1. Revenue Impact with Big Bang Implementation Presented by: Jack Hueter & Novi Vinod

2. Agenda for today ▪ Introductions ▪ LVHN organization and timeline ▪ Steps taken throughout implementation ▪ End results ▪ Lessons learned ▪ Introductions ▪ LVHN organization and timeline ▪ Steps taken throughout implementation ▪ End results ▪ Lessons learned

3. 5 Campuses 5 Campuses 1 children’s Hospital 1 children’s Hospital 140+ Physician practices 140+ Physician practices 17 Community Clinics 17 Community Clinics 12 Health Centers 12 Health Centers 10 ExpressCARE locations 10 ExpressCARE locations 80 Testing and Imaging Locations 80 Testing and Imaging Locations 13,100 Employees 13,100 Employees 1,340 Phsycians 1,340 Phsycians 582 Advanced Practice Clinicians 582 Advanced Practice Clinicians 3,700 Registered Nurses 3,700 Registered Nurses 60,585 Admissions 60,585 Admissions 208,700 ED Visits 208,700 ED Visits 1,161 Acute Care Beds 1,161 Acute Care Beds

4. Scope at LVHN ▪ Ambulatory Big Bang Go Live – February 18, 2015 175+ sites 700+ Physicians and 300+ AP’s 90% converted from GE Centricity 10% paper ▪ Inpatient Big Bang Go Live – August 1, 2015 3 Inpatient Campuses – Cedar Crest, Muhlenberg, 17 th Street Included Hospital based Outpatient clinics 100% converted from GE Centricity Enterprise – Revenue, Clinical, Radiology, Pharmacy Other major systems – T systems, PHS Scheduling, OR Tracker, RIS, Metavision ICU/PICU, Teletracking, Orion portal ▪ Ambulatory Big Bang Go Live – February 18, 2015 175+ sites 700+ Physicians and 300+ AP’s 90% converted from GE Centricity 10% paper ▪ Inpatient Big Bang Go Live – August 1, 2015 3 Inpatient Campuses – Cedar Crest, Muhlenberg, 17 th Street Included Hospital based Outpatient clinics 100% converted from GE Centricity Enterprise – Revenue, Clinical, Radiology, Pharmacy Other major systems – T systems, PHS Scheduling, OR Tracker, RIS, Metavision ICU/PICU, Teletracking, Orion portal

5. TIMELINE

6. Big Bang Implementation Guidelines ▪ Governance and Team structure ▪ Project management support ▪ Importance of scoping & direction setting ▪ Build phase ▪ Testing phase ▪ Training phase ▪ Governance and Team structure ▪ Project management support ▪ Importance of scoping & direction setting ▪ Build phase ▪ Testing phase ▪ Training phase

7. Steps taken to minimize revenue impact ▪ Revenue cycle ownership and governance ▪ Set expectations with department heads and leadership ▪ ARCR leads identified and leveraged ▪ Identified Key KPI’s to monitor pre go-live Compute accurate baselines prior to go-live ▪ Testing ▪ Revenue cycle ownership and governance ▪ Set expectations with department heads and leadership ▪ ARCR leads identified and leveraged ▪ Identified Key KPI’s to monitor pre go-live Compute accurate baselines prior to go-live ▪ Testing

8. Testing ▪ Charge testing ▪ Parallel Revenue Charge Testing (PRCT) ▪ Claims testing ▪ Charge testing ▪ Parallel Revenue Charge Testing (PRCT) ▪ Claims testing

9. Ambulatory Accounts Receivable

10. Ambulatory Claims Acceptance

11. Ambulatory Charges to Baselines

12. Inpatient Focus Area Achievements Revenue Cycle Management 4 Weeks 8/18/299/26 10/31 1/30 8 Weeks Payments in Epic exceed baseline weekly 13 Weeks (90 Days) 26 Weeks (180 Days) Legacy AR Days <10% of Baseline HB 100% charging HB weekly claims sent exceed charges. Achieved on/before target. Upcoming target. Achieved after target. Achieved on/before target. Upcoming target. Achieved after target. HB go-live hold fully removed HB first Epic-AR week over week decrease

13. Inpatient Charges to Baseline

14. Inpatient Claims Acceptance Rate

15. Inpatient – Revenue Tracker 15 Daily Revenue Tracking Snap Shot

16. Inpatient Metric Guardrails week 7 Metric Guardrail/ Top 25% Long-term TargetCurrent WeekChangeStatus AR (Percent change from baseline) 17% - 3% --2%0% Cumulative Charges 99% - 101% 100% 0% Cumulative Cash Variance (in Weeks) -1.19 Weeks - -0.39 Weeks 0-1.44 Weeks-0.04 Weeks CFB Days 12.03 Days - 7.68 Days -10.56 Days-0.39 Days Coding in CFB 4.91 Days - 7.68 Days -3.6 Days-0.11 Days Claim Errors 4.18 Days - 1.68 Days -3.02 Days0.25Days Open Denials Days <4 Days -0.13 Days0.04 Days Legacy AR % of baseline 38% - 31% -33%-2% Claims Acceptance % 90% - 99% -93%19% = On track Improving = Watch = Serious Negative Trend

17. ▪ Important to have SMEs and operational owners “on board” with Epic ▪ These are the people that will be key in helping shift focus of current state to new improved future state with Epic ▪ Important to have SMEs and operational owners “on board” with Epic ▪ These are the people that will be key in helping shift focus of current state to new improved future state with Epic Revenue Cycle Lessons Learned 17 Early buy-in from SMEs and operational owners

18. ▪ Identify and validate future workflows building off current workflows Build in Epic to maximize efficiencies in current workflows and process ▪ Focus on maximizing efficiencies within Epic and build to future state workflows ▪ Incorporate 3 rd party tools upfront in design and planning workflows ▪ Identify and validate future workflows building off current workflows Build in Epic to maximize efficiencies in current workflows and process ▪ Focus on maximizing efficiencies within Epic and build to future state workflows ▪ Incorporate 3 rd party tools upfront in design and planning workflows Revenue Cycle Lessons Learned 18 Identify and validate future workflows

19. ▪ Revenue cycle representation needs to be included in decisions made at on the clinical side ▪ This ensures charges are captured and revenue is not impacted negatively at go- live ▪ Testing begins right away with unit testing of workflows and continues until go-live ▪ Revenue cycle representation needs to be included in decisions made at on the clinical side ▪ This ensures charges are captured and revenue is not impacted negatively at go- live ▪ Testing begins right away with unit testing of workflows and continues until go-live Revenue Cycle Lessons Learned 19 ALL build, testing and communication needs to include representation across ALL modules within Epic

20. ▪ Align Epic’s project workplan with organization’s project workplan early and set expectations/targets ▪ Incorporate enough time in the project plan to build, test and validate for the revenue cycle ▪ Users need to not only understand basic functionality within Epic but also to understand how to navigate within Epic so they can do their jobs efficiently and effectively ▪ Align Epic’s project workplan with organization’s project workplan early and set expectations/targets ▪ Incorporate enough time in the project plan to build, test and validate for the revenue cycle ▪ Users need to not only understand basic functionality within Epic but also to understand how to navigate within Epic so they can do their jobs efficiently and effectively Revenue Cycle Lessons Learned 20 Revenue Cycle cannot wait for optimization to get it right

21. ▪ Important to begin new revenue cycle with clean slate ▪ Have a plan to support the legacy run down ▪ Important to begin new revenue cycle with clean slate ▪ Have a plan to support the legacy run down Revenue Cycle Lessons Learned 21 Keep AR in legacy system

22. ▪ Facility design is an integral part of the Epic’s core build - it touches every module within Epic Revenue Cycle Lessons Learned 22 The facility structure is the most crucial build in your Epic system - once built, cannot be “undone”

23. ▪ Again - start the planning and build process in the very early stages in the project and involve both the hospital side and professional side Revenue Cycle Lessons Learned 23 Payor/Plan is the another crucial build in Epic because it is shared between hospital and Ambulatory in Epic

24. Takeaways ▪ Testing ▪ Operations have to own the process ▪ Knowing your current condition (baseline) pre go-live to assess your success post go-live ▪ Outsource or work down legacy A/R prior to go-live ▪ Be ready to be flexible with your workflows (based on how build is interacting with other modules or SME feedback) ▪ Testing ▪ Operations have to own the process ▪ Knowing your current condition (baseline) pre go-live to assess your success post go-live ▪ Outsource or work down legacy A/R prior to go-live ▪ Be ready to be flexible with your workflows (based on how build is interacting with other modules or SME feedback)