The document provides an overview of new healthcare revenue opportunities for banks that are presented by recent healthcare reforms. It discusses how leading financial institutions can capitalize on these opportunities by (1) strengthening relationships with existing customers in the healthcare sector, (2) growing deposits and fee income, (3) increasing household penetration, and (4) acquiring new customers. The presentation then outlines specific products and services that banks can offer to healthcare providers, such as revenue cycle management, payment automation, and consumer-directed healthcare accounts.
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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.
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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
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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
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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
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
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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.
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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
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.
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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
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17. Health and Financial
Network Solutions
Product overview, based on your client’s needs:
HealthGateway and HealthCollect
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
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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
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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
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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)
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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
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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?
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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