectively               •   180 financial centers in and
  monitoring payer performance and coding errors               around Tennessee
• Electronic payment solutions provide for the
                                                           •   5,400 employees
  timeliest, most efficient and secure processing of
  payment transactions                                     •   Provide a full complement of Treasury
Employee benefits:                                             and Payment Management Services

• Health Savings Accounts
Healthcare 101
Today’s rapidly changing, healthcare landscape
News Update



                                                                  Health spending rose to a
Press Release dated, Friday, Oct., 8 2010
                                                                  record 17.6% of the U.S.
The NCVHS recently sent a letter to Secretary Sebelius,           economy in 2009 − an
Department of Health and Human Services (HHS), advising that      increase of 4% from 2008
CAQH CORE meets the requirements as the authoring entity for      Source: Wall Street Journal, Jan. 7, 2011
operating rules for non-retail pharmacy-related eligibility and
claim status transactions outlined in Section 1104 of the ACA.
News Update



              The Republican-controlled
              House of Representatives
              passed a repeal of H.R. 3590,
              which is not expected to reach
              the president




                                       10
Timeline – Administrative Simplification
Section 1104 of H.R. 3590



    Transaction Set           Adopted         Effective               Penalty *
Eligibility (270/271)     July 1, 2011   Jan. 1, 2013           Jan. 1, 2014
Claims Status (276/277)   July 1, 2011   Jan. 1, 2013           Jan. 1, 2014
EFT/ERA (835)             July 1, 2012   Jan. 1, 2014           Jan. 1, 2014
Medicare EFT              July 1, 2014   Jan. 1, 2015           NA
Member Services           July 1, 2014   Jan. 1, 2016           NA



                                            Notes:
                                            Health plans must document compliance with
                                            adopted transaction standards or face a penalty
                                            of $1 per covered life, per day.




                                                                                     11
Average Collection Rates


Healthcare providers                              100%
have abysmal                                      90%
receivables aging
                                                  80%
and bad debt rate.
                                                  70%
                       Average Collections Rate
Industry bad debt is                              60%
widely gauged at                                  50%
around 50%.
                                                  40%

                                                  30%
                                                  20%
                                                  10%
                                                   0%
                                                         1-30         31-60     61-90       91-180    181-270     271-365 After 1 Year

                                                                          Number of DAR (Days in Accounts Receivable)
                                                   Source: MGMA, Celent
Patient Self-pay Ratios


Healthcare providers
are going to have to                              30%
increasingly collect
from patients rather
                                                  25%
than from health       % Percent Responsibility
plan carriers.
                                                  20%



                                                  15%


                                                  10%

                                                        2007           2008            2009           2010   2011   2012

                                                  Source: Celent, Effective Solutions, athenahealth, CMS
Convergence of Health
and Wealth
Opportunities for financial institutions
Why Enter the Healthcare Market?


• Add potentially thousands of new
 client relationships
 – Practice Management System (PMS)
   vendors
 – Claim adjudication vendors
 – Health payers and providers
 – All of us (consumers = members)

• Stickier, household penetration
 –   Lines of credit
 –   Mortgage/refinancing
 –   Equipment financing/leasing
 –   High net worth portfolio management
                                           Believe it or not, you have much to offer.


                                                                                        15
What to Think About Next

How do your healthcare initiatives fit with your…..
  •   Strategic goals
  •   Growth plan
  •   Client base
  •   Timeline
  •   Risk exposure

Identifying the right product(s)…..
  •   Evaluate …
      – Product/service gaps                          • Deployment options…
      – Time to market                                   – Develop “in-house”
      – Development cost                                 – Outsource
      – Internal expertise (sales and                    – Referral
          support)                                    • Vendor Selection…
  •   Risk …                                           – Strength of vendor
      – Reputation                                     – Product maturity
      – Regulatory                                     – Product strategy
  •   Expected benefits…                               – Partnership (defined roles)
                                                       – References

                                                                                       16
Health and Financial
Network Solutions
Product overview, based on your client’s needs:
HealthGateway and HealthCollect
Revenue Cycle (RCM) Flow
Claim creation, submission and reconciliation




       HealthGateway                            HealthCollect   HealthGateway




                                                                                18
HealthGateway


• Complete, provider dashboard encompassing           Target Market: Providers
 all claims and payment activity
 – Re-association of claims and payments              Value Proposition: Integrated
 – Integrated view of all receivables – payer,        claim submission, tracking,
    patient, lockbox integration                      reconciliation and
                                                      clearinghouse solution;
• Provider benefits                                   excellent complement to a
                                                      weak or legacy PMS system
 – Elimination of manual processes and
   disconnected systems
 – Reduced eligibility/claims handling costs due to
   electronic processes
 – Provider member with an estimated cost, at time
   of care
 – Vendor consolidation


                                                                                 19
What’s New and Innovative


• Recessionary economy/rising healthcare costs creating significant market shift
 – Employers moving to low cost health plans, creating a cost shift from payers to
   employees/consumers
 – Need for providers to supply members with an estimate of services rendered

• Providers need to shift revenue collections focus from payers to patients.
 – Provider revenue collections currently lack patient cost transparency
 – 37% of provider locations expected to have RCM solutions by 2014


                                                    What’s on the horizon?

                                   ID verification   mobile ID cards           patient estimator
                                  payment assurance and compliancy            propensity to pay



                                                                                             20
Revenue Cycle (RCM) Flow
Patient statement and payment




      HealthGateway             HealthCollect   HealthGateway




                                                                21
HealthCollect

• White label/banking branding
                                                   Target Market: Providers
• Comprehensive print and electronic bill
 presentment and payment solution
                                                   Value Proposition: Integrated
 – Streamlined bill creation                       receivables management,
 – Electronic bill presentment (and                patient payments and
   economical/streamlined print distribution)
                                                   collections; excellent
 – Flexible payment options – credit, debit, ACH   compliment to the patient
   acceptance via phone or Web
                                                   accounting system

• Provider benefits
 – Ease of payment tracking and reconciliation
 – Reduction in bad debt/unpaid claims
 – Improved cash flow and collections




                                                                              22
What’s New and Innovative


• Integration with provider PMS
   platform (their system or record)
                                        What’s on the horizon?
                                        Mobile payments
                                        SMS text
• Receivables management                ID verification
 – First-party collections
 – Third-party collections

• Connectivity and “look and feel” to
 the partner’s Web site
 – Single Sign On (SSO)




                                                             23
What Else Is New and Innovative
Revenue Cycle (RCM) flow




                                  What’s on the horizon?
                                  EFT & ERA riding the same “rail system”
                                  Standardized EFT provider enrollment form
                                  “Straight through” claim processing
                                  Greater fraud and abuse prevention


                                                                          24
Conclusion
Concluding Thoughts


                                       • Leading financial institutions cannot
                                           afford to ignore the healthcare
            Automating the                 sector
            Claim Payments             •   Largest fast-growing sector of the
                Process
                                           economy – and growth is likely to
                                           continue for the foreseeable future
                                       •   Significant opportunities for new
                      Activating the       entrants
    Streamline        Power of Point
   Patient Pays         of Service     •   Significant unmet customer needs
                                       •   Retention and new customer
                                           acquisition opportunity
                                       •   Multiple product sales opportunity


                                            What will be your institution’s story in healthcare?

                                                                                        26
Questions and Answers
Karen Doyle
Thank you                                 SVP, Sr. Product Manager, First Tennessee Bank
Karen Doyle
SVP, Sr. Product Manager, First Tennessee Bank
                                                        John Reynolds
John Reynolds                                President, Healthcare, Government & Biller
President, Healthcare, Government & Biller Solutions, FIS  Solutions, FIS

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Healthcare Opportunities for Banks

  • 1. New Healthcare Revenue Opportunities for Banks April 5, 2011 Karen Doyle SVP, Sr. Product Manager, First Tennessee Bank John Reynolds President, Healthcare, Government & Biller Solutions, FIS
  • 2. Session Overview New Healthcare Revenue Opportunities for Banks The recent healthcare reform bill creates new imperatives for stakeholders to take action to address the industry's chronic inefficiencies − creating opportunities for those that are part of the solution. Leading financial institutions cannot afford to ignore the healthcare sector as it represents significant opportunity for financial institutions to strengthen existing customer relationships, grow deposits and fee income, increase household penetration, add new customers and stay ahead of competition. FIS™ and First Tennessee discuss the convergence of the healthcare and financial services industries − and the emerging revenue opportunities for banks, including provider revenue cycle management, payment automation and CDH accounts/services. 2
  • 3. Introduction to FIS and First Tennessee Bank Experience in Healthcare
  • 4. 4
  • 5. Strategic Focus in Healthcare • Healthcare Payments Solutions Division created in 2006 to create a seamless consumer healthcare experience • Leverage core financial institution solutions • Investing in Strategic Acquisitions We Are an − BenSoft Industry Leader − Printing for Systems (PSI) − Medibank (MBI) − AdminiSource − CapMed • Participate in the CAQH/CORE; ABA/ABIA HSA Council • Leader in SIGIS and IIAS Initiatives 5
  • 6. Strategic Focus in Healthcare • 60 million healthcare ID cards created in 2009: No. 2 Market Share • More than 9 million benefit payment cards: No. 1 Market Share We Provide Mission • Over 190 financial institutions utilizing HSA Solution Critical Solutions • Over 550,000 HSAs processed • Over 1 million CDH accounts administered • 7 million healthcare authorizations per month • 260+ Third-party administrator clients • 90+ Health plan clients • 155+ TPAs use BenSoft full flexible benefits platform 6
  • 7. Treasury Management At First Tennessee, we offer a package of dedicated services designed to take much of the manual process out of the provider’s back-office and streamline their cash conversion efforts. Benefits that save time and money: • Timely, accurate collection options that accommodate electronic payments, cash and checks • Acceleration of claim payments into cash for debt • Headquartered in Memphis, Tenn. reduction or investment • $23 billion in assets • Management reporting tools for effectively • 180 financial centers in and monitoring payer performance and coding errors around Tennessee • Electronic payment solutions provide for the • 5,400 employees timeliest, most efficient and secure processing of payment transactions • Provide a full complement of Treasury Employee benefits: and Payment Management Services • Health Savings Accounts
  • 8. Healthcare 101 Today’s rapidly changing, healthcare landscape
  • 9. News Update Health spending rose to a Press Release dated, Friday, Oct., 8 2010 record 17.6% of the U.S. The NCVHS recently sent a letter to Secretary Sebelius, economy in 2009 − an Department of Health and Human Services (HHS), advising that increase of 4% from 2008 CAQH CORE meets the requirements as the authoring entity for Source: Wall Street Journal, Jan. 7, 2011 operating rules for non-retail pharmacy-related eligibility and claim status transactions outlined in Section 1104 of the ACA.
  • 10. News Update The Republican-controlled House of Representatives passed a repeal of H.R. 3590, which is not expected to reach the president 10
  • 11. Timeline – Administrative Simplification Section 1104 of H.R. 3590 Transaction Set Adopted Effective Penalty * Eligibility (270/271) July 1, 2011 Jan. 1, 2013 Jan. 1, 2014 Claims Status (276/277) July 1, 2011 Jan. 1, 2013 Jan. 1, 2014 EFT/ERA (835) July 1, 2012 Jan. 1, 2014 Jan. 1, 2014 Medicare EFT July 1, 2014 Jan. 1, 2015 NA Member Services July 1, 2014 Jan. 1, 2016 NA Notes: Health plans must document compliance with adopted transaction standards or face a penalty of $1 per covered life, per day. 11
  • 12. Average Collection Rates Healthcare providers 100% have abysmal 90% receivables aging 80% and bad debt rate. 70% Average Collections Rate Industry bad debt is 60% widely gauged at 50% around 50%. 40% 30% 20% 10% 0% 1-30 31-60 61-90 91-180 181-270 271-365 After 1 Year Number of DAR (Days in Accounts Receivable) Source: MGMA, Celent
  • 13. Patient Self-pay Ratios Healthcare providers are going to have to 30% increasingly collect from patients rather 25% than from health % Percent Responsibility plan carriers. 20% 15% 10% 2007 2008 2009 2010 2011 2012 Source: Celent, Effective Solutions, athenahealth, CMS
  • 14. Convergence of Health and Wealth Opportunities for financial institutions
  • 15. Why Enter the Healthcare Market? • Add potentially thousands of new client relationships – Practice Management System (PMS) vendors – Claim adjudication vendors – Health payers and providers – All of us (consumers = members) • Stickier, household penetration – Lines of credit – Mortgage/refinancing – Equipment financing/leasing – High net worth portfolio management Believe it or not, you have much to offer. 15
  • 16. What to Think About Next How do your healthcare initiatives fit with your….. • Strategic goals • Growth plan • Client base • Timeline • Risk exposure Identifying the right product(s)….. • Evaluate … – Product/service gaps • Deployment options… – Time to market – Develop “in-house” – Development cost – Outsource – Internal expertise (sales and – Referral support) • Vendor Selection… • Risk … – Strength of vendor – Reputation – Product maturity – Regulatory – Product strategy • Expected benefits… – Partnership (defined roles) – References 16
  • 17. Health and Financial Network Solutions Product overview, based on your client’s needs: HealthGateway and HealthCollect
  • 18. Revenue Cycle (RCM) Flow Claim creation, submission and reconciliation HealthGateway HealthCollect HealthGateway 18
  • 19. HealthGateway • Complete, provider dashboard encompassing Target Market: Providers all claims and payment activity – Re-association of claims and payments Value Proposition: Integrated – Integrated view of all receivables – payer, claim submission, tracking, patient, lockbox integration reconciliation and clearinghouse solution; • Provider benefits excellent complement to a weak or legacy PMS system – Elimination of manual processes and disconnected systems – Reduced eligibility/claims handling costs due to electronic processes – Provider member with an estimated cost, at time of care – Vendor consolidation 19
  • 20. What’s New and Innovative • Recessionary economy/rising healthcare costs creating significant market shift – Employers moving to low cost health plans, creating a cost shift from payers to employees/consumers – Need for providers to supply members with an estimate of services rendered • Providers need to shift revenue collections focus from payers to patients. – Provider revenue collections currently lack patient cost transparency – 37% of provider locations expected to have RCM solutions by 2014 What’s on the horizon? ID verification mobile ID cards patient estimator payment assurance and compliancy propensity to pay 20
  • 21. Revenue Cycle (RCM) Flow Patient statement and payment HealthGateway HealthCollect HealthGateway 21
  • 22. HealthCollect • White label/banking branding Target Market: Providers • Comprehensive print and electronic bill presentment and payment solution Value Proposition: Integrated – Streamlined bill creation receivables management, – Electronic bill presentment (and patient payments and economical/streamlined print distribution) collections; excellent – Flexible payment options – credit, debit, ACH compliment to the patient acceptance via phone or Web accounting system • Provider benefits – Ease of payment tracking and reconciliation – Reduction in bad debt/unpaid claims – Improved cash flow and collections 22
  • 23. What’s New and Innovative • Integration with provider PMS platform (their system or record) What’s on the horizon? Mobile payments SMS text • Receivables management ID verification – First-party collections – Third-party collections • Connectivity and “look and feel” to the partner’s Web site – Single Sign On (SSO) 23
  • 24. What Else Is New and Innovative Revenue Cycle (RCM) flow What’s on the horizon? EFT & ERA riding the same “rail system” Standardized EFT provider enrollment form “Straight through” claim processing Greater fraud and abuse prevention 24
  • 26. Concluding Thoughts • Leading financial institutions cannot afford to ignore the healthcare Automating the sector Claim Payments • Largest fast-growing sector of the Process economy – and growth is likely to continue for the foreseeable future • Significant opportunities for new Activating the entrants Streamline Power of Point Patient Pays of Service • Significant unmet customer needs • Retention and new customer acquisition opportunity • Multiple product sales opportunity What will be your institution’s story in healthcare? 26
  • 28. Karen Doyle Thank you SVP, Sr. Product Manager, First Tennessee Bank Karen Doyle SVP, Sr. Product Manager, First Tennessee Bank John Reynolds John Reynolds President, Healthcare, Government & Biller President, Healthcare, Government & Biller Solutions, FIS Solutions, FIS